title: Assessing third-year medical students' ability to address a patient's spiritual distress using an OSCE case.
abstract: OBJECTIVE
  To inform curricular development by assessing the ability of third-year medical students to address a patient's spiritual distress during an acute medical crisis in the context of an objective structured clinical examination (OSCE) case.
  
  
  METHODS
  During March and April 2010, 170 third-year medical students completed an eight-station videotaped OSCE at Albert Einstein College of Medicine of Yeshiva University. One of the standardized patients (SPs) was a 65-year-old man with acute chest pain who mentioned his religious affiliation and fear of dying. If prompted, he revealed his desire to speak with a chaplain. The SP assessed students' history taking, physical examination, and communication skills. In a postencounter written exercise, students reported their responses to the patient's distress via four open-ended questions. Analysis of the postencounter notes was conducted by three coders for emergent themes. Clinical skills performance was compared between students who reported making chaplain referral and those who did not.
  
  
  RESULTS
  A total of 108 students (64%) reported making a chaplain referral; 4 (2%) directly addressed the patient's religious/spiritual beliefs. Students' clinical performance scores showed no significant association with whether they made a chaplain referral.
  
  
  CONCLUSIONS
  Findings suggest that the majority of medical students without robust training in addressing patients' spiritual needs can make a chaplain referral when faced with a patient in spiritual crisis. Yet, few students explicitly engaged the patient in a discussion of his beliefs. Thus, future studies are needed to develop more precise assessment measures that can inform development in spirituality and medicine curricula.
authors.affiliation: Ms. McEvoy is associate professor of family and social medicine and assistant professor of pediatrics, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York. Dr. Schlair is assistant professor, Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine of Yeshiva University, Bronx, New York. Dr. Sidlo is a fourth-year medical student, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York. Dr. Burton is associate professor, Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York. Dr. Milan is professor of clinical medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York.
authors.forename: Mimi
authors.initials: M
authors.lastname: McEvoy
authors.forename: Sheira
authors.initials: S
authors.lastname: Schlair
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Sidlo
authors.forename: William
authors.initials: W
authors.lastname: Burton
authors.forename: Felise
authors.initials: F
authors.lastname: Milan
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D026443:Spiritual Therapies / Q000193:education*; D014743:Videotape Recording