title: Religion, Spirituality, and the Hidden Curriculum: Medical Student and Faculty Reflections.
abstract: BACKGROUND
  Religion and spirituality play an important role in physicians' medical practice, but little research has examined their influence within the socialization of medical trainees and the hidden curriculum.
  
  
  OBJECTIVE
  The objective is to explore the role of religion and spirituality as they intersect with aspects of medicine's hidden curriculum.
  
  
  METHODS
  Semiscripted, one-on-one interviews and focus groups (n = 33 respondents) were conducted to assess Harvard Medical School student and faculty experiences of religion/spirituality and the professionalization process during medical training. Using grounded theory, theme extraction was performed with interdisciplinary input (medicine, sociology, and theology), yielding a high inter-rater reliability score (kappa = 0.75).
  
  
  RESULTS
  Three domains emerged where religion and spirituality appear as a factor in medical training. First, religion/spirituality may present unique challenges and benefits in relation to the hidden curriculum. Religious/spiritual respondents more often reported to struggle with issues of personal identity, increased self-doubt, and perceived medical knowledge inadequacy. However, religious/spiritual participants less often described relationship conflicts within the medical team, work-life imbalance, and emotional stress arising from patient suffering. Second, religion/spirituality may influence coping strategies during encounters with patient suffering. Religious/spiritual trainees described using prayer, faith, and compassion as means for coping whereas nonreligious/nonspiritual trainees discussed compartmentalization and emotional repression. Third, levels of religion/spirituality appear to fluctuate in relation to medical training, with many trainees experiencing an increase in religiousness/spirituality during training.
  
  
  CONCLUSIONS
  Religion/spirituality has a largely unstudied but possibly influential role in medical student socialization. Future study is needed to characterize its function within the hidden curriculum.
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA. Electronic address: Michael_Balboni@dfci.harvard.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Balboni
authors.affiliation: Department of Sociology, Brandeis University, Waltham, Massachusetts, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Bandini
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Mitchell
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Zachary D
authors.initials: ZD
authors.lastname: Epstein-Peterson
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ada
authors.initials: A
authors.lastname: Amobi
authors.affiliation: Theology Department, Boston College, Chestnut Hill, Massachusetts, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cahill
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Enzinger
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: John
authors.initials: J
authors.lastname: Peteet
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Balboni
mesh_terms: D004501:Education, Medical; D005178:Faculty; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D012577:Schools, Medical; D029181:Spirituality; D013337:Students, Medical / Q000523:psychology*
keywords: Professionalism; hidden curriculum; medical education; religion; spirituality