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Exploring Whole Person Care through Michigan Medical School’s Health, Spirituality and Religion Program

Out of the countless PowerPoint slides from M1 year, there’s one that, four years later, I can still picture with absolute clarity. Presented in coordination with the University of Michigan Medical School’s Program on Health, Spirituality and Religion (HSR), the slide was part of a lecture on attending to the religious and/or spiritual identities of our patients, and it portrayed the Theory of Total Pain. Proposed by the founder of modern hospice, Dr. Cicely Saunders MD, this theory describes suffering as the sum of a patient’s physical, psychological, social, and spiritual distress. This slide and its message has stuck with me as, over the course of medical school, I have seen Dr. Saunders’ multidimensional view of health and suffering come to life in the stories of my patients.

Figure 1: Dr. Cicely Saunders’ Theory of Total Pain

As clinical students, we have the privilege of accompanying people during some of their most joyous and some of their most challenging moments. These patient relationships range from witnessing someone deliver their newborn baby to walking alongside someone mourning the reality that they are dying. While at vastly different ends of the emotional continuum, a common thread connects these two relationships. Both prompt a sense of wonder about how patients and their loved ones navigate such significant moments of transition. It’s in these moments where it becomes particularly clear to me that the practice of good medicine demands both provision of excellent biomedical care as well as a willingness to connect, person to person, with the human sitting in front of me.

Our HSR Welcome Dinner, a time for medical students and HSR core faculty members to connect, reflect, and eat good food!

Within this connection, patients consistently teach me about Dr. Saunders’ theory of medicine in conveying that health is not solely biological or physical, but together with other essential dimensions of health and personhood – health is also psychological, emotional, social, and spiritual. Their instruction to me of these dimensions comes in many forms: a request to keep family informed about clinical updates, an inquiry about Halal food options in the cafeteria, a desire to spend time outside in the midst of a long hospital admission. It is these lessons about the multidimensional nature of health and suffering that have led me to dive into all that the HSR Program has to offer.

The HSR Program was created in 2017 with the mission of developing opportunities for medical trainees and physicians to explore the intersections between health, spirituality, and religion. Broadly speaking, spirituality is anchored in where an individual finds meaning, whether that be in a world religion, nature, family, music, etc. Our exploration of this intersection occurs through lectures, research, and interdisciplinary training and is all geared towards enhancing patient centered care and encouraging personal meaning making in the practice of medicine. With this mission in mind, we host a speaker series, create courses/curricula on health, spirituality and religion and mentor students on how their religious and/or spiritual identity contributes to their professional identity formation. This innovative program is led by an incredibly kind and thoughtful group of attending physicians, Drs. Kristin Collier (Internal Medicine), Jeremy Baruch (Psychiatry), Adam Baruch (Ob/Gyn), and Phil Choi (Pulmonary & Critical Care).

To expand further upon opportunities for engagement with the HSR Program, I want to share some of my highlights from my involvement. Our monthly Woll Family Speaker Series on Health, Spirituality and Religion (an opportunity that is open to all who are interested!) brings in speakers who share how the intersections between HSR are apparent in their own experiences with patients. We’ve heard lectures from physicians affiliated with the University of Michigan, including our own Dr. Scott Stonington, an Internal Medicine physician and anthropologist, who presented a talk entitled “Working the Mind-Body: Discomfort and the Pragmatics of Spirituality (in Thailand and the U.S.).” We also bring in speakers from other institutions. Recently, we hosted Dr. Rita Charon, an Internal Medicine physician at Columbia University and literary scholar credited with creating the field of Narrative Medicine, who led an interactive discussion entitled, “Native Fusion: Creativity, Responsibility, Meaning,”. These seminars have led to rich discussions about the nature of suffering and what it means to be healthy, all the while building up a sense of community among students, faculty, staff, and members of the Ann Arbor area who are interested in engaging with such questions of humanity and healthcare in all its fullness.

In addition to the seminar series, all medical students rotating through an intensive care unit (ICU) have the opportunity to participate in the HSR Program’s Healing Presence elective, which I participated in during my Pediatric ICU rotation. The ICU directors love Healing Presence and encourage all medical students to partake. For participating students, you have the opportunity to develop new patient care skills focused on the spiritual needs of your patients. This development occurs through rounding with chaplains in the ICU during which you have the chance to explore various skills such as taking a spiritual history, providing supportive listening, and sharing healing words/prayer. You also engage in a structured, small group facilitated by a chaplain to process your own experience working with critically ill patients and their families. Personally, the Healing Presence elective helped promote my wellbeing while on an intense rotation and has helped me feel more equipped to attend to the spiritual distress of my patients and to work effectively with Spiritual Care colleagues.

Presenting the Conference on Medicine and Religion workshop that Dr. Baruch and I created.

At the core of my experience with the HSR program has been the longitudinal mentorship I received. What started with a “cold email” sent near the beginning of M1 year has turned into what I hope will be lifelong mentoring relationships with Drs. Kristin Collier and Adam Baruch. Through their mentorship, I have grown personally and professionally and added depth of meaning to my understanding of the practice of medicine. They have opened the door to unique opportunities for scholarship. I’ve contributed to curriculum development, specifically working alongside attending physicians and other medical students to evolve in the Doctoring session on “Religion and Spirituality in Patient-Centered Care.” In coordination with Dr. Collier, I’ve co-presented a talk entitled, “Whole Person Care” at a Continuing Medical Education event hosted by Michigan Medicine. I’ve collaborated with Dr. Baruch in conducting an Ob/Gyn Grand Rounds presentation and a Conference on Medicine and Religion workshop, both of which were entitled, “Cultural and Religious Humility: A Foundation for Relationships in Medicine.” With the help of another medical student, we’ve subsequently turned these presentations into a manuscript that is pending submission.

These mentoring relationships and my engagement with the HSR Program has culminated in being the inaugural student fellow for the program during the 2022-23 academic year. Within this role, I’ve had the privilege of helping develop our programming through participating in regular HSR core faculty meetings, helping select speakers for the Woll Family speaker series, providing near-peer mentoring of a clinical trunk student, and cultivating a community among students interested in what the HSR Program has to offer. Having wrapped up medical school, I’m thrilled to know that three, all-star medical students will step into the role of HSR student fellow for this upcoming academic year. I can’t wait to see how they help shape the HSR Program and community!

While I’m immensely proud of our scholarly work, what is most significant to me is the way I anticipate this work finding expression in my practice of medicine. As I look ahead to July and the start of my OBGYN residency at the University of Michigan (Go Blue!), I’m confident that my involvement in the HSR Program will continue to come to life in the patients I help care for and in the ways they will take up Dr. Saunders’ torch in teaching me about health and suffering as the sum of their physical, psychological, social, and spiritual states. And more personally, I’m grateful for the ways that my role as an interested student, mentee and fellow continue to help me feel more deeply connected to sources of meaning in medicine, a gift that feels particularly significant amidst the crisis of physician burnout.

A fun dinner outing with core faculty for the HSR Program!

The HSR Program has so much to offer the intrigued Michigan medical student. Opportunities abound both for dabbling in our programming and for more in-depth exploration. You can find these opportunities summarized on our website, and while you should absolutely explore this webpage, I would be remiss if I didn’t encourage you to reach out to talk with us! At the core of this Program’s mission is its commitment to personal connection with students who have never had the opportunity to explore this space or who wish to dive deeper into this space of whole person care. If you find yourself interested, please reach out! You can connect with me at sarosie@med.umich.edu or message our HSR Program email at Health.Spirituality.and.Religion.Info@umich.edu. Whether you’re a current or prospective medical student, we would love to hear from you!

From Professional Football to Med School: A New Path LEADs to the Same Goal

Not every path is linear, especially when it comes to going to medical school. Some students may move directly from their undergraduate into M1, others may take a few years off before entering the field. Then there are individuals who have paved their way towards a certain career and turn to medicine as their new goal. My path was somewhere in the middle. With the intention to pursue medicine after my undergraduate degree, a different career delayed my way.

I entered freshman year of undergrad with the intent of going to medical school upon graduation. As an athlete, I balanced sport and academia, knowing they both gave me a unique future opportunity. I completed all required pre-medical prerequisites and graduated in May of 2015 with my undergraduate degree. I transferred to Michigan later that year to continue playing football while working towards a Master’s in Kinesiology. Following my Wolverine season, I was fortunate enough to have the opportunity to keep playing football for another five years after college.

When football seemed to be fading from my future, I poured myself into a year of MCAT prep and working through the application cycle. The goal of pursuing medical school was back at the forefront. I was ready to start living my dream, a full six years from diploma in hand.

Needless to say, I had some anxiety going back to school. On one hand, I knew an MD was exactly where I wanted to be and exactly what I needed to do. On the other hand, I’ve been in meeting rooms and practice fields for the last half decade, a vastly different atmosphere. As I pride myself in being prepared, I desired something that could help get my feet wet, so to speak, before returning to the books full time. I wanted something that could help me adjust between two different worlds.

As fate would have it, a former teammate of mine from Michigan told me about a pre-matriculation program that helped him feel a bit more comfortable before starting the four-year journey of medical school. That program is called LEAD (Leadership and Enrichment for Academic Diversity), a two-week leadership course to aid in the transition of becoming a medical student. Learning more about the program, I realized it would help ready me for the school year. Without hesitation, I sent my application.

Feeling a sense of inferiority as I walked in, it took no time at all to feel welcomed, as if I was part of a team. I gained mentors who were more than willing to help me out with whatever I needed throughout school. Throughout the two weeks, we had various discussions and lessons on what to expect as well as tips and tricks of navigating medical school. While we discussed things you might expect such as study tools and med student resources, we also talked about the emotional journey of medicine, which includes success and failure. I found many of the lessons taken from LEAD helped provide perspective while also gearing me up for the long journey ahead.

Our days were mostly typical of a job schedule, wherein we would get to school around 8:00 and be done around 5:00, give or take depending on the day. Thankfully, no work needed to be completed at home. This scheduling alone allowed me to get back in the groove of things as the previous year I had been focused on waiting for applications to come back, and my wife and I were anxiously awaiting the arrival of our first child. Furthermore, even navigating a simple change of which room and which building we were to meet in proved to be more helpful than I could have initially imagined. According to the coordinator, the change in location that occurred nearly daily was by design.

Through LEAD, I was also able to make friends and build a sense of community among my classmates. Meeting periodically throughout the year, we’d learn from someone in the Michigan community about various topics like building your residency application, finding a mentor and creating a CV.

As a bridge connecting my gap years away from academia to the beginning of my medical training, I have no regrets in having devoted two weeks of my time to engage in the LEAD program. The simple step of getting my feet wet provided me with a sense of connectedness and calmness moving forward as I walked across the stage to receive my first white coat.

How I Harmonized Music and Medicine in Medical School

Although I can no longer play Liszt etudes or Rachmaninoff piano concertos with the ease that I once had, my deep appreciation for music and piano has continued to be fostered throughout medical school.

On several occasions on the orthopedic surgery residency interview trail, I was asked by faculty, “if you had to choose a career outside of medicine, what would it be?” Without hesitation, I would answer: a concert pianist. In fact, for college, I applied to both music conservatories and normal universities. I won several international piano competitions, made my concerto debut with the Indianapolis Symphony Orchestra, performed in recitals at Carnegie Hall, France, and Poland. I ended up attending MIT for college majoring in chemistry, but I continued to study piano at MIT and the New England Conservatory of Music in Boston and performed a concerto with the MIT Symphony Orchestra. After college, I spent a year in Poland on a Fulbright Scholarship doing chemistry research, while also studying Polish classical piano music at the Chopin University of Music in Warsaw.

In medical school, I sought out ways to incorporate music with medicine. The University of Michigan Medical School has a unique program called the Medical Arts Program (MedArt), one of the few programs in the country that connects medical students, residents and faculty to the humanities and the arts. As a first-year medical student, I performed in the Medical Arts Program Artists’ Guild Showcase, which is an opportunity for medical student artists, poets, dancers and musicians to perform at the Kerrytown Concert House in downtown Ann Arbor. I performed Libertango, a piano duet by Astor Piazzola, with a fellow medical school classmate, and Chopin Nocturne Op. 48, No. 1 in C Minor. I enjoyed having the opportunity to perform with my classmates and watch the performances of the numerous, multi-talented medical students at University of Michigan.

Every year, the Department of Anatomical Sciences at the University of Michigan Medical School, organizes a memorial service to honor donors and their families, and thank them for the gift of knowledge. The ceremony is an opportunity for students, faculty and family to remember the donors through experiences of gratitude. In addition to spoken word, my classmates and I wanted to express our gratefulness to the donors and their families through music. Through coordination with the anatomy faculty, we performed songs on the piano, cello and voice for the 2020 memorial service.

While learning medicine, I also wanted to maintain my piano skills. Practicing piano and studying new piano compositions was therapeutic as I navigated medical school. After spending hours on my computer flipping through Anki flashcards and solving UWorld questions for shelf exams, I would head over to the School of Music’s Earl V. Moore Building to practice piano alongside music students. I loved hearing the kaleidoscope of melodies from various instruments in the hallway as I entered the music building. Through the University of Michigan School of Music, Theatre and Dance (SMTD), U-M students from other departments, including the medical school, are able to take private instrumental and voice lessons from master’s and PhD students in the SMTD. I participated in biweekly, private piano lessons with a student in the SMTD completing her PhD in classical piano performance. During medical school, I studied Debussy Prelude No. 2, Voiles, the 1st movement of Schumann Piano Concerto in A minor, and Rachmaninoff Prelude Op. 3 No. 2. In contrast to being in the operating room, I would sit in front of a piano to focus on perfecting a difficult chord progression, phrasing the theme of a piece with affettuoso, and singing along to a beautiful tune in bass clef.

As a fourth-year medical student, I played the piano in the band for the Smoker, a beloved, annual musical parody of life at the University of Michigan Medical School that is written, directed, produced and performed by medical students. Medical students across all classes come together to sing, dance, act, design, write and perform in the Smoker. The 2023 Smoker was based off of the movie Shrek and titled “VaSHREKtomy.” The band played a wide genre of music, including songs by Smash Mouth, Van Halen and Dr. Dre. Being in the Smoker band was a highlight of my time in medical school (shout out to my bandmates!).

While I will be pursuing a career in orthopedic surgery, piano will remain an integral aspect of my life as a therapeutic outlet outside of the hospital and a medium to connect with others through music. I believe that music, like medicine, can bring people together and heal.

Changing Lives Through Advocacy: The University of Michigan Asylum Collaborative

As the wheels of their plane hit the runway, my parents were greeted with the announcement, “Welcome to JFK International airport.” My mother, five months pregnant at the time, was flying from their then third-world country: Trinidad and Tobago. Like countless other immigrants, my family came under the promise of “the American Dream,” but what does that really look like? For us, it meant the opportunity to access the best education possible. 

We settled in the bustling metropolis of New York City, a place that’s home to over 700,000 unauthorized immigrants. Imagine arriving to a foreign country with only a few hundred dollars in your pocket, ineligible for food stamps or Medicaid. You take over-the-counter supplements, daily turmeric and excessive amounts of tea, hoping to stave off any illness. Finding a job becomes a daunting task when you’re suddenly asked to disclose your citizenship status on page eight of the job application. Then, a global pandemic hits, and you’re left jobless without any access to unemployment benefits or stimulus checks. But that’s not all – the mere sound of a police siren or the sight of a law enforcement officer fills you with paralyzing fear. You become accustomed to feeling this way, with a racing heart and sleeping with one eye open becoming a normal part of daily life.

When it comes to discussing the topic of immigration, the mainstream media frequently overlooks a crucial aspect: the 10-year ban that immigrants face if they attempt to visit their home country to see their loved ones. The heartbreaking reality of missing important life events like funerals, weddings and the births of nieces and nephews often goes unmentioned. Yet, despite all these struggles, the opportunity for a better life in America is worth it, and immigrants endure decades of hardship, instability and emotional turmoil to create that better life for their families. This is the story of my parents, two of the many immigrants who came to America.

Medical students, residents, and physicians actively listening to Dr. Jessica Pierce describing how to conduct the psychological evaluation for asylum seekers and refugees.

My journey brought me to the University of Michigan Asylum Collaborative (UMAC), a non-profit, medical student-run human rights clinic. UMAC offers free physical and psychological evaluations to survivors of human rights abuses who are seeking asylum in the United States. As the training coordinator, I recently had the opportunity to invite influential individuals in the field of asylum medicine to present to a room full of medical students, residents and physicians.

One of our speakers was Dr. Vidya Ramanathan, a pediatrician, human rights advocate and medical director of our organization. She trained our attendees on how to conduct the forensic medical exam and write the medical affidavit. Using the Physicians for Human Rights Istanbul Principles, she demonstrated the gold standard of effective investigation and documentation of torture.

Another speaker was Dr. Jessica Pierce, a child and adolescent psychiatrist who is passionate about civil rights and social action. She guided the crowd on how to conscientiously conduct a psychiatric/psychological asylum evaluation. Dr. Pierce defined psychological torture, explained the psychiatric review of systems and challenged us to strengthen our cultural understanding, especially when working with this population.

We closed with Teresa Duhl, the fund development and engagement manager at Freedom House Detroit. She informed us on asylum law through a unique case study following a family’s journey to the United States. Freedom House is a non-profit organization in Detroit devoted to helping asylum seekers rebuild a safe life through providing shelter, community and legal assistance. Many of the cases we receive are referred to us from Freedom House. Our training program is designed to equip our volunteers with the skills needed to provide free forensic medical evaluations to those escaping persecution and seeking refuge in America. After successfully completing the training program, our attendees can volunteer and make a meaningful difference in the lives of those who need it the most.

As medical students, we may not have the power to change immigration laws or provide direct medical care for all who needs it, but I believe that we can still make a meaningful contribution to the lives of immigrants by giving our time, kindness and commitment to learning more about the challenges they face.  Recently, I had the privilege of sitting in on an evaluation case as part of UMAC. This experience opened my eyes to the immense transformative power of medicine and helped me understand that the role of a physician goes beyond clinical presentations and medical diagnoses. A physician must truly grasp a person’s life experiences, strengths, traumas and culture to provide the best possible care. This requires building a deep human connection that forms through empathy, understanding and compassion, ultimately leading to the establishment of trust. What I witnessed on that call was the cultivation of hope and strength through storytelling and advocacy. To be trusted by this person to convey their story and experiences in a medical affidavit left me feeling humbled and grateful. It is a privilege to be part of an organization that challenges me to constantly reflect on my privilege and use it to drive change. By advocating for immigrants seeking to rebuild a safe, secure and beautiful life for themselves and their future generations, I have found a sense of purpose that is truly fulfilling.

To me, the power of humanity lies in our ability to form deep connections and support each other through adversity. While we may not be able to solve all the world’s problems, we can make a lasting impact by lifting each other up in times of need. This is a lesson I learned from my parents, who made selfless sacrifices to bring me to this country and instilled in me a passion for uplifting marginalized populations through service and advocacy. UMAC has provided me with a platform to turn that passion into meaningful action. As I reflect on my journey as a first-year medical student at the University of Michigan Medical School, I feel grateful for the opportunity to contribute to a cause that is bigger than myself and to work towards creating a more just and equitable society for all.

A New Student-Designed LGBTQIA+ Health Curriculum at the University of Michigan Medical School

As almost-graduated M4s at the University of Michigan Medical School (UMMS) we have had a lot of exposure to the full breadth of the curriculum from the foundational Scientific and Clinical Trunks during our M1 and M2 years all the way up to the broad elective time in the Branches during our M3 and M4 years. We feel so fortunate that we were both able to develop a strong foundation early on and have the time to explore our own areas of interest later in the curriculum. However, as we moved through the curriculum, one area that we hoped to have more exposure to was LGBTQIA+ health.

As is true for many medical schools across the country, coverage of topics relating to LGBTQIA+ health in medical curricula can feel sparse and disjointed. At the time that we both matriculated, UMMS had existing LGBTQIA+ health teaching during a couple of required sessions in the M1 and M3 Doctoring curriculum, as well as through the optional Transgender Health elective that can be taken in the Branches. While these sessions were certainly necessary and beneficial, we felt that a more comprehensive and cohesive course covering foundational and advanced topics relating to LGBTQIA+ patient care would be highly valuable for UMMS students.

In addition to our own personal experiences with the UMMS curriculum, we also participated in a research effort in collaboration with Dr. Dustin Nowaskie, a current faculty member at Keck School of Medicine and Founder and President of OutCare Health. Through this study, we learned that medical students may need as many as 35 hours of curricular education in order to ensure high levels of LGBTQIA+ cultural humility in patient care. Driven by this, we led the effort to create a new course titled “Introduction to LGBTQIA+ Health”.

Taking advantage of flexibility in the Branches phase of the curriculum, in addition to the resources available to us via the Capstone for Impact program, we embarked on a nearly one-year journey of developing this novel curriculum. Under the invaluable mentorship of Dr. Julie Blaszczak in the Department of Family Medicine, we brainstormed any and all topics relating to LGBTQIA+ health that a future physician would find useful in caring for a LGBTQIA+-identified patient. Through many weeks of revisions and gathering outside input, we decided that this course would fit best as a two-week, online elective and would cover a broad range of topics in nine distinct modules building from basic, foundational concepts and ending in specialty-specific care topics.

Foundational Concepts, General Clinical Skills, Specialty-Specific Topics

Overview of the nine modules of the course: Starting from basic foundational concepts, moving to general clinical skills, and finishing with relevant LGBTQIA+ care topics in different specialties.

In order to make the course as engaging as possible, we incorporated a variety of learning modalities including required readings, journal articles, podcasts and videos. We also reached out to content experts at our institution and across the country to record lectures, which we embedded into the course. Through OutMD, our LGBTQIA+-focused student group, we also recruited other medical students to help with construction of each of the nine course modules.

After many hours of hard work in planning, designing and building these modules, our team is so proud that this course is up and running for UMMS students to take during their M3 and M4 years in the Branches! From initial data taken from students who have completed the course, we were able to show that students have higher basic knowledge in this area and are more clinically prepared and confident in the care of LGBTQIA+ patients.

We are ecstatic about how this course has turned out, and we hope that it has a lasting positive impact on future UMMS students. More and more people in the U.S. are identifying as LGBTQIA+ and as such we as future physicians have a responsibility to provide the most competent and informed care possible to this growing subset of the population. We hope that this course bridges a gap in medical education and will overall make UMMS graduates more able and comfortable in delivering healthcare to LGBTQIA+ patients.