Avaliação do impacto da implementação de um currículo em Religiosidade e Espiritualidade (R/E) em residências médicas em psiquiatria no Brasil

Abstract

Introduction: The influence of religiosity–spirituality (R/S) on health has been robustly demonstrated in the scientific literature. Various professional associations advocate for the training of healthcare professionals to include the spiritual dimension of patients in their clinical practice. However, there remains a gap between this recommendation and the actual training provided in the education of such professionals, including in Psychiatry. There are still relatively few studies that quantitatively evaluate these interventions. Objective: To evaluate the impact of a standardized curricular proposal for teaching on religiosity/spirituality (R/S) in psychiatry residency on the development of residents’ religious-spiritual competencies. Method: Educational intervention study (pre- and post-test with non-randomized control) conducted in 15 psychiatry residency programs in Brazil, involving a total of 104 residents, 66 in their second year and 38 in their third year of training. Sociodemographic profile, R/S dimensions, beliefs, attitudes, knowledge, and competencies regarding the integration of R/S in clinical practice, as well as satisfaction with the course, were assessed. Skills in addressing R/S were also evaluated using a standardized patient. Inferential statistical analysis was performed using tests of equality of means for independent samples and paired mean tests. Finally, chi-square tests and Correspondence Analysis were conducted for qualitative variables in contingency tables (cross-tabulation frequency tables). Results: Most residents, in the pre-test, reported having a religious affiliation (59.5%) and considered themselves more spiritual than religious. Although most participants initially reported asking (94.8%) and listening empathetically (96.8%) to patients regarding religion/spirituality, 54.9% indicated that they addressed these issues only rarely or sometimes. Despite recognizing the clinical importance of religion/spirituality (97.9%), 71% initially reported a barrier (e.g., 66.7% insufficient training and 42.2% fear of offending patients/family members). In general, except for insufficient time, there was a decrease in the residents' perception of barriers. The residents initially demonstrated moderate knowledge of the test administered to them, with an average score of 5.8 ± 1.8 (SD) on 9 questions. The training was associated with increased competence in addressing R/E issues, both in self-assessment (p<0.001) and in assessment using a simulated patient (p<0.001). Residents showed high satisfaction with the course (average of 8 out of 10). Conclusion: This curricular intervention aimed at teaching R/S competencies to psychiatry residents was well accepted and led to gains in R/S competencies, both in self-assessment and in evaluation through a standardized patient. These findings may indicate the importance of R/S training as a means of reducing the gap in addressing this topic in clinical practice.