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Academic Leadership from the Inside Out: Attending to Spiritual Needs (Diane Magrane)

Diane Magrane is a physician leader of physician leaders. “Education cuts through the politics and the educator then becomes an inside advocate for new ideas,” says Diane. As Professor of Obstetrics and Gynecology and Executive Director of the International Center for Executive Leadership in Academics at Drexel University, she works with women leaders who are so smart and so successful, they sometimes have difficulty learning new behaviors.

For Diane, each use of LS is laid out like a teacher’s lesson plan. “I organize the activities from the opening to the closing with the intention of moving the audience from familiar to less familiar and from curiosity to surprise. I create a “script” for myself and then mentally rehearse. With this preparation, I feel free to improvise in the moment."

Great teachers have enough experience and multiple scenarios in their head so they can simultaneously teach and learn, making adjustments at every step. Leading this way is exhilarating and demanding.”

MD Competencies: Attending to Spiritual Needs of Patients

When asked to facilitate a national conference for the George Washington Institute for Spirituality and Health (GWISH) to develop competencies and learning objectives in spirituality for medical student education, she agreed—under the condition that the group approach the project collaboratively with an open mind for new insights. Teams of medical faculty, clergy, and trainees competed to be one of eight teams selected to work together on this national project. Groups from eight medical schools were selected to participate in exploring how physicians might better “attend to the spiritual needs of patients.”

A variety of LS were employed, beginning with Discovery and Action Dialogues (DAD) weeks before the conference. “I had previously guided different groups through a process of designing competencies for medical student training. We always used creative methods and interdisciplinary small group discussions. As the facilitator, I ended up doing a lot of cataloguing and using my formal authority to move the project forward. Too often participants advocated and jockeyed to protect their discipline. The process required a powerful mediator."

Pictured above: A diverse group of faculty, clergy, and medical students working together on national competencies. (Diane in the center, Keith horizontal)

I wanted this project to be different. Teams from each medical school were made up of professors, palliative care specialists, pastoral care professionals, and a handful of students."

We introduced the DADs first with the project organizers and then with each team in a telephone conference. Each group conducted three or more DADs in academic and clinical settings, then contributed reports of their findings as source materials for the summit.

It was fascinating watching them learn how to suspend their assumptions about how spirituality shows up in clinical care and watching them realize how much they could discover by using their natural curiosity. The pre-meeting work took them to a different place than they would have been without those explorations. By using DAD they discovered a much deeper and richer perspective on how spiritual needs were tended to under a wide range of situations and extreme conditions.

Paradoxically, an unusual group of suspects emerged. Medical students were a major source of insight. Whereas many of the clinicians felt encumbered by the crunch of time in clinical encounters, grousing that they did not have time to tend to spiritual needs in addition to the medical needs of patients, students on clinical rotations observed physicians doing just that—sharing difficult diagnoses with patients in a manner that respected spiritual needs. They could describe us how busy doctors were able to compassionately attend to spiritual needs while completing the rest of their technical duties.

The work was extremely collaborative and open. In the course of analyzing the DADs summit participants identified six competencies, plus one to tend to the spiritual needs of practitioners and students as well as to patients.

They surprised themselves by integrating spirituality into their work at the conference. In the closing circle, when we read out loud the top ten ideas from 25/10 Crowd Sourcing, a deep silence followed. I recall discomfort until one of the members asked, “Can we read the others?” We proceeded to read and acknowledge every single idea. A deep respect for each individual had emerged. A community of belonging had formed.

Action Research with Discovery and Action Dialogue

In preparation for our conference, you are responsible for facilitating and collecting data from three DADs. A variety of settings is recommended: with medical students only; with preselected mix of students, residents, RN, MD and patients; with a mixed group on a hospital unit; and, in an extreme setting in which attending to spiritual needs is MORE difficult (e.g., ICU).

Here are the dialogue questions:

  1. How do you know when the spiritual needs of patients are being neglected?
  2. How do YOU attend to your own spiritual needs & the spiritual needs of patients?
  3. What prevents you from doing this or taking these actions all the time?
  4. Is there a person or a unit/group seems to be particularly successful at attending to spiritual needs? How do they do it?
  5. Do you have any ideas?
  6. What steps would start to bring these ideas to life? Any volunteers?
  7. Who else needs to be involved?

Pictured right: Small group working on a competency for Compassionate Presence. How do you teach and learn presence in the midst of mastering the technical practice of medicine!?

Participants developed medical school competencies as well as methods of assessment and evaluation in six areas.

Knowledge: Acquire the foundational knowledge necessary in integrating spirituality in the care of patients.

Patient Care: Integrate spirituality into daily clinical practice.

Communication: Communicate with patients, family and healthcare team about spiritual issues.

Compassionate Presence: Establish, and action with patients, family and colleagues.

Professional Development: Incorporate spirituality into professional development.

Health Systems: Apply knowledge of healthcare systems to advocate for spirituality in patient care

DADs revealed the behaviors that enabled effective practice of the competencies. The behaviors, in turn, helped to generate evaluation of teaching and learning methods.

Reflecting on Learning and Leadership

Diane’s goal is to help leaders feel confident in messy situations, believing more in themselves when the path forward is challenging. Diane is keenly aware that she does not solve problems for people. Rather she helps them discover their own solutions. “I am there to catch them if they fall back.”

Diane genuinely believes that if we dig deeply enough, we all can find more courage to lead (and teach). “I push people and myself to cognitive, spiritual and emotional deepening. This is not a rule-driven process familiar to academics but rather something that emerges. Leaders see the process and themselves in a new way.”  Surprise!