ACPE Research

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October 2021 Article of the Month
 
by John Ehman, Editor, ACPE Research Article-of-the-Month
and Manager for Pastoral Care, Penn Presbyterian Medical Center, Philadelphia PA

 

Clevenger, C., Cadge, W., Stroud, I. E., Palmer, P. K., Haythorn, T. and Fitchett, G. "Education for professional chaplaincy in the US: mapping current practice in Clinical Pastoral Education (CPE)." Journal of Health Care Chaplaincy 27, no. 4 (October-December 2021): 222-237.

SUMMARY and COMMENT: A vitally useful focus of research for chaplains is what we do as a collective group. This informs the development of our profession, helps us get our bearing on our practice in relation to others, and might be thought of as systematically crowd-sourcing the wisdom of samples of peers. This month's study involves ACPE educators, but it raises for all chaplains the issue of how much of our attention should we be giving to "propositional knowledge" in our field vis-a-vis relational skills and self-awareness in the clinical encounter. The question, "How should chaplains be educated?" is relevant to every chaplain's responsibility for continuing education and professional self-assessment. Data presented here are from only 19 educators, but the sample is purposive, selected from across the US and various CPE settings, and offers much food for thought.

The article's introductory section [pp. 222-224] sets up the debate among educators about the place of didactic material in preparing chaplains for effective careers. It is an open-ended concern, because, "Unlike other health professions, healthcare chaplaincy does not have a professional body that specifies a curriculum that must be offered or completed in order to sit for a licensing exam or other certification process" [p. 223]. And, while major professional chaplaincy organizations require four units of Clinical Pastoral Education for certification, "there are few specifications for what content must be covered in these units" [p. 223].

Traditionally, CPE has emphasized developing self-awareness and interpersonal skill through an action-reflection approach to education.... ...This tradition has meant less emphasis on specific bodies of knowledge that residents may need to be successful chaplains; that is, less emphasis on what is known in CPE as didactic education. N. Keith Little...has observed that while the action/reflection method is excellent for understanding chaplaincy interactions, it does not facilitate the development of a "propositional knowledge" base related to facts, ideas, and theories. Without this base of foundational knowledge residents may leave CPE programs insufficiently prepared for the challenges they face in clinical settings such as how to meet the needs of diverse religious and non-religion populations..., navigate changing health care systems..., or address common ethical issues. [p. 223, and see Related Items of Interest, §II, below]

So, the present research queried ACPE educators about their thoughts on bringing didactic material into the curriculum and specifically explored five knowledge-base areas identified from the chaplaincy education literature: diversity, ethics, organizational behavior, trauma, and research. Data were collected from 1-2 hour interviews conducted in 2018* using a semi-structured guide. All 19 sites had updated curricula, as a function of their having "recently completed the reaccreditation and associated self-study process through the ACPE Accreditation Commission" [p. 224].

In short, the researchers found "substantial variation in the emphasis they place on didactics" [p. 225] and, while "[m]ost shared the belief that CPE needs to balance a focus on intra- and interpersonal skills with propositional knowledge, [they] held different perspectives on what and how this content should be taught" [p. 234]: "...CPE educators are far from agreeing on what that knowledge should be and whether they want to be the ones to teach it" [p. 235].

The authors consider the responses according to whether the participants indicated a strong commitment to didactics, a weak commitment to didactics, or a shift in their thinking on the subject.

  • "Educators with the strongest commitment to didactics believe CPE residents need to be taught a core curriculum that includes specific bodies of knowledge and content. Rather than viewing the development of relational skills and didactic knowledge as competing priorities within CPE, they see them as complementary threads of chaplaincy education." [p. 225]  For example: one educator commented that chaplains need to understand the theory of listening or of grief "before you really proceed to develop the skill set that is needed" [p. 225], and others held that "learning the norms, policies, vocabularies, and procedures of an institution is just as critical to providing spiritual care as developing relational skills." [p. 226]

  • "Although less common, a few educators explicitly resisted prioritizing didactic content in their CPE curriculum. Educators with a weak commitment to didactics expressed the belief that relational skills are more important than knowledge." [p. 226]  For example: one educator argued that "while you may assign a book on grief or another topic, if residents do not have the skills to integrate that knowledge into their chaplaincy practice, they will not progress with it," and he noted that "when residents struggle with the 'relationship piece' they may want to secure themselves with substantive knowledge rather than working on important interpersonal issues." [p. 227]

  • "In our study, the data did not suggest a common set of factors that led CPE educators to value didactic learning. However, some educators described a broadened focus from the personal formation of individual students to teaching residents how to effectively provide care for patients and staff." [p. 227]  For example: one educator who in the course of professional development was exposed to new areas of research "began incorporating a stronger focus on didactic content and research literacy at her CPE center" [p. 228], while others were motivated to put greater emphasis on didactic material by peers and mentors. The authors observe, though, that "for some educators the decision to place a greater emphasis on didactics in CPE may feel like a violation of their own training and professional socialization." [p. 228]

Among the findings about specific areas of a potential core knowledge base:

  • "We found a focus on caring for diverse populations is part of most CPE programs in both formal and informal ways.... Depending on the center this could include religious diversity (including care for those without traditional religious affiliations), racial/ethnic diversity, and diversity in sexual orientation and gender identity. While educators addressed multiple forms of diversity, they emphasized religious diversity most frequently." [p. 228]  While many educators addressed diversity in formal didactics (e.g., inviting guest speakers), some others took a more experiential approach.

  • "Like diversity, teaching about ethics is part of the curriculum at most of the centers. ...[T]he majority of educators report discussing bio-ethics, health care ethics, clinical ethics, medical ethics, or professional ethics as part of CPE curriculum. ...At four of the CPE centers, residents gain more experiential knowledge by observing ethics committees or consultations." [p. 231]

  • "At most CPE centers, educators address trauma through curriculum on trauma theory, trauma informed care, or intervention techniques.... Not surprisingly, the type of CPE center played a significant role in how educators thought about addressing trauma. ...Three educators said that while they offer a strong curriculum on grief, they would like to deepen their focus on trauma." [p. 232]

  • "A third of [the] educators reported teaching research literacy to students during residency...."  ..."[A] number of educators discussed the challenges of teaching research literacy" [p. 232], including time demands and funding. "Three educators explained that they do not do much around research, but are planning to do more in the future." [p. 233]

  • "When we asked educators about organizational behavior, fewer curriculum patterns emerged.... While educators who work in large hospital systems recognized the importance of understanding organizational behavior and administration, how these topics were incorporated into formal curriculum varied widely." [p. 233]  Some emphasized institutional leadership and administrative skills, including specific texts, while others "reported giving residents the opportunity to observe organizational processes at their hospitals first hand." [p. 233]

The most intriguing findings of the study for most readers may be in two tables that list "Most important didactic topics" [p. 229] and "Curricula for specific topics" [p. 230]. These are rich sources for ideas, in addition to being representative samples of what is being taught at the 19 involved centers, and they suggest a starting point for general discussion of a possible didactic core curriculum for chaplaincy education. Unfortunately, the table regarding "Curricula for specific topics" is slightly but confusingly misprinted, such that the first topic of diversity appears as if it were the overall subject of the table; but apart from that formatting error, the table is clearly presented.

The authors are forthright about the limitations of this study: small sample size, a focus on only five content areas, and reliance upon educators' self-reports (which in at least one case appeared somewhat out of sync with a center's accreditation materials). Nevertheless, this study seems to this reader a significant contribution to a crucial discussion about the nature of basic chaplaincy education (and, by extension, continuing education), affecting the direction of chaplaincy organizations and the character of chaplaincy as a discipline. The Discussion and Conclusion also acknowledges the practical issue of how much can be covered in the time frame of standard CPE programs. Some educators "warned of the risks of overloading CPE curricula" [p. 234], and one "lamented, 'there is more to teach than you can teach in a year of residency'" [p. 235]. Some alternate models of chaplaincy education are noted, like locating more of the basic curriculum in theological schools and encouraging second-year residencies. Over it all, though, hangs the key finding of the "diversity of CPE educator views and practices related to didactic education for chaplains" [p. 235].

*NOTE: The date of data collection is from a direct communication by the corresponding author.


 

Suggestions for Use of the Article for Student Discussion: 

This month's article favors an audience of educators, but chaplains at every stage of education and career should find it engaging and useful. For new CPE students, it could open a discussion of what they are interested in for their program. For more advanced students, it could lead to a meaningful consideration of ratios of "propositional knowledge" to the development of self-awareness and interpersonal skills. Do they fully understand what is meant by that distinction? Might the group be challenged to use the two tables in the article to construct their own ideal curriculum for didactics? In their opinion, is anything missing from those tabular lists? What do they think of the five identified topics of diversity, ethics, organizational behavior, trauma, and research? If the facilitating educator could set a quota on the number of didactic slots in a curriculum, the group could debate which topics they would prioritize for time and which they would accept being cut. For students in their third or fourth units of CPE, they could be asked whether they'd prefer a basic requirement of more than four units for professional certification as a chaplain in order to cover more educational ground. Is an additional residency (or three additional units) necessary in order to prepare a person fully for professional practice? In what ways do they feel as presently unprepared? Also, the ACPE educator or program director could even use the occasion to articulate the theory and rationale for the existing curriculum (or elaborate upon what has already been stated in the program's handbook or during orientation). What are the students' thoughts on the advantages and disadvantages of a standardized knowledge base curriculum for all CPE programs versus the variety educational foci currently found center to center? Discussion could be quite different between students in part-time/single units and those in residencies, so the mixing of students from the two types of programs might lead to people talking on different wavelengths. Finally, such a discussion of curricula could be used to raise students' consciousness about the responsibility inherent in the very concept of adult learning.


 

Related Items of Interest:

I.  Another branch of the current investigation into didactic material for chaplaincy has been undertaken with faculty of theological schools who teach chaplaincy courses. The work is cited in the present article as still in press, but it has since been published and is available freely online (open access) from the journal.

Cadge, W., Stroud, I. E., Palmer, P. K., Fitchett, G., Haythorn, T. and Clevenger, C. "Training chaplains and spiritual caregivers? The emergence and growth of chaplaincy programs in theological education." Pastoral Psychology 69 (2020): 187-208. [(Abstract:) This paper describes the history of chaplaincy programs in theological education, the content of their curricula, the goals of the programs as described by faculty, and the programs’ approaches to issues of spiritual and religious diversity. It is based on a sample of 21 schools that offer specific chaplaincy education through masters of divinity or masters of arts degrees. We conducted semi-structured interviews with faculty at these schools and reviewed materials from course catalogues and other sources. We found substantial growth in chaplaincy-focused programs in theological schools in the last 20 years as well as the lack of standardization across them that one might expect in a rapidly growing field. The programs mostly developed independent of one another. They have not come to consensus about the skills and competencies chaplains need to do their work and have only engaged in that question across institutions in limited ways. As a group, these programs are also not well connected to clinical chaplaincy training or the day-to-day employment requirements of paid chaplaincy positions. We describe opportunities for collaboration that might strengthen this emerging field and better position it in the changing religious landscape.]

 

II.  The bibliography for this month's article is relatively short but provides good leads for further reading. However, one article seems foundational to the authors' approach about the place of "propositional knowledge" and should be considered as basic background reading:

Little, N. K. "Clinical pastoral education as professional training: some entrance, curriculum and assessment implications." Journal of Pastoral Care and Counseling 64, no. 3 (Fall 2010): 5.1-8 [electronic journal article designation]. [(Abstract:) Clinical Pastoral Education is professional training for pastoral care. This paper compares CPE against the professional training model. While limiting the discussion to Christian pastoral care, the professional education model suggests a clarification of the trainee's theological and other entry requirements for a basic unit, a more thoughtful provision of information during CPE training, a careful attention to group membership and an appropriate integration with the theological curriculum. It also suggests more specific competency standards and more reliable, valid and objective assessment methods.]

 

III.  The Chaplaincy Innovation Lab syllabi page provides a variety of links to resources for didactic content as well as curriculum materials overall.

 

IV.  See our ACPE Research page on Incorporating Research into CPE for some materials useful for didactic purposes.

 

V.  One potentially interesting way to think about didactic material for chaplains might be to consider the materials that chaplains have used to train spiritual care generalists (e.g., physicians, nurses). That's a very different audience, and yet if chaplains believe there to be a core curriculum for those other providers, then the topics may well be ones that chaplains should be in a position to speak to in the course of interprofessional work. See, for instance, the table of Didactic Components of [a] Spiritual Care Generalist Workshop, on p. 816 of the following:

Robinson, M. R., Thiel, M. M., Shirkey, K., Zurakowski, D. and Meyer, E. C. "Efficacy of training interprofessional spiritual care generalists." Journal of Palliative Medicine 19, no. 8 (August 2016): 814-821. [(Abstract:) BACKGROUND: Provision of spiritual/religious (S/R) care has been associated with improvements in patient care, patient-provider relationships, and resource utilization. Clinicians identify a lack of training in S/R care as the primary impediment. The purpose of the study was to evaluate the effectiveness of one-day, simulation-based workshops to prepare interprofessional clinicians to function as capable, confident, and ethical spiritual care generalists. METHODS: Interprofessional practitioners (physicians, nurses, social workers, psychologists, child life specialists) in a quaternary care academic pediatric hospital participated in daylong Spiritual Generalist workshops utilizing professional actors to learn requisite spiritual generalist skills. Participants completed pre- and postworkshop questionnaires on the day of the workshop, and three-month follow-up self-report questionnaires that included 1-5-point Likert scale items focused on 15 spiritual generalist skills. RESULTS: One hundred fifteen interprofessional staff members completed pre- and postquestionnaires and three-month follow-up surveys. Analysis revealed significant mean improvement in all 15 spiritual generalist skills targeted for developing mastery within each of three broad domains: Spiritual Screen and Care Plan, Provision of Spiritual Care, and Professional Development. Although the initial degree of improvement tended to be greater immediately postworkshop, 14 of the 15 spiritual generalist skills remained significantly higher at three months compared to preworkshop. CONCLUSIONS: This daylong workshop of concentrated instruction, including didactics, visual slideshow, simulation of clinical scenarios, and debriefing/discussion components, was efficient and effective in training clinicians from varied disciplines to learn basic generalist-level spiritual care skills and to collaborate more effectively with chaplains, the spiritual specialists.] [This was our August 2016 Article-of-the-Month.]

 

VI.  The ACPE Curriculum Committee is currently hosting a series of online Curriculum Resource Room sessions to stir discussion about curriculum development, and in some cases, didactic elements in particular. ACPE members should see the Learning & Resources section of the ACPE SharePoint site for the latest information and access to recordings of past Resource Rooms.

 

 
If you have suggestions about the form and/or content of the site, e-mail Chaplain John Ehman, Article-of-the-Month Editor, at john.ehman@uphs.upenn.edu
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