Gisella Anastasia(1*), Yoyo Suhoyo(2), Prattama Santoso Utomo(3), Doni Widyandana(4)

(1) Medical Education Unit, Faculty of Medicine and Health Science, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia
(2) Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(3) Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(4) Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(*) Corresponding Author


Background: Indonesian society assume spirituality as an important aspect in life especially in sickness. Spiritual care can restore patients’ quality of life by providing them comfort, strength, and compassion. Because lack of education about spiritual care, doctors often feel not fully equipped. Reflection has proven to increase awareness of spiritual care, but the impact of this method still needs further research. This study aims to explore the impact of reflection on student awareness about spiritual care.

Methods: This study used Interpretative Phenomenological Analysis with reflective writing and in-depth interview. Nine clinical medical students divided into four groups which was facilitated by clinical teacher. Intervention were three reflective writings interspersed with two small group discussion. The writings were analyzed using Transtheoretical Model to identify behavioral change then content analysis for the transcript to explore the study’s impact and the feasibility.

Results: Five students increased their awareness because clinical experience, time-management, writing volume, and reflective thinking. Three students increase faster because learning from peers, engage with patient, and role-model. Two students increase slower because lack understanding of reflection and incorrect facilitators’ feedbacks. Two students stable because lack understanding of discussion and low engagement with patient. One student experienced a decrease because lack of task-commitment and interest. One student did not get awareness because difficulty interpreting emotions.

Conclusion: Reflection method can be used to teach spiritual care to clinical medical students by considering several factors that might play a role. Further research with improvement to the method is still needed.


Keywords: Spiritual care; spirituality; reflection; clinical medical student


Spiritual care; spirituality; reflection; clinical medical student

Full Text:



1. WHO executive board. Review of the Constitution of the World Health Organization: report of the Executive Board special group [Internet]. 1998 Jan [cited 2020 Mar 4]. (101st session). Report No.: EB101.R2. Available from:

2. Koenig HG. The Spiritual Care Team: Enabling the Practice of Whole Person Medicine. Religions. 2014 Dec;5(4):1161–74.

3. Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: reaching national and international consensus. J Palliat Med. 2014 Jun;17(6):642–56.

4. Ichihara K, Ouchi S, Okayama S, Kinoshita F, Miyashita M, Morita T, et al. Effectiveness of spiritual care using spiritual pain assessment sheet for advanced cancer patients: A pilot non-randomized controlled trial. Palliat Support Care. 2019 Jan 26;1–8.

5. Anandarajah G, Hight E. Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment. AFP. 2001 Jan 1;63(1):81.

6. Puchalski CM. The role of spirituality in health care. Proc (Bayl Univ Med Cent). 2001 Oct;14(4):352–7.

7. Selby D, Seccaraccia D, Huth J, Kurrpa K, Fitch M. A Qualitative Analysis of a Healthcare Professional’s Understanding and Approach to Management of Spiritual Distress in an Acute Care Setting. Journal of Palliative Medicine. 2016;19:1197–204.

8. Pronk K. Role of the doctor in relieving spiritual distress at the end of life. Am J Hosp Palliat Care. 2005 Dec;22(6):419–25.

9. Tiew LH, Creedy DK. Development and preliminary validation of a composite Spiritual Care-Giving Scale. Int J Nurs Stud. 2012 Jun;49(6):682–90.

10. Jafari N, Farajzadegan Z, Zamani A, Bahrami F, Emami H, Loghmani A, et al. Spiritual therapy to improve the spiritual well-being of Iranian women with breast cancer: a randomized controlled trial. Evid Based Complement Alternat Med. 2013;2013:353262.

11. Vermandere M, De Lepeleire J, Smeets L, Hannes K, Van Mechelen W, Warmenhoven F, et al. Spirituality in general practice: a qualitative evidence synthesis. Br J Gen Pract. 2011 Nov;61(592):e749-760.

12. Rochmawati E, Wiechula R, Cameron K. Centrality of spirituality/religion in the culture of palliative care service in Indonesia: An ethnographic study. Nursing & Health Sciences. 2018;20(2):231–7.

13. Ramakrishnan P, Karimah A, Kuntaman K, Shukla A, Ansari BKM, Rao PH, et al. Religious/spiritual characteristics of indian and indonesian physicians and their acceptance of spirituality in health care: a cross-cultural comparison. J Relig Health. 2015 Apr;54(2):649–63.

14. Indonesian Medical Council. Standar Kompetensi Dokter Indonesia. Konsil Kedokteran Indonesia. 2012;

15. Lucchetti G, Ramakrishnan P, Karimah A, Oliveira GR, Dias A, Rane A, et al. Spirituality, Religiosity, and Health: a Comparison of Physicians’ Attitudes in Brazil, India, and Indonesia. Int J Behav Med. 2016 Feb;23(1):63–70.

16. Paal P, Helo Y, Frick E. Spiritual Care Training Provided to Healthcare Professionals: A Systematic Review. J Pastoral Care Counsel. 2015 Mar;69(1):19–30.

17. Boud D, Keogh R, Walker D. Reflection: Turning Experience Into Learning. Kogan Page; 1985. 180 p.

18. Gordon T, Kelly E, Mitchell D. Spiritual Care for Healthcare Professionals: Reflecting on Clinical Practice. Radcliffe Pub.; 2011. 162 p.

19. Ledford CJW, Seehusen DA, Canzona MR, Cafferty LA. Using a teaching OSCE to prompt learners to engage with patients who talk about religion and/or spirituality. Acad Med. 2014 Jan;89(1):60–5.

20. Pietkiewicz I, Smith J. A practical guide to using Interpretative Phenomenological Analysis in qualitative research psychology. CPPJ. 2014 Jan 1;20:7–14.

21. Taylor EJ. Spiritual Care: Nursing Theory, Research, and Practice. Prentice-Hall; 2002. 324 p.

22. Gibbs G. Learning by Doing: A Guide to Teaching and Learning Methods. FEU; 1988. 129 p.

23. Driessen E, Tartwijk J van, Dornan T. The self critical doctor: helping students become more reflective. BMJ. 2008 Apr 10;336(7648):827–30.

24. Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ Theory Pract. 2009 Oct;14(4):595–621.

25. Ayala GX, Elder JP. Qualitative methods to ensure acceptability of behavioral and social interventions to the target population. J Public Health Dent. 2011;71(0 1):S69–79.

26. Aronson L. Twelve tips for teaching reflection at all levels of medical education. Med Teach. 2011;33(3):200–5.

27. Sandars J. The use of reflection in medical education: AMEE Guide No. 44. Med Teach. 2009 Aug;31(8):685–95.

28. Vivekananda-Schmidt P, Marshall M, Stark P, Mckendree J, Sandars J, Smithson S. Lessons from medical students’ perceptions of learning reflective skills: A multi-institutional study. Medical Teacher. 2011 Oct 1;33(10):846–50.

29. Swanwick T, Forrest K, O’Brien BC. Understanding Medical Education: Evidence, Theory, and Practice. second. John Wiley & Sons; 2014. 602 p.

30. Tanaka M, Okamoto R, Koide K. Relationship between Reflective Practice Skills and Volume of Writing in a Reflective Journal. Health. 2018 Mar 14;10(3):283–8.

31. Soodmand Afshar H, Farahani M. Reflective Thinking and Reflective Teaching among Iranian EFL Teachers: Do Gender and Teaching Experience Make a Difference? Procedia - Social and Behavioral Sciences. 2015 Jun 1;192:615–20.

32. Aronson L, Niehaus B, Lindow J, Robertson PA, O’sullivan PS. Development and pilot testing of a reflective learning guide for medical education. Medical Teacher. 2011 Oct 1;33(10):e515–21.

33. Sukhato K, Sumrithe S, Wongrathanandha C, Hathirat S, Leelapattana W, Dellow A. To be or not to be a facilitator of reflective learning for medical students? a case study of medical teachers’ perceptions of introducing a reflective writing exercise to an undergraduate curriculum. BMC Med Educ. 2016 Apr 4;16:102.

34. Lailiana NA, Handayani A. Motivasi Berprestasi Ditinjau Dari Komitmen Terhadap Tugas Pada Mahasiswa. Proceedings Education and Language International Conference [Internet]. 2017 Jun 7 [cited 2020 Apr 23];1(1). Available from:

35. Shahabuddin Hashim, Mahani Razali, Ramlah Jantan. Psikologi pendidikan. Kuala Lumpur: PTS Professional Pub.; 2006.

36. Hojat M, Gonnella JS, Mangione S, Nasca TJ, Veloski JJ, Erdmann JB, et al. Empathy in medical students as related to academic performance, clinical competence and gender. Medical Education. 2002;36(6):522–7.

37. Stanley S, Bhuvaneswari GM. Reflective ability, empathy, and emotional intelligence in undergraduate social work students: a cross-sectional study from India. Social Work Education. 2016 Jul 3;35(5):560–75.

38. Irfani TH, Gunawan J, Tosepu R, Nuru H. Experiences of being co-assistant: a pilot study. International Journal of Research in Medical Sciences. 2017 Jan 14;3(10):2580–3.

39. MacLean CD, Susi B, Phifer N, Schultz L, Bynum D, Franco M, et al. Patient Preference for Physician Discussion and Practice of Spirituality. J Gen Intern Med. 2003 Jan;18(1):38–43.

40. Wen LS, Baca JT, O’Malley P, Bhatia K, Peak D, Takayesu JK. Implementation of small-group reflection rounds at an emergency medicine residency program. CJEM. 2013 May;15(3):175–7.


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