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Vanessa Ruan (VR): As a spiritual care educator, what are some skills that you teach spiritual care trainees?Ìý

Allison Kestenbaum (AK): We tell our trainees that palliative care is just good care. While we give them the tools of planning conversations, specialized knowledge about ethics, end of life rituals, and postmortem wishes and care, generally, we teach our folks to embrace the interprofessional mode of care. For instance, one way we do this is through spiritual screening, which is a way of capturing a person's spiritual needs and distress from the medical record and direct interactions. We also teach trainees how to interpret that spiritual need for the rest of the team in terms of, for instance, how it may impact pain management and patients’ decisions, and how it may explain the dynamics that have taken place. This is important because many patients keep their feelings private from medical professionals, but not the spiritual care provider. Additionally, we teach our trainees general skills that can be helpful for sustainable professional practice, including mining their own spiritual and religious practices that keep them going in this difficult work, consulting peers to get the help they need, and being self-reflective.Ìý

Allison Kestenbaum

VR: Evaluations are helpful for learning and improving, but i³Ù’s hard to imagine how these skills that you mentioned, such as having a conversation, can be evaluated.Ìý

AK: One thing that we have built in our spiritual care training is evaluation from peers, clinicians, and preceptors from other disciplines. In addition to getting feedback from these reviewers, our trainees also perform a transcription exercise called verbatim, which is writing the dialogue as they remember it. They can use their verbatim for self-evaluation, and they get intensive feedback about it as well.Ìý

VR: You mentioned that the trainees need to embrace the interprofessional mode of care in palliative care. What are some key challenges for them when ³Ù³ó±ð²â’r±ð integrating into the interprofessional palliative care teams?Ìý

AK: Overall, people who work in palliative care and spiritual care show a strong willingness to cooperate. However, people often assume that everyone will easily figure out how to collaborate, so that when there's tension, it may be seen as a sign that the trainee is not a good fit for the team. But collaboration is not easy because the training medical providers and spiritual care trainees receive are very different, not to mention that there areÌýalready so many stressors in the setting of palliative care. Despite these challenges, I would encourage people to have some faith in the collaboration, to try and welcome cultural differences, and to bring as much curiosity to the spiritual care trainees as possible, because good collaboration will ultimately benefit the people that we're caring for.Ìý

VR: How can we promote the integration of spiritual care trainees into the palliative care team?Ìý

AK: I think it's about identifying those shared values and finding that shared language between non-spiritual care team members and spiritual care trainees. Practically speaking, when the trainees are starting, I encourage them to start with parts of the team that are the most open and willing to have them. When there is a problem, I would encourage spiritual trainees and non-spiritual care palliative care team members to communicate with each other. ThisÌýcanÌýpromote mutual respect and understanding and have lasting benefits for both parties. Besides daily interactions, inviting non-spiritual care team members to be part of the advisory group for the training program to shape the curriculum with different voices can also promote the integration of the trainees into the team.Ìý

VR: The training program aims to help the spiritual care trainees practice sustainably, embrace the interprofessional mode of care, and integrate into the palliative care team. How can we establish financially sustainable spiritual care training?Ìý

AK: For the program, there are two general principles. First, if possible, ensure that the operating budget for the training program is not grant-dependent. Try to find a way for the institution to own the training program and have grant support for special projects and additional tuition assistance for the learners. The second thing is to be open to collaborations. Different collaborations in our community have really allowed us to scale the program. For instance, we collaborate with religious and spiritual communities that understand how a healthcare context, especially with serious illness that involves mortality and suffering, can provide rich learning experiences that are helpful to pastoral care training.Ìý

We also aim to support trainees who are already working in hospice and palliative care as chaplains but have not had the opportunity to have clinical training. To make the training financial sustainable for them, we set up our program to allow our trainees to keep their day jobs, either halftime or full time and we do asynchronous learning. They can also use their working hours, for instance, in the hospice, towards their clinical training. Compared to most chaplaincy programs that have an intensive year-long residency, allowing trainees to keep their day jobs is more realistic, as they »å´Ç²Ô’t have to take a huge financial risk to get the education.Ìý

To listen to Allison Kestenbaum’s lecture, please join us for the hybrid National Grand Rounds lecture on June 17th, 2026, from 12:00-13:00 EST. The lecture will be held in the Auditorium (basement level) of St. Mary's Hospital Center, 3830 Av. Lacombe, Montréal and online through Zoom. This will be the last National Grand Rounds lecture before we take a break for the summer, so make sure you register!Ìý