 So, our next speaker is Dr. Pharr Kerlin, and think of the McClain Center family, Pharr may be one of the best examples of what good things can happen if you are truly passionate about a topic and you keep on persevering despite obstacles. Pharr was a medical student at the University of North Carolina at Chapel Hill, then a medical resident at the University of Chicago, then he was a Robert Wood Johnson clinical scholar here, and I still vividly remember Pharr's first research and progress conference where he introduced his topic of religion and medicine, and he got what I thought was quite a bit of unfair criticism, but really kept at it, and so he only did some of the seminal national work, national survey work, looking at physician practice patterns of a variety of issues that are related to the topic of religion and medicine, as well as theoretical work thinking about theology, spirituality, and medicine. He eventually became a social professor of medicine at the University of Chicago, a Green Wall Foundation scholar and director of the program on medicine and religion here at the University, and in 2014 Duke recruited him to become the Zazaya C. Trent professor of medical humanities in the medical school and Divinity School there at Duke. Pharr is a practicing palliative medicine physician and is working to create a new interdisciplinary community of scholarship and training focused on the intersection of theology, medicine, and culture, and today Pharr will speak on the topic of ventures in theology and medicine. Thank you, Marshall. It's good to be back. It's good to be reminded of how much I owe to the McLean Center colleagues, and particularly to you, Mark, of course, for the amazing opportunities I've had within the worlds of medicine and ethics, so I'm very grateful and thank you. Two years ago, I left, as Marshall said, I left Chicago for Duke because I was offered my dream job. At Duke I practice medicine in an inpatient hospice unit. I work with colleagues in the Trent Center for Bioethics, Humanities, and the History of Medicine, which is as close as Duke gets to something like the McLean Center. I have a joint appointment in the Duke Divinity School where I co-direct with my colleague and friend, Warren Kinghorn, what we call the Theology, Medicine, and Culture Initiative or TNC. The Theology, Medicine, and Culture Initiative invites participants to re-imagine and to re-engage contemporary practices of health and medicine in light of Christian tradition and the practices of Christian communities. We emphasize scholarship, vocation, and witness. These are three concepts that are rich with meaning within Christian tradition and today I want to tell you about one of our primary projects which focuses on vocation. We call it the Fellowship in Theology, Medicine, and Culture. The Fellowship in Theology, Medicine, and Culture invites those with full-time vocations to health and medicine, broadly conceived, to come to Duke Divinity School for a year of intensive theological study and formation. Fellows study full-time toward one of our residential master's degrees. In addition to formal coursework, fellows participate in communal prayer, structured mentorship, weekly conferences, church-based practicums, and semi-annual retreats. The aim is that the fellows will experience themselves not only as students learning about theology, but as participants in a community of prayer, dialogue, and friendship with others who share a desire to faithfully live into their vocations in health and medicine. How do we come up with this? We began with the fact that American health care practitioners are increasingly exhausted and bewildered. American professionals seem at least as bewildered as everyone else. This has been brought up, I note, in this conference multiple times, this sort of alienation, bewilderment, frustration that so many medical practitioners experience. We know that this growing burnout and alienation plagues contemporary health care, and wherever I speak with physicians and nurses and other practitioners, I find that many are struggling to make sense of their day-to-day work. Why is it worthwhile? What does any of it have to do with what they thought they were called to do and to be as healers? Isn't there a better way? This strikes me as odd, particularly with respect to Christian practitioners. Few human practices, after all, resonate more with Jesus' ministry than caring for the sick. Jesus used the analogy of a physician offering healing to describe his work. He also identified himself with those who are sick, telling those who had visited the sick, truly, I tell you, just as you did it to one of the least of these who are members of my family, you did it to me. Through his concern for those who were sick and his powerful miracles of healing, Jesus demonstrated the inauguration of his kingdom. That's part of the Christian story. His early followers startled their pagan neighbors with their practices of caring for the sick and discarded. In late antiquity, Christians formed the first ancestors of the modern charity hospital. I think of St. Basil of Caesarea, under whom early Cappadocian monasteries developed infirmaries for those who were ill. What was new about this is that they took care of people without respect to their social class or their capacity to pay for their care. In the late Middle Ages, the church promulgated manuals for lay people, instructing them how to suffer illness and to live faithfully in the face of impending death. Leah Dugdale, who's with us, recently edited a collection of essays on this ours, Moriindia, as it was called, this literature. And even into the 20th century, the majority of community hospitals in the United States were sponsored by Christian denominations. This history displays how attending to the sick long has been considered a paradigmatic Christian vocation or calling. So then why is it that Christian health practitioners now experience so much bewilderment? Why do they not readily experience their professional roles as consonant with who God has called them to be or experience their work as resonant with what God has invited them to do? To begin to answer that question, it seems to us we have to pay attention to some important dynamics in contemporary medicine. I hope none of this will be controversial because it's been mentioned by several folks already. The United States deploys, as we all know, the most technologically advanced and expensive health care system in the world. Yet despite consuming roughly 20% of our gross domestic product, that system has not made Americans any healthier than residents of other economically advanced and politically stable nations. Moreover, as the health care system has grown in scope and power, it steadily has become more complex, technical, and bureaucratic. I think Dan's wonderful presentation gives us sort of some of the history of how that came about in our age. But inside this system, practitioners increasingly feel like cogs in a vast machine driven along by faceless forces, harried and prodded and disciplined to chase outcomes that seem far removed from the needs of the particular patients they encounter. It seems to me that this sense of being driven and harried probably explains some of the outrage and anger that Lois Nora described yesterday. It's been directed at the American Board of Medical Specialties. It's no wonder then that the burnout rate among both physicians and nurses approaches 50%. And that patients are so often distressed by the impersonal and bureaucratized care that they receive. This moral and spiritual bewilderment of Christians working in health care poses a challenge to Duke Divinity School. The mission of the school is, quote, to engage in spiritually disciplined and academically rigorous education in service and witness to the triune God in the midst of the church, the academy, and the world. And that mission is pursued primarily by training pastors and teachers. But as our recent dean, Richard Hayes, who was our dean until he was diagnosed with pancreatic cancer just a few months ago, as he has written, wherever the church experiences renewal, it discovers that it does not exist for its own sake. It exists in order to bear witness, in order to be light to the nations. With respect to health and medicine then, we think of our challenge as that of forming scriptural imagination so that the church might bear witness and embody light in these important domains of our contemporary life together. And obviously we have plenty of work to do. Few Christian health practitioners have received any deep theological formation with respect to their work. Almost two-thirds of health professionals in the United States, and others from our own research, almost two-thirds identify themselves as Christians. Most say their religious beliefs influence their practices. They often seek to link their work to Jesus' healing ministry. But few have learned to think theologically about foundational dynamics that shape American health care. And so what I observe is that where practices, that accept where practices cross a bright line of moral impermissibility, Christian practitioners tend to take the structures and practices of medicine for granted. For example, Christian health practitioners regularly work with patients and families at the end of life. But few have considered how the Christian tradition of living well in the face of death, that tradition I mentioned before, might inform decisions about how, when, and to what extent we use technology to prolong our lives. Christian physicians and nurses lament the loss of personal contact and connection with their patients. Oh for the day when you only had five minutes of paperwork per patient. So they lament that. But few have reflected on how modern medicine tends to treat the body as machine rather than as person, an extent to which Christian communities have erroneously, in my view, embraced this view. Christian practitioners have strong opinions about shifting health care policies. But few have examined how the Christian affirmation that Christ is present in the one who is sick in a particular way might inform debates about health care reform. Christian health practitioners know that the gospel should matter for how medicine is practiced, but they are not practiced in saying or seeing or saying how. And this is a problem. It's this lack of theological formation combined with the broader social dynamics toward more bureaucratic and instrumentally driven medicine leads Christian health practitioners to be increasingly alienated from their work. As a result, many relegate their faith to the personal sphere and their work to the professional, thereby detaching from the task of discerning how to faithfully fulfill their professions. They experience bewilderment and their routine. Daily practices become increasingly disconnected from their original sense of calling and vocation. They don't know how to describe what's wrong or how to start again in a new way. Much less are they practiced in turning to the gospel and to Christian tradition for guidance. It's a problem also for the churches, whose members are called to bear witness to the gospel not only in times of health, but also in times of sickness, not only within the church walls, but also within the halls of institutional medicine. In their book, Reclaiming the Body, Christians and the Faithful Use of Medicine, Joel Schumann and Brian Volk say that it is a sign of illness that most North American Christians approach medicine without much consideration of its relation to their theological convictions. A first importance they suggest is that Christians should always understand themselves as part of a gathered people, integral parts of a community called the body of Christ. In other words, we never really go to the doctor alone. But Christians do go to the doctor alone, in part because their pastors also feel marginalized within health care institutions, unable to exercise authority in guiding and caring for the sick and the faithful to whom they minister. Performing and renewing a theological imagination for health and medicine requires, we think, a particular kind of institutional space. And one that Duke Divinity School is perhaps uniquely able to sustain. Today's health practitioners, I assume most all of us would put in that basket, have received a great majority of our professional formation within academic medical centers, the structures of which overwhelmingly emphasize empirical and instrumental modes of reasoning. Health practitioners have difficulty finding conversation partners for sustained serious theological engagement with the practices of medicine. It's not a space in which you're often invited to think, what would it mean to practice medicine faithfully? They also find it challenging to gain the theological formation they need in churches or in other Christian contexts outside the university. Even faith-based health care institutions tend to divide the professional from the personal, the public from the private. And although many pastors and congregations care deeply about health and illness, churches are often not equipped to provide in-depth formation for people who work in the health and medical fields. Divinity school, in contrast, like the one at Duke, provides a prominent institutional context in which these challenges can be overcome. So first, the Div school at Duke is committed to the practices of the church and to the formation of Christian ministers. So here we can equip those being trained for the ministry to reclaim their ecclesial authority within the medical context. It's often said that doctors are the real priests of the modern West, that when Christians and their clergy enter the hospital, the real authority lies with the medical team. I'll say from a lot of conversations with clergy that that's the way many experience things. The Div school can help Christians push back against this distortion to help them understand themselves within the medical context as those whose bodies belong to the Lord. There we can seek the theologically informed configurations of medicine at the local level that can serve as models for fruitful and transformative Christian practices of healing and health care. Second, the Div school is in close proximity to Duke's world-class medical center, like the University of Chicago's. Maybe the only two Div schools that are so closely approximated. And our faculty includes four physicians as well as many others whose scholarship focuses on the body, health, suffering, illness, and death. So what we try to do is to bring health practitioner students and ministerial students together in a context that's directly responsive and deeply responsive to the realities of contemporary health care. So that students can connect what they're learning in the classroom with what they've experienced and will experience in their clinical domains. Third, the Div school is an internationally renowned center for theological scholarship and education, which is committed to engaging the broader culture with the gospel and historic Christian tradition. So the Div school is committed to engaging the academy and the world as equal participants in an ongoing public discourse about our common life, not merely as an enclave of individuals working out their personal values in private. Here it's consistent with the Div school's mission to invite seminarians, clergy, students in the health professions, practicing clinicians to study information that prepares them to reimagine and then re-engage their work in the world. And finally, the Div school seeks not simply the transmission of knowledge, but formation. Toward that end, formal study occurs within the practices of Christian prayer, worship, and service. And in this way, we are all equally, those of us in this adventure together, equally participants in a community of theological formation and Christian practice, whether we go out and work in a parish or work in an oncology ward. So in this venture, this venture in theology and medicine, we believe we are called to respond to the moral and spiritual bewilderment of Christians working in healthcare by inviting them to be transformed by the renewing of their minds. Through practices of engaging Christian tradition, we hope to help practitioners gain clarity about the purposes and meaning of their work, about how to attend faithfully to those suffering illness, pain, debility, and death. And through practices of worship and gratitude, to be encouraged to begin again with joy, seeking creatively to participate with God's ministry of suffering, presence, and healing. Our prayer is that through the formation of a scriptural imagination, that those who participate in this venture, their eyes would be opened to new possibilities and new practices that bear witness and bring light to contemporary health and medicine. Thank you. To speak to the first vision, we don't wanna be, I'm a palliative medicine doc, but we don't want to palliate the symptom and not address the problem. So we see burnout as just a prominent symptom. It's a symptom of a deep loss of connection between one's work and one's identity. So we don't aspire to be a place for primarily dealing with burnout. Whether this will inspire, I think our hope is that this will inspire two kinds of renewal. One would be that people gain new eyes to see choices within the structures of contemporary medicine as they are, that they didn't see possible before. I'll give you a little tiny example of that. John Hart, you know this example, Dan, but John Hart, who was a fellow also in the McLean Center, started a formation program at Loyola, and one of the students reported that he had begun the practice of every time he squirts the alcohol in his hands of meditatively for just a moment, remembering that what he was about to do was akin to a priest washing his hands before touching the body of Christ. And that would be, my guess is that practice changes the way he shows up, but it wouldn't be a parallel practice of medicine. At the same time, something like the hospitals formed in Cappadocia are examples of the innovation that we would love to see inspired. So we'd love to see new models of care that are not really imaginable within the current structures of things. Have you done a survey, that I've struck by this number, that he said to the doctors in the U.S., identifying themselves as Christians, have you done a survey to assess whether that population of physicians, I mean the majority of physicians, take serious account of their Christian traditions in their practice? Well, whether, like many physicians, the religious practices of care separate them from sin, but it was meant for the purpose. It's a good question. We did ask them whether they agreed or disagreed with the statement. My religious beliefs influenced my practices of medicine, and roughly half said they thought they did. 55% is a Waldox. Thank you, a Waldox. And I can't remember how that varied for Christian docs. It was probably about the same proportion. Yeah. Now, but I'll just say from my experience of talking to a lot of people about how does it show up, there's just a sense of, of course it's gotta matter. Most of you will think of it as mattering as making them more compassionate, that are making them as compassionate as they are and that they're more than they would be if they weren't thinking about this vocational calling. But they're not practiced in talking about how or why this, their work is different because they're Christians, for most docs. We just wanna be one fellow larger than yours. Each year, for 28 years. No, we would love to see it get up to about 20 fellows a year. You know, the Div School has all the structures to accommodate the students. We don't have to do nearly as much because we just have to invite them into a particular kind of space, but the Div School set up to have students that are in larger numbers. They pay tuition because they're studying full time. We have some grant support that mitigates that, but they pay about $10,000 a piece, plus their living expenses. Thanks, Farah, just a quick question. How many, to follow up with Mark's comment, how many fellows have you had already and how many, and then do you intend to draw from practitioners in private practice or academia or both and who do you anticipate would be attracted to this besides like burnt out physicians regardless of where they are? Do you think most will come from one section and where do you think they'll go after your fellowship and back to academia or back to private practice or do you think they'll change or do you have any idea yet? We just have our first cohort, eight fellows, five of which are either medical students currently taking off a year or doing a gap year on their way to medical school. We have one nurse who's signed up to come next year. We have a couple of other folks that don't, that are working in health and medicine, but not as clinicians. We want to develop a postdoctoral fellowship program that trains those who are really interested in being academics, becoming leaders in this space. That would be a more on the model of RWJ or something like that. But at present, we're open to who comes and can meet the admission requirements. So all of you are welcome to apply. Thanks.