Title:An Education Framed By Faith

Faculty perspectives on teaching with faith in mind

Georgetown’s Catholic, Jesuit identity draws applicants to the School of Medicine for reasons beyond the university’s cutting edge research and science. Students are attracted to the school’s emphasis on the Jesuit principle of cura personalis, care for the whole person, and on the importance of serving society’s most vulnerable populations. Once here, students experience the school’s foundation of faith in their own unique ways.

Many people are surprised to learn that Georgetown is home to one of just five Catholic medical schools in the country. Georgetown University Medical Center embraces its role as a preeminent academic medical center that also values spirituality and ethics-centered leadership in an increasingly secularized profession. The commitment to caring for the whole person extends from the classroom—where clinicians-in-training study and discuss such topics as bioethics and moral decision making—to opportunities in the community that prepare them to support and recognize individual spiritual journeys for both patient and practitioner. Faith, spirituality, service and ethics are key touchstones in Georgetown’s medical curriculum.

“Faith has a critical role for those who are truly humbled to have such sobering responsibility for the lives of our patients,” says Stephen Ray Mitchell, dean of medical education. He recently embraced Georgetown’s Jesuit roots by completing a retreat over a nine-month period to learn the spiritual exercises of St. Ignatius.

“And this Episcopalian pediatrician uses them daily,” he adds.

ETHICS THROUGH THE LENS OF FAITH

Kevin Donovan, professor in pediatrics and director of the Edmund D. Pellegrino Center for Clinical Bioethics, considers it a special privilege to teach at a medical school where “faith and ethics are natural and valued parts of the conversation.”

He is keenly aware of the unique opportunity that Georgetown offers. In contrast, he previously studied and taught at the University of Oklahoma. “As a state school, naturally religion couldn’t play a part in the teaching of ethics unless it was just an overview of how it affects the way your patients respond,” he explains. “At Georgetown, we can introduce concepts, knowing that our students have different faith traditions or differing perspectives within the same faith, yet they will learn and understand the values of the institution.”

Donovan describes the literal interpretation of cura personalis, which commits Georgetown “to value those whom society doesn’t always value” and which has a profound influence on educating practitioners. “Our society is showing a tendency to disvalue the weakest, most vulnerable members of society. It is reflected in the way we treat patients across the gamut, from neonatal to the elderly,” he explains. “When we send a message that you are only as valuable as your usefulness to society, then people who have lived long and full lives and experience the normal impairments that come with age are made to feel that they are a burden rather than a contributor.”

He believes that countering this tendency has important implications in many areas: interpersonal relationships between doctors and patients, the delivery of health care to those in need, the protection of vulnerable patients and the consideration of every individual as a valuable human being. “I think that  Georgetown understands these priorities and teaches them,” he concludes.

All Georgetown medical students take Introduction to Clinical Ethics in their first year. In this course, students examine how medical professionalism, ethics and law set standards for physician role and behavior. They also look inward, reflecting on how principles of ethics influence their own character and behavior. The course includes a panel about religious traditions and patient care. In the spring of their second year, students take a module called Health Care Ethics, with the goal of facilitating and encouraging a deeper understanding of ethical reasoning and decision-making.

This two-fold approach has an important effect on students, says Donovan, with the second module building on the students’ recently acquired clinical experiences. “When we meet them in the first course, their realm of experience is narrow. Most have no clinical background yet,” he says. “But when we meet them in their second year and beyond, it becomes much more than a theoretical classroom discussion.”

TEACHING DISCERNMENT

For Carol Taylor, professor of nursing and senior clinical scholar at the Kennedy Institute of Ethics, cura personalis goes beyond caring for a person’s physical needs. Her goal is to teach practitioners like graduate nursing students who come from very different perspectives to be discerning about what people really need to flourish.

“Often the caregivers’ goal is high patient satisfaction, which prioritizes giving patients what they want,” says Taylor. “I try to suggest a very different role to them: bring your own nursing experience and your work with physician colleagues to the situation. Clinicians must feel equipped to use the resources at their disposal, including their training and experience, to make decisions for themselves and to help patients and families make good decisions.”

Georgetown helps student practitioners understand the difference between law and ethics, and how the two interact in patient care. Taylor explores the issue in her classes, which include online courses with students from across the country, by leading the group in a simulation of a challenging clinical ethics consult.

“Introducing ethics consults to graduate nursing students is an interesting exercise,” she explains. “Often they tell me that in their practice, everything is viewed through a legal lens. In my course, we look at the same things through an ethical lens—how are humans going to be affected by the choices they make.”

Taylor and her students examine broad examples of ethical situations, such as those in war or genocide, and then look more specifically at how those principles impact them in a clinical setting. “Whether you’re looking globally or you’re looking at the individual patient and family, you have a role,” she tells her students. “If things aren’t working for people, and if good and wise people don’t speak up, nothing’s ever going to change.”

She believes that a clear understand- ing of bioethics is key to being a caring practitioner: “It’s all to empower our graduates. I remind them that every day they show up for practice, they literally hold the well-being of people in their hands. Who they choose to be will affect—and sometimes determine—how people are born, even if they’re born, how they live, suffer, age and die. And if they don’t think we need to be careful about how we step into people’s lives, they might want to do something other than become a health care professional.”

WISE GUIDES

To teach students to address the needs of their patients beyond the physical, Taylor introduces what she defines as the universal spiritual needs.

“Independent of anyone belonging to a particular religious tradition, we all struggle with questions about meaning and purpose, love and relatedness, and forgiveness,” she says. “Oftentimes it’s the experience of illness that puts those questions in a much sharper relief. Your days here look shorter rather than longer. ‘Why am I here?’ becomes, ‘When I’m gone, will I matter to anyone?’ And, to the extent that we all make mistakes in our life, what forgiveness has to happen before we can be at peace as we confront death?”

Contending with these universal spiritual needs for purpose, legacy and forgiveness undergirds much of Taylor’s work. In her teaching and writing, she speaks to what she describes as “the limits of the biomedical model” for patient care. “We are not just machines —organisms that exist at the molecular level. It is important to talk about biology and psychology, as well as social and spiritual models of health.”

Taylor believes the field is lagging in this area of understanding, which, on a positive note, offers great opportunity for engagement and education, especially at places like Georgetown where they are recognized and accepted. “In my entire nursing practice, no one ever held me accountable to identify a spiritual need and either respond or refer it appropriately. We haven’t begun to hold one another accountable for addressing spiritual needs. So it’s a huge opportunity.”

Taylor concludes that the role of spirituality and ethics is more important for health care practitioners graduating now than ever before: “Science is making so much more possible today, but it does not always equate to a better life. Health care professionals bridge vulnerable persons and this huge array of diagnostic and therapeutic options. I believe the role of walking with people and helping them make wise choices is more critical than ever before. That’s what I hope we’re doing well at Georgetown—preparing our graduates to be wise guides.”

WOMEN AND MEN FOR OTHERS

Since 1995, the School of Medicine has provided a service-learning program to help medical students recognize and address community health priorities. Today, the now-required course has grown to include 200 students, 27 faculty team leaders and 29 community partners. Service learning enables students to work with underserved and at-risk populations, in keeping with Georgetown’s mission.

“It was popular from the start,” says Jay Siwek, vice chair and professor in the department of family medicine at Georgetown. “We had to turn away students because we didn’t have enough slots. Every year we tried to piece together more funding, more community sites and more faculty.”

All first-year medical students take the service-learning course. They are hosted by community sites that serve non-native English speakers, those affected by domestic violence, school-aged children, the homeless, senior citizens and people with disabilities. The medical students work as a group at a single site over the course of their first semester, building a deeper understanding of the complex factors that create health care challenges for the population in their community. The personal relationships and connections help students understand issues like access to care and social determinants of health beyond textbook statistics.

ETHICS RESOURCES AND COOKIES

When students do seek textbook statistics and other scholarly resources on ethics and faith-based medical and health care questions, they visit the university’s world- renowned Bioethics Research Library. Located in Healy Hall, the library serves the entire Georgetown community, in addition to outside researchers and practitioners. The collection began in 1971 as a few shelves of books collected by the university’s ethics scholars. As the interdisciplinary field of bioethics grew, so did the library. Today it is home to

the world’s largest and most extensive collection of materials on ethics, medicine and biomedical research. The historic study space contains more than 100,000 books, journals, archival materials and digital objects covering the spectrum of religious, political and cultural perspectives developed globally.

The bioethics library features popular events such as the weekly “Cookie Friday” program hosted by Laura Bishop, head of academic programs at the Kennedy Institute of Ethics (KIE), with speakers discussing bioethics issues or cases. Recent topics have included organ and tissue donation, Ebola, the issue of coercion and genome sequencing. Podcasts are available for those who can’t attend.

Complementary to the KIE but housed at the Medical Center, the Edmund D. Pellegrino Center for Clinical Bioethics was established over two decades ago to focus on clinical care with roots in the Catholic, Jesuit tradition. With appointments spanning the Medical Center, the Pellegrino faculty members teach, conduct research and participate in patient care. The center provides ethics consultation service for MedStar Georgetown University Hospital, in addition to consulting for outside organizations like the Catholic Health Association.

In the field of professional education, the Pellegrino Center also supports Georgetown University’s world- renowned Intensive Bioethics Course, offered for over 40 years through the KIE. The weeklong program brings policy makers, nurses, doctors, researchers, hospital chaplains and institutional review board panelists to the Hilltop to grapple with some of the most profound moral issues they confront in their work. The course includes plenary lectures on key principles of bioethics, followed by small group discussions led by expert facilitators. Two half-days are devoted to lectures on diverse topics such as genomics, collaborative reproduction and neuroethics.

MINISTRY AT THE MEDICAL CAMPUS

Medical students from a variety of faith traditions often turn to the Medical Center’s campus ministry program for support and fellowship, or to simply find a quiet, reflective space. The department focuses on caring for the spiritual needs of the students, and instilling a spirit of collaboration among graduate students of clinical medicine, medical research and nursing and health sciences. Students meet with the chaplains at the beginning of their first year, and the four chaplaincies—Catholic, Protestant, Jewish and Muslim—offer programming specifically for medical students.

Trained as a nurse early in his career and later a hospital chaplain at Georgetown, Fr. Sal Jordan, S.J., runs the Medical Center campus ministry today. He conducts weekday noon Mass at the St. Ignatius Chapel in the Med- Dent building, leads student interfaith retreats, hosts the monthly “Pizza with the Padres” outreach event and enjoys one-on-one counseling with patients and students of all faiths.

“The job of chaplain must be flexible, so that I can be present here when a phone call comes, or there’s a knock at the door from someone in need,” says Fr. Jordan. “The healing ministry is such a sacred ministry and we are all called to that here. It’s very uplifting.”

As a Jesuit institution and thought leader in bioethics, the medical center strikes a balance to educate the next generation of practitioners who integrate cutting-edge science with the grounding principle of cura personalis, with faith as a welcome element.

“As part of our mission, Georgetown pays attention to those universal spiritual needs,” says Taylor. “And we invite each student to not only become a technical expert in the health profession, but to value being a responsible, compassionate and humane healer.”

A Mass of Gratitude

Before Georgetown’s first-year medical students begin their Gross Anatomy course each fall, the chaplain leads the class in a blessing of the cadavers. Over the course of the year, students work in small groups with the same body, slowly and respectfully uncovering a person’s medical story. In the spring, the students organize the Anatomical Donor Mass, a ceremony honoring those who have made the greatest gift: donating their bodies to science. Families and loved ones of the donors attend the multi-faith prayer service followed by a Mass. During the ceremony, students carry in a glowing candle to express their deep gratitude and respect for the donors, who have offered the aspiring physicians the opportunity to begin to know the human body by becoming their first patients.