Title:Flourishing on Campus

Georgetown is making changes that matter to support student mental health

In the process of learning, it is natural for students to struggle, whether they are in middle school, or medical school. By definition, learning new things requires mental development, an exercise for the mind, an expansion of thought. But for young adults in university, the demands on time combined with academic rigor and competition can be especially overwhelming. Which begs the question: When does the pressure to perform shift from an academic challenge to a mental health concern?

Universities across the country are working to answer this question both at the undergraduate and graduate level, as they face a rising demand for mental health services on campus. In a 2017 survey by the American College Health Association (ACHA), U.S. students reported that anxiety and depression are among the biggest factors that negatively affect their academic performance. Nearly 40 percent reported feeling so depressed in the past year that it was difficult to function, while over 60 percent reported feeling lonely.

At Georgetown, several initiatives are underway to support student well-being, including programs for those in medicine. The programs—launched in part due to President John J. DeGioia’s involvement in national student wellness efforts— aim to respond to both the challenges facing Georgetown students and the opportunities that new research is making possible. Engaging with organizations such as the American College Health Association, The Steve Fund, JED, and the American Council on Education, the university efforts are built around the fundamental question: How can we enhance our support for the personal formation of our students and their own capacities for flourishing?

These broader initiatives complement the work of Carol Day, director of health education services and adjunct assistant professor in human science at Georgetown University. Along with a team of researchers from universities across the country, she has tracked mental health among college students since 2009 and has seen a significant increase in the number of students reporting mental health concerns.

“It used to be that students would come to the counseling center because they were dealing with loneliness or homesick-ness, a relationship break-up or something that felt more developmental,” says Day. “Now, they’re coming in with anxiety, a history of depression. Maybe they’ve also experienced assault in high school or they’ve had a family tragedy.”

While reporting these issues is a sign that students feel comfortable asking for help, the demand for mental health and wellness services on campuses is becoming more urgent.

Flourishing through academic interventions

To address the rising demand, Day along with Sarah Stiles, professor of sociology at Georgetown University, developed a new course for first-year undergraduates. “Flourishing: College & Community” aims to teach students resilience techniques and evidence-based wellness practices, such as keeping a sleep journal, meditation, and practicing gratitude to cultivate a meaningful life.

“We give students scientific research to demonstrate that these well-being practices work, and can help them optimize, build resilience, and cope with difficult stressors in life,” says Day. They have found that graduates of the course are dealing with fewer mental health challenges, have fewer sleep problems and are more able to cope with whatever comes their way as compared to their peers.

“I learned that I need to take more risks,” says one student after taking the course. “Life is all about getting involved and meeting new people. Studying is good, but learning how to balance academics and friends is even more important in living a healthy life.”

This program is not the first of its kind at Georgetown. In 2005 the university launched a similar classroom model, now known as the Engelhard Project for Connecting Life and Learning, to destigmatize mental health-related topics, and infuse academic learning with themes of well-being and compassion.

In one course, for example, students explore the mental health impact of sleep deprivation as part of a neuroscience class in synaptic transmission. They study abnormal psychology, and observe and catalog their own patterns of negative thinking. Then they learn how to reframe these ideas using positive thought formulation techniques.

Since it began, the Engelhard Project has offered nearly 500 courses taught by over 100 trained faculty members. Serving as a model for Jesuit education and the Ignatian principle of cura personalis, or care for the whole person, the project encourages students to reflect on their own attitudes and behaviors while fostering connections both in and out of the classroom.

Medical students Jose Alejandro Almario (M’22) and Victoria Angelucci (M’19) try out “the best medicine.”

Helping our future healers heal

Along with the expanding efforts in the undergraduate sphere, the School of Medicine is also putting a renewed emphasis on student well-being and asking important questions about how to make changes that matter.

Georgetown joins medical schools across the country in an effort to address the unique challenges facing students who are pursuing careers in medicine. A 2016 study in JAMA found the prevalence of depression among medical students at 27 percent, three times greater than non-medical students of the same age.

“What is our responsibility as an institution to ensure that the environment we create is conducive to wellness?” asks Daniel Marchalik, MD (G’16), assistant professor of urology at the School of Medicine and medical director of physician well-being at MedStar Health, Georgetown’s clinical partner. The issue of burnout is largely systemic, he says, and solutions may emerge from taking a close look at the academic culture or climate.

“It’s hard for us to let go of our old habits, especially in medicine,” he says. “We hold on to our customs and rituals. For example, we think having a long or difficult anatomy lab is a staple of medical education, but maybe it’s not.”

The medical school grading system is something Georgetown has altered in recent years to help improve student well-being. In a grassroots effort, a group of students made a convincing, evidence-based case for a pass/fail grading system, which the administration implemented shortly thereafter.

Stephen Ray Mitchell, MD, MBA, dean for medical education, recalls the group of students that petitioned for this change, presenting their case to several faculty subcommittees.

“They probably did that presentation twelve times, and finally getting there took a cultural shift,” Mitchell says. “But they presented the data thoroughly, and when faculty had questions they went back and found the answers to those questions. That is leadership.”

“Some of this requires us to think innovatively about how we’re going to approach medical education,” Marchalik adds.

One of these innovative approaches began in 2002. Following in the Jesuit tradition of cura personalis, Nancy Harazduk, associate professor at Georgetown University School of Medicine, launched the Mind-Body Medicine program to teach students how to better take care of themselves and others.

“The first objective of the course is to introduce self-awareness to students so that they can affect change. The second objective is to introduce them to various mind-body practices that will help them deal with stresses of medical school and of life, really,” Harazduk says.

The program trains students in a span of wellness practices, such as meditation, guided imagery, autogenic training, biofeedback, journal writing, intuitive drawing, and movement. Starting with a group of 30 students, the program has grown to 80 students total, with 70 medical students and 10 students from the School of Nursing & Health Studies (NHS).

Harazduk has seen a marked difference in students who participate in the program. When they start out, she says, they feel a great deal of anxiety and stress. However, when they connect with each other and share their vulnerabilities or fears with the group, she has seen that stress decrease.

“I’ve seen a huge shift. They come in worried, worried, worried. As time goes on, they’re not as anxious,” she says.

Hannah Day (M’22), a student in the Mind-Body Medicine program, emphasizes the importance of the program in fostering community among students.

“It’s easy for medical students to feel isolated, and there’s this need for a deeper connection,” she says. “I think the most impactful and important function of the program is helping students feel that they are not alone—neither in the demands of getting through school, nor in their psychological and emotional experiences of trying to meet those demands.”

The literature aligns with her experience. According to a 2019 survey in Academic Medicine, mindfulness-based stress management training, adaptive coping skills, and social support help reduce the risk of anxiety, stress, and depressive symptoms in medical students specifically—all of which the Mind-Body Medicine program incorporates.

Emily Aron (M’08), child and adolescent psychiatrist at MedStar Georgetown University Hospital, recently completed the three-day Mind-Body Medicine program facilitator training run by Harazduk, which has had a profound impact on her personally and professionally.

“The feeling of connection carries forward,” she shares. “For physicians, nurses and anyone in the health care field, you can start to feel isolated in your experience because it’s a patient-centered universe. It was great to foster that closer connection with others, and I can see how this would be extremely valuable to learn as a medical student early on.”

Cura personalis in action

Steeped in a rich spiritual tradition, Georgetown University has found several ways to integrate spiritual practices into the fabric of student wellness.

Practices that encourage reflection and daily contemplation directly align with Georgetown’s Jesuit tradition. Rev. Mark Bosco, S.J., vice president for Mission & Ministry, emphasizes the Jesuit principle of contemplation in action as a way to help bring more intentionality into one’s life. This principle, along with tools such as the Daily Examen, will be shared at a new retreat for medical students in the spring.

“It’s the idea of sitting, breathing, disengaging, thinking, feeling, bringing that to God, and bringing that back to the world. That’s one way in which Ignatian spirituality can be part of daily life for a person,” he says.

To encourage student reflection through daily meditation, the John Main Center for Meditation and Interreligious Dialogue was founded in 2005 as a partnership between Georgetown and the World Community for Christian Meditation. The center hosts daily, non-discursive meditations and spiritual programming with leaders from various faith traditions. In addition, it offers lectures on meditation, mental health, well-being, and topics related to spiritual growth and resilience.

“We feel a responsibility at Georgetown to present meditation as a discipline, as a deep practice that is open to Mystery or the Divine, while also helping students with self-integration and self-understanding,” says Tony Mazurkiewicz, director of the center.

Georgetown’s commitment to reflection has become a framework for programs campus-wide. Dustyn Wright, director of student learning, and pediatrician Maria Marquez, associate dean for reflection and professional development, are co-directors of the professional identity formation curriculum at the School of Medicine. The effort helps incorporate the practice of intentional reflection and development around physician identity formation within medical student education. Through the Cura Personalis Fellowship, a formal faculty development program, faculty clinician coaches are paired with medical students and their associated academic family.

The program, taking place throughout the entirety of a student’s medical education, is structured through the use of an e-Portfolio, in-person group sessions, and individual check-ins. Clinician-mentors serve as personal identity formation coaches for students and meet with them regularly to discuss various topics related to well-being, such as impostor syndrome or perfectionism.

Aron, who is also a professional identity coach and co-director of the program this year, sees immense value in the work.

“You get to watch the students figure out how to utilize resources, their own inner resources,” she says. “They start to understand that each one of them is on their own path and don’t need to compare. It’s been amazing to see that light bulb go on.”

“Introspection is an important component of resilience,” says Marchalik, who also directs the Literature and Medicine track at the School of Medicine. “It gives you a chance to make sense of your own experience, what you’re going through, and I think that’s the key to thriving.”

 

 

The future of medical education

Nancy Harazduk sees hope in the changing landscape of medical education.

Since the start of the Mind-Body Medicine program in 2002, the training has expanded its reach beyond Georgetown. “We’re seeing medical schools from across the country now incorporate this into their curriculum,” she shares.

Supporting well-being for students in graduate and undergraduate communities will take continued institutional change, says Carol Day. “We need more accommodating systems, more recognition and awareness. If students are constantly stressed and not sleeping, that greatly diminishes their capacity to learn. We need some systemic changes, which take time and continued support from leadership to prioritize student well-being.”

To address some of these cultural and institutional changes, medical students at Georgetown have taken a grassroots approach to student wellness. In the last year, they have introduced student-led yoga sessions, healthier food options on the medical campus, and conducted a school-wide mental health survey.

“The culture at Georgetown fosters a supportive environment among students,” says Hannah Day, who is also the first-year representative on the newly formed Committee on Medical Student Wellbeing (COMSW). “If you’re a student who has an idea that’s going to benefit the student body and it makes sense, you’ll be heard.”

“We listen to the students,” echoes Mitchell. “It would be foolish not to because they make the school better. They pay it forward.”

In response to rising mental health needs among students, Georgetown Counseling and Psychiatric Services recently hired a psychologist, Simoné M. Jalon, PsyD, to serve the School of Medicine.

With an emphasis on emotional regulation, sleep health, high-risk suicidality, anxiety, depression, and other related issues, Jalon has experience working with mental health issues that typically arise in high-pressure environments such as medical school.

“I was attracted to this position because I see a need for it. There doesn’t seem to be a huge focus on self-care and well-being in this field in general, and I can see how a lot of the work that I’ve done can dovetail nicely to help medical students,” Jalon shares.

She began receiving appointment requests from students within her first few days at Georgetown in March, and offers evening appointments to meet with third and fourth-year students on clinical rotations. She encourages students to reach out to her and hopes to dismantle the stigma that may be associated with therapy.

“I’ve worked with people in the health care field and, in these roles, they’re often the helper,” she shares. “It’s easy to focus on everyone else. But how can you be effective in taking care of your patients, if you’re not taking care of yourself?”

Efforts to improve student wellness will be a continuing priority at Georgetown.

For Marchalik, merely drawing awareness to the issue marks an important shift. “The fact that we’re having this conversation, that there are student wellness committees, and that I have a job monitoring physician well-being, are all signs that things are moving in the right direction.”