Balancing Bioethics

Somewhere during the time that I was an undergraduate trying to decide whether or not the famous unconscious violinist had a right to use my kidneys, I got hooked on bioethics. I couldn't believe that people actually got to do this for a living! Prior to this point I had been languishing somewhat aimlessly with a religious-studies major, much to my parents' chagrin, after deciding that the premed course on which I had embarked simply wasn't for me (thank heavens for organic chemistry!). After becoming totally enamored with this field of applied philosophy, I began researching graduate programs. It seemed logical to add a double major in philosophy, which I did.

I chose the University of Tennessee (UT) for graduate school primarily because of its dual practica: one at the master's level and one at the doctoral level (Carter et al. 2000). There were three major areas of education important to my professional development: clinical education and presentations, role modeling, and coursework.

Clinical Education and Presentations

One of the most useful skills that I developed in the practica at UT was the ability to make presentations of various sorts to clinical audiences. We were required to participate in grand rounds, monthly conferences, and unit-specific events in order to gain experience in and comfort with speaking to healthcare professionals. This also fostered my confidence in the role that I was to play in the clinic when I saw that the providers valued my contribution, whether through formal or informal sessions. As this is a regular aspect of my job in Nebraska, I am especially grateful for this training.

Role Modeling in Professionalization

Professional role modeling helps those in training develop the skills and behavior necessary for success in the field. In may programs there is often cognitive dissonance between classroom education and practical application, and successful role models can help to bridge this gap by serving as inspirations, guides, and confidants (Reynolds 1999).

In bioethics training, role modeling is essential, especially early in one's educational progress. When I entered the program I had no clinical background, unlike some of my colleagues. I knew that part of the goal of the practicum was to develop my sense of how a clinic worked, but another part was also to understand the role of the ethicist in the clinic. The first goal was more successfully met than was the second. UT required extensive "field time"; at the doctoral level, this consisted of approximately 400 hours in the clinic. Those hours were valuable, as the sheer volume of time we logged and visibility we acquired gained us credibility. However, it was not always clear to me what my role was during those many hours.

It would have been helpful, especially in the beginning, to shadow the ethicists (just as we shadowed the healthcare professionals) as they encountered clinical issues. This is always a challenge in a place like Tennessee where the ethicists are primarily academic philosophy professors and do not spend much time in the clinic, but perhaps a particular effort could be made for more direct involvement during the semesters when students are in the practicum.

I have found in my position at the University of Nebraska Medical Center that much of the ethicist's job is self-motivated and self-initiated. Learning how to identify and make use of hospital resources has been integral to my professional development. Modifying the program so that it is more goal- and outcome-oriented rather than hours-oriented would benefit students and faculty by clarifying the expectations of both parties.

Finally, much of clinical ethics work is done by committees or by teams. The study of academic philosophy, on the other hand, is an individualistic process. Learning how to effectively contribute to a diversely constituted ethics committee or how to understand one's role on, say, the institutional review board, would be valuable additions to any training program in bioethics. This process...