Abstract
How should clinical ethicists be trained? Scholars have stated that clinical ethics fellowships create well-trained, competent ethicists. While this appears intuitive, few features of fellowship programs have been publicly discussed, let alone debated. In this paper, we examine how fellowships can foster effective mentoring relationships. These relationships provide the foundation for the fellow’s transition from novice to competent professional. In this essay, we begin by discussing our pedagogical commitments. Next, we describe the structures our program has created to assist our fellows in becoming competent ethicists. We then outline the kinds of knowledge, skills, and professional attributes mentors should possess. Following this, we focus on the knowledge, skills, and professional attributes that fellows develop as they co-create effective mentoring relationships. We will not prescribe a single approach to fellowship training; instead, our perspective will, we hope, become a catalyst for further conversation on training and mentoring clinical ethics fellows.
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We will set aside the debate as to whether these professional traits must also be conceived of as attitudes, behaviors, character traits, dispositions, habits, personal qualities, virtues, or the like. We are committed to the less controversial proposition that the mentor and the fellow must exhibit something like these traits for an effective mentoring relationship.
References
Agich, G. J. (2001). The question of method in ethics consultation. The American Journal of Bioethics, 1(4), 31–41.
American Society for Bioethics and Humanities. (2011). Core competencies for healthcare ethics consultation (2nd ed.). American Society for Bioethics and Humanities.
Andre, J. (2002). Bioethics as practice. University of North Carolina Press.
Aultman, J., & Pathmathasan, C. (2020). A call for diversity and inclusivity in the HEC-C program. The American Journal of Bioethics, 20(3), 46–50.
Bayley, H., Chambers, R., & Donovan, C. (2004). The good mentoring toolkit for healthcare. Radcliffe Publishing.
Benbassat, J. (2014). Role modeling in medical education: The importance of a reflective imitation. Academic Medicine, 89(4), 550–554.
Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402–407.
Bleakley, A., Bligh, J., & Browne, J. (2011). Medical education for the future: Identity, power and location. Springer.
Bruce, C. R., Feudtner, C., Davis, D., & Benner, M. B. (2019). Developing, administering, and scoring the healthcare ethics consultant certification examination. Hastings Center Report, 49(5), 15–22. https://doi.org/10.1002/hast.1050
Burgess, A., van Diggele, C., & Mellis, C. (2018). Mentorship in the health professions: A review. The Clinical Teacher, 15(3), 197–202.
Campelia, G., & Tate, T. (2019). Empathetic practice: The struggle and virtue of empathizing with a patient’s suffering. Hasting Center Report, 49(2), 17–25. https://doi.org/10.1002/hast.989
Carraccio, C. R., Englander, R., Van Melle, E., ten Cate, O., Lockyer, J., Chan, M.-K., Frank, J. R., & Snell, L. S. (2016). Advancing competency-based medical education: A charter for clinician–educators. Academic Medicine, 91(5), 645–649. https://doi.org/10.1097/acm.0000000000001048
Chen, H. C., van den Broek, W. S., & ten Cate, O. (2015). The case for use of entrustable professional activities in undergraduate medical education. Academic Medicine, 90(4), 431–436.
Clevenger, C., Cadge, W., Stroud, I. E., Palmer, P. K., Haythorn, T., & Fitchett, G. (2020). Education for professional chaplaincy in the us: Mapping current practice in clinical pastoral education (CPE). Journal of Health Care Chaplaincy. https://doi.org/10.1080/08854726.2020.1723191
Cooke, M., Irby, D. M., & O’Brien, B. C. (2010). Educating physicians: A call for reform of medical school and residency. Jossey-Bass.
Crites, J. S., & Horsburgh C. C. (2020). Reconciling the HEC-C and clinical ethics fellowship training programs: Implications of the Baylor experience. The American Journal of Bioethics, 20(3), 37–39. https://doi.org/10.1080/15265161.2020.1718797
DeRenzo, E. G. (2021). Going backwards to fill in the missing processes for training and evaluation of clinical bioethicists: What has been needed for decades to move real professionalism forward. Journal of Clinical Ethics, 32(2), 149–154.
El-Haddad, C., Damodaran, A., McNeil, H. P., & Hu, W. (2016). The ABCs of entrustable professional activities: An overview of “entrustable professional activities” in medical education. Internal Medicine Journal, 46(9), 1006–1010.
Fowler, J., & Cutcliffe, J. R. (2011). Clinical supervision: Origins, overviews and rudiments. In J. R. Cutcliffe, K. Hyrkas, & J. Fowler (Eds.), Routledge handbook of clinical supervision: Fundamental international themes (pp. 8–20). Cambridge University Press.
Frank, J. R., Mungroo, R., Ahmad, Y., Wang, M., De Rossi, S., & Horsley, T. (2010). Toward a definition of competency-based education in medicine: A systematic review of published definitions. Medical Teacher, 32(8), 631–637.
Guerin, R. M., Diekema, D. S., Hizlan, S., & Weise, K. L. (2020). Do clinical ethics fellowships prepare trainees for their first jobs? A national survey of former clinical ethics fellows. The Journal of Clinical Ethics, 31(4), 372–380.
Hauer, K. E., Teherani, A., Dechet, A., & Aagaard, E. M. (2005). Medical students’ perceptions of mentoring: A focus-group analysis. Medical Teacher, 27(8), 732–734. https://doi.org/10.1080/01421590500271316
Henry-Noel, N., Bishop, M., Gwede, C. K., Petkova, E., & Szumacher, E. (2019). Mentorship in medicine and other health professions. Journal of Cancer Education, 34(4), 629–637.
Horner, C., Childress, A., Fantus, S., & Malek, J. (2020). What the HEC-C? An analysis of the healthcare ethics consultant-certified program: One year in. The American Journal of Bioethics, 20, 9.
Hynds, J. A., & Raho, J. A. (2020). A profession without expertise? Professionalization in reverse. The American Journal of Bioethics, 20(3), 44–46. https://doi.org/10.1080/15265161.2020.1714812
Iobst, W. F., Sherbino, J., ten Cate, O., Richardson, D. L., Dath, D., Swing, S. R., Harris, P., et al. (2010). Competency-based medical education in postgraduate medical education. Medical Teacher, 32(8), 651–656. https://doi.org/10.3109/0142159X.2010.500709
Jankowski, J., Feldman, S. L., Morley, G., & Rose, S. L. (2020). Looking to other professions to advance the health care ethics consultant certification program. The American Journal of Bioethics, 20(3), 21–24. https://doi.org/10.1080/15265161.2020.1714816
Kadushin, A., & Harkness, D. (2014). Supervision in social work. Columbia University Press.
Kaufman, D. M. (2019). Teaching and learning in medical education: How theory can inform practice. In T. Swanwick, K. Forrest, & B. C. Orien (Eds.), Understanding medical education: Evidence, theory, and practice (pp. 37–69). Wiley.
Kennedy, T. J. T., Regehr, G., Baker, G. R., & Lingard, L. A. (2005). Progressive independence in clinical training: A tradition worth defending? Academic Medicine, 80(10), S106–S111. https://doi.org/10.1097/00001888-200510001-00028
King, N. L. (2014). Perseverance as an intellectual virtue. Synthese, 191(15), 3501–3523.
Kolb, D. A. (2014). Experiential learning: Experience as the source of learning and development. Pearson Education.
Launer, J. (2003). Practice, supervision, consultancy and appraisal: A continuum of learning. British Journal of General Practice, 53(493), 662–665.
Leach, D. C. (2016). Resident formation–a journey to authenticity: Designing a residency program that educes professionalism. In R. L. Cruess, S. R. Cruess, & Y. Steinert (Eds.), Teaching medical professionalism: Supporting the development of a professional identity (pp. 93–107). Cambridge University Press.
Little, K. N. (2010). Clinical pastoral education as professional training: Some entrance, curriculum and assessment implications. Journal of Pastoral Care & Counseling, 64(3), 1–8.
May, T. (2020). You kids get off my ethics lawn! An admitted curmudgeonly critique of credentialing individual clinical ethics consultants. The American Journal of Bioethics, 20(3), 32–34. https://doi.org/10.1080/15265161.2020.1714800
Moore, B., & Horner, C. (2020). Variation in Clinical Ethics Fellowship Programs: Lessons from the Field. The Journal of Clinical Ethics, 31, 277.
Obeso, V., Brown, D., Aiyer, M., Barron, B., Bull, J., Carter, T., Emery, M., Gillespie, C., Hormann, M., Hyderi, A., & Lupi, C. (2017). Toolkits for the 13 core entrustable professional activities for entering residency. Association of American Medical Colleges.
O’Brien, B. C., Forrest, K., Wijnen-Meijer, M., & ten Cate, O. (2019). A global view of structures and trends in medical education. In T. Swanwick, K. Forrest, & B. C. O’Brien (Eds.), Understanding medical education: Evidence, theory, and practice (pp. 7–22). Wiley.
Pianalto, M. (2016). On patience: Reclaiming a foundational virtue. Lexington.
Proctor, B. (2011). Training for the supervision alliance: Attitude, skills and intention. In J. R. Cutcliffe, K. Hyrkas, & J. Fowler (Eds.), Routledge handbook of clinical supervision (pp. 241–249). Cambridge University Press.
Ramani, S., Gruppen, L., & Kachur, E. K. (2006). Twelve tips for developing effective mentors. Medical Teacher, 28(5), 404–408. https://doi.org/10.1080/01421590600825326
Ryan, R. M., & Deci, E. L. (2017). Self-Determination theory: Basic psychological needs in motivation, development, and wellness. The Guilford Press.
Sawyer, K. E., Dundas, N., Snyder, A., & Diekema, D. S. (2021). Competencies and milestones for bioethics trainees: Beyond ASBH’s Healthcare Ethics Consultant Certification and Core competencies. Journal of Clinical Ethics, 32(2), 127–148.
Schmutz, J. B., & Eppich, W. J. (2017). Promoting learning and patient care through shared reflection: A conceptual framework for team reflexivity in health care. Academic Medicine, 92(11), 1555–1563. https://doi.org/10.1097/ACM.0000000000001688
Schön, D. A. (1984). The reflective practitioner: How professionals think in action. Basic Books.
Shelton, W. N., & White, B. D. (2016). The process to accredit clinical ethics fellowship programs should start now. The American Journal of Bioethics, 16(3), 28–30. https://doi.org/10.1080/15265161.2015.1134715
Snell, L., Son, D., & Onishi, H. (2019). Instructional design: Applying theory to teaching practice. In T. Swanwick, K. Forrest, & B. C. O’Brien (Eds.), Understanding medical education: Evidence, theory, and practice (pp. 89–100). Hoboken: Wiley.
ten Cate, O., & Scheele, F. (2007). Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice? Academic Medicine, 82(6), 542–547. https://doi.org/10.1097/ACM.0b013e31805559c7
ten Cate, O., Snell, L., Mann, K., & Vermunt, J. (2004). Orienting teaching toward the learning process. Academic Medicine, 79(3), 219–228. https://doi.org/10.1097/00001888-200403000-00005
Well Star Health System. (2020). Propelling clinical ethics forward. Retrieved December 17, 2021, from https://www.wellstar.org/about-us/ethics-program/unconference
Walsh, D. (2014). The nurse mentor’s handbook: Supporting students in clinical practice (2nd ed.). McGraw-Hill Education.
Watson, L. (2015). What is inquisitiveness? American Philosophical Quarterly, 52(3), 273–287.
Acknowledgements
Thanks to Dr. Alison Suen for reviewing versions of this manuscript. Thanks to Dr. Amy McGuire and Professor Courtenay R. Bruce for contributing to the development of the program we discuss. Thanks to our colleagues at Weill Cornell Medical College's Division of Medical Ethics for their collaboration on our fellowship program.
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Bibler, T.M., Nelson, R.H., Moore, B. et al. Building Effective Mentoring Relationships During Clinical Ethics Fellowships: Pedagogy, Programs, and People. HEC Forum 36, 1–29 (2024). https://doi.org/10.1007/s10730-022-09473-z
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DOI: https://doi.org/10.1007/s10730-022-09473-z