Jaime Konerman-Sease, Ph.D.(c)

Cultivating a pipeline remains a popular topic in the world of Catholic health care ethics since CHA identified the need for a pipeline for new ethicists as part of Project Legacy. HCEUSA has previously published examinations on developing and running an internship program¹ as well as attempts to create shared terminology, expectations, and structures for a pipeline.² This survey contributes to the project of building an ethics pipeline by examining what graduate students in bioethics want in Catholic health internships. Exploring the desires and interests of potential interns is an important step to creating successful internships as positive internship experiences are likely to lead to a broader candidate pool for positions in Catholic health care ethics.

METHOD
In the summer of 2021, a brief 24 question survey was sent by email to graduate students in Bioethics programs from a variety of programs. Questions focused on interest in participation in different aspects of clinical ethics including ethics committees, consultation, chart notes, case discussions, and clinician education. Answers were gathered via google form and no identifying information was collected.

RESULTS
Characteristics of Respondents
Thirteen students responded. Three first-year graduate students, three second-years, one third year responded, four fourth years, one fifth year and one sixth year. Eight have never completed an internship in Catholic healthcare, three were current interns, and two were former interns.

EXPERIENCES VALUED BY FORMER AND CURRENT INTERNS
Former interns valued the opportunities to learn about and participate in the daily activities of clinical ethics in Catholic health care on the local consultation level as well as any systems-level projects. Former interns wished they could have learned more about healthcare systems such as the economics and finances of healthcare, they also wished for an opportunity to lead an ethics consult and learn more about navigating ethics committees. Current interns appreciated experiencing the practical day to day operations of Catholic Healthcare and connecting with leaders in the field.

EXPERIENCE

Consultation Experience
A majority of students have observed an ethics consult (84.6%). Two have observed no ethics consults (15.4%), almost half have observed one to five ethics consults (46.2), the remaining 38.5% have observed five or more ethics consults. Ten students were confident that they would like more experience observing ethics consults (76.9%), two were tentatively interested in more observation (15.4%) and one was not interested in observing more consults (7.7%).

Overall students had less experience participating in ethics consults than observing. Five students had participated in no ethics consults (38.5%) while 3 had participated in 1 – 5 (23.1%) and five students had participated in five or more consults (38.5%). An overwhelming majority were interested in participating in more ethics consults (12, 92.3%) while one student was not.

Chart Note Experience
Six students had never independently written a chart note for an ethics consult (46.2%) while five had written 1-5 chart notes (38.5%). Two students have written over 5 chart notes independently (15.4%). Eight students have never written a chart note in collaboration with another ethicist (61.5%), while two students have collaborated on 1-5 chart notes (15.4%) and three students have collaborated on five or more chart notes (23.1%). Ten of students responding want more experience writing chart notes.

Ethics Committee Experience
Overall, students had the most previous experience with ethics committees. Almost half of respondents (6) have observed 10 or more ethics committee meetings. Over half of the students have participated in five or more committee meetings (53.9%). Students were overall interested in both observing more ethics committee meetings (76.9%) as well as participating (92.3%).

Leading Ethics Education Sessions
About half of the students have not led an ethics case study (53.8%), while two have led one case study and four have led more than one. 11 students were interested in leading a case study as part of their internship (84.6%). When asked if they have presented on ethics topics to clinicians outside of an academic conference setting, 10 students responded yes (76.9%) and 3 responded no (23.1%). Almost all students were interested in presenting on ethics topics to clinicians in an internship (92.3%).

Internship Type
The number of hours a week students were available for an internship varied. Two were available for up to five hours, four were available for up to 10 hours, two were available for up to 15 hours, and four were available for up to 20 hours. Available hours did not correspond with what year students were in their graduate studies.

Students were mixed on internship payment type. Seven would participate in unpaid internships, six would participate in internships for course credit, eight would participate in an internship which pays minimum hourly wage for hourly work, and all 13 would participate in an internship with a stipend comparable to a graduate assistantship at their university.

Other Experience
When asked what other experiences students would like to gain from an internship with a Catholic Healthcare System, most students mentioned aspects of organizational ethics, church relations, and professional development. Students were interested in gaining mentors in the field as well as working with patients, families, community groups, and chaplains. When it comes to clinical ethics experience, most students were interested in gaining more consultation experience (46.2%), three wanted more experience working with ethics committees (23.1%), two wanted more experience education clinicians on ethics issues (15.4%) and two wanted more experience in organizational ethics (15.4%).

DISCUSSION
This survey was notably focused towards clinical ethics questions to reflect that the intention of internships is to prepare students for entry level positions which overall require clinical ethics experience. Responses show that many students were interested in more clinical ethics experience, however the opportunity to gain experience in organizational ethics was also appreciated. Participation was more appealing than solely observation experience, however most students were interested in both. Those who had significant experience still wanted more experience observing and participating in all activities of Catholic healthcare ethics.

Students who responded "no" to interest in particular observation or participation experience were likely to have significant experience (10 or more times) in that particular option. No student had significant experience in all of the clinical ethics options and no student answered "no" to all or even a majority of the options in this survey.

Student experience in clinical ethics is varied among the graduate students who participated in this survey. Due to the small sample size, it is difficult to generalize this data to the wider population of bioethics graduate students. However, this data can be helpful in creating internship experiences and reveals that students likely will come to an internship with a diverse set of experiences and interests. Therefore, each internship should be tailored to the particular intern in order to offer a meaningful learning experience.

In the interest of diversifying the field of Catholic health care ethics, it's important to start with internships as the pipeline into the field. Payment is an important thing to consider. Research from other fields including law, STEM, and business show that students from higher socio-economic backgrounds are more able to intern without pay.³ Unpaid internships are likely to select for the type of people already have resources and can do unpaid work. We must consider this when building internships with the hope to diversify the future candidate pool of ethicists in Catholic health.

Jaime Konerman-Sease, Ph.D.(c)
Ph.D. Candidate
SSM Health Saint Louis University Hospital
Murfreesboro, Tennessee
[email protected]

BIBLIOGRAPHY
Bedford, Elliott Louis. "Catholic Health Ethics Internships: Lessons Learned From Five Years' Experience," 2020, 2.

Burke, Debra D., and Robert Carton. "The Pedagogical, Legal, and Ethical Implications of Unpaid Internships." Journal of Legal Studies Education 30, no. 1 (2013): 99–130.

Fournier, Auriel M. V., Angus J. Holford, Alexander L. Bond, and Margaret A. Leighton. "Unpaid Work and Access to Science Professions." PLOS ONE 14, no. 6 (June 19, 2019): e0217032. https://doi.org/10.1371/journal.pone.0217032.

Gremmels, Becket. "A Proposed Pipeline for Ethicists," 2021, 4.

ENDNOTES

1. Bedford, "Catholic Health Ethics Internships: Lessons Learned From Five Years' Experience."
2. Gremmels, "A Proposed Pipeline for Ethicists."
3. Burke and Carton, "The Pedagogical, Legal, and Ethical Implications of Unpaid Internships"; Fournier et al., "Unpaid Work and Access to Science Professions."