Can you learn about ethics on the World Wide Web?
Can you learn about ethics on the World Wide Web?
Wisconsin center offers on-line certification
A teacher in a nursing school at a small university in the Southeast wants to advance her education in bioethics to give her students an ethical framework for making clinical decisions. A medical librarian at a large hospital in the West is appointed to her institution’s ethics committee and needs information on ethical issues faced by health care professionals.
They are among a growing number of people benefiting from a new study program offered through the Milwaukee-based Medical College of Wisconsin’s (MCW) Center for the Study of Bioethics. In an attempt to provide its educational and research resources to a wider base, the center is now offering a four-course Certificate in Clinical Bioethics through an innovative distance-learning program that allows students to take specialized "classes" on the Internet.
"When I came here two years ago, one of the first things I wanted to do was expand our ability to bring our graduate offerings to our ethics committee network," explains Mark Kuczewski, PhD, associate professor of bioethics at the Medi cal College of Wisconsin and the director of graduate studies at the center.
The school’s network consisted of ethics committees at hospitals, medical centers and teaching institutions in the four-state area of Wiscon sin, Minnesota, Iowa, and northern Illinois. The committees rely on the center and each other to provide educational resources and changes in existing laws that may have bioethical implications.
"We have this huge geographic region, but, basically, with the Midwestern winters, our ability to get to those hospitals and do some educational programs for them was really quite limited," Kuczewski says. "We have this marvelous graduate program here that really was only of use to people in the greater Milwaukee area. Somehow we wanted to bring the resources of that program to serve the greater geographic region."
The solution, Kuczewski found, was in setting up a resource on the Internet known as a listserv — a mailing list on a specific topic that allows "subscribers" to see messages from the host, or moderator, of the list and to see other subscribers’ responses as well.
Students enroll in the program and are assigned a password, which allows them access to the listserv on the Web. The professor "teaching" the class posts a lecture of about eight or nine pages and assigns a case study to read along with the lecture. Students must follow instructions and then submit an analysis or opinion in reply that is distributed to the listserv.
"For example, we have assigned readings, which come from books and journal articles, and then there is a task for them, like a case for discussion, and they send their opinion or analysis to the listserv for the whole group to read," he explains.
Four courses offered
The four courses now offered through the distance learning program are:
• clinical topics in bioethics;
• law and bioethics;
• philosophical bioethics;
• justice in health care (a class dealing with "resource allocation at the societal level, specifically, managed care issues," says Kuczewski).
The graduate-level courses can be applied to completion of the master of arts in bioethics degree at MCW. Courses also can be applied to certificate levels of study, and they offer continuing medical education and nursing continuing education credit hours.
The format offers benefits not found in the traditional classroom, Kuczewski says. (For information on other on-line programs, see box, above right.)
"One thing, in a classroom, the discussion is limited by class time," he says. "Here, students can compose their answers at their leisure, take the time they want, and they are not limited. If they want to say more later, they can. And for me as an instructor, I can give them individualized feedback because I can reply directly back to off of the list."
Eventually, the center plans to offer its master of arts in bioethics degree through a distance-learning program. Students could take the majority of classes over the Internet, with an intensive in-residency seminar on MCW’s campus.
"It would follow sort of the executive MBA model, the Web-based learning combined with some intensive study here," he says.
Problems with distance learning
Some on-campus time will be essential for students to get a proper background in bioethics, says Arthur Derse, MD, JD, associate director for medical and legal affairs at the center. "We have been able to do some amazing things with the distance learning program, but there are some other issues that have to be addressed, and we are addressing them," he notes.
Although case studies and the study of the philosophical foundations of ethics are important, some time at the bedside of patients and in a clinical setting is essential, Derse says. A way of incorporating the clinical experience and real situations will have to be part of the program if it is to provide the truest benefit to the participants, he says.
In accepting students into the initial on-line offering, Kuczewski says the center was careful to include students from a variety of backgrounds.
"Most people do have some sort of clinical encounters in their professions, the perspective of a physician, nurse, social worker, health care attorney," he explains. "Others are people such as the medical librarian appointed to an ethics committee, or a transplant coordinator at a hospital. If you keep the class limited to a small number of people, even those who haven’t had direct patient contact, they can still get that from interacting with the other clinicians."
The on-line format also lacks another important component of the traditional program, Kuczewski says. "The Web doesn’t really teach you the same skills that you need for oral pre sentations. When you have to speak in front of a group or facilitate a discussion at a meeting or talk at grand rounds, you are speaking orally, there is a [podium from which] you are looking at the audience, you have body cues and all of that. People will be asking questions, you have to know how to respond."
Blending on-line and hands-on
The center is working on how to blend on-line education with hands-on experience to serve the needs of health care professionals who do not have access to a traditional program at a major academic center.
More and more, bioethics education programs are looking for ways to provide resources to a wider audience. The Centre for the Study of Human Bioethics at Monash University in Clay ton, Australia, already offers its master’s in bio ethics in coursework degree through an Internet- based distance-learning format. The University of Pennsylvania offers continuing medical education credits in bioethics on-line.
The center at MCW and others will continue to search for innovative ways to bring resources for the study of bioethics to more people working in the health care field, says Kuczewski. That includes the on-line course offerings, plus videoconferences and other materials that graduates can use to facilitate discussions and seminars in their own institutions.
"We have sort of a moral mission in this," he says. "It has been, to some extent, the scandal’ of bioethics that we have been confined to the academic health science centers, which are mostly in urban areas. But, people are born, live, and die everywhere, and we have to get out there somehow."
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