A Pre-Doctoral Clinical Ethics Fellowship for Medical Students

Area of Science:

• Medical Education
• Bioethics
• Professional Development

Background:

• Limited fellowships exist for training physician ethicists, typically requiring graduate degrees.
• Standardized credentialing and evolving medical education create opportunities for earlier ethics training.
• Innovative models are needed to expand formal ethics training for aspiring clinical ethics consultants (CECs).

Purpose of the Study:

• To develop, implement, and evaluate a pre-doctoral clinical ethics fellowship program for senior medical students.
• To assess the program's effectiveness in meeting established competencies for CECs.
• To determine the feasibility of training medical students as CECs prior to graduation.

Main Methods:

• A pre-doctoral clinical ethics fellowship was established at the University of Michigan Medical School (2017-2019).
• Consultation notes from fellows were assessed using the Ethics Consultation Quality Assessment Tool (ECQAT).
• Inter-rater reliability and score trends were analyzed to evaluate fellow performance.

Main Results:

• Three students completed the fellowship, conducting over 50 consultations and gaining teaching and research experience.
• Fellows showed improved ECQAT scores, with all achieving adequate or above holistic ratings.
• 92% rater agreement on consult notes; two fellows passed the Healthcare Ethics Consultant-Certification (HEC-C) exam.

Conclusions:

• A pre-doctoral fellowship model can successfully train medical students to become certified CECs.
• This model provides early-career ethics training aligned with professional certification standards.
• Integrating such programs expands opportunities for formal ethics education within medical school curricula.