APA Newsletters
Fall 1999
Volume 99, Number 1

Mark G. Kuczewski
Medical College of Wisconsin

The Import of Web-Based Education in Bioethics

In the 1990s, a considerable number of graduate programs in bioethics have sprung up at educational institutions around the nation. Most award a Master of Arts degree. These programs are structured in a variety of ways and the debate concerning their mission is lively. However, there is some consensus that these programs of study are meant to enhance the skills of clinicians who wish to better address ethical issues in their practice, or researchers who wish to enrich their scholarship through an interdisciplinary course of study. As such, these are often characterized as "value-added" degrees, much like Master of Public Health degrees.

The Master of Arts program in Bioethics at the Medical College of Wisconsin (MCW) was founded in 1992. It is located within the Graduate School of Biomedical Sciences and is the only M.A. program amidst a sea of basic science Ph.D. programs and a small but growing number of M.S. programs. Although we have had a small number of international students and students from around the nation, the program has mainly served the greater Milwaukee health care community. Because of the limitations imposed by the winters of the Midwest, it is difficult for students from beyond a fifty-mile radius to pursue study in our program.

These geographic limitations have been a source of frustration for our faculty. We believe that health care institutions everywhere need staff with extensive training in bioethics. Bioethics cannot be confined to major urban academic health-science centers and those fortunate enough to be located within geographic proximity. Furthermore, we think that the sporadic resources that ethics committee networks are able to supply to distant members may be helpful to staff who have extensive training in bioethics. But such network resources are seldom sufficient to provide training to those responsible for ethics education within a health care institution. So, even though the Midwest Ethics Committee Network (MECN) is based at MCW, we were highly motivated to develop web-based versions of some of our graduate offerings.

My initial idea was to create scaled-down versions of four of our courses, place them on the web, and provide continuing medical education credit rather than graduate credit for such coursework. In this way, distance education would always be a pale imitation of the classroom offering. However, we quickly found that we were underestimating what was possible. To my surprise, the first class I offered on the web was not inferior to the classroom version, but was actually superior.

The enrollees in our on-line courses are highly motivated individuals drawn from across the nation (and a small number of international students). They are directors of residency programs at teaching hospitals, faculty in nursing programs and rural colleges, physicians, administrators, information technology specialists, and nurses from a variety of types of institution. And a few are health-care professionals from rural Wisconsin.

The Future of Web-Based Instruction at MCW

Are there drawbacks to the web-based format? Indeed. Such courses are extremely faculty intensive. The creation of high-quality on-line lectures demands release time from other faculty duties. Furthermore, in a sense, class is always "in session," twenty-four-hours-a-day, and the ability to provide individualized feedback seems to carry its own imperative to do so. Personally, I find this demanding and suggest that this format will only work for faculty who find interaction with this kind of student intrinsically rewarding.

The other major drawback is the inverse of one of the strengths I mentioned earlier. Although the e-mail format of discussion allows for universal participation in a comfortable manner, it is not obvious how to develop the presentation skills of the student. In a traditional classroom, graduate students receive extensive experience in running seminar classes that develop their skills as peer educators and group facilitators. Written submission of one’s thoughts to a listserver cannot simulate these activities. These two drawbacks need to be overcome in our efforts to make web-based instruction a greater part of our curriculum.

At the moment, MCW only offers four courses for graduate credit via the World Wide Web. By completing these four courses, the student earns a "Certificate in Clinical Bioethics." It seems likely that the majority of persons who avail themselves of our distance learning program will be content to stop at this point. In addition, it is likely that many doctoral candidates in philosophy around the country will wish to participate in one or two of these courses and transfer the credit to their home institution. But, there are some who wish to be able to complete a Master of Arts entirely by distance education. We are making plans to accommodate such persons.

Endnotes

1. Case illustration and discussion is an extremely important part of our program. This component is vital to making the on-line "lectures" clear and in facilitating lively and fruitful discussion in the course. Copious use is made of casebooks such as Mark G. Kuczewski and Rosa Lynn Pinkus, An Ethics Casebook for Hospitals: Practical Approaches to Everyday Cases (Washington, DC: Georgetown University Press, 1999), and Terrence Ackerman and Carson Strong, A Casebook of Medical Ethics (New York: Oxford University Press, 1989).

2. The pilot course is the subject of a doctoral dissertation in information sciences that documents many of these properties of the program. See Elizabeth Buchanan, "Dialogue, Empowerment, and Distance Education," University Microfilms, Ann Arbor, MI, 1999.