They attend the morning report at the hospital each weekday, then meet with a clinical faculty member from medical humanities at Baylor each week to discuss what they have experienced. The students are also required to keep logs that comply with the federal law regarding the privacy of medical information (HIPAA) — which will come in handy later when teaching — as well as make a presentation to the medical team about an ethical topic and provide a written summary report at the end of their fellowship. Before they can begin the clinical fellowship, students must complete lots of paperwork, undergo HIPAA training, make sure their immunizations are current and submit to a criminal background check — standard expectations of those working in a medical environment. They’re given an ID badge that provides access to sensitive areas of the hospital, and they’re required to dress professionally, but not in scrubs or any clothing that might prompt someone to mistake them for a medical professional.
FROM THE MUNDANE TO THE COMPLEX Dr. Allison Krile Thornton, who earned her doctorate in philosophy from Baylor in the spring of 2018, joined the philosophy department at the University of Southern Alabama as an assistant professor this fall. She said the clinical fellowship at Baylor in the summer of 2017 “immersed” her in the environment in which doctors must make decisions. “A lot of what we dealt with were very mundane ethical issues that don’t necessarily rise to the level of cases that are going to show up in your medical ethics textbook,” she said. “So that was a really good experience for me to familiarize myself with very normal, run-of-the-mill everyday issues.” Thornton also experienced less routine cases, such as that of a woman who was transported from hospice care to the hospital with a broken hip and who had a “do not resuscitate” (DNR) order in place. “It raised a lot of questions for the medical team about how to treat patients who come in on hospice, which is not what most doctors in particular are trained to do. They’re trained to see a problem and fix
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it,” Thornton said. “There was quite a bit of working out among the doctors, but also engaging with the patient, who changed her mind a few times about what she wanted.” The patient ultimately canceled her DNR and requested surgery, but went into cardiac arrest and died before the medical staff could operate. Thornton talked to the attending physician afterward, who explained why she had offered the patient the option of surgery. But she also explained why another doctor could be correct in making a different decision in the case. “I think there are objective answers in ethics,” Thornton said. “I don’t think relativism is true. I think there are answers, but I think that there’s also a lot of gray area where the answers are hard to find. It takes a certain kind of investigative ability in order to ferret out the right thing to do in those gray areas.”
they had, questions they asked each other, seeing the administrative work that they had to go through and hearing some of their frustrations,” he said. Tweedt said the residents were open to his presence and would even ask his opinion. “Sometimes they were discussing something and they knew I was listening, and they’d turn to me and say, ‘What do you think?’ and we’d have a conversation about ethics,” he said.
PATIENT ROOMS AND DOCTOR LOUNGES Far away from Waco at Virginia’s Christopher Newport University, Dr. Chris Tweedt is teaching medical ethics to premed students using the experience he gained as a Baylor Clinical Fellow making rounds at Hillcrest. In addition to earning his doctorate from Baylor in 2017, Tweedt has earned master’s degrees from Baylor and Southern Evangelical Seminary, and has a bachelor’s degree from Iowa State University — all in philosophy. He also spent a lot of time in hospitals with family members during his high school years, but the clinical fellowship gave him an in-depth look at the lives of doctors and the decisions they make. “In general, it was really helpful to know what their lives are like. Even just being there gave me an idea of what the culture is like among a medical team,” Tweedt said. Some days he would stay after his scheduled hours and hang out with the medical residents in the hospital lounge. “I spent time there some afternoons witnessing the kinds of conversations
Tweedt also learned much from the attending physicians, who displayed their different personal styles and approaches to similar situations. “Talking to the attending physicians helped me see what the progression of a medical student to a resident is like, and helped me to identify the various maturity levels of medical residents in that timeline,” he said. But the heart of the fellowship experience was making rounds and observing the interactions between doctors and patients. “In almost every room we walked into there were people just holding on to hope. The situations were really bad in most of the rooms. You only saw people at their worst. The kinds of authority that doctor’s