Fellows could be attorneys, judges, journalists, professors or social workers who work in the health care arena, but lack clinical experience

A new fellowship at MUSC to provide nonclinical health care professionals with first-hand, on-site exposure to intensive, inpatient and ambulatory clinical services welcomed its first round of three fellows into its five-month program Jan. 5.

MUSC's Interdisciplinary Fellowship in Health Care, designed by MUSC’s Institute for Human Values in Health Care and directed by pediatric cardiothoracic surgeon Robert M. Sade, M.D., targets a wide variety of professionals who work in the health care arena, but lack clinical experience.

Fellows entering the program could be attorneys practicing health law, or judges hearing health law cases. They could be journalists specializing in science and medicine, or professors in a variety of university disciplines like economics, social sciences, political science, philosophy, behavioral sciences, religious studies, or history. Or they could be social workers in private or public agencies involved with health care delivery.

“Whatever their interests, many nonclinical professionals don’t understand what sick people go through, and they don’t know what it’s like to take care of sick people,” Sade said. Yet each, in some way, affects the course of health care, how it’s delivered, how it’s financed, who gets it, and what the public thinks about it.

“These are people who work in fields related to health care,” Sade said, “but most of these practitioners and educators have had little or no clinical exposure, and therefore have limited understanding of the clinical realities confronting sick people.” Sade cites two important, but lacking, attributes: “With no clinical training, they lack a context in which to solve the problems they face in their professions, and they lack credibility among the physicians and other clinicians with whom they must collaborate.”

The program, which Sade doubts is duplicated anywhere, was generated out of the experiences at MUSC of Furman University philosophy professor, medical ethicist and Sade's friend, Dr. Douglas MacDonald. “I planned a three-month experience here for him during his sabbatical in 1993,” Sade said. “He spent time in our intensive care units, our clinics, and went on rounds with our residents and students.”

MacDonald called it an “absolutely life-changing experience,” Sade said. “He told me he’d never teach medical ethics the same way again, and that he had revised all his courses to reflect the insights he received.”

At that point it occurred to Sade that a large and growing group of health care professionals are making life-changing decisions about health care delivery, financing, and public policy without having experienced what goes on in a hospital. Plenty of programs and fellowships exist to teach medical ethics and health care policy and administration to clinicians, Sade said, “But as far as we know, this is the only program explicitly designed to give nonclinical professionals in health care fields the exposure and experience of observing the diagnosis and treatment of sick people.”

MUSC will reap huge benefits from the fellowship program, Sade said. While the fellows will gain the clinical experience and insights they have lacked, they will also be participating in clinical rounds, adding to discussions from their own expertise, participating in grand rounds on various services, and giving seminars on topics in their own fields. They will also work on a scholarly product, research of their own, while they are at MUSC.

The fellowship program is initially supported by MUSC College of Medicine, but once its full value and uniqueness is recognized, Sade expects it will receive foundation funding and will expand to its full capacity of eight fellows per five-month session.

Cynthia L. Haney, J.D., currently serves as Washington counsel in the American Medical Association Division of Legislative Counsel office in Washington, D.C. She has particular interest in legislative and regulatory issues which deal with the care of the aged, disabled and dying, and medical record confidentiality. Haney has more than eight years of federal and state experience representing organized medicine before government and private bodies. She received her B.A. in political science from Georgia State University in 1983, and her J.D. from George Washington University in 1988.

David Perlman is a philosopher who specializes in bioethics and in conflict resolution, especially mediation. He currently serves as graduate teaching associate at the University of Tennessee, Knoxville, teaching introductory philosophy and ethics. Perlman’s research has concentrated on the power relationships between health care providers and patients. He has a particular interest in clinical ethics consultation and assisting in resolving ethical difficulties in the clinical setting. He received his B.A. in biology and philosophy/classics from Emory University in 1992, his master of arts in philosophy from Georgia State University in 1993, and expects to earn his Ph.D. in philosophy from the University of Tennessee in 1998. His e-mail: <perlmand@musc.edu>

Katherine McGrath, J.D., served as director and counsel, legal compliance for Blue Cross and Blue Shield of the National Capital Area, in Washington, D.C. She was responsible for federal and state regulatory compliance of BC/BS. She has extensive experience as an in-house attorney in the health insurance/managed care industry. McGrath received her B.A. degree in English and psychology from Washington and Jefferson College in 1974, her J.D. degree (cum laude) from Suffolk University Law School in 1981, and her master's in public health from Yale University in 1990.