If asked to name the main target audience for bioethics education, you’d probably think of either practicing clinicians, or medical and nursing students.

“There is little emphasis on deep medical ethics education for undergraduates,” says Margaret R. McLean, PhD, associate director of the Markkula Center for Applied Ethics at Santa Clara (CA) University.

Research suggests, however, that medical schools can neither improve ethical inclinations, nor guarantee progress in moral reasoning for students who lack well-developed moral motivation and moral sensitivity when starting such training.1

McLean sees undergraduate students as more open to ethics education than clinicians. “The packed curriculum in professional schools often does not allow students to reflect on many important ethical issues they will face in practice,” she adds.

The Markkula Center for Applied Ethics developed a program in ethics education for undergraduates. Participants spend the academic year shadowing health professionals at local hospitals and clinics. “Students observe clinicians’ everyday work,” says McLean. “They are directly exposed to ethical issues arising in the healthcare setting.”

The Health Care Ethics Internship consists of clinical rotations, reflection sessions, and ethics lectures. With more than 190 alumni since the program began in 2001, the current class is composed of 16 junior and senior undergraduates.

“Students develop a deep understanding of current ethical issues in healthcare, strong critical thinking skills, and compassion,” says McLean.

Santa Clara University does not have a medical or nursing school, or any programs in the health professions. Thus, great effort is put into building relationships with the local hospitals and clinics that host and mentor students.

“We work one-on-one with hospital administrators and unit managers to develop rotations in both inpatient and outpatient settings, from the ICU to the pharmacy,” says McLean.

Students are paired with a mentor such as a nurse, physician, social worker, or chaplain. “We’re always a phone call away, should questions arise,” says McLean.

Interns are held accountable for physician/provider confidentiality by the hospitals and by the university. “At the university, the students attend multiple orientation sessions at which confidentiality is discussed,” says McLean.

The students all sign contracts agreeing to adhere to confidentiality standards established by the university and the hospitals, and to comply with federal privacy and security regulations, California patient privacy laws, and The Joint Commission’s patient confidentiality standards.

The students also must complete hospital-specific training. “This includes an onsite educational session on patient privacy regulations, and online training in confidentiality and corporate compliance,” says McLean.

More Ethical Awareness

Recently, the students’ mentors completed a survey to ascertain the effect of the Health Care Ethics Internship on themselves and their organization. “We are looking at the impact that the ethics interns have on the ethical awareness of their mentors,” McLean explains.

The survey included questions on how participation in the internship influences the individual’s ethics awareness in the workplace and in everyday life. “We have gathered over 30 responses from a variety of healthcare professionals who serve as mentors for the student interns, and/or help coordinate the program within the organizations,” says McLean.

Students are also surveyed on their experience. One commented, “That year, I experienced my first case of child physical abuse. I watched a physician break the news to a young adult that her athletic career was over, and a physician hold the hands of family members while their father was taken off life support.”

“Our experience demonstrates that undergraduate medical ethics education aids in the development of critical ethical reflection skills,” says McLean. “These carry over into professional schools and careers.”

One graduate stated, “I have used [the ethics knowledge gained in the internship] in numerous decisions that I have faced in the hospital working as a nurse.” Another student wrote, “The social work rotation was immersed in ethical issues surrounding racial and ethnic disparities, and inspired my future interests.”

While the program’s focus is on bioethics education, the students also explore their vocational commitments. A few decided that a career in healthcare was not right for them. “Better to come to this realization as an undergrad than in the third year of medical school,” says McLean.


  1. Morton KR, Worthley JS, Testerman JK, et al. Defining features of moral sensitivity and moral motivation: Pathways to moral reasoning in medical students. Journal of Moral Education 35(3); 2006:387-406.


  • Margaret R. McLean, PhD, Associate Director, Markkula Center for Applied Ethics, Santa Clara (CA) University. Email: mmclean@scu.edu.