By Stacey Kusterbeck
Many ethics committee members want to increase their ethics expertise. However, tailoring work schedules around course demands is an obstacle for many. After practicing in clinical settings for years, some ethics committee members are somewhat intimidated at the prospect of reentering a classroom in a formal academic setting.
“We realized that these individuals weren’t looking to get a master’s degree or PhD, but instead were interested in becoming more qualified — or at least better familiar with ethics, and with the literature and the approaches. We thought a certificate program would be a good way to address that,” says Thomas May, PhD, Floyd and Judy Rogers Endowed Professor at Washington State University. To meet this need, May, along with faculty at the Regional Ethics Department of Kaiser Permanente Northern California, collaborated to create a Medical Ethics Certificate Program.1
Many ethics committee members also are full-time practicing healthcare providers. To accommodate participants’ busy schedules, much of the program is asynchronous. Students are only required to attend in-person sessions twice monthly. Affordability was a pressing concern, given that individuals usually are not reimbursed for work on the ethics committee. However, most students obtain tuition reimbursement at their institutions. “We don’t make any guarantees in that regard — it depends on their particular institution and reimbursement policies. But most of our students are able to get it fully covered,” says May.
The first semester covers the theoretical foundations of clinical ethics, including autonomy, informed consent, justice, and moral reasoning. The second semester moves into skills-based learning and the actual practice of clinical ethics. Students learn how ethicists go about documenting, making recommendations, and using mediation and negotiation to resolve conflicts.
The program culminates in a simulated clinical ethics consultation. Students play the role of an ethics consultant, helping to resolve a conflict between family members about what the right thing to do is for a loved one. In real life, the ethics consult might take several days, but the process is spread throughout the semester.
Two professional actors play the part of the family members and have done so through eight cohorts of students. The actors’ improvisational skill and experience has turned out to be an important factor. “Traditional patient simulations in medical school, where they have you talk to a simulated patient so you can come to a diagnosis, are fairly scripted. Here, each case unfolds differently, because the actors react to how they’re approached by the student,” says Pauley.
Students contact the family members, introduce themselves as an ethics consultant, and explain the role of ethics and what to expect during an upcoming family conference. The student also speaks with an actor who plays the role of the attending physician. The student then holds the family conference and facilitates the discussion. The physician is unable to attend the meeting (this gives the student experience with the difficulty of getting key stakeholders in a room at a specific time). “This simulated ethics consult experience helps students to approach a conversation, and to avoid exacerbating conflicts or negative attitudes,” says May.
The student records the meeting so faculty can review it and provide feedback. The student also completes a self-review form. “There are red herrings in this setup. We do know that there are places where students go wrong during certain pathways. This is somewhat unique among other educational programs, in terms of how we attempt to make it very close to real life,” says Pauley. For example, the scenario includes an advance directive that was completed by the patient but witnessed incorrectly, rendering it invalid. Some students focus narrowly on this issue instead of the bigger picture of what the patient would want.
May views the program as most valuable for institutions where ethics committee members serve as ethics resources but are not professional ethics consultants, and where clinicians do have access to professional ethicists for complex cases. The program’s goal is to increase the number of people who can handle basic, routine ethics dilemmas, explains May.
Not all participants end up actually performing ethics consultations. Some are hospital administrators or clinicians with a general interest in ethics who just want to be well-prepared to understand everyday ethical dilemmas. After completing the program, all participants are better able to recognize the need for an ethics consultation. “We’ve had several students who have told us, ‘Everybody should go through this in medical school,’” says May. “It’s one thing to read about it, and it’s another thing to watch somebody do it. But it’s a whole different thing to be engaged in yourself.”
Reference
1. Pauley MD, Craig JM, Bennett A, et al. Meeting our students where they are: An ethics certificate program for hospital ethics committees. Camb Q Healthc Ethics. 2024;Dec 2:1-9. doi: 10.1017/S0963180124000495. [Online ahead of print].
Many ethics committee members want to increase their ethics expertise. However, tailoring work schedules around course demands is an obstacle for many. After practicing in clinical settings for years, some ethics committee members are somewhat intimidated at the prospect of reentering a classroom in a formal academic setting.
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