The Association of Bioethics Program Directors (ABPD) is currently considering standards for healthcare ethics consultation training programs. “There are currently no clear standards for training clinical ethics consultants,” says Amy L. McGuire, JD, PhD, current president of ABPD. McGuire is Leon Jaworski professor of biomedical ethics and director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine in Houston.

“As a result, it is difficult to assess the competence of an individual who completes a training program and professes to have expertise in clinical ethics consultation,” says McGuire.

The purpose of developing standards for training programs is to ensure that all clinical ethics consultants who graduate from training programs are proficient in the core competencies required to conduct ethics consultations.

“There is really no other aspect of patient care that does not require training in a program of demonstrated quality to meet industry standards,” says McGuire.

ABPD looked at accreditation and evaluation standards for different fields. David Magnus, PhD, a past president of ABPD and chair of the workgroup that addressed the development of training standards,, notes, “There was a lot of heterogeneity in the quality of the assessments. Frankly, accreditation in some fields is not worth having.” For instance, one clinical field requires a financially stable program and a certain number of hours in practice, but has absolutely no content requirements for accreditation.

Magnus says that in most fields, including medical specialties, there are significant deficiencies in how educational programs are actually evaluated, compared to what the literature says is necessary for valid evaluations.

“So while we thought — and still think — accreditation is worthwhile, we want to take the time to do it right,” says Magnus, director of Stanford (CA) Center for Biomedical Ethics and Thomas A. Raffin professor in medicine and biomedical ethics at Stanford University.

ABPD developed a self-study guide for ethicists to put together a substantial amount of information about their program. “The problem was in defining what counted as passing,” says Magnus.

Magnus feels certification of individual practitioners will be needed to motivate programs to be accredited. “The accreditation will need to provide an output to assist in program evaluation, rather than relying solely on ‘environmental’ assessment of the educational program through information provided by the programs,” says Magnus.

Programs that have fellowships in clinical ethics have made efforts to agree on standards. “But to date, consensus has been elusive,” says Magnus.

There are substantial differences of opinion about how many hours and cases a trainee needs to lead, and how much philosophical and ethical background a trainee should have prior to a fellowship.

“We expect to continue to work to see if we can achieve consensus, and potentially bring any disagreement to the larger ABPD group to adjudicate the differences,” says Magnus.

SOURCES

  • Amy L. McGuire, JD, PhD, Leon Jaworski Professor of Biomedical Ethics/ Director, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston. Phone: (713) 798-2029. Fax: (713) 798-5678. Email: amcguire@bcm.edu.
  • David Magnus, PhD, Director, Stanford (CA) Center for Biomedical Ethics. Phone: (650) 723-5760. Email: dmagnus@stanford.edu.