Standardized methods to teach ethics skills in dermatology residencies are currently unavailable. A recent paper offers a model curriculum.1

“We hope that our proposed ethics curriculum will be adopted by other programs across the U.S.,” says Jane M. Grant-Kels, MD, one of the paper’s authors. Grant-Kels is professor of dermatology, pathology, and pediatrics and vice chair of the department of dermatology at UConn Health in Farmington, CT.

Robert T. Brodell, MD, FAAD, another of the paper’s authors, notes that dermatologists in clinical practice encounter ethical issues every day. “Traditionally, physicians would have tried to follow the Hippocratic Oath or asked themselves, ‘What would my gray-haired professor have done?’” says Brodell, professor and chair in the department of dermatology at University of Mississippi Medical Center in Jackson.

Case-based discussions with residents and experienced faculty can be “stimulating, fun, and educational for all concerned,” says Brodell. “We wanted to present an option, rather than have every dermatology residency program reinvent the wheel.”

The model curriculum is designed to impart the knowledge and skills to meet the Accreditation Council for Graduate Medical Education (ACGME) Dermatology Milestones for Professionalism over a three-year cycle.

Enough material is included for a three-year program of monthly topics. These range from academic honesty in preparing for the certifying examination, to business conflicts and self-promotion. The goal of the curriculum is to provide a framework of topics and resources that all programs, even those without access to faculty trained in ethics, can use.

“It is widely accepted that ethics training should be integral to both undergraduate and graduate medical education,” notes co-author Lionel Bercovitch, MD, a professor of dermatology at Warren Alpert Medical School of Brown University in Providence, RI.

Topics change and evolve over the years. Ethical issues around acquisition of practices by private equity are one example. “What might be accepted as the norm in one decade may be considered unethical, or even unlawful, in another,” says Bercovitch. “There is never a shortage of topics to discuss.”

Ethics training has become a major goal of residency programs and the Norcross, GA-based Association of Professors of Dermatology. “All of the bureaucratic demands on doctors results in their having less time to consider these issues,” says Grant-Kels.

The vast amount of knowledge covered in residency programs leaves little time for ethics. “But one of the features of the curriculum is its elective nature, allowing individual programs to tailor it to their needs and time availability,” Bercovitch says.

Individual topics can be chosen from the list based on resident and faculty interest level. “It is meant primarily as a guideline for ensuring that trainees receive exposure and a level of competence in the ACGME ethics and professionalism milestone,” says Bercovitch.

Each of the authors has implemented a version of the curriculum. “We have found that case-based discussions serve to cement information about the science of dermatology while considering the care options through an ethical lens,” says Brodell.

Twelve hours of ethics education is performed each year at the University of Mississippi. At Uconn Health, a 24-hour series is conducted over three years, using case-based PowerPoint presentations to generate a lot of group discussion. “The feedback from the residents is very positive,” reports Grant-Kels.

For Brodell, the biggest challenge is doing “one more thing” when the didactic curriculum of residency programs already is chock-full.

“Ultimately, we need to continue having open, honest point/counterpoint discussions about issues of the day,” says Brodell.

Knowing the answer to an ethical question isn’t always enough in a complex care environment. “This is why guidelines should be developed to codify ethical performance, when possible, in areas such as the ethics of genetic testing,” says Brodell. Dermatologists won’t necessarily agree on a single “right” answer.

“But if a significant majority can come to agreement, guidelines of care could be developed around ethical issues, just as they have been developed around scientific issues,” says Brodell.

REFERENCE

1. Stoff BK, Grant-Kels JM, Brodell RT, et al. Introducing a curriculum in ethics and professionalism for dermatology residencies. J Am Acad Dermatol 2018; 78(5):1032-1034.

SOURCES

• Lionel Bercovitch, MD, Director, Pediatric Dermatology, Hasbro Children’s Hospital, Providence, RI. Phone: (401) 444-7137. Email: lionel_bercovitch@brown.edu.

• Robert T. Brodell, MD, FAAD, Professor and Chair, Department of Dermatology, University of Mississippi Medical Center, Jackson. Phone: (601) 815-8000. Email: rbrodell@umc.edu.

• Jane M. Grant-Kels, MD, Professor of Dermatology, Pathology and Pediatrics/Vice Chair of the Department of Dermatology, UConn Health, Farmington, CT. Phone: (860) 679-7692. Email: grant@uchc.edu.