Training approaches for ethics consultation vary across hospitals, including multiple days of intensive training, online courses, case simulation videos, podcasts, and standardized curricula, according to the authors of a recent study.1 To learn some specifics about ethics consultation training needs, researchers surveyed individuals involved in ethics consultation or healthcare ethics at 600 U.S. hospitals.2 “One of the surprising findings of our study is the size of the potential market for ethics consultation training,” says Ellen Fox, MD, president of Fox Ethics Consulting.

Based on the survey responses, Fox and colleagues estimated approximately 62,000 individuals at U.S. hospitals would benefit from basic-level training on how to perform ethics consultation, and 37,000 would benefit from advanced-level training. “These numbers seem high in relation to the total number of individuals who perform ethics consultation in U.S. hospitals each year, which we estimate to be 27,000,” Fox says.

Fox and colleagues interpreted this to mean survey respondents thought there were many individuals who were not currently performing ethics consultation who would benefit from ethics consultation training, especially at a basic level. “When considering the market for ethics consultation training, it’s important to note that likelihood of participation is dependent not only on price, but also on the desirability of the training in terms of its content, format, and other characteristics,” Fox notes.

Training needs assessments can be useful in this regard to help educators specifically tailor training programs to match identified needs of their target audience. “This extends the reach and, ultimately, the impact of their training,” Fox says.

Most respondents indicated if they were to participate in ethics consultation training, it would be important for them to be able to interact with instructors, receive a certificate showing ethics consultation training was finished, complete the training during work hours, and practice ethics consultation skills. “Taken together, our results suggest that ethics consultation educators in hospitals might want to consider offering basic-level training that focuses on common ethical issues using case examples, that offers a certificate for completion, and that can be taken during work hours through distance learning at the learner’s own pace,” Fox offers.

At 19.1% of hospitals, respondents said their hospital would be unwilling to pay anything for ethics consultation training in the next two years. Willingness to pay for ethics consultation training did not vary based on hospital characteristics. “Administrators might be unwilling to pay for ethics consultation training for several reasons,” Fox observes.

For example, they might think training is not needed because the people who perform ethics consultation are adequately trained, or they might think ethics consultants should be responsible for their own training.

Preferences regarding ethics consultation training vary based on hospitals characteristics. Academic medical centers often employ one or more professionally trained ethicists, but these facilities make up only a small fraction of hospitals in the United States. “Most hospitals do not have any academic affiliations at all, and about half have fewer than 100 beds. These hospitals perform very few consults each year, and their consults tend to be of lower complexity,” Fox explains.

Thus, the training needs of these hospitals are likely to be different from those of academic medical centers. “It’s important that educators be clear about the target audience for their training and tailor the content and format of their training accordingly,” Fox adds.


  1. Fox E, Tarzian AJ, Danis M, Duke CC. Ethics consultation in U.S. hospitals: Opinions of ethics practitioners. Am J Bioeth 2021:1-19.
  2. Fox E, Tarzian AJ, Danis M, Duke CC. Ethics consultation in United States hospitals: Assessment of training needs. J Clin Ethics 2021;32:247-255.