Pedagogical Goals for Academic Bioethics Programs

Bioethics Education

Pedagogical Goals for Academic Bioethics Programs DENISE M. DUDZINSKI, ROSAMOND RHODES, and AUTUMN FIESTER

Introduction Scientists, healthcare providers, and members of institutional review and ethics boards find themselves confronting bioethical issues without sufficient expertise to address them. In response, academic bioethics programs have proliferated and specialized to meet the needs of these diverse professionals and scholars. Inspired by and written for the Second Cambridge Consortium for Bioethics Education in April 2012, in this article we articulate general pedagogical goals for various academic bioethics programs. These goals have been influenced by debates in the bioethics literature, scholarly presentations and publications, and insights gained from designing curricula at our institutions. This publication is intended as a preliminary proposal—a point of reference for veteran and burgeoning academic bioethics programs. Because the authors are most familiar with U.S. bioethics programs, we have focused on what we know. We expect that this article will spark a discussion about

This article was inspired and informed by the Second Cambridge Consortium for Bioethics Education. We are grateful to Thomasine Kushner, Ph.D., Editor of Cambridge Quarterly of Healthcare Ethics, and Mark Zadrozny, Publisher at Cambridge University Press, as well as the participants in the Second Cambridge Consortium for Bioethics Education for their support, suggestions, and engagement with this project.

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similarities and differences among U.S. and international programs. We ask readers to consider how our suggestions can be improved upon and refined. In the United States bioethics education in the health sciences tends to be linked to various competencies— behaviors and skills that can be demonstrated and measured. This emphasis on measurement may seem to diminish the importance of education designed to enrich moral sensibilities.1 We believe all bioethics programs must attend to character development, knowledge, and skills; however, we recognize that programs may place emphasis on one or another of these components. Bioethics is taught both in educational programs and in an ad hoc fashion. For example, observation of mentors and colleagues undoubtedly shapes moral behavior; however, the focus of this article is on academic programs in which bioethics education occurs by design. Although the settings may include classrooms, clinical and research arenas, and professional contexts, academic bioethics programs always involve curricula and pedagogical objectives. Additionally, although some academic programs focus on physician education, the objectives and pedagogical approaches are often easily adapted to training for other healthcare professionals. Our intention is to be inclusive rather than exclusive. Cambridge Quarterly of Healthcare Ethics (2013), 22, 284–296. Ó Cambridge University Press 2013. doi:10.1017/S0963180113000108

Bioethics Education Goals for Undergraduate Medical Education (UME) Programs Over the past 30 years, bioethics education has become an integral part of UME in North American medical schools and medical schools around the world.2,3,4,5,6,7 Medical education organizations have officially endorsed the incorporation of bioethics into the required medical school curriculum.8,9,10 Most bioethics educators agree that the bioethics curriculum should be vertically and horizontally integrated throughout all four years of medical education, with ethics teaching included in both the preclinical years and the clinical years.11,12,13,14 As in other areas of medical education, the program goals in bioethics are often articulated in terms of competencies and are informed by professional statements and guidelines.15,16 The preclinical years should focus on the basic principles of medicine’s ethics and appreciation of their normative force. Medical students should be able to explain the basic concepts, recognize how the concepts apply in clinical scenarios, and apply the principles in relevant situations. Brief lectures, case-based teaching sessions, discussion forums, short readings, and assignments are useful in explaining basic concepts. As the curriculum advances to more complex concepts and skills, readings and lectures deepen the students’ understanding of the relevance and application of bioethics in clinical practice. Case-based small-group work and collaborative teaching (with bioethicists and clinicians) are especially effective strategies. The curriculum should also provide ample opportunities for students to practice their interpersonal, communication, and moral reasoning skills. A curriculum should, therefore, help medical students to understand their professional responsibilities and the distinctive ethics of medicine, nurture them to become trust-

worthy and exemplary physicians, and provide them with the tools that they will need to do what patients and society reasonably expect of them. These goals suggest that medical school ethics education should address those issues that physicians are most likely to encounter during their medical careers. This focus is especially important because of the extreme pressure on time in the medical schedule, which requires triage of topics in the design of an ethics curriculum. As background for their medical ethics education, students should be exposed to some of medicine’s long history. They should become familiar with the codes and oaths that have marked off medical ethics from common morality and distinguished the commitments of physicians from those of others. The medical school bioethics curriculum should also address the interpersonal skills and cognitive habits that are crucial tools for physicians. Students need to learn the importance of demonstrating compassion, caring, and respect in their interactions with patients, families, and colleagues. Students should also develop the habits of critical reflection and skills in clinical moral reasoning.17 It is also important for them to learn that it is appropriate to discuss ethical issues in clinical practice with other health professionals who cooperate in implementing ethical decisions. In addition to teaching the knowledge and skills required of physicians, a curriculum must enable students to develop the distinctive character of an exemplary physician, so they mature into competent professionals with the appropriate dispositions and attitudes (i.e., the character and virtues) essential to being a good physician.18,19 Students must also become compassionate, caring, respectful of autonomy, and committed to upholding the ethics of medicine. As the content of courses in bioethics has evolved broad agreement on the importance of

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Bioethics Education bioethics assessment has emerged. Similarly, there is broad agreement that successful assessment of bioethics education requires demonstration that the learner has acquired the specific skills or competencies defined by the curriculum.20,21,22,23,24 The professional literature discusses a variety of assessment methods that represent different underlying views of appropriate goals for UME bioethics education.25,26,27,28,29 To be competent in medical ethics, students should have a deep understanding of the basic principles of medicine’s ethics. They should be able to recognize them in clinical scenarios, understand how they apply within a clinical context, and appreciate their normative force. They should also be able to recognize moral conflicts when they arise and should be capable of navigating their way through a dilemma to a resolution that they can justify to their colleagues. In sum, a UME program in medical ethics is responsible for promoting students’ competency in medical ethics. By the end of their training students should be able to demonstrate their ability to d

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Articulate the commitments of medical ethics Describe and employ the basic concepts of medical ethics Identify moral issues that arise in medical practice Identify moral conflicts and formulate the dilemma as a question Deliberate about ethical issues with peers Resolve ethical dilemmas with supporting reasons from professional ethics Identify matters that need further investigation Plan the practical steps for implementing a decision, foreseeing future issues, and taking them into account

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Employ the bioethics and medical literature in clarifying concepts and helping to resolve ethical issues

Goals for Graduate Medical Education (GME) Programs Most medical specialties mandate ethics education for trainees in their programs. The U.S. Accreditation Council for Graduate Medical Education (ACGME), which governs all U.S. residency and fellowship programs, lists professionalism as one of its six core competencies and defines it in terms of ‘‘carrying out professional responsibilities, ethics, sensitivity.’’30 Nevertheless, bioethics education in North American residency and fellowship programs is far less formalized than it is in UME, although there is increasing interest in delineating bioethics and medical humanities curricula.31,32,33,34 That said, medical ethics education is at least as important in GME as it is in UME. As with UME, the GME competency aims should be informed by the idea that medical education is training for the profession and that joining the profession entails accepting the moral commitments of medicine as one’s own. In the process of transforming trainees into exemplary physicians, educators should help trainees to acquire the knowledge and skills of medical ethics that they will need to fulfill their duties. This entails learning both the content and the justification of their special responsibilities as physicians. Trainees should become knowledgeable and skilled in their medical specialty as well as developing virtuous practices. Medical ethics educators in residency and fellowship programs should, therefore, aim at the goals of developing trainees’ knowledge of the core concepts

Bioethics Education of medical ethics and skills in addressing moral dilemmas and the attitudes (character, virtues) that they will need to reliably fulfill their professional responsibilities. This training should also focus on preparing trainees for discussions involving informed consent, limits of confidentiality, nonadherence with treatment regimens, end-of-life treatments, sharing bad news, and disclosing errors and adverse events. Bioethics education can be provided in a number of different formats, with the curriculum spread over the several years of the training program. It can be delivered through didactic sessions or discussions of cases that residents and Fellows encounter. Bioethics education may also be incorporated into the regular schedule of teaching rounds. This approach has the advantage of demonstrating that ethical considerations are an important feature of medicine and that they need to be considered along with the scientific and clinical decisions that are made. Medical trainees will need to develop a clear understanding of their distinctive professional responsibilities as well as the basic vocabulary of bioethics. They must master the skill of identifying ethical concerns and applying ethical concepts to clinical cases. They must also gain skill in navigating the common moral dilemmas of clinical practice and in collaborating with fellow healthcare providers in moral deliberation and conflict resolution. Beyond mastering the basic ethical concepts that are embedded in the practice of medicine, trainees will also need to learn the local and federal laws that govern their practice as well as the institutional policies with which they are required to comply. This may be especially important because during their training residents and Fellows often work in multiple settings that are governed by different laws and policies. In sum, by the end of their medical

training, physicians should be competent in medical ethics. They should have a deep understanding of the basic principles of medicine’s ethics. They should be able to recognize them in clinical scenarios, understand how they apply within a clinical context, and appreciate their normative force. They should also be able to recognize moral conflicts when they arise and be capable of navigating their way through a dilemma to a resolution that they can justify to their colleagues. By the end of their training residents and Fellows should be able to demonstrate their ability to d

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Articulate the commitments of medical ethics Describe and employ the basic concepts of medical ethics Identify moral issues and conflicts that arise in medical practice and formulate the dilemma as a question Relate federal and local laws as well as institutional policies that govern medical practice Convey compassion, caring, respect, and professionalism Deliberate about ethical issues with colleagues Resolve ethical dilemmas with supporting reasons Identify matters that need further investigation Plan the practical steps for implementing their decision, foreseeing future issues and taking them into account Employ the bioethics and medical literature in clarifying concepts and helping to resolve ethical issues

Goals for Masters-Level Graduate Education Programs In recognition of the need and demand for bioethics education by both working

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Bioethics Education professionals and professionals in training, masters-level graduate degree programs in bioethics and medical humanities were established in universities and medical schools across the United States, with programs in other parts of the world. The central goal of many of these programs is to enable professionals whose work involves bioethical issues, themes, and conflicts to develop an understanding of the debates, cases, methods, and concepts of bioethics and/or medical humanities.35 In the United States alone, there are more than 25 programs of this kind.36,37 These masters-level graduate programs vary in size, and the degree can usually be completed in one or two calendar years. Many masters programs require 10–12 courses. The most common structure for such programs is on-site, traditional weekly academic coursework, although there are some long-standing and emerging programs in distance learning, and a few programs that use an executive education model of intensive courses a few days per month. Masters-level training provides working professionals and professionals in training with the education and skill set they need to tackle the daunting bioethical dilemmas they face in their workplace settings.38,39,40,41,42 Although a few doctoral programs in bioethics exist, a masters degree in bioethics is recognized as a valuable complement to a terminal degree in another field (medicine, law, nursing, philosophy, social work), and is, therefore, the usual training path. There are several types of masters degrees in the field of bioethics. Master of Arts in Bioethics The master of arts degree in bioethics is an interdisciplinary program designed to give students exposure to a broad range of topics and problems in contem-

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porary bioethics and medical humanities. It is intended to familiarize the graduate student with the basic concepts, terminology, and broad issues of bioethical inquiry; help the student become conversant in the literature of bioethics; and assist the student in applying those concepts to the analysis of the bioethical conflicts and dilemmas related to the student’s individual professional practice. The master of arts degree is modeled after the masters programs of schools of arts and sciences and is a degree that places a premium on breadth of exposure rather than on specialization. It seeks to inspire, edify, and transform, but it may also include more specialized training in a specific set of skills (e.g., clinical ethics). Although it has realworld application, its central mission is to expand the vocabulary and analytical tools of its learners, expose them to new approaches and ideas, strengthen their skills in moral reasoning, and broaden their perspectives on bioethical issues and dilemmas. Its hallmarks are exposure to different disciplinary approaches and interaction with students and faculty from diverse disciplines, who inevitably bring distinctly different understandings and interpretations of bioethical issues. Students earning the master of arts degree in bioethics come from three broad categories: midcareer professionals, dual-degree students, and postbaccalaureate students. Trainees are students and professionals in the diverse fields of medicine, nursing, religion, law, hospital administration, dentistry, social work, mental health services, genetic counseling, regulatory affairs, research compliance, public policy, allied health, veterinary medicine, and the pharmaceutical and biotech industries. The M.A. is most valuable when it is combined with an advanced degree, because it is usually not sufficient by itself to prepare a student

Bioethics Education for a career as a scholar in the field of bioethics. The curriculum in master of arts degrees in bioethics varies widely from program to program. The pedagogical format is often a combination of lectures, case analysis, small seminars, web-based learning, student presentations, independent research, and scholarly writing. Most programs have a core curriculum. Many programs offer courses in the traditional topic areas in the field of bioethics, such as reproductive ethics, end-of-life ethics, clinical ethics, bioethics and law, justice/rationing, research ethics, transplantation, moral reasoning, and genetics. Other programs include courses in medical humanities, philosophy, research methods, or emerging areas in the field, such as neuroethics, pharmaceutical ethics, disability bioethics, and animal biotechnology. At the end of their training, graduates of master of arts programs in bioethics should be able to demonstrate their ability to d

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Understand the basic concepts, terminology, and broad themes of bioethics Articulate issues raised by key debates in bioethics Understand and explain several specific content areas in the field (such as rationing, clinical ethics, research ethics, transplantation, reproductive ethics, end-of-life ethics, etc.) Demonstrate an understanding of landmark legal cases and policies and their implications Apply concepts to the analysis of cases in clinical and research ethics Utilize the bioethics literature appropriately Demonstrate competence in authoring an original piece of scholarship

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Apply the knowledge of bioethics to one’s specific area of professional practice

Goals for Competency-Based Graduate Educational Programs (e.g., Master of Science Degrees) In contrast to the master of arts degree, which seeks to expose students to the broad themes of bioethics, the goal of competency-based masters programs is to develop the students’ skills and the conceptual background required for undertaking specific responsibilities in bioethics. Thus, competency-based programs tend to focus on a particular area of bioethics, such as clinical ethics, research ethics, or empirical methods. We discuss the goals of such programs in turn. Regardless of its particular area of focus, every graduate of a bioethics competencybased program should be able to d

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Employ the basic concepts and terminology of bioethics Articulate issues raised by key debates in bioethics Demonstrate in-depth knowledge of one or more specific content areas in the field (such as rationing, clinical ethics, research ethics, transplantation, reproductive ethics, end-of-life ethics, etc.) Demonstrate an understanding of landmark legal cases and policies and their implications Apply concepts to the analysis of cases in clinical, research, or other specialties within bioethics Utilize the bioethics literature

Clinical Ethics Clinical ethics is the branch of bioethics that attends to ethical issues related to patient care and institutional policies and practices. Clinical ethics training

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Bioethics Education prepares students to assist other health professionals as consultants/advisors (as opposed to UME and GME training, which focuses on the inculcation of values and skills that the practitioner brings to her own clinical practice). Competency-based clinical ethics graduate programs prepare students for roles on ethics committees and consultation services and to provide peer and patient education in bioethics. The majority of students entering these programs work in (or plan to work in) patient care arenas (medicine, nursing, social work, spiritual care, health law, etc.) These programs require students to research and deliberate about common clinical ethics issues in adult and pediatric clinical settings. For many programs, especially in the United States, the ASBH Core Competencies in Health Care Ethics Consultation, an influential set of practice guidelines for ethics consultation, shape or inform the curriculum.43 However, multiple methodologies and authoritative resources can effectively be used to meet the pedagogical goals in the following list.44,45,46,47,48,49 Students are introduced to ethical theories and methods, practice moral reasoning, and learn how theories inform ethical debates. In both classroom and nonclassroom settings, a combination of pedagogical strategies may be employed: mentorship, case studies, small-group discussions, standardized patients, online modules, mock ethics consultations, practicum experiences, lectures, case write-ups, and scholarly writing. In sum, graduates should be able to competently provide ethics consultation on standard cases and display the knowledge, skills, and attitudes described in the Core Competencies for Healthcare Ethics Consultation II (or comparable clinical ethics practice guidelines).50 They should be able to facilitate a multidisciplinary ethics consultation, effectively elicit the

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values of various parties (including patients and surrogates), respectfully articulate various perspectives on an ethical issue, reference and utilize the bioethics and professional literature, explain the rationale for possible courses of action, and facilitate resolution of conflicts of values without usurping the authority of primary decisionmakers. In competency-based programs that focus on clinical ethics training, a graduate should be able to d d

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Provide ethics consultation Gather relevant patient care, medical, legal, and policy information Critically analyze cases using multiple ethical frameworks Model and facilitate moral reasoning in the clinical context Articulate ethical issues raised by key court cases and policy debates Collaborate with colleagues, patients, and families to address clinical and organizational ethics issues Write an ethics consultation chart note Understand how laws and institutional policies inform patient care and ethics consultation Demonstrate respect, compassion, and flexibility in facilitating resolution of ethical conflicts Educate healthcare providers, patients, and families on clinical ethics issues Serve as an informed member or chair of an ethics committee Identify circumstances that require additional expertise or ethics committee deliberation

Research Ethics Recently, people working in basic science, biomedical research, the pharmaceutical industry, and research regulation have begun to demand training in research ethics. They have been interested in expanding their knowledge because of

Bioethics Education issues that they encounter in their work and in service on research-related committees. In response to this interest, masters-level programs in research ethics have developed. In addition to teaching the basics of bioethics, these programs aim to prepare students to consider ethical issues in research and can help prepare students to serve in research ethics consultation services. Focused courses in these programs provide students with knowledge of research practices and procedures, as well as relevant federal and state regulations and the role of various oversight and accrediting bodies. Students become well versed in concepts related to the responsible conduct of research. Students also learn about governing codes of ethics and standards of professional conduct as well as institutional structures such as institutional review boards (IRBs) and institutional animal care and use committees (IACUCs). They explore issues that are specific to research with human subjects and issues that are specific to the use of animals in research. Students are also prepared to interact with peers and colleagues in various professional roles such as service on an IRB or IACUC or in consultation services. In competency-based programs that focus on research ethics training, a graduate should be able to d

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Describe and explain common research ethics practices and procedures Describe and explain the elements of responsible conduct of research Describe the regulations and agencies that govern biomedical research Define and apply basic concepts of research ethics Analyze a research protocol, appraise the ethical acceptability of its various elements, and raise questions about ethical issues in the study

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Serve as an informed member of an IRB, IACUC, or consultation service

Empirical Methods in Bioethics Empirical methods programs provide rigorous methodological and conceptual training in bioethics. These programs are designed to train physician-scientists or other Ph.D.-prepared trainees aspiring to bioethics faculty positions in academic medical centers and universities. Such programs are modeled on medical school degree programs that train physicianscientists in epidemiology, translational research, public health, or biostatistics. Like those programs, these bioethics programs are intended to fill a serious need for junior faculty and to foster interdisciplinary scholarship. These programs incorporate a combination of empirical methods coursework, topics-based and conceptual bioethics courses, and mentored research. Empirical courses include qualitative or quantitative training in data-collection methods, statistics, regression analysis, survey techniques, and so on. Programs might require conceptual, normative, or philosophical courses in bioethics, as well as courses in the particular topic areas related to the student’s area of research. Students are also required to engage in independent scholarly research. Intensive mentoring tends to be an important component of such programs, given the expectations that the student’s research project should be of publishable quality. In competency-based programs that focus on empirical training, a graduate should be able to d

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Employ statistical and epidemiological empirical methods Identify questions in bioethics that can be addressed by empirical methods

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Design and implement an empirical or theoretical research project Prepare a scholarly paper and/or publish in the bioethics and medical literature

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Goals for Bioethics Continuing Education (CE) Programs CE programs that introduce working professionals to bioethics issues take many forms—long courses, lectures, grand rounds, certificate programs, online instruction, and seminars. The general goal of these programs is to develop professionals’ competency to address and navigate ethical issues that commonly occur in professional practice. The target audience depends on the specialty area within bioethics— scientists and clinicians might attend a research ethics course, whereas clinicians might attend a clinical ethics course. There are a plethora of CE courses in various bioethics subspecialties. CE programs usually provide an introduction to bioethics methods, principles, or skills, whereas certificate programs build advanced skills. For example, after completing a week-long course in clinical ethics, students should have developed basic skills to become effective ethics committee members. CE programs introduce students to basic concepts in bioethics and the application of those concepts to a particular professional context, often through utilization of case studies. Students learn how these issues have been addressed, analyzed, and resolved. They leave with a richer, more nuanced understanding of key ethical issues and with better strategies and resources to address them in real time. Through continuing bioethics education, learners should be able to d

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Employ basic concepts of bioethics

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Identify ethical issues that commonly arise in professional practice Apply basic concepts to cases Utilize both bioethics and professional resources to address ethical issues in clinical practice Analyze common cases/issues Identify possible resolutions to ethical dilemmas and provide supporting reasons Collaborate with multidisciplinary colleagues to resolve ethical issues Plan practical steps for implementing decisions, foreseeing future issues and taking them into account

Clinical Ethics Certificate Programs Bioethics certificate programs are a form of continuing education that provides in-depth and specialized instruction in clinical ethics. Clinical ethics certificate programs primarily train professionals to provide clinical (case-based) and some organizational (non-case-based) ethics consultations, and they may also prepare students to educate ethics committees or hospital staff. The Core Competencies for Healthcare Ethics Consultation II51 shape many clinical ethics certificate programs by identifying the knowledge, skills, and attitudes that are required for competent ethics consultation. Certificate programs tend to be 6–12 month programs and may utilize distance learning and on-site classroom components. Certificate courses may function as electives in an affiliated M.A. or M.S. program. Because many students in these programs are clinically experienced but lack training in philosophy, theology, or bioethics, programs provide students with the bioethics tools and skills that they lack. Courses in moral theory, methods in clinical ethics, bioethics mediation and facilitation, medical ethics and jurisprudence,

Bioethics Education and justice in healthcare as well as practicum courses are common. In addition to the ethics knowledge gained through classroom instruction, certificate students learn practical skills in addressing bioethical issues in professional contexts. Students observe ethics consultations or committee meetings, practice skills in facilitating a consultation or meeting, discuss diverse values reflected in a case, and discern which ethical issues are most pressing. Students practice writing ethics consultation chart notes and learn to navigate between their clinical role and their role as an ethics consultant. They also practice eliciting values and perspectives from healthcare providers, patients, and surrogates, and they practice formulating succinct questions to focus the discussion. By the end of a clinical ethics certificate program, graduates should be able to d

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Model and facilitate moral reasoning in the clinical context Competently conduct an ethics consultation Identify the nature of the value uncertainty and pluralism of values that underlie the consultation52 ‘‘Facilitate resolution of conflicts in a respectful atmosphere with attention to the interests, rights, and responsibilities of all those involved’’53 Gather relevant patient care, medical, legal, and policy information Critically analyze cases using multiple ethical frameworks Understand how laws and institutional policies inform patient care and ethics consultation Write an ethics consultation chart note Identify circumstances that require additional expertise or ethics committee deliberation

Goals for Postdoctoral Training Programs The objective of postdoctoral training in bioethics is to provide rigorous methodological, clinical ethics, and/or conceptual training in bioethics for scholars who aim to become academic bioethicists. Although there are many bioethicsrelated masters-level graduate programs in the United States, most programs are not designed to train physician-scientists or other scholars aspiring to bioethics faculty positions in academic medical centers and universities. A pipeline for junior faculty in the field of bioethics is a postdoctoral training program. Candidates for postdoctoral fellowships typically hold an M.D., Ph.D., J.D., or equivalent degree and are interested in a future career as a physicianscientist or academic bioethicist. Students in postdoctoral training programs largely fall into two categories: M.D.-level students who intend to become physicianscientists and want their primary area of scholarship to be bioethics and Ph.D.- or J.D.-level scholars who intend to focus their research interests on bioethics and require training in clinical ethics, empirical bioethics, or conceptual bioethics. Ph.D.-level scholars may come from a variety of disciplinary backgrounds, including philosophy, history, science, health policy, public health, and social sciences. Unlike most masters programs in the United States, which charge tuition, postdoctoral fellowship programs typically offer Fellows both tuition remission and a stipend. Most programs train Fellows for one or two years. Because of the intensive mentoring required for a successful faculty-training program, the cohort size for postdoctoral programs is small; they typically provide training for only one or two new Fellows each year. Fellowship programs differ significantly in how they are structured, but

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Bioethics Education their ultimate goal is to help Fellows develop a research agenda and a publication record in preparation for the academic job market. Most programs offer training in both empirical and conceptual methods in bioethics. In some fellowship programs, Fellows enroll in traditional courses or pursue a graduate degree in tandem with the fellowship. Some utilize speaker series or journal clubs. Many fellowship programs include a clinical component, which often involves attendance at morning rounds and provision of mentored ethics consultation. This clinical aspect aims at familiarizing students with the culture, issues, and dilemmas of clinical medicine and building competencies in clinical ethics. Additionally, postdoctoral training programs assist Fellows with job placement and preparation for academic positions. By the end of their postdoctoral training period, Fellows should be able to d

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Understand the basic concepts, terminology, and broad themes of bioethics Articulate issues raised by key debates in bioethics Demonstrate expertise in at least one, if not several, specific content areas in the field Demonstrate an understanding of landmark legal cases and their implications Apply concepts to the analysis of cases in clinical and research ethics Utilize the bioethics literature Identify questions in bioethics that can be addressed by empirical or conceptual methods Design and implement an empirical or theoretical research project Demonstrate competence in completing original scholarship Publish in the bioethics and medical literature

Conclusion In our review, we have proposed curricular goals for major academic bioethics programs. We understand that other kinds of programs exist. With the exception of UME and GME, most of the programs we described are designed for students from diverse scholarly and healthcare backgrounds. All of these programs operate from the belief that a commitment to patient welfare unifies all healthcare professionals under an umbrella of obligation, virtue, and responsibility. The program goals that we have enumerated represent our combined efforts to articulate what we have been trying to accomplish in the various programs that we oversee. We present them here as a guide for others and with the expectation that our remarks will initiate conversations about the goals of bioethics education. This article is designed as an invitation rather than a conclusion. We look forward to the readers’ comments, refinements, and elaborations on what we have proposed. Notes 1. Pellegrino ED, Thomasma DC. The Virtues in Medical Practice. Oxford: Oxford University Press; 1993. 2. Mattick K, Bligh J. Teaching and assessing medical ethics: Where are we now? Journal of Medical Ethics 2006;32(3):181–5. 3. DuBois JM, Burkemper J. Ethics education in U.S. medical schools: A study of syllabi. Academic Medicine 2002;77(5):432–7. 4. Savulescu J, Crisp R, Fulford KW, Hope T. Evaluating ethics competence in medical education. Journal of Medical Ethics 1999;25(5): 367–74. 5. Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Academic Medicine 1994;69(11): 861–71. 6. Association of American Medical Colleges. Learning Objectives for Medical Student Education: Guidelines for Medical Schools. Washington, DC: Association of American Medical Colleges; 1998.

Bioethics Education 7. Musick DW. Teaching medical ethics: A review of the literature from North American medical schools with emphasis on education. Medicine Health Care and Philosophy 1999;2(3): 239–54. 8. See note 6, Association of American Medical Colleges, 1998. 9. American Board of Internal Medicine. Project Professionalism. Washington, DC: American Board of Internal Medicine; 1994; available at www.abim.org (last accessed 31 Dec 2012). 10. Bickel J. Promoting Medical Student’s Ethical Development: A Resource Guide. Washington, DC: Association of American Medical Colleges; 1993. 11. Miles SH, Lane LW, Bickel J, Walker RM, Cassel CK. Medical ethics education: Coming of age. Academic Medicine 1989;64(12):705–14. 12. Fox E, Arnold RM, Brody B. Medical ethics education: Past, present, and future. Academic Medicine 1995;70(9):761–9. 13. Goldie J. Review of ethics curricula in undergraduate medical education. Medical Education 2000;34(2):108–19. 14. Eckles RE, Meslin EM, Gaffney M, Helft PR. Medical ethics education: Where are we? Where should we be going? A review. Academic Medicine 2005;80(12):1143–52. 15. See note 6, Association of American Medical Colleges, 1998. 16. Liaison Committee on Medical Education. Accreditation Standards; available at www.lcme. org (last accessed 31 Dec 2012). 17. Rhodes R, Alfandre D. A systematic approach for clinical moral reasoning. Clinical Ethics 2007;2(2):66–70. 18. See note 1, Pellegrino 1993. 19. Rhodes R. The professional responsibilities of medicine. In: Rhodes R, Francies L, Silvers A, eds. The Blackwell Guide to Medical Ethics Oxford: Blackwell Publishing; 2007:71–87. 20. See note 4, Savulescu 1999. 21. See note 14, Eckles et al. 2005. 22. Carlin N, Rozmus J, Spike J. The health professional ethics rubric: Practical assessment in ethics for health professional schools. Journal of Academic Ethics 2011;9:277–90. 23. Arnold RM, Forrow L. Assessing competence in clinical ethics: Are we measuring the right behaviors. Journal of General Internal Medicine 1993;8(1):52–4. 24. Goldie J, Schwartz L, Morrison J. A process evaluation of medical ethics education in the first year of a new medical curriculum. Medical Education 2000;34(6):468–73. 25. See note 2, Mattick, Bligh 2006. 26. Patenaude J, Niyonsenga T, Fafard D. Changes in students’ moral development dur-

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