Debating an Accreditation Council

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Should those who purport to train individual clinical ethics consultants using the ASBH educational core competencies as a guide establish an Accreditation Council on Graduate Bioethics Education (ACGBE)?

A personal note and disclaimer from the blog administrator

Over the past few weeks, I’ve had more than 100 face-to-face and electronic conversations or exchanges about the accreditation of particular bioethics training programs with colleagues and friends. I have suggested that the time has come for those purporting to train others who offer individual clinical ethics consultation services to participate in establishing an accreditation council for graduate bioethics education (ACGBE).

In this regard and throughout the blog, I use this phrase “educational program that purports to train individual clinical ethics consultants or that graduates students who make the unchallenged claim that they have the peer-accepted educational background and skills to serve as individual clinical ethics consultants” to identify the training programs. I use this phrase because there are some programs that specifically claim to train individual clinical ethics consultation professionals, but there are also some who train students whose faculty know or reasonably should know that their graduates represent themselves to others—for example, university faculty, physicians, patients, and hospital administrators—that they have the educational background and skills set to practice independently as individual clinical ethics consultation professionals. I think both program types—those who actively and those who passively train individual clinical ethics consultation professionals—have the same responsibility to their graduates and those who rely on their graduates’ professional expertise to assure that the quality of the instruction they provide meets or exceeds minimum peer-established and peer-recognized standards as best they can.

To me, it was curiously striking that not one individual discouraged me in these conversations or exchanges toward the establishment of a provisional accreditation council. Some suggested caution; some noted that the American Society for Bioethics and Humanities (ASBH) through its Clinical Ethics Consultation Affairs Committee (CECAC) was working on certification and accreditation issues and preparing a report with recommendations; some said they needed additional information; some said that they do not specifically train individual clinical ethics consultants; and some said “You can count on support from our program faculty.”

Please let me explain the reason I feel the time has come to do this and why I feel that I should be involved. I have been personally serving as an individual clinical ethics consultant since beginning the clinical medical ethics fellowship program at the University of Chicago in 1990. I have directed small teaching-hospital-based clinical ethics fellowship programs since 1993 in world-class institutions: St. Thomas Hospital, Nashville, Tennessee (460 bed teaching affiliate of Vanderbilt), 1993-1998; and St. Joseph’s Hospital and Medical Center, Phoenix, Arizona (670 bed teaching affiliate of the University of Arizona and Creighton University), 2004-2010. I have trained persons who serve as members of hospital ethics committees locally and in hospital systems nationwide since 1991, including the Daughters of Charity National Health System (about 45 hospitals; now Ascension Health); HealthTrust hospitals (about 80 hospitals; now merged with Hospital Corporation of America); Hospital Corporation of America (about 200 hospitals); and LifePoint Hospitals (about 45 hospitals). I have directed a statewide effort to improve ethics committee member education in Alabama since 1999 at Samford University, Birmingham. For the last six months, I have served as director of the Alden March Bioethics Institute (AMBI) at Albany Medical College, Albany, New York. In each training effort since the publication of the ASBH Core Competencies, colleagues associated with me and I have attempted to instruct others in the educational core competencies described by peers. At AMBI, my colleagues and I specifically tell our students in the certificate of clinical ethics, Master of Science in bioethics, and clinical ethics fellowship that we use the ASBH Core Competencies to inform us as we develop curricula and educational experiences. If faculty are engaging in training individual clinical ethics consultation professionals, I think they should teach to national and peer-recognized standards and they should seek peer-acceptance and peer-approval of their educational efforts, just as other educators who train professionals do.

Some may criticize efforts of faculty like me for urging the creation or establishment of a peer accreditation council for graduate bioethics education for a number of reasons. For one, I have self-interest because my program and I stand to benefit from achieving accredited status. Of course this is a charge that may have been leveled on each occasion when practitioners raised the possibility of accreditation of professional training programs in the past. Conflicts of interest are typically dealt with by disclosure. But more importantly, I would like to think that my colleagues and I that support accreditation of training programs also have the best interests of our students and those the students will eventually serve (e.g., patients and health care providers) in mind as well.

Secondly, critics of accreditation efforts at this time may say that it might be better to support the notion of certification of individual clinical ethics consultation professionals first. They make a good point. But I ask: Why not pursue both concurrently; one does not have to precede the other. In some cases, accreditation of programs came before certification of individuals in the development of professional standards. Moreover, typically the group that certifies professionals (e.g., the American Board of Pediatrics) is completely separate from and composed of different persons than the group that accredits professional programs (e.g., the Pediatrics Residency Review Committee of the American Council on Graduate Medical Education).

Thirdly, critics of accreditation efforts at this time may say that one should not use the name Accreditation Council on Graduate Bioethics Education since clinical ethics consultation professionals are but a subset of the broader category of bioethicist professionals. Perhaps the name Accreditation Council on Graduate Clinical Ethics Education might be more clear and applicable at this time? This may be case. But again, thinking about the future growth of bioethics—and using the American Council on Graduate Medical Education as a prototype for bioethics should other practice categories of bioethics practitioners or professionals evolve—one might suggest that having a review committee for clinical ethics consultation professionals operating under the umbrella of an Accreditation Council on Graduate Bioethics Education might provide more opportunity for professional collaboration. (This seems consistent with the same rationale that led to the development of the American Society for Bioethics and Humanities—as a more inclusive and cooperative arrangement—by merger of three separate but related bioethics organizations.)

Please review the materials and documents in the blog and participate in the debate online to improve the efforts to make any accreditation process that might result the very best that it can be for the benefit of the profession and the public, and in the public interest. Some may think it quite presumptive of any one person to develop materials such as these without the extensive collaboration of peers. Allow me to report that the key reason these materials and documents were developed was to provide a discussion framework with drafts to see wherein friends and collaborators might find opportunity for consensus or identification of points of disagreement toward possible conflict resolution among similarly situated educators and practitioners.

Regardless, some will say: “Wait—the time is not right—be patient. We’re not quite ready yet.” To them I respond: “The time has come! Join in the process now!”

Bruce D. White

Alden March Bioethics Institute
Albany Medical College
www.amc.edu/bioethics
 

 

518-262-6082 (Ms. Faria Grant)
whiteb@mail.amc.edu
 
 
August 8, 2010
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