Purpose:
Distinction in Biomedical Ethics acknowledges advanced training and experience in clinical bioethics. This Distinction is granted by Vanderbilt University Medical Center and the Office of Graduate Medical Education (GME) after successful completion of a curriculum coordinated through the Vanderbilt Center for Biomedical Ethics and Society (CBMES). The program seeks to enhance physician leadership in clinical knowledge, practical competency and institutional infrastructure for healthcare ethics.
Eligibility and Application Process
Only current, active trainees in Vanderbilt GME programs are eligible to participate in this ethics program. Trainees must obtain approval from their program director (PD) prior to applying in the form of a brief letter of support. The letter of support must indicate that the trainee has availability to commit to the program requirements (below). This does not need to be a formal letter of recommendation; the PD must only indicate their support for the trainee’s time commitments to the program. In addition, applicants should submit a brief personal statement (less than 200 words) indicating prior experience, intentions and interests. No prerequisite training or experience is necessary to apply or complete this program. Applicants should also submit a CV.
Curriculum and Requirements
The ethics program has three primary components: group discussion seminars and conferences, experiential activities, and a capstone project.
Group Discussion Seminars and Ethics Conferences: Seminars are designed to cover primary areas of clinical biomedical ethics and will be coordinated with CBMES faculty. Seminars are led by the trainees and facilitated by faculty; participation is required. At each seminar, two trainees will present a 30-minute didactic on the subject of that seminar. This will be followed by an hour-long case-based discussion lead by the trainee.
Completion of the program requires attendance at seminars, and no more than two absences will be permitted without making alternative arrangements for fulfilling the requirement. Seminars will be scheduled in the early evening to allow for attendance by all participants. When obtaining PD support for the program, excused absence from clinical duties for these conferences is expected, except during extenuating circumstances. Seminars should be completed during one academic year (exceptions will be made on a case by case basis). In addition to the seminars, participants will participate in activities at the CBMES including Monday afternoon conferences.
Seminar Content:
- Approaching ethics at the bedside: theories and principles
- Informed consent, decision-making capacity, surrogacy and advanced directives
- Financial conflicts and resource allocation
- End-of-life, withdrawal of care and do not resuscitate
- Medically ineffective care (futility)
- Mistakes and disclosure of errors
Experiential: The core experiential activity will include participation on the Vanderbilt Ethics Consultation Service and in the work of the VUMC Ethics Committee. Each participant may have different scheduling of the Consultation Service experience depending on their clinical responsibilities. This will require coordination with their training PD as part of the application process. In total, the experiential component will consist of at least two weeks. In order to capture the arc of a consult, there should be continuity with at least one week at a time on site at the CBMES. Completion of this requirement may occur over any number of years necessary for the trainee. However, it is best if participants can complete some portion of the Consultation service rotation early in the year. Participants will also become members of the VUMC Ethics Committee, and participation in Ethics Committee meeting will be expected whenever scheduling permits.
After completion of the experiential component, a trainee will have competency in working through an ethics consultation. The components include: how and why consults are generated, initial intake and analysis by the consultation service, intervention planning and implementation, further analysis, documentation and follow up.
Capstone: The capstone component will focused around a case in which the trainee was involved either during their clinical experiences or while on the Consultation service. Participants will work with CBMES faculty to develop this case for the following settings: (1) Group Discussion Seminar, (2) Ethics Committee Meeting, (3) CBMES Monday Case Conference. Finally, participants will be encouraged and supported in scholarly productivity to find a journal for publication of their case. The primary goals of the program are for participants to be leaders in peer-education and to develop a substantive foundation for practical engagement with biomedical ethics. The capstone may be tailored to the interest of each participant, working with their departmental training programs and the program director.
Summary
Completion of the Distinction in Biomedical Ethics certificate requires:
- Group Discussion Seminars (9 credit hours; intermittent)
- Leadership of 1 seminar session: didactic teaching and case-based discussion
- Experiential:
- a. Ethics Consultation Service (60 credit hours; 2 weeks)
- b. Ethics Committee Attendance (2 credit hours, intermittent)
- Capstone:
- a. Ethics Committee Presentation
- b. Monday Case Conference at CBMES
Program Accreditation
Vanderbilt University Medical Center – Graduate Medical Education Committee. The PD from the trainee’s specialty, the Director of the CBMES and Associate Dean for Graduate Medical Education will sign off on each certificate.
Faculty:
Brian C. Drolet, MD – Course Director, Center of Biomedical Ethics and Society
Allison M. McCarthy, PhD – Co-Director Ethics Consultation Service
Joe Fanning, PhD – Co-Director Ethics Consultation Service
Keith Meador, MD, ThM, MPH – Director, Center of Biomedical Ethics and Society
Luke Gregory – CEO Vanderbilt Children’s Hospital
Ricky Shinall, MD, PhD – Surgery, Center of Biomedical Ethics and Society
Will Martinez, MD, MS – Internal Medicine
Gilbert Gonzalez, PhD – Health Policy
Uche Anani, MD – Pediatric Neonatology, Center of Biomedical Ethics and Society
Britany Raymond, MD – Anesthesiology
Shayne Taylor, MD – Director, VUMC Clinic for Transgender Health