Structuring a Written Examination to Assess ASBH Health Care Ethics Consultation Core Knowledge Competencies

Abstract

As clinical ethics consultants move toward professionalization, the process of certifying individual consultants or accrediting programs will be discussed and debated. With certification, some entity must be established or ordained to oversee the standards and procedures. If the process evolves like other professions, it seems plausible that it will eventually include a written examination to evaluate the core knowledge competencies that individual practitioners should possess to meet peer practice standards. The American Society for Bioethics and Humanities (ASBH) has published core knowledge competencies for many years that are accepted by experts as the prevailing standard. Probably any written examination will be based upon the ASBH core knowledge competencies. However, much remains to be done before any examination may be offered. In particular, it seems likely that a recognized examining board must create and validate examination questions and structure the examination so as to establish meaningful, defensible parameters after dealing with such challenging questions as: Should the certifying examination be multiple choice or short-answer essay? How should the test be graded? What should the pass rate be? How may the examination be best administered? To advance the field of health care ethics consultation, thought leaders should start to focus on the written examination possibilities, to date unaddressed carefully in the literature. Examination models—both objective and written—must be explored as a viable strategy about how the field of health care ethics consultations can grow toward professionalization.

Keywords:

• professional ethics
• professional—patient relationship
• virtues
• regulatory issues
• conflict of interest
• education

ACKNOWLEDGMENTS

The authors gratefully acknowledge the thoughtful comments and reviews of the following in preparing the article: John D. Lantos, MD, Children's Mercy Hospitals and Clinics, Kansas City, MO; Gerard Magill, PhD, Duquesne University, Pittsburgh, PA; Martin L. Smith, STD, Cleveland Clinic, Cleveland, OH; and the several anonymous journal reviewers.

Notes

1.  Terminology is difficult at times when debating “health care ethics consultation services” since those professionals involved do not completely agree on labels and scope. For purposes here, the focus on health care ethics consultation is directed toward conversations with patients and family members whose health care decisions may be impacted by recommendations offered by individual clinical ethics consultants (i.e., “clinical ethics consultation” or “case consultation”). How much any certification examination should focus on “case consultation” versus other types of health care ethics consultation must be clarified.

2.  Currently, it seems appropriate to refer to the “field” of clinical ethics consultation, rather than the “profession.” For a field to become accepted, it may be important to form a certification or accreditation body to support the enforcement of agreed-upon standards for those who perform services (Dubler et al. 2009).

These steps appear very similar to medical specialty “board certification” requirements (Schiedermayer and La Puma 2012).

From this one might suggest that the Fins–Kodish “quality attestation” assessment includes two of the four Smith and colleagues components: the portfolio review and the oral examination. Perhaps, strategically for those interested in professionalization, the “attestation” credential appears to be a prudent initial step, with “certification” a possibility at a later date with the completion of the other components.

Source: American Society for Bioethics and Humanities (2011).