June 12, 2014 | Posted By Wayne Shelton, PhD

For over a decade the faculty of the Alden March Bioethics Institute has been designing and developing simulated cases for our graduate students who wish to learn the core skills of clinical ethics consultation. The model that we use is called “mock consultations”, which provides students the opportunity to perform an ethics consultation on a simulated case from the beginning when the request is made, to data collection, interviewing key players in the case, and on to case analysis the final recommendation.

In the process of developing simulated cases we have made every effort to make them as real to life as possible. All of the cases we use are from ethics consultation cases that have been deidentified and made into anonymous teaching cases. We have benefitted immensely from working closely with Albany Medical College’s (AMC) Patient Safety Clinical Competence Center (PSCCC). Those involved in medical education will recognize the importance of simulated cases using standardized patients (SP) and the role they play in training new doctors to communicate effectively with patients and families.

The core communication and interpersonal skills on which we focus in simulated cases, reflect the same basic skills required of all clinical caregivers, including clinical ethics consultants. That is, all professional caregivers who go into the hospital clinical setting to provide a service to patients and families must have a basic proficiency in communication and interpersonal skills. This is why we at AMBI feel that training the clinical ethics consultants should and does occur in the same educational context as all professional clinical caregivers including physicians.

So in collaboration with the staff of AMC’s PSCCC we have developed at least five simulated cases for our students to use when they come on site for the AMBI Capstone in Clinical Ethics Consultation, which is a one-week intensive workshop in the ASBH Core Competencies. In preparation for doing two mock consultations, students are offered mini-workshops in mediation, interviewing, chart reviewing and more. Three of the simulated cases are done as a class activity in which students, one at a time, interview the patient or family member. One of the cases is a family meeting about a patient who has had a serious stroke and lacks capacity. In all three of the cases, there are ethical questions about which the consultant must make a recommendation that first requires effective communication and interaction with key decision makers.

The culmination of the Capstone occurs when the students perform individually two mock ethics consultations. Each case begins with the call or reason for the consultation. Students may ask questions to learn more about the requester’s concerns. Through role playing students may ask the physician and others about the facts of the case in preparation for doing a chart review in a mock chart, which has been developed specifically for the case.  Once students have a clear sense of the key ethical questions and issues they need to discuss with key decision makers, they are ready for the interview with the SP will be acting out a key role in the simulated case. The student-consultant interview with the SP goes on for 20 minutes during which it is recorded for post review and also simultaneously viewed by AMBI faculty. In addition to developing communication and interpersonal skills but it is also for the express purpose of using those applied skills to make progress in performing an ethics consultation. For example, the goal of the interaction may be to clarify the prior wishes of an incapacitated patient from a family surrogate and to support decision making for setting goals of care.

Following the interview, students have a 360 degree assessment beginning first with a self-assessment, then an SP and faculty assessment—each of these three assessments follow the same design so that rating scores on a range of areas, such as “showed support”, “listened”, “validated concerns”, “summed up the issues” and “left with a clear plan”, etc., can be easily compared.  Also, students meet with the SP and the faculty member who assessed them following the interview for one on one discussion and feedback. Finally, students do a process recording of the interaction with the SP in which they attempt to reproduce and analyze what was said to foster attentiveness in clinical interviewing; and they do a full consultation write up using the standard format of the AMBI consultation service.

Each student performs at least two mock consultations, each requiring a half-day in the PSCCC, on two separate simulated cases. Over the years we have been able to tweak and fine-tune the mock consultation process considerably. Students who go through the Capstone almost unanimously feel that the mock consultations were important learning opportunities for them in their development of ethics consultation skills. Even for students who have previously done consultations they have reported feeling more competent and confident following this the Capstone. And for students with little or no clinical experience they have a sound orientation to go and work under supervision to get more experience and develop their consultation skills on a solid basis.

We feel that mock consultations as we provide them to our graduate students at AMBI could become an useful model of training and certifying clinical consults who wish to recognized as professional clinical ethics consults. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

3 comments | Topics: Clinical Ethics , Consultation , Education



Brenda wrote on 06/13/14 5:49 PM

I took the capstone class at Albany Medical Center, I feel it was a valuable tool for teaching students to preform Ethics Consult. Great learning experience!!
Howard Cain

Howard Cain wrote on 06/16/14 9:21 PM

I also did mock consultations with standardized patients as part of the Clinical Ethics Capstone and found it invaluable for my learning experience.
Wayne Shelton

Wayne Shelton wrote on 06/18/14 7:45 PM

We had a great group--one of the best ever!!

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.