Medical Ethicists Urge Caution in Teaching High Value Care

JOHNS HOPKINS BERMAN INSTITUTE OF BIOETHICS
Media Contact: Leah Ramsay, lramsay@jhu.edu, 202.642.9640

Press Release
December 6, 2016
For Immediate Release

Medical Ethicists Urge Caution in Teaching High Value Care

Calling for an “unwavering focus on the primacy of patient welfare,” a pair of medical ethics scholars urges careful consideration of how the concept of high-value care (HVC) should be integrated in medical education.

The JAMA Viewpoint published December 6 states, “if primacy of patient welfare is to truly remain fundamental to the profession, instilling commitment to this principle should be the most critical ethical value instilled in cultivating professional identity.”

If ‘value’ is considered the ratio of health benefits achieved per unit of cost, value can be increased in several ways: increasing health benefits, decreasing costs, or accepting less health benefit as a trade-off for cost savings.

Teaching approaches that over-emphasize cost savings “could risk causing trainees to lose sight of individual patient welfare or create unintended consequences for subsequent bedside decision-making,” write Viewpoint authors Matthew DeCamp, MD PhD, and Kevin Riggs, MD, MPH.

“Physicians must sometimes balance ethical tension between cost-saving and patient welfare. The best way to do this is unsettled among ethics scholars and practicing physicians. This lack of consensus could lead to inexperienced medical trainees misunderstanding their duty,” says DeCamp, assistant professor at the Johns Hopkins Berman Institute of Bioethics and Division of General Internal Medicine.

The consequences could be damaging to both the physician-patient relationship and the profession, the authors say. “[A]mbiguity regarding the primacy of patient welfare in HVC education risks patient distrust and societal backlash against what might be perceived as training future physicians to control costs at the expense of patient welfare.”

The authors do believe that the concept of value can be ethically introduced in medical education, but the distinct perspectives of patients, organizations, and society must be included, and how value is taught may need to be tailored to medical trainees’ level of experience.

“Early on, it may be more appropriate to focus on teaching medical students to communicate about costs with patients. Later, more complex concepts of value could be introduced, DeCamp says. “This is much the same way we teach in other areas of medicine – blood draws first, heart catheterizations later.”

# # #

JAMA Viewpoint: “Navigating Ethical Tensions in High-Value Care Education”
http://jamanetwork.com/journals/jama/fullarticle/2589350
JAMA. 2016;316(21):2189-2190. doi:10.1001/jama.2016.17488

Dr. Riggs’ work on this manuscript was supported by National Institutes of Health grant T32HL00718

About the Johns Hopkins Berman Institute of Bioethics
One of the largest bioethics centers in the world, the Johns Hopkins Berman Institute of Bioethics is the home for collaborative scholarship and teaching on the ethics of clinical practice, public health and biomedical science at Johns Hopkins University. Since 1995, the Institute has worked with governmental agencies, nongovernmental and private sector organizations to address and resolve ethical issues. Institute faculty members represent diverse disciplines including medicine, nursing, law, philosophy, public health and the social sciences. More information is available at www.bioethicsinstitute.org.

 

 

Heidi Holtz

Heidi Holtz is a Hecht-Levi Fellow at the Berman Institute of Bioethics and a Research Scholar at Johns Hopkins Hospital.  Heidi received her PhD in Nursing Science at Indiana University.  As a PhD student, Heidi developed a program of research on nursing students’ experiences and consequences of faculty incivility.  Incivility in nursing, medicine, education, and clinical practice create critical ethical dilemmas that affect communication, trust, mental and physical well-being, and damage the culture of safety for patients and clinicians.  During her Hecht-Levi Fellowship, Heidi’s goal is to contribute to the development of interventions and policies to reduce and/or prevent the frequency of moral distress and burnout amongst healthcare providers.  Heidi has a special interest in researching the construct of moral resilience and applying that research to develop innovative approaches to foster moral resilience in healthcare environments.

Katherine Heinze

Katherine Heinze received her PhD in Nursing from the Johns Hopkins School of Nursing in August 2016.  Prior to her graduate studies, she worked as a nurse in the pediatric oncology and bone marrow transplant department at the Johns Hopkins Hospital, an experience which motivated her dissertation research:  “Parent and Family Responses to a Child Undergoing BMT during Transitions in Care.” During her H-L Fellowship, she will continue to study families with children who have serious illnesses, with an emphasis on palliative care and bioethics. She also is interested in investigating the moral distress that healthcare providers experience in ethically challenging contexts. Her personal research mission is to reduce suffering in seriously ill children, their family members, and the healthcare providers who care for them.

Angie Boyce

 Angie Boyce completed her PhD in 2014 at Cornell University in the Science & Technology Studies program.  She wrote her dissertation on inter-agency collaboration around the detection and control of national foodborne disease outbreaks. Prior to graduate school, she worked at the Stanford Center for the Integration of Research on Genetics and Ethics.  Angie is currently completing a postdoctoral fellowship in population health at the Harvard School of Public Health.  During her H-L Fellowship, Angie will serve as Project Director of our CEER (Center for Excellence in ELSI Research) on “Ethical, Legal and Social Issues for Precision Medicine and Infectious Disease”.

Data Indicate Significant Impact of NIH African Bioethics Training Programs

JOHNS HOPKINS BERMAN INSTITUTE OF BIOETHICS
Press Release
Contact: Leah Ramsay, lramsay@jhu.edu, 202.642.9640

October 31, 2016
FOR IMMEDIATE RELEASE 

Data Indicate Significant Impact of NIH African Bioethics Training Programs
A Johns Hopkins study looks back on 10 years of research ethics training sponsored by the NIH Fogarty International Center

From HIV to Malaria to Ebola, health and medical research with human participants in Africa — and the ethical evaluation of that research — has long been conducted by non-African scholars, a circumstance that can present its own ethical challenges. For over a decade, the Fogarty International Center (FIC) at the US National Institutes of Health has funded programs to strengthen capacity among African professionals to provide high quality ethics review of research and conduct their own bioethics research and teaching, leading to significant gains across the continent, according to a study published in BMJ Open.

Nancy Kass, lead author of the study, says, “I have been fortunate to work with many scholars participating in Fogarty bioethics programs. The data we’ve collected indicate that former trainees from sub-Saharan Africa are leaving a tremendously positive mark on the African bioethics landscape, both in terms of service and important scholarship. Their work clearly is making a critical impact on the welfare of communities and on improving health research institutions.”

Kass jointly leads the Johns Hopkins-Fogarty African Bioethics Training Program with Adnan Hyder, both professors at the Johns Hopkins Berman Institute of Bioethics and the Johns Hopkins Bloomberg School of Public Health. The Johns Hopkins-Fogarty program has trained African scholars since 2000, and now coordinates the African Bioethics Consortium, a network of US and African institutions working collaboratively to enhance institutional capacities in international research ethics through training, research and service.

The BMJ Open study looks back on the 10 bioethics training programs FIC funded between 2000 and 2011 that were available to African scholars, including the Johns Hopkins-Fogarty program. According to surveys returned by 171 former trainees, they were significantly more likely to be a bioethics course instructor, serve on an Institutional Review Board, serve as an investigator on a bioethics research grant, and to have published a bioethics-related research manuscript than before training.

Prior to Fogarty bioethics training, 22% of respondents reported spending at least half of their professional time on bioethics, a figure that had grown to 53% post-training.

The study proposes that “a crucial outcome of organised training programmes may be their ability to foster lasting networks of professional researchers and academics.” Hyder, senior author of the study, points to specific data, noting that all but seven scholars who responded to the study were living and working in Africa, with the large majority (93%) living in the same country as when they participated in the training program.

“Along with the other findings on teaching, research and service, this shows that the Fogarty programs are building sustainable bioethics capacity in Africa, and that trainees are taking what they learn and implementing it at home,” says Hyder.

Jacek Mostwin

Dr. Mostwin received his medical degree from the University of Maryland School of Medicine and his doctor of philosophy degree at the University of Oxford. He completed his medical internship in internal medicine at the University of Maryland. Hospitals, his general surgical training at the University of Michigan Hospitals, and his urology residency at Brady Urological Institute, Johns Hopkins Medical Institutions.