Curriculum Proposal: Bioethics Certificate

1.Overview

The Bioethics Certificate Program is a formal, competency-based course of study that would focus on philosophical, legal, research, and clinical foundations of bioethics with an emphasis on practice-based implications for health-related decisionmaking. The program, involving four 3-credit courses, will be offered entirely on-line and so will directly respond to requests for continuing education programs from working health and human service professionals including hospital administrators, nurses, physicians, pharmacists, health lawyers, pharmaceutical representatives, social workers, psychologists, public health officials, clergy, and educators as well as members of hospital-based ethics committees and Institutional Review Boards. In addition to serving the needs of working professionals, the certificate coursework could offer a valuable graduate and undergraduate elective program for persons preparing for careers in health and health-related professions.

2. Need

a. To what specific need is the institution responding in developing the proposed program?

Bioethics Certificate Programs are currently offered by approximately a dozen universities throughout the country. However, none of the existing programs are located in the mountain west and none have a primary focus on the kinds of issues that complicate health and human service-related decisionmaking in more rural areas of the country. The need for this kind of coursework has been substantiated by more than 12 years of empirical bioethics research, conducted by Professors Ann Cook and Helena Hoas, research professors in the Department of Psychology. The findings from their multi-method studies, conducted in a 14 state area, show that the majority of health and human service respondents report that they lack access to bioethics resources and have inadequate access to bioethics training. Healthcare providers report that the lack of access to resources and training can inhibit clinical decisionmaking and undermine the provision of quality health and human service interventions. Health and human service providers who have participated in surveys, interviews, and focus groups have also reported that existing certificate programs, as well as bioethics texts, national ethics conferences, workshops and seminars, are not particularly relevant or helpful as they do not typically address the rural context and problems that develop within that context. The findings from these studies have validated the need for a course of study that has been shaped and enriched by empirical findings and so is responsive to realities and needs that emerge when trying to make health-related decisions or develop mechanisms, like hospital-based ethics committees and institutional review boards, in more rural areas of the US and in rural settings worldwide.

b. How will students and any other affected constituencies be served by the proposed program?

The program will be offered on-line and so will be available to constituencies who live in even very isolated rural communities. Health and human service providers in such communities often report an inability to access options for continuing education. The decision of a rural physician or nurse to participate in an off-site training opportunity, for example, can mean that the community may lack access to medical support. The certificate program would provide an opportunity to link communities of students – nationally and internationally – who want to pursue practical, relevant coursework in bioethics. In addition to serving the needs of working professionals, certificate coursework offers a valuable graduate and undergraduate elective course of study for persons preparing for careers in health and health-related professions.

c. What is the anticipated demand for the program? How was this determined?

This program responds to requests for bioethics education opportunities from health and human service providers throughout the US and from other countries including Canada, Australia, New Zealand, Ireland, Germany, and Sweden. The demand for this program emerged from a series of multi-method studies that were designed to: (1) assess and document the needs for bioethics services in rural communities and health-related settings; (2) identify emerging ethics-related issues; (3) coordinate bioethics expertise and training; and (4) disseminate field-tested ethics-related materials and resources. The findings from these studies have shed light on how health and human service providers and residents in rural communities identify, discuss, and resolve bioethics-related issues that accompany the delivery of health and human services. The findings have also helped identify approaches to ethics-related coursework that would be helpful.

3.Institutional and System Fit

a. What is the connection between the proposed program and existing programs at the institution?

While the certificate programis not directly associated with any existing program, itcomplements the mission of other UM efforts such as the MPH program and could provide additional, highly relevant options for MPH students. The program would also provide options forrelevantcoursework for pre-med students and students pursuing a number of other health and human service-related majors. The certificate effort is also well aligned with existing UM-sponsored initiatives including the Institute for Medicine and Humanities (a joint UM/St. Patrick Hospital venture) and the Area Health Education Center (AHEC) housed within the College of Health Professions.

b. Will approval of the proposed program require changes to any existing programs at the institution? If so, please describe.

Approval of this program would not require any changes to any existing programs.

c. Describe what differentiates this program from other, closely related programs at the institution (if appropriate).

There is no program, currently offered through the Montana University system that could be defined as “closely related.” While some bioethics courses may be offered at other institutions, the courses offered through this program would be developed in response to research findings, would place a heavy emphasis on relevance to a rural context, and would be offered entirely online and so would be accessible to professionals working in even very isolated communities.

d. How does the proposed program serve to advance the strategic goals of the institution?

The proposed program advances the goals of the institution to increase the range and scope of online courses, particularly those that address needs emerging in rural communities. This is therefore highly relevant to the state of Montana.

e. Describe the relationship between the proposed program and any similar programs within the Montana University System. In cases of substantial duplication, explain the need for the proposed program at an additional institution. Describe any efforts that were made to collaborate with these similar programs; and if no efforts were made, explain why. If articulation or transfer agreements have been developed for the substantially duplicated programs, please include the agreement(s) as part of the documentation.

There is no duplication with existing programs. The letters of support that accompany this application attest to its unique and well justified features.

4.Program Details

  1. Provide a detailed description of the proposed curriculum. Where possible, present the information in the form intended to appear in the catalog or other publications. NOTE: In the case of two-year degree programs and certificates of applied science, the curriculum should include enough detail to determine if the characteristics set out in Regents’ Policy 301.12 have been met.

(1) Clinical Topics in Rural Bioethics

This course will explore the moral values and norms that guide the actions of healthcare professionals (physicians, nurses, pharmacists, administrators) and human service providers and so influence the delivery and the reception of healthcare and human services in rural and underserved communities. Assigned readings and resources will guide the examination of concrete bioethical problems that are influenced by issues that include: professional responsibility, professional codes, and relationships, policy development, research, environmental health, occupational health, resource allocation and rationing, human error, and genetics. Weekly case studies, decisionmaking guides, and other tools will give students opportunities to apply norms and values when trying to resolve practical problems.

(2) Introduction to Empirical Research Ethics

This course will focus on the study and development of ethically attuned protocols for developing, conducting, and evaluating qualitative and quantitative research studies with rural or vulnerable populations. Coursework will focus on issues that include the examination of processes, approaches, and protocols designed to optimize protection of human subjects and support informed consent. The course will also support examination of emerging issues such as the tension between the goals of science and the best interests of a population, the good of the community, and rights of individuals.

(3) Ethical Foundations for Quality Improvement and Assessment in Healthcare

This course will explore processes for decisionmaking including the individual, professional, and system conflicts and burdens that can accompany health and human service decisionmaking especially in resource limited settings. Coursework will allow examination of practical issues such as medical error in the context of health care delivery, the role of disclosure in quality improvement processes, and approaches for engaging the public in health-related decisionmaking about issues such as quality and resource allocation. Particular emphasis will be placed on the ethical issues that can challenge quality improvement activities. Coursework will also focus on the development of ethically attuned services such as ethics committees and Institutional Review Boards.

(4) Bioethics and Healthcare Policy

This course will explore the foundations for health policy decisionmaking. It will include examination of relevant factors such vulnerability, use of power, foreseeable risks, exploitation, and other issues that can compromise policies designed to enhance health and safety.

b. Describe the planned implementation of the proposed program, including estimates of numbers of students at each stage.

The initial course would be offered Spring semester, 2010. One course would be offered during the 10 week summer session, one course would be offered in the Fall and one during the Intersession. The initial registration could involve 10-15 students but numbers would be expected to increase after the first year.

5. Resources

a. Will additional faculty resources be required to implement this program? If

yes, please describe the need and indicate the plan for meeting this need.

This program can be supported with extant faculty members, although they will be covering this program as an extra-to-load project. UMOnline is prepared to provide financial support in the form of course development stipends and extra-comp salaries to teach the courses online each year.

Additionally, UMOnline is equipped to provide comprehensive instructional design guidance and technical support for the faculty members.

6. Assessment

Assessment of the certificate program will focus on both the assessment of the student and the assessment of the program. Student assessment will be tied to authentic assessment approaches that link learning activities to attainment of specific competency based skills. Required readings will be directly linked to case studies that have emerged in rural communities and/or with vulnerable populations. The standards for student dialogue and resolution of case studies will be outlined on a Matrix for class assessment. The Matrix. Which can be provided upon request, will define the standards for competency.

The success of the program will be measured by student evaluations and enrollment. Students who complete the program will be enrolled, if willing, in a long term evaluation effort that will seek specific feedback about the utility of the program, its impact on their professional lives, and suggestions for new topics or issues for inclusion in the study program. Exit interviews will be conducted with students who enroll but do not complete the program in order to better understand barriers that could be addressed so as to optimize the success of the certification program.

7. Process Leading to Submission

The need for this program surfaced as a result of studies conducted throughout a multi-state area. The subject and design of the courses has been influenced by insights of working professional including physicians, nurses, pharmacists, social workers, and healthcare administrators. Letters of support from faculty and health professionals who attest to the need and utility of this program are provided.

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