- Email: [email protected]
Web Modules on Professionalism and Ethics
Web Modules on Professionalism and Ethics William Hendee, PhDa, Jennifer L. Bosma, PhDb, Linda B. Bresolin, PhDc, Leonard Berlin, MDd, R. Nick Bryan, MD, PhDe, Richard B. Gunderman, MD, PhDf
Health care disciplines have always held resolutely to a commitment to professionalism and high ethical standards. With the present emphasis on public accountability, professionalism and ethics are receiving enhanced attention in health care education and practice. A challenge for radiologists, radiation oncologists, and medical physicists is to define the scope and depth of knowledge about professionalism and ethics that are necessary for the practice of the disciplines. A further challenge is to develop accessible educational materials that encompass this required knowledge. About 2 years ago, the ABR Foundation decided to address these challenges through the development of an ethics and professionalism curriculum and production of a series of Web-based educational modules that follow the curriculum. Six organizations agreed initially to contribute financially to construction of the curriculum and modules and were later joined by a seventh. The curriculum was developed by the ABR Foundation and included in a request for proposals that was widely distributed. Teams of authors for each of 10 modules were selected from respondents to the request for proposals. As the modules were developed, they were reviewed in 3 successive stages, including peer review by members of the ACR Committee on Professionalism and the RSNA-ACR Task Force on an Ethics Curriculum. After revisions were prepared in response to the reviews, the modules were translated into a format compatible with the e-learning platform on which they are mounted. The modules are now available to all who wish to study them. Key Words: Ethics, professionalism, modules, accountability, curriculum J Am Coll Radiol 2012;9:170-173. Copyright © 2012 American College of Radiology
BACKGROUND
Professionalism connotes the dedication of a group of individuals to place the welfare of society above their own specific interests, and ethics refers to rules of acceptable behavior by individuals that have been agreed upon by a respectable group of peers. Professionalism and a commitment to high ethical standards have always been cherished values in the many disciplines of health care. Today, these values are receiving increased emphasis as health care accepts greater accountability to patients and the public and as professionals engaged in health care respond to an increased obligation to ensure that the welfare of patients is always the top priority [1]. Medical schools are emphasizing the social responsibility of physicians to an unprecedented degree [2], and certification a
Mayo Clinic, Rochester, Minnesota. American Board of Radiology Foundation, Tucson, Arizona. c Radiological Society of North America, Oak Brook, Illinois. d Skokie Hospital, Skokie, Illinois. e University of Pennsylvania Health System, Philadelphia, Pennsylvania. f University of Indiana, Indianapolis, Indiana. Corresponding author and reprints: William Hendee, PhD, Mayo Clinic, PO Box 7319, Rochester, MN 55903; e-mail: [email protected]. b
170
boards are expecting candidates to answer questions on ethics and professionalism. In the health care disciplines of radiology, radiation oncology, and medical physics, increased attention is being directed to ethics and professionalism for individuals in both practice and training. The ABR is including these topics in its new certification examination for radiologists and in its Maintenance of Certification program. Professional organizations are offering greater opportunities for their members to learn more about professionalism and ethics. A challenge facing radiologists, radiation oncologists, and medical physicists is to identify the core knowledge in professionalism and ethics that all individuals should know and share. About 2 years ago, this challenge was discussed at length by the ABR Foundation (ABRF). The discussion led to a decision to work with several other organizations to develop an ethics and professionalism curriculum and to design Web-based educational modules on the basis of the curriculum. The decision of the ABRF to develop the modules evolved naturally from the mission of the ABRF to “demonstrate, enhance and continuously improve accountability to the public in the use of medical imaging and radiation therapy” [3]. © 2012 American College of Radiology 0091-2182/12/$36.00 ● DOI 10.1016/j.jacr.2011.11.014
Hendee et al/Web Modules on Professionalism and Ethics 171
Fig 1. Topics of the 10 ethics modules.
SOLICITATION PROCESS
The ABRF approached 6 organizations with a request to help support the production of the Web-based modules on ethics and professionalism, and all 6 responded favorably. The 6 organizations are the ABR, the ACR, the RSNA, the American Association of Physicists in Medicine (AAPM), the American Society for Radiation Oncology, and the American Radium Society. Later, the Academy of Radiology Research added its support to the effort. These societies are sponsors of the Web-based modules, and without their financial support, the ABRF would have been unable to create the modules. Once financial support had been secured, a request for proposals (RFP) was created on the basis of the professionalism and ethics curriculum that was separated into 10 major areas for 10 modules. The RFP called for responses from teams of potential authors that included radiologists, radiation oncologists, and medical physicists. A timeline was established for the submission of draft and revised modules through the entire production, review, and revision stages. Arrangements were negotiated with the RSNA to host and manage the modules on the RSNA Web site. Authors were encouraged to express their creativity in developing the modules, within guidelines for module production developed by the ABRF working collaboratively with the RSNA. Modules were to be submitted as Microsoft Word documents and converted by RSNA staff members under the supervision of one of the authors of this paper (L.B.B.) to a format compatible with the RSNA’s e-learning platform. The RFP was sent to the 6 original sponsoring organizations with a request to distribute it to the organizations’ members. AUTHORING PROCESS
Responses to the RFP received by the deadline were reviewed, and successful applicants were identified and notified, with a reminder of the guidelines established for pre-
paring a module and the deadline for submission of a first draft. Questions by successful applicants as they worked on their modules were referred to 2 of the authors of this paper (W.H., J.L.B.) if they were content focused and to RSNA staff members if they were format focused. Applicants were furnished specific instructions for submitting illustrations and videos. Authors were encouraged to include special features such as “tell me more” pop-ups, video clips, periodic questions to test comprehension, and so on. Authors were required to provide several questions at the end of the module with reference back to the area of the text where each question was addressed. Authors were also asked to provide a citation to the literature for each question. These questions must be answered correctly by individuals wishing to acquire continuing education or self-assessment modules (SAMs) credit for successfully completing the module and who wish to print out a certificate of completion of the module. Authors for the individual modules are listed in Appendix A. REVIEW PROCESS
The first draft of each module was reviewed and edited by 2 of the authors of this paper (W.H., J.L.B.), and comments and instructions for revision were returned to the module authors. This review process for each module was completed within a few days after receipt of the draft module, so that authors would have the maximum time available to revise the module. When revised modules were received, they were sent to 2 or 3 external reviewers for comments and suggestions for improvement. Reviewers were members of 2 committees: the RSNA-ACR Task Force on an Ethics Curriculum, chaired by Nick Bryan, MD, PhD, and Leonard Berlin, MD, and the ACR Committee on Professionalism, chaired by Richard Gunderman, MD, PhD. Individuals who provided reviews of the modules are listed in Appendix B. For each module, reviews from members of these committees were provided to the authors, who then prepared a final version of the module for publication. This final module
172 Journal of the American College of Radiology/ Vol. 9 No. 3 March 2012
Fig 2. Screen shot of the table of contents of module 1.
was edited by ABRF staff members before being sent to the RSNA for mounting on its Web site. MODULE ACCESS
Diplomates and candidates of the ABR can access the modules from the ABRF (http://www.abrfoundation. org) and ABR (http://www.theabr.org) Web sites by entering their ABR IDs and passwords, which will take them directly to the modules mounted on the RSNA Web site. Members of the RSNA may access the modules directly by going to the RSNA Web site (http://www.rsna.org) and entering their RSNA IDs and passwords. Members of the ACR may access the modules through the ACR Web site (http://www.acr.org) by entering their ACR IDs and passwords and then by clicking on “ACR Education” and “Online Modules on Ethics and Professionalism.” The same process is used for AAPM members: they can access the modules from the AAPM Web site (http://www.aapm.org) by entering their AAPM IDs and passwords. Where the modules are actually mounted (ie, on the RSNA Web site) is invisible to individuals accessing the modules from any of these sites. For physicians, continuing education credit is granted by the RSNA. For physicists, continuing education credit is provided
by the Commission on Accreditation of Medical Physics Educational Programs. An individual who is not a diplomate of the ABR or a member of the RSNA, ACR, or AAPM can access the modules by going to the Web site of the ABRF (http://www. abrfoundation.org) and clicking on the access modules button. This action will take visitors to a site where they can register for module access at no charge. An individual chooses an ID and a password to use whenever access to the modules is desired. Access to the modules without cost by anyone who desires to study them reflects the commitment of the ABRF and the sponsoring organizations to share the information widely to improve the stature of medicine and its benefits to patients and the public at large. MODULE DESCRIPTION
The topics covered by the 10 modules are listed in Figure 1. In the opinion of the RSNA-ACR Task Force on an Ethics Curriculum, these topics provide a comprehensive overview of the ethics issues relevant to the practice of radiology, radiation oncology, and medical physics. We would appreciate suggestions of additional ethics concerns, if any, that should be covered in future revisions of the modules.
Hendee et al/Web Modules on Professionalism and Ethics 173
Each of the ethics modules is different in format and content from the others. As an example of 1 module, a screen shot of the table of contents is shown in Figure 2. CONCLUSIONS
The intent of the modules is to assist radiologists, radiation oncologists, and medical physicists in their concerns over ethical and professional issues arising in their practices and laboratories. It is the hope of the ABRF, sponsoring organizations, and module authors, editors, and reviewers that the modules will be widely used to help maintain the high level of professionalism and ethical practice that patients want and deserve. As John A. Patti, MD, chair of the ACR Board of Chancellors, has stated, “These modules should become an embedded core element of our culture as a specialty, particularly for our residents and fellows. The future of radiology depends on the value that is added beyond image interpretation.” APPENDIX A Authors of the Ethics and Professionalism Modules
Attributes of Professions and Professionals: Drs Gary Becker, Jennifer Bosma, Stephen Thomas, Kay Vydareny, and Paul Wallner and Ms Jennifer Hutson. Conflict of Interest: Drs Adam Alessio, Felix Chew, David Lewis, and Annemarie Relyea-Chew. Ethical Issues in Human Subject Research: Drs Daniel Eisenberg, Jed Peterson, and Kenneth Lee Zeitzer. Ethics in Graduate and Resident Education: Drs Leonard Bok, Kenneth Hogstrom, Kenneth Matthews II, and Mary Ella Sanders.
Ethics in Research: Drs John Antolak, Nicolas Hangiandreou, William Hendee, and David Kallmes. Ethics of Personal Behavior, Peer Review and Contract Negotiations with the Employers: Dr G. Stephen Brown and Mr Per H. Halvorsen. Physician-Physician and Physician-Patient Interactions: Drs John Aarsvold, Ashley Aiken, Bruce Barron, Susie Chen, and Narayan Sundaram. Publication Ethics: Drs Elaine Gould, Kenny Lien, and Andrew Maleson. Relationships with Vendors: Drs William G. Bradley Jr, Jonathan Lewin, Carolyn Cidis Meltzer, Andrew Menard, and Steven Seltzer. Research Involving Vertebrate Animals: Drs Daniel Alan Eisenberg, Jed Peterson, and Kenneth Lee Zeiter. APPENDIX B Reviewers of the Ethics and Professionalism Modules
Drs Michele Barton, Leonard Berlin, Charles Bowkley, Linda Bresolin, R. Nick Bryan, Lori A. Deitte, Richard Gunderman, William Herrington, Thomas Hoffman, Valerie Jackson, Lawrence Liebscher, John Livoni, Rodney Owen, James Rawson, Anne Roberts, and Vanessa Wear. REFERENCES 1. American Board of Internal Medicine Foundation. Medical professionalism in the new millennium: a physician charter. Available at: http:// www.abimfoundation.org/Professionalism/Physician-Charter.aspx. Accessed January 7, 2012. 2. Dharamsi S, Ho A, Spadafora SM, Woolard R. The physician as health advocate: translating the quest for social responsibility into medical education and practice. Acad Med 2011;86:1108-13. 3. American Board of Radiology Foundation. Home page. Available at: http://www.abrfoundation.org. Accessed January 7, 2012.
Health care disciplines have always held resolutely to a commitment to professionalism and high ethical standards. With the present emphasis on public accountability, professionalism and ethics are receiving enhanced attention in health care education and practice. A challenge for radiologists, radiation oncologists, and medical physicists is to define the scope and depth of knowledge about professionalism and ethics that are necessary for the practice of the disciplines. A further challenge is to develop accessible educational materials that encompass this required knowledge. About 2 years ago, the ABR Foundation decided to address these challenges through the development of an ethics and professionalism curriculum and production of a series of Web-based educational modules that follow the curriculum. Six organizations agreed initially to contribute financially to construction of the curriculum and modules and were later joined by a seventh. The curriculum was developed by the ABR Foundation and included in a request for proposals that was widely distributed. Teams of authors for each of 10 modules were selected from respondents to the request for proposals. As the modules were developed, they were reviewed in 3 successive stages, including peer review by members of the ACR Committee on Professionalism and the RSNA-ACR Task Force on an Ethics Curriculum. After revisions were prepared in response to the reviews, the modules were translated into a format compatible with the e-learning platform on which they are mounted. The modules are now available to all who wish to study them. Key Words: Ethics, professionalism, modules, accountability, curriculum J Am Coll Radiol 2012;9:170-173. Copyright © 2012 American College of Radiology
BACKGROUND
Professionalism connotes the dedication of a group of individuals to place the welfare of society above their own specific interests, and ethics refers to rules of acceptable behavior by individuals that have been agreed upon by a respectable group of peers. Professionalism and a commitment to high ethical standards have always been cherished values in the many disciplines of health care. Today, these values are receiving increased emphasis as health care accepts greater accountability to patients and the public and as professionals engaged in health care respond to an increased obligation to ensure that the welfare of patients is always the top priority [1]. Medical schools are emphasizing the social responsibility of physicians to an unprecedented degree [2], and certification a
Mayo Clinic, Rochester, Minnesota. American Board of Radiology Foundation, Tucson, Arizona. c Radiological Society of North America, Oak Brook, Illinois. d Skokie Hospital, Skokie, Illinois. e University of Pennsylvania Health System, Philadelphia, Pennsylvania. f University of Indiana, Indianapolis, Indiana. Corresponding author and reprints: William Hendee, PhD, Mayo Clinic, PO Box 7319, Rochester, MN 55903; e-mail: [email protected]. b
170
boards are expecting candidates to answer questions on ethics and professionalism. In the health care disciplines of radiology, radiation oncology, and medical physics, increased attention is being directed to ethics and professionalism for individuals in both practice and training. The ABR is including these topics in its new certification examination for radiologists and in its Maintenance of Certification program. Professional organizations are offering greater opportunities for their members to learn more about professionalism and ethics. A challenge facing radiologists, radiation oncologists, and medical physicists is to identify the core knowledge in professionalism and ethics that all individuals should know and share. About 2 years ago, this challenge was discussed at length by the ABR Foundation (ABRF). The discussion led to a decision to work with several other organizations to develop an ethics and professionalism curriculum and to design Web-based educational modules on the basis of the curriculum. The decision of the ABRF to develop the modules evolved naturally from the mission of the ABRF to “demonstrate, enhance and continuously improve accountability to the public in the use of medical imaging and radiation therapy” [3]. © 2012 American College of Radiology 0091-2182/12/$36.00 ● DOI 10.1016/j.jacr.2011.11.014
Hendee et al/Web Modules on Professionalism and Ethics 171
Fig 1. Topics of the 10 ethics modules.
SOLICITATION PROCESS
The ABRF approached 6 organizations with a request to help support the production of the Web-based modules on ethics and professionalism, and all 6 responded favorably. The 6 organizations are the ABR, the ACR, the RSNA, the American Association of Physicists in Medicine (AAPM), the American Society for Radiation Oncology, and the American Radium Society. Later, the Academy of Radiology Research added its support to the effort. These societies are sponsors of the Web-based modules, and without their financial support, the ABRF would have been unable to create the modules. Once financial support had been secured, a request for proposals (RFP) was created on the basis of the professionalism and ethics curriculum that was separated into 10 major areas for 10 modules. The RFP called for responses from teams of potential authors that included radiologists, radiation oncologists, and medical physicists. A timeline was established for the submission of draft and revised modules through the entire production, review, and revision stages. Arrangements were negotiated with the RSNA to host and manage the modules on the RSNA Web site. Authors were encouraged to express their creativity in developing the modules, within guidelines for module production developed by the ABRF working collaboratively with the RSNA. Modules were to be submitted as Microsoft Word documents and converted by RSNA staff members under the supervision of one of the authors of this paper (L.B.B.) to a format compatible with the RSNA’s e-learning platform. The RFP was sent to the 6 original sponsoring organizations with a request to distribute it to the organizations’ members. AUTHORING PROCESS
Responses to the RFP received by the deadline were reviewed, and successful applicants were identified and notified, with a reminder of the guidelines established for pre-
paring a module and the deadline for submission of a first draft. Questions by successful applicants as they worked on their modules were referred to 2 of the authors of this paper (W.H., J.L.B.) if they were content focused and to RSNA staff members if they were format focused. Applicants were furnished specific instructions for submitting illustrations and videos. Authors were encouraged to include special features such as “tell me more” pop-ups, video clips, periodic questions to test comprehension, and so on. Authors were required to provide several questions at the end of the module with reference back to the area of the text where each question was addressed. Authors were also asked to provide a citation to the literature for each question. These questions must be answered correctly by individuals wishing to acquire continuing education or self-assessment modules (SAMs) credit for successfully completing the module and who wish to print out a certificate of completion of the module. Authors for the individual modules are listed in Appendix A. REVIEW PROCESS
The first draft of each module was reviewed and edited by 2 of the authors of this paper (W.H., J.L.B.), and comments and instructions for revision were returned to the module authors. This review process for each module was completed within a few days after receipt of the draft module, so that authors would have the maximum time available to revise the module. When revised modules were received, they were sent to 2 or 3 external reviewers for comments and suggestions for improvement. Reviewers were members of 2 committees: the RSNA-ACR Task Force on an Ethics Curriculum, chaired by Nick Bryan, MD, PhD, and Leonard Berlin, MD, and the ACR Committee on Professionalism, chaired by Richard Gunderman, MD, PhD. Individuals who provided reviews of the modules are listed in Appendix B. For each module, reviews from members of these committees were provided to the authors, who then prepared a final version of the module for publication. This final module
172 Journal of the American College of Radiology/ Vol. 9 No. 3 March 2012
Fig 2. Screen shot of the table of contents of module 1.
was edited by ABRF staff members before being sent to the RSNA for mounting on its Web site. MODULE ACCESS
Diplomates and candidates of the ABR can access the modules from the ABRF (http://www.abrfoundation. org) and ABR (http://www.theabr.org) Web sites by entering their ABR IDs and passwords, which will take them directly to the modules mounted on the RSNA Web site. Members of the RSNA may access the modules directly by going to the RSNA Web site (http://www.rsna.org) and entering their RSNA IDs and passwords. Members of the ACR may access the modules through the ACR Web site (http://www.acr.org) by entering their ACR IDs and passwords and then by clicking on “ACR Education” and “Online Modules on Ethics and Professionalism.” The same process is used for AAPM members: they can access the modules from the AAPM Web site (http://www.aapm.org) by entering their AAPM IDs and passwords. Where the modules are actually mounted (ie, on the RSNA Web site) is invisible to individuals accessing the modules from any of these sites. For physicians, continuing education credit is granted by the RSNA. For physicists, continuing education credit is provided
by the Commission on Accreditation of Medical Physics Educational Programs. An individual who is not a diplomate of the ABR or a member of the RSNA, ACR, or AAPM can access the modules by going to the Web site of the ABRF (http://www. abrfoundation.org) and clicking on the access modules button. This action will take visitors to a site where they can register for module access at no charge. An individual chooses an ID and a password to use whenever access to the modules is desired. Access to the modules without cost by anyone who desires to study them reflects the commitment of the ABRF and the sponsoring organizations to share the information widely to improve the stature of medicine and its benefits to patients and the public at large. MODULE DESCRIPTION
The topics covered by the 10 modules are listed in Figure 1. In the opinion of the RSNA-ACR Task Force on an Ethics Curriculum, these topics provide a comprehensive overview of the ethics issues relevant to the practice of radiology, radiation oncology, and medical physics. We would appreciate suggestions of additional ethics concerns, if any, that should be covered in future revisions of the modules.
Hendee et al/Web Modules on Professionalism and Ethics 173
Each of the ethics modules is different in format and content from the others. As an example of 1 module, a screen shot of the table of contents is shown in Figure 2. CONCLUSIONS
The intent of the modules is to assist radiologists, radiation oncologists, and medical physicists in their concerns over ethical and professional issues arising in their practices and laboratories. It is the hope of the ABRF, sponsoring organizations, and module authors, editors, and reviewers that the modules will be widely used to help maintain the high level of professionalism and ethical practice that patients want and deserve. As John A. Patti, MD, chair of the ACR Board of Chancellors, has stated, “These modules should become an embedded core element of our culture as a specialty, particularly for our residents and fellows. The future of radiology depends on the value that is added beyond image interpretation.” APPENDIX A Authors of the Ethics and Professionalism Modules
Attributes of Professions and Professionals: Drs Gary Becker, Jennifer Bosma, Stephen Thomas, Kay Vydareny, and Paul Wallner and Ms Jennifer Hutson. Conflict of Interest: Drs Adam Alessio, Felix Chew, David Lewis, and Annemarie Relyea-Chew. Ethical Issues in Human Subject Research: Drs Daniel Eisenberg, Jed Peterson, and Kenneth Lee Zeitzer. Ethics in Graduate and Resident Education: Drs Leonard Bok, Kenneth Hogstrom, Kenneth Matthews II, and Mary Ella Sanders.
Ethics in Research: Drs John Antolak, Nicolas Hangiandreou, William Hendee, and David Kallmes. Ethics of Personal Behavior, Peer Review and Contract Negotiations with the Employers: Dr G. Stephen Brown and Mr Per H. Halvorsen. Physician-Physician and Physician-Patient Interactions: Drs John Aarsvold, Ashley Aiken, Bruce Barron, Susie Chen, and Narayan Sundaram. Publication Ethics: Drs Elaine Gould, Kenny Lien, and Andrew Maleson. Relationships with Vendors: Drs William G. Bradley Jr, Jonathan Lewin, Carolyn Cidis Meltzer, Andrew Menard, and Steven Seltzer. Research Involving Vertebrate Animals: Drs Daniel Alan Eisenberg, Jed Peterson, and Kenneth Lee Zeiter. APPENDIX B Reviewers of the Ethics and Professionalism Modules
Drs Michele Barton, Leonard Berlin, Charles Bowkley, Linda Bresolin, R. Nick Bryan, Lori A. Deitte, Richard Gunderman, William Herrington, Thomas Hoffman, Valerie Jackson, Lawrence Liebscher, John Livoni, Rodney Owen, James Rawson, Anne Roberts, and Vanessa Wear. REFERENCES 1. American Board of Internal Medicine Foundation. Medical professionalism in the new millennium: a physician charter. Available at: http:// www.abimfoundation.org/Professionalism/Physician-Charter.aspx. Accessed January 7, 2012. 2. Dharamsi S, Ho A, Spadafora SM, Woolard R. The physician as health advocate: translating the quest for social responsibility into medical education and practice. Acad Med 2011;86:1108-13. 3. American Board of Radiology Foundation. Home page. Available at: http://www.abrfoundation.org. Accessed January 7, 2012.