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Arny and Anne Porath Clinical Ethics Fellowship

UCLA Health System Ethics Center 


About the Fellowship

UCLA Health System Ethics Center's primary commitment is to the promotion of excellence in patient care. Given the value-laden nature of healthcare, this excellence can only be achieved in care environments where moral insight, sensitivity and commitment flourish. Our fellowship program exists to educate and train gifted individuals who share this vision to become the next generation of clinical ethicists. To this end, our two year fellowship program is open to individuals possessing an advanced degree in bioethics who are seeking the opportunity to acquire the necessary clinical experience, education and training to apply their existing theoretical expertise to the practical demands of the clinical setting. The volume and complexity of ethics consultation at UCLA Health System (which includes transplant medicine, complex critical care, trauma surgery, emergency medicine, oncology, psychiatry, neurology, neonatology, pediatrics and gerontology), our close relationship with various academic departments, and the learning resources available on campus affords our fellows unrivaled prospects for training. This combination with intensive individual mentorship and assessment provided by our expert ethics consultants, offers our fellows an opportunity to acquire and refine the full range of skills necessary to offer ethics consultation on a highly competent, professional basis. It is our confident expectation that those who graduate from our program will be uniquely placed both nationally and internationally to assume the responsibilities of leadership in clinical ethics as it emerges as a fully professional practice.  The Fellowship is in part supported by generous donations from Arny and Anne Porath and Rachel and Jay Tarses.

Fellowship Director
James A. Hynds LL.B., Ph.D.

Current Fellow
Tyler S. Gibb, J.D., Ph.D. (c) (2013-2015)

Former Fellow
Kevin M. Dirksen, M.Div., M.Sc. (2011-2013)


I. Goal and Structure of Fellowship

A. The Goal of the Fellowship

The Ethics Center is committed to the professionalization of clinical ethics and to the intellectual and practical excellence that this demands. The goal of the fellowship program is to provide the fellow with the clinical experience, education, and training necessary to function, upon completion of the fellowship, as an expert clinical ethicist. Both the educational and practical dimensions of the fellowship program have as their immediate and primary goal the fellow's acquisition of the substantial knowledge-base and skill set necessary to demonstrate advanced proficiency in clinical ethics consultation. The 'core competencies' (advanced level) for ethics consultation developed and recently revised by the American Society for Bioethics and the Humanities form the basis for identifying and evaluating the advanced proficiency in clinical ethics consultation necessary to successfully complete our fellowship program. Although the primary focus of the fellowship program is the attainment of clinical consulting skills by the fellow, the fellowship program will also provide the fellow with the opportunity to acquire advanced skills in clinical ethics education, policy development and research as these skills are integral to the professional clinical ethicist.


B. Fellowship Structure: Education and Training

The ethics fellow will be expected, upon completion of the fellowship program, to demonstrate both advanced knowledge and advanced skills competence in clinical ethics consultation.

II. Knowledge Competence

Advanced knowledge competence will be expected and assessed in three domains: (1) the nature and challenges of delivering health care in a hospital setting; (2) the nature of ethical issues as they arise in the clinical setting and how they are appropriately addressed and resolved; and (3) the nature, goals and methods of professional clinical ethics consultation and the appropriate role of the professional clinical ethics consultant.

To help the fellow attain these competences, the following learning opportunities will form an integral part of their fellowship program:

A. Tutored Reading Courses

The fellow will participate in two tutored reading courses:

1. TRC-1 Issues in Clinical Ethics (taught during the fellow's observership)

This course will explore the most common ethical issues which arise in the clinical setting. Topics to be discussed will include: decision-making capacity; informed consent; pediatric ethics; ethics at the end of life; and truth telling and confidentiality. These issues will be discussed in the context of the relevant state and federal laws, professional codes and guidelines and UCLA Health System policy.

2. TRC-2 Clinical Ethics Consultancy

This course will explore the goal, nature and scope of clinical ethics consultation and the role of the professional clinical ethics consultant. Topics to be discussed will include: the goals of ethics consultation; the problem of methodology; ethics consultation and moral pluralism; the relationship between the ethics consultant and their institution; the ethicist as moral expert; ethics consultation as a profession; and the challenge of evaluating ethics consultation.


B. Shadowing and Clinical Rounding

In the first year of their fellowship, the fellow will shadow a wide variety of healthcare professionals in each of our three medical centers as they discharge their professional responsibilities. These shall include physicians, nurses, social workers, chaplains, risk managers, legal counsel and hospital administrators. The fellow will also have the opportunity to join clinicians from a wide variety of medical specialties as they make their clinical rounds on patients. It is anticipated that the fellow will have the opportunity to round with clinicians from general internal medicine, pulmonary and neurological critical care, palliative care, neonatal and pediatric care, surgery and geriatrics.


C. Skills Competence

The fellow, upon completion of the fellowship program, must demonstrate advanced skill competence in clinical ethics consultation. These skills include the ability:

  • to gather all information pertinent to a consult request.
  • to understand clinical data (diagnosis, potential treatments, prognosis, etc.) and its particular relevance to each consult.
  • to identify the ethical issues embedded in a consult request (including the ability to determine that an issue is not primarily of an ethical nature).
  • to establish realistic expectations of the ethics consult service.
  • to identify individuals with a legitimate interest in the outcome of a consult and facilitate their participation in the consult process.
  • to listen attentively to and communicate effectively and empathetically with all individuals involved in a consult.
  • to elicit the moral views and commitments of others.
  • to organize and lead ethics meetings (e.g. family meetings, interdisciplinary meetings, ethics committee meetings) and to facilitate respectful listening and constructive dialogue.
  • to rigorously analyze the ethical issues embedded in a consult request.
  • to develop and communicate ethics recommendations (both verbally and in the medical record).
  • to educate others regarding the scope and limits of their rights and responsibilities.
  • to facilitate the principled resolution of ethical conflicts.

 To help the fellow attain the necessary skills competence, the following learning opportunities will form an integral part of the fellowship program:


1. Observership and Supervised Consultation

The fellowship program begins with a six week observership. During this period the fellow will accompany Ethics Center faculty as they conduct ethics consultations. The purpose of the observership is to familiarize the fellow with the hospital environment and the ethical issues that arise in the clinical setting. The fellow takes TRC-1 (Clinical Ethics Issues) during this time.

After an appropriate period of observation and education, the fellow will be expected to participate in the consult service as an ethics consultant in training. Initially the fellow will have responsibility for the ingathering of consult information and its ordered presentation daily to the attending ethicist and at weekly departmental rounds. Gradually, as the fellow acquires more experience, they will be expected to assume more fully the role of consulting ethicist; analyzing ethical issues and making ethical recommendations. Each consult shall conclude with a debriefing session which shall function as both a learning experience for the fellow and an opportunity for faculty to informally assess the fellow's competence. Throughout this period the fellow will be closely supervised and mentored by the attending ethicist who shall always have ultimate responsibility for the integrity of the consultation process. It is our expectation that after an appropriate period of education and training, the fellow will be able to consult in a more independent fashion albeit under the direction of the attending ethicist. Before assuming this more independent role and assume on-call responsibilities, the fellow shall be required to pass the clinical competence examination.

2. Weekly Departmental Rounds

Once each week the ethics service meets to present and discuss the consults the service has received in the last week and any other consults where ethics involvement is on-going. The purpose of these rounds is to analyze collegially the ethical issues embedded in each consult and to discuss practical strategies to address and resolve the ethical problem presented by the consult request. Rounds provide the members of the ethics service with an invaluable opportunity for on-going shared learning. The fellow will be expected to attend and participate in these discussions. When the fellow has progressed sufficiently to be consulting on a more independent basis themselves, they will be expected to present and discuss their own consults and to integrate faculty feedback into their consult practice.

3. Ethics Committee Membership

As a member of the Ethics Center, the fellow will be a member of each of our three hospitals ethics committees. The three committees provide a diverse experience for the fellow, representing quaternary care, community hospital care and psychiatric care. Although each committee functions differently, all the committees are actively engaged in ethics consult review, ethics education and the development of ethics policy. By attending and actively participating in the deliberations of our ethics committees, the fellow has the opportunity to develop the skills necessary to discharge these important functions.


III. Fellowship Assessment

The fellow will be assessed both formally and informally throughout the fellowship program. The primary goal of assessment will be to evaluate the fellow's attainment of the requisite knowledge-base and skill set necessary to function independently as a professional clinical ethicist. The 'advanced' Core Competencies for Health Care Ethics Consultation (2010) identified by the American Society for Bioethics and the Humanities shall form the basis for this knowledge and skills assessment.

A. Informal evaluation

The fellow will be subject to on-going informal evaluation by Ethics Center faculty. The fellow will be evaluated for their analytic, organizational and interpersonal skills.

Initially, when the fellow is shadowing members of the Ethics Center faculty as they do ethics consults, evaluation of the fellow will take the form of pre- and post- ethics consult debriefing. The fellow can expect to be evaluated on their ability to identify the relevant ethical issue, to analyze the challenge the issue presents in the particular clinical circumstances and to suggest practical strategies to address the challenge appropriately.

As the fellow progresses to a more independent consulting role, informal evaluation of their ability will take the form of being shadowed by an Ethics Center faculty member and participation in a pre- and post- consult debriefing sessions. The fellow can expect to be evaluated on their ability to identify the relevant ethical issues in a consult, to analyze the challenge the issue presents in the particular clinical circumstances, on how they relate interpersonally with patients, families and members of the care team, and on how they organize and lead any consult intervention (e.g. family meetings, staff debriefing sessions).

In addition to pre- and post- consult debriefing, the fellow will be expected to actively participate in weekly Ethics Rounds. Initially the fellow will be expected to discuss and analyze current ethics consults being managed by other Ethics Center faculty. As the fellow assumes a more independent consulting role, they will be expected to present their own consults at weekly rounds. These presentations will be subject to informal evaluation.

As the fellow assumes a more independent consulting role, they will be expected to enter clinical notes into the medical record of patients for whom an ethics consult has been called. Without exception, all clinical notes must be submitted for review to the attending ethicist before they are placed in the patient's chart. The fellow can expect such notes to be evaluated for punctuality, accuracy, clarity of exposition, sensitivity of expression, awareness of applicable law and practicability of their clinical recommendations.

The fellow will be expected to enter consult data into the ethics consult database. Their database entries will be subject to evaluation for punctuality, accuracy, and clarity.

 

B. Formal Assessment

1. Clinical Competence Examination

Upon completion of TRC-1 Issues in Clinical Ethics, and before assuming on-call responsibility for the clinical ethics consultation service, the fellow will be formally examined to assess their ability to identify, analyze and address ethical issues that arise in the clinical setting. The assessment will take the form of a multiple choice exam and written case analyses.

2. Course Papers

It is expected that a fellow graduating from the fellowship program will be sufficiently knowledgeable and skilled in clinical ethics consultation to contribute significantly to scholarship in the area. To cultivate and evaluate the scholarly abilities of the fellow, they shall be required to research and write two academic papers. The papers will be evaluated for: (1) contemporary or perennial relevance of the topic; (2) accuracy of factual data; (3). intellectual sophistication of analysis; (4) appropriate integration of relevant literature; and (5) writing style. Each paper should be of such a quality that it is suitable for publication in a peer reviewed journal.

a. Clinical Paper

The fellow shall write a paper which discusses a substantive ethical issue(s) encountered in clinical practice. It may be normative or descriptive, theoretical or practical. The fellow is free to choose any of the Center's faculty to mentor this paper.

b. Professionalism Paper

Given the Ethics Center's commitment to the professionalization of ethics consultation, there is a particular expectation that the fellow will be able to contribute to the important (and not uncontroversial) national debate which surrounds this issue. In the second paper the fellow will discuss a topic related to professionalism in clinical ethics consultation. Possible topics include (but is not limited to) the following: the appropriate goals of ethics consultation; the problem of methodology; ethics consultation and moral pluralism; the ethicist as moral expert; ethics consultation and conflict of interest; professionalizing ethics consultation; and evaluating ethics consultation.


3. Summative Assessment

The fellow will be formally examined at the end of the fellowship program to attest that they have attained the requisite advanced competency in clinical ethics, particularly clinical ethics consultation. The ASBH core competences will form the basis for this evaluation.

a. Consult Portfolio

To this end the fellow shall develop and submit a consult portfolio for review by the Center's faculty. The portfolio shall consist of their professionalism paper and no fewer than 6 written case studies drawn from the fellow's own consulting experience. The fellow shall select cases for inclusion in their portfolio which demonstrate the breadth of their clinical experience and which contain elements of significant clinical and ethical complexity, uncertainty and/or conflict.

b. Oral Examination

The fellow shall be subject to a summative oral examination by the Center's faculty and at least one external examiner. The fellow will asked to analyze two unseen clinical cases and to discuss and defend the contents and of their portfolio.

c. Learning Support

The fellowship program is intended to be a mentored learning experience provided in a respectful and supportive environment. To this end, the fellow will have the opportunity to meet on a monthly basis with the fellowship Program Director to discuss their fellowship experience and how any learning or professional needs or challenges might be better met by the program. The fellow can also expect to receive on-going learning and professional support for all members of the Center's faculty who shall happily make themselves available to the fellow upon request.

 d. Fellowship Evaluation

The Ethics Center is committed to providing our fellows with the best learning experience possible. We are always looking for ways to enhance and improve our program to better meet the needs of the fellows. Periodically, therefore, the fellow will be asked to formally evaluate the fellowship program and to suggest ways in which it might be appropriately developed.


IV. Service Expectation of the Fellow

Although the fellowship's primary focus is the professional education and training of the fellow, there are significant service expectations of the successful applicant. The responsibilities of the fellow include:

  • providing clinical ethics consultation to Ronald Reagan UCLA Medical Center,
  • Resnick Neuropsychiatric Hospital and Santa Monica UCLA Medical Center and Orthopedic Hospital.
  • after an appropriate period of observation, providing supervised on-call coverage for the ethics consultation service.
  • participating on the three UCLA Health System Ethics Committees.
  • collaborating in developing ethics education programs for staff.
  • participating in ethics rounds.
  • attend Ethics Center lectures.
  • collaborating in policy development activities.
  • participating in educational activities.
  • mentoring of the junior ethics fellow.
  • contribute to departmental research projects.
  • community involvement: including attendance at the Southern California Bioethics Committee Consortium.

V. Application Process

We are searching for a compassionate and empathic professional with excellent interpersonal skills who is able to utilize critical and creative thinking in navigating complex ethical issues. The ability to integrate cross-cultural care, end of life/palliative care, psychosocial and spiritual care into clinical care is critical to this role. A strong interest in collaborative and interdisciplinary work is required.
Consistent with our Center's commitment to the professionalization of clinical ethics consultation, the applicants must possess a Ph.D. or masters degree in bioethics upon commencement of the fellowship program.
Stipend is $55,000, plus excellent benefits and a subsidy for conference travel.
Fellowship entails a full-time commitment from September 2, 2014 - September 1, 2016.

To apply:
Please apply online at http://www.uclahealthcareers.org/all-jobs/Senior-Ethics-Fellow-1-year-contract/H69692
AND submit the following to: ethicscenter@mednet.ucla.edu. This e-mail address is being protected from spambots. You need JavaScript enabled to view it
1. Your curriculum vitae
2. A letter, no longer than a page and a half describing why you are interested in obtaining clinical experience, potential research interests, your goals post-fellowship, and relevant character traits that make you well suited for clinical ethics. Please also include three references with email addresses and phone numbers.

Deadline for applications is January 27, 2014