Category Archives: Workshop results

Hidden Curricula

Hidden Curricula

On February 10th, three instructors from the Medical Sciences Program at Indiana University Bloomington presented a panel on the role of medical education in shaping students into physicians. Mark Bauman, MD, Doug Carr, MD, and Sarah Tieman, MD, encouraged the audience, which included several students interested in pursuing medical education, to share their ideas about what forces help shape the kind of doctor a person becomes.

The list included: core motivations (which vary person to person), relationships with faculty and mentors (preclinical and clinical), formative interactions with patients, financial pressures (tuition & debt), educational standards and metrics, and “pre-formation” or the values and abilities that medical students arrive with from their upbringing and primary education. Bauman opined that as much as nurturing key relationships and experiences as well as knowledge is essential, the core values and motives that students arrive with are most often persistent – what you learned in kindergarten really does make a big difference to who you become later.

Of particular interest for contemplating the future of professional ethics was the discussion of the formal curriculum (knowledge & competencies), and the hidden curriculum (workplace culture and the incentive structure of the for-profit health care system).

Stats in our last blog post showed that fewer than 60% of professionals surveyed across three sectors report an “ethical or strong ethical-leaning” workplace culture. What might the results be for health care system employees? Regardless, even in an ethically congenial working environment, the gap between education and practice demands careful moral reasoning.

The problem of deciding just how much contextual knowledge a newcomer needs to take meaningful – and ethically well-advised – initiatives seems like one that could apply to many professions beyond medicine. On the one hand, newcomers to a workplace can cause unintended harm when they try to assert their ideas before they get to know the local context in real depth – how do you gauge the amount of knowledge you need to fulfill good intentions in an unfamiliar context? On the other hand, for young professionals aware that they may be entering workplaces whose ethical culture needs continued improvement, how do you avoid uncritically assimilating to local norms that really should change?

Tieman pointed out that when students cycle through short-term internships, they often don’t have time to develop the level of either detailed knowledge or investment to try to be problem-solvers – and may walk away without much insight into the struggles of their colleagues and patients. She argued that a benefit of the longer concurrent rotations that IU School of Medicine is now testing out might be that young professionals have enough time to build relationships with patients, to comprehend and evaluate the big picture of how a unit works, and thus to make thoughtful decisions about where to invest their time and energy.

Certainly, the robust culture of reflection discussed at our third #FutureEthics Workshop at IUB would serve to help young professionals be mindful of the gap between their training in a formal curriculum and the informal but extremely powerful hidden curriculum of their profession.

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Workshop Review: Developing and Defending Your Ethical Professional Brand

The third in the Indiana University Bloomington Future of Professional Ethics Workshop Series took place on January 29th, 2016, hosted by the School of Public and Environmental Affairs.

Keynote speaker Trish Tchume explored the question, “How do you walk through the world of work with integrity?” She opened by sharing a conversation she had with a friend about the stress of ethical concerns on the job. Allow me to paraphrase the striking conversation she reported: “You know how you have this sense of a fence in the distance between you and behaving unethically. And most people, they get more and more cautious as they approach that fence. But certain co-workers just go running at it full tilt. They might always stop short, but you hate to work with them because you feel like you’re being dragged along in their mad dash toward the boundaries of what’s right.”

Tchume went on to outline some great ways to make this metaphor more specific and practical:

What makes up the ethical fence? For the nonprofit sector, it is ultimately the IRS tax code and the definition of a nonprofit as an organization that acts “for the benefit of the general public…without a profit motive.”

What’s testing the ethical fence? Tchume cited several things that shape the environment new grads will go into. One is a characteristic of the workforce: widespread sector-agnosticism, meaning many graduates are willing to consider working in nonprofit, for-profit, or government sectors, they are more focused on results than dedicated to a specific way of getting them. However, these sectors all have different legal and ethical fences. They also expose young professionals to vastly different potential payscales and raise the question of how much – or how little – compensation professionals will expect. Finally, the traditional nonprofit worker finds herself in a competitive funding environment that can pit organizations against each other on the one hand, and on the other hand part of a general social trend toward efficiencies of scale and a focus on metrics, which push all organizations to define success in more business-like terms. Tchume pointed to the recent controversy over the Wounded Warrior project as a case study in some of the tensions involved in scaling organizations up.

Finally, Tchume urged listeners to ask “What slows me down as I run screeching toward the fence?” She advocated for the importance of creating reflective time and space to work this deeply. She shared a graphic(1) originally published by Robert Nash that illustrates the several levels of reflection: listening to your own feelings and intuitions to make sure your job is staying in alignment with your personal brand of ethics, considering the ethical culture of your organization and the specific duties of your role, expanding that reflection to the context of the community your organization works in, and finally thinking most broadly about the story you want your life, your career to tell. During Q&A, she suggested that this multi-level can be a way to grapple with issues like staff investment and retention – by seeing yourself and your colleagues as part of a story that includes but also transcends your current organization.

Panelists Jill Long Thompson and Beth Gazely seconded the keynote’s focus on the vital importance of regular reflection, emphasizing that although most people in government and nonprofits want to do good, it’s a mistake to think that ethics just comes naturally – rather, like building muscles, it takes practice. They agreed that reflective space and conversation is vital to build emotional intelligence, develop those ethical muscles, and to contribute to workplace culture. In concert, the speakers made a compelling case that building space for ethical reflection is imperative for professionals, as individuals, as colleagues, as managers, as friends, and as mentors.

This imperative is all the more urgent in light of survey results Tchume shared early in her talk from www.ethics.org: “58% of nonprofit employees surveyed report a strong or strong-leaning ethics culture in their workplace; 52% in business; and 50% in government.” These numbers drive home the point that young professionals can’t expect the right decisions to always be obvious.

 

(1)Graphic- Spaces for Developing Your Professional Ethical Brand

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Ethics Education: Can You Change a Moral Compass?

Samantha Strong

During the Nov. 13 keynote address for the Future of Professional Ethics workshop, “Committed Professionals: Handling Obstacles to Ethics,” Lisa M. Lee, Ph.D., M.A., M.S., Executive Director for the Presidential Commission for the Study of Bioethical Issues, discussed the importance of ethical preparedness in public health. Such preparedness, she argued, is essential to outbreak and disease management; it is a key component to effectively navigate the political realm; and it is the foundation upon which difficult decisions are made. Such preparedness, she stated, is the responsibility of every professional. Such preparedness can be generated through education.

Ethics is everywhere. In the allocation of scarce resources, the application of big data, traversing the political realm, and in the use of authority — ethics is everywhere. And it is for this reason ethics training should be integrated into the education of all professionals, particularly among public health professionals. The day’s conversations revolved around the application and inclusion of ethics training: Should scientists receive ethics training? How should such training be incorporated into public health professional’s education? What about medical schools? How much can we depend on IRBs for ethical matters? What is our responsibility? The conclusion was unequivocal: Ethics training and preparedness are everyone’s responsibility. Physicians, politicians, drug manufacturers, research scientists, public health professionals — we are all ethically responsible. What did remain unanswered, however, was how to ensure all professionals are adequately prepared.

Ethics education and training should be integrated into all professionals’ educations. While this is easier said than done, ethically important issues demand successful application. The incorporation of bioethical training and preparedness in public health curricula will enhance ethical preparedness and hasten the assimilation of ethics across disciplines. As Dr. Lee noted, “having a straight moral compass and being ethical are not the same thing.” Public health educators are not responsible to straighten students and professionals’ moral compasses; they are obliged to teach and prepare their students for an ethical and effectual career. Public health is an “ultra-disciplinary” field, making it a beautiful challenge worth undertaking. Ethical competency is necessary to successfully take on such a challenge.

Public health professionals are not the only ones responsible for ethical competency. It is on the shoulders of all professionals, including scientists. Dr. Lee noted the occasionally strained relationship between science and ethics, stating that such a relationship is not an “ either or an or, but an and.” Science is not the enemy, but it is up to all professionals to learn and discover what we should do in addition to what we can do. Many barriers are preventing ethics from entering the public health sphere, but beneficence, ethics, and responsibility are necessary components in the public health sector. Serving the public requires fulfilling many roles, facing many conflicts, and making difficult decisions. All are enhanced in a humanitarian, civic, and societal level when built upon a foundation of ethics. Ethical preparedness and education can lay this foundation.

Samantha Strong is an undergraduate student at Indiana University studying bioethics and political and civic engagement. 

December 14, 2015

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Complacency in the Medical-Industrial Complex

Hussain Ather

Long gone are the days of scientists only locked up in labs, secluded from everything but their microscopes and calculators. Now, more than ever, scientists find themselves writing reports and grant proposals, managing jobs, sitting on committees, and delivering lectures. Scientists work in issues at the forefront of policy, ethics, law, and other areas of society. Though these duties may be as fluid as viscous liquid or as dynamic as biological evolution, scientists and non-scientists alike struggle everyday with understanding science’s role in society.

Lisa M. Lee, Ph.D., M.A., M.S., Executive Director for the Presidential Commission for the Study of Bioethical Issues, gave her talk, Committed Professionals: Handling Obstacles to Ethics, on November 13 to an audience of professors, physicians, and other professionals, she considered the current state of affairs in public health ethics and bioethics. She spoke from her background in bioethics, including her work in public health surveillance and privacy. But, as I sat in the front row of the lecture hall, I couldn’t help but wonder, if scientists have expanded their roles in other areas, why was there still such a huge gap between science and policy?

We’ve taught ourselves to be complacent. With the slow death of the liberal arts education, we’ve sold science as a way to manufacture jobs, but forgotten about the important values of humanism necessary for personal growth. We need to encourage science as a way to seek the truth, of both the economy and virtues. No doubt, science should make money, but it should also teach us values such as wonder, curiosity, and humility in the world.

Dr. Lee suggested requiring ethics training programs for graduate students. I was dubious of this solution because, while it may help students understand ethics, a requirement can only do so much to foster curiosity and humanism before encouraging complacency and discouraging innovation.

Students who aspire to become physicians suffer from this complacency. As pre-medical undergraduates, we have long paths in front of us before becoming a practicing physician. We spend four years taking courses like organic chemistry, physics, and biology while preparing for the Medical College Admissions Test (MCAT). Along the way, we volunteer, shadow, and engage in extracurricular activities before entering a four-year medical school program. After that, we have residency and training before becoming a fully-practicing physician. With such a long, stringent path, it’s easy to forget about what’s really important and how to “live in the moment.” Instead, we succumb to utilitarian, consumerist motives as we value information over wisdom, marketability over authenticity, and dogmatism over free thought. And, when we aren’t prepared for the future, the “Medical-Industrial Complex,” as Dr. Lee puts it, thrives.

We can only address the ethical issues in science, medicine, and public health through a thorough examination the values we instill in ourselves through education. Those of us who can break from the complacency of everyday life to higher ideals, including courage, justice, and empathy, will be ready to fight the problems of tomorrow.

Hussain Ather is a pre-med undergraduate student at Indiana University Bloomington and co-founder of the IU Undergraduate Bioethics Society.

December 3, 2015

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Workshop review — Committed Professionals: Handling Obstacles to Ethics in Public Health

Matthew Prior

Abstract Public health professionals face tough ethical questions in our daily practice and need guidance on how to handle the ethical contours of our complex profession. Public health is a multidisciplinary field with professionals from epidemiology to education, medicine to microbiology, engineering to environmental sciences, veterinary medicine to virology, and many more. Public health professionals work in a variety of settings — public and private, state and local, national and international. We are professionals committed to social justice and health equity who bring our varied discipline-specific skills to bear on complex problems that affect health and wellbeing. Our ‘patient’ is the community as well as the individual. We come from a variety of ethical traditions, not all of which map well to the goals of public health. As a nascent field, public health ethics borrowed heavily from other ethical approaches in medicine and health. Numerous frameworks have extended these early approaches by adding a clear focus on justice — social justice and distributive justice — and on public beneficence — doing good for the community. In parallel, a public health code of ethics — the field’s ethical expectations of professionals — was developed in the early 2000s. APHA is working to revise the field’s code of ethics to encompass expectations for organizations as well as individuals. We must continue to develop tools and train public health professionals to identify, articulate, and handle the inevitable ethical dimensions of our field.

On Friday, November 13, Dr. Lisa M. Lee, Executive Director for the Presidential Commission for the Study of Bioethical Issues, presented a keynote address for The Future of Professional Ethics workshop series hosted by Indiana University‘s School of Public Health and the Poynter Center for the Study of Ethics and American Institutions.

The workshop event began with a panel discussion featuring Dr. Lee and Indiana University Bloomington faculty members Albert Gay, Jon Macy, and Antonio Williams of the School of Public Health, and Mark Bauman of Medical Sciences Program. This discussion focused on a number of ethical public health topics ranging from the Public Health Service Syphilis Study at Tuskegee project to health communication pertaining to e-cigarettes. The discussions sparked dialogue about the role of ethics in public health from the panelists and the audience of faculty and students alike.

Dr. Lee’s keynote presentation, “Committed Professionals: Handling Obstacles to Ethics in Public Health,” highlighted several key topics, including the evolution of public health ethics over the years, professional ethics in public health, and ethical obstacles and opportunities in public health. Dr. Lee emphasized the importance of being “good” (beneficent) public health professionals; some of their qualities, she noted, include accountability to the public they serve, transparency, and the ability to make ethical decisions when faced with real ethical conflicts. She highlighted some of the work of the Bioethics Commission on the topic of democratic deliberation as a strategy for coming to ethical conclusions when faced with conflicts.

Dr. Lee noted several barriers to public health ethics highlighted by a lack of ethics training in many schools on public health, poorly defined ethics competencies required by many professional accrediting organizations, and an outdated, but persistent, view of ethics as an obstacle to public health work. Further referring to the Bioethics Commission’s work, she noted that ethical considerations, when integrated “early and explicitly” in public health preparedness and practice, facilitate public health activities by anticipating potential concerns and providing decision-making tools to resolve conflicts should they arise.

Dr. Lee closed by suggesting some opportunities and resources for people to get involved in public health ethics, including IUB’s very-own Association for Practical and Professional Ethics (APPE).

This well-attended presentation shows how highly Indiana University students and faculty value professional and public health ethics. In attendance were representatives from a variety of schools, programs, and departments including business, medical sciences, kinesiology, and public health. The audience was engaged throughout and offered many thoughtful questions during the discussion period, including many from students with well-formed thoughts on ethics.

Dr. Lee and the Bioethics Commission staff would like to thank the School of Public Health and the Poynter Center for being such wonderful hosts and for the zeal in which it embraced this very important topic.

Matthew Prior
Communication and Outreach Lead
Presidential Commission for the Study of Bioethical Issues
November 24, 2015

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Why Do We Care about What Who Wants? Not-so-Mundane Challenges to Being a Value-Bearing Organization

Emma Arrington Stone Young

A very striking contradiction came to light during the panel discussion following Steve Salbu’s[1] keynote for the first IU Bloomington Future of Professional Ethics workshop hosted at the Kelley School of Business, Indiana University on September 25.

At the national level, perceived student demand has driven a shift in emphasis away from the liberal arts and toward “professional” schools, even at traditionally liberal arts colleges. As noted by Salbu, in his experience as a Dean, students are increasingly taking an instrumental view of higher education as they seek high-paying and high-status jobs. However, during the panel discussion it came out that college career placement services have been hearing pushback from employers in law, media, and informatics: These employers often want to see graduates with stronger critical thinking and communication skills – in other words, with a stronger liberal arts education.

This seems to paint a picture in which drivers, incentives, and outcomes have become mismatched: students are interested in appealing to high-status employers, and these student/parent desires are evidently driving higher education policies — yet employers are less than satisfied with the results, and recent graduates are less than satisfied with their financial prospects. Meanwhile, within the academy, faculty are concerned about mission drift — and academic careers have become exemplars of the kind of life path that doesn’t pay for its own University-charged entry cost. Being an institution dedicated to values above and beyond its own self-preservation, whether it be university, a newspaper, or a political party, naturally involves debate over what the precise values are. But in the picture painted above, no coherent vision of the value of education is getting its way. So what is driving higher ed policy?

Responding to the keynote’s emphasis on shifting values in higher education, panelist Tim Hallett[2] brought up the spread of Enrollment Management programs (EM) in colleges and universities. This bureaucratic innovation links Admissions and Financial Aid departments, with the result that financial aid is used as a tool to recruit target populations of students. Hallett cited a study of the growth of EM by Kraatz, Ventresca, and Deng 2010*, which offers several criticisms of the phenomenon:

Studies have shown that “strategic” financial aid policies strongly favor middle-class students with a greater ability to pay, thereby undermining equal access to higher education (Baum & Lapovsky, 2006; Davis, 2003). They have also shown that rapidly growing enrollment management expenditures have consumed a growing percentage of colleges’ budgets and diverted scarce institutional resources away from core academic areas such as instruction and academic support (Goral, 2003; Redd, 2000).

Kraatz et al. ultimately argue that organizational values can be quietly subverted as organizations “adopt new and ostensibly innocuous innovations that promise to solve their technical and administrative problems.” The problems with EM provide one example.

It is not difficult to see how this account could be applied to the problems raised in our workshop as well. While the proper organizational values of higher education are, I think, inherently contestable, in the discussions of many higher education policies, the questions being asked are part of a different conversation altogether: What do our consumers (primarily high school students and current undergraduates) see when they look at our PR? And what do they see when they look at our competitors (other colleges)?

This type of framing radically narrows the focus, and pushes any consideration of graduate futures, community or social needs, employer interests, or academic integrity to the margins — except insofar as they impact the newly central questions of how to appeal to test-savvy students. It places a premium on the judgments of a relatively naïve consumer. The practice of certain law schools, which overall have shown very low employment rates for graduates over the past several years, of padding their employment stats in the college rankings used for recruitment, is one example cited by Salbu. This type of administrative decision can only make sense in a very narrow decision-making framework focused on getting students in the door. How it could ever make good ethical sense is difficult to imagine at all.

Kraatz et al. are concerned to find out what makes an organization more or less susceptible to such mission drift and value subversion. Their questions thus offer a perfect segue from the issues explored in the first IU Bloomington #FutureEthics workshop to the issues shaping the next: Committed Professions: Handling Structural Obstacles to Ethics {outlink}.

* All quotes from: PRECARIOUS VALUES AND MUNDANE INNOVATIONS: ENROLLMENT MANAGEMENT IN AMERICAN LIBERAL ARTS COLLEGES. Academy of Management Journal 2010, Vol. 53, No. 6, 1521–1545.

[1] Cecil B. Day Chair, Professor of Law and Ethics at Georgia Institute of Technology

[2] Associate Professor & Director of Undergraduate Studies, Department of Sociology, Indiana University Bloomington,

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Workshop review – Professions and Service to All: Challenges, Problems, and Solutions

Saul Kutinicki,
Emma Arrington Stone Young, and
Kenneth D. Pimple

Professions and other occupations exist because they serve human needs. The degree to which professions strive to meet vital needs vary across professions, within professions and organizations, and across time. There can be no doubt that in the United States today, many vital needs are not met, often because providing those needs is not profitable. Providing pro bono services and taking up specialties that serve underprivileged people or underpopulated areas are not practical for many young professionals who are burdened by tens of thousands of dollars of student loan debt.
From the workshop description

The first of Indiana University Bloomington’s workshops of five in the series on the Future of Professional Ethics drew about twenty-five academic administrators, faculty, and a few undergraduate and graduate students (plus at least one retired professional) representing law, medicine, journalism, sociology, informatics, and more.

The workshop began with a common observation from the keynote speaker, Steven Salbu, Cecil B. Day Chair, Professor of Law and Ethics at Georgia Institute of Technology: IU has one of the most beautiful campuses he has ever seen. His follow-up was less common, but far from unique: How much does it cost to continually plant and re-plant every flower patch on the campus, and who pays for it? The answer to the latter is, at least in part, students pay for it.

Professor Salbu went on to highlight the terrible effects of rising costs in higher education that, according to the Wall Street Journal, exceed even the rate of rising costs in healthcare. Examples included  students who choose paying tuition at the cost of housing or food and scandals in which schools are sued by the dozen for padding their graduate employment statistics.

To trace the causes and ramifications of the increasing cost of a college degree, Salbu drew on his experience as both an instructor and a Dean. Focusing first on the role of higher education in society, including its role in mediating access to medical care and legal advice, Salbu noted that he sees more and students taking an instrumental view of education or making choices driven by financial pressure from their parents. He lamented the gap between those forces and the desire for personal growth and intellectual adventure that powered his own education. Worse yet, he argued that policy makers in university administration have taken up an “academic arms race” as they compete for ratings based on metrics devised and published by the likes of the U.S. News & Education and the U.S. Department of Education’s Government College Scorecard. The scorecard defines success in narrowly economic terms.

In the last third of the talk, Salbu turned to law and medicine, both of which he argued are failing to fulfill their vital social roles due to rising access barriers – to which higher education policies contribute. Young adults who are interested in providing important services are too often blocked from higher education due to the high cost. If they are able to afford professional licensure,  high student debt often diverts them from specialties that benefit under-privileged populations and areas in favor of careers that minister to the well-off. Diminishing citizen access to these essential professions undermines core social values. Salbu suggested that Milton Friedman might have offered an idea worth entertaining when he opposed professional licensure on the grounds that it drives up costs and limits access.

Following the keynote, three IUB panelists commented on Salbu’s themes:

  • Tim Hallett, Associate Professor and Director of Undergraduate Studies for the Department of Sociology
  • Carwina Weng, Clinical Professor of Law and Director of the Disability Law Clinic at the Maurer School of Law, and
  • Jim Kelly, Association Professor and Director of Undergraduate Studies at The Media School.

The audience who responded to the keynote and panelists included academic administrators and faculty in all those areas, as well as medicine, informatics, and more.

The panel discussion and comments from the audience went in many directions, several of which will be explored in future posts: The role of new college admissions procedures in this picture; the emphasis of law school programs on facilitating corporate law careers over other types of legal service; the varying insights suggested by different definitions of “professional;” how wider social values about health care bear on the moral responsibility of medicine; and journalism as a profession that has been uniquely defined precisely by an ethical code and not by professional licensure barriers, yet which now are losing that touchstone.

Which issues do you find most interesting? We’d love to hear from you.

October 23, 2015

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Live tweets from first IUB workshop

Thanks to Saul Kutnicki for live tweeting the first workshop of the IU Bloomington series today, “Professions and Service to All: Challenges, Problems, and Solutions.” The keynote speaker was Steven Salbu,  Cecil B. Day Chairholder and Professor, Scheller College of Business, Georgia Institute of Technology (a.k.a. Georgia Tech).

Here are the tweets:

There will be more about this workshop as soon as we can manage.

Ken Pimple
September 25, 2015
2:40 pm EDT

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