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Mapping the Terrain of Ethics Education for Physician Assistants: A Delphi Consensus Panel Report

TheAccreditation Standards for Physician Assistant Education require instruction on the principles and practices of medical ethics, for it is well accepted in the physician assistant (PA) community that ethics education is a critical component of PA training. Yet, “despite the recognition of its importance, there does not seem to be consensus on the bioethical topics that should be studied.” Though by no means complete, a literature has been promulgated specifying ethics education objectives for medical students and the topics that should be included in ethics courses. In light of the deficit of guiding literature for PA ethics education, one potential workaround might be to rely on the ethics education scholarship that exists for medical students. However, Paola and colleagues identify 2 reasons why ethics curricula formedical students should not be used in PA programs: (1) PAs are dependent practitioners, which is foundationally different than that of physicians and may lead to unique ethical dilemmas in practice, and (2) PA education is substantially shorter than that of physicians. Ultimately, because the scope of practice for PAs is different than the scope of practice for either physicians or nurses, it seems illogical for coursesdesigned forphysicians or nurses to simply be duplicated in PA programs. Few publications about PA ethics education currently exist. Two opinion pieces suggest content that should be incorporated into PA ethics education. Paola argues that PA ethics curriculum should include materials about: (1) the nature of morality, (2) the interactions between the PA and the supervising physician, and (3) the harmful effect medical education can have on altruism and compassion. In somewhat stark contrast, Rohlf and Bertocci propose that ethics education for PAs (as well as physicians, nurses, and other health care providers) should have “2 central foci: (1) the American Medical Association Council on Ethical and Judicial Affairs’ Code of Medical Ethics . . . and (2) a clear method for ethical decision-making.” Two additional articles on PA ethics education are more data driven. Stone and colleagues created an interdisciplinary ethics course for students from 7 disciplines (including PA students) and then conducted a comparative analysis of each of the 7 disciplines’ codes of ethics to find common topics of interest. The topical areas were then grouped into 8 categories of professional responsibility to the person, profession, client, health care team, employer, researchers and practitioners, and the public. Fasser and colleagues report on the interdisciplinary medical ethics instruction at Baylor College of Medicine and investigate the question of how we ought to deliver PA ethics curricula. They argue that a case-based, small group procedure is most likely to result in improvements in moral reasoning. This thoughtful—if sparse—prior scholarship sets the stage for further systematic exploration of best practices in PA ethics education. To advance the data-driven discussion, we conducted aDelphi panel of experts todeterminewhat objectives and topics were most important for PA ethics education.