3. Ethics & Professionalism


Ethical behavior and professionalism include conduct congruent with generally accepted moral principles and values and with professional guidelines based on those principles and values.

This definition includes general leadership ethics, such as honesty and responsibility, as well as ethics specific to the MCH population, such as reducing health disparities and behaving in a culturally competent manner.

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Knowledge Areas

Through participation in this program, a participant will know:

  • The principles, values, and ethical behaviors such as beneficence, nonmaleficence, truthfulness, justice, and respect for autonomy that underlie professional conduct with in the health care system.
  • Ethical and legal principles of public health and clinical practice.
  • His or her professional association’s code of ethics.
  • Institutional review board processes and criteria for ensuring ethical study design and informed consent as they relate to human subjects research and translation of research to practice.

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Basic. Through participation in this program, a participant will:

  1. Identify and address ethical issues in patient care, human subjects research, and public health theory and practice.
  2. Describe the ethical implications of health disparities within MCH populations.
  3. Interact with others and solve problems in an ethical manner.

Advanced. With more experience and building on the basic skills, MCH leaders will:

  1. Identify ethical dilemmas and issues that affect MCH population groups and initiate and act as catalyst for the discussion of these dilemmas and issues.
  2. Consider the culture and values of communities in the development of polices, programs, and practices that may affect them.
  3. Describe the ethical implications of health disparities within MCH populations and propose strategies to address them.

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Educational Experiences

  • Read articles recommended by faculty on ethical issues.
  • Observe faculty negotiate ethical dilemmas in clinical practice, in research, in teaching and in administering a program.
  • Participate in solving ethical dilemmas in clinical practice, in research, in teaching and in administering a program.
  • Be evaluated by faculty in solving ethical dilemmas in clinical practice, in research, in teaching and in administering a program.
  • Develop an IRB proposal and outline why the subject should be raised to an IRB.
  • Pass a test on HIPAA.

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Resources/Assessment Tools – 3. Ethics & Professionalism

Key Documents

Bioethics: Health Care Law and Ethics – Furrow, Barry R. et al., 1997.

American Medical Association, Strategies for Teaching and Evaluating Professionalism (STEP)

AMA. Principles of Medical Ethics.

American Society for Bioethics and Humanities, Task Force on Graduate Medical Education on Bioethics and Humanities – Response to the ACGME General Competencies: The Model Curriculum Project on Bioethics and Humanities

Epstein RM, Hundert EM. Defining and assessing competence. JAMA 2002;287;226-35.

Papakakis MA, Hodgson CS, Teherani A, Kohatsu ND. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med 2004;79:244-9.

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Assessment Tools

Inclusion Criteria –

To be considered for initial inclusion in this web site, the materials had to meet several criteria:

  • the material needed to focus on one or more of the skills listed for a particular competency
  • the material needed to describe either a measurement instrument or theory that could support the creation of such an instrument
  • the material had to be publicly available, that is, where the item is not a commercial entity available for purchase
  • the material needed either psychometric information about its properties as a measure or, particularly in the case of material found only on the Web, a high degree of face validity

Copyright and Use Issues –

The materials initially described were identified for consideration by MCH interdisciplinary training programs. Many of these materials are copyrighted and thus, may not be copied, distributed, transmitted, or published without the express written permission of the copyright owner. It is the responsibility of each user to ascertain whether materials may be freely used or whether such permission is needed.


Portfolios are collections of information that can be used to evaluate MCH knowledge in action.

Portfolios include materials prepared by a learner to demonstrate learning in response to a plan. There is increasing evidence of the utility of portfolios for assessment of learning and for competency assurance in health care.

For a portfolio to be effective, it should include:

  • a learning plan that contains specific goals and objectives
  • materials that demonstrate achievement relative to the learning plan
  • learner reflections
  • learner and faculty evaluations of the material

The ACGME, in its draft Toolbox of Assessment Methods, provides some information about the properties and uses of portfolios for assessment.

Information at: http://www.acgme.org/outcome/assess/toolbox.asp

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360-Degree Assessment

As a group, professional and ethical skills may be assessed from the perspectives of the various participants with whom one interacts in the setting of interest. This type of assessment, known as 360-degree assessment, relies on the judgments of individuals at various levels – supervisors, peers, subordinates, and in some instances, clients – to provide a complete picture of the learner’s skills.

While this type of assessment has been used more in business organizations than in health care, the ACGME, in its table of toolbox methods, suggests that 360-degree ratings are a desirable way to assess a number of competencies. The ACGME’s Toolbox of Assessment Methods provides some information about the properties and uses of portfolios for assessment.

Research to date shows that, in general, comprehensive feedback such as that provided in a 360-degree assessment, can improve performance. While the notion that comprehensive feedback such as that gathered in a 360-degree assessment will inform and influence behavior is attractive, research to date shows that the realization of this utility is guarded. Atwater and Brett (2005) studied ratings by others, self-ratings, and motivation. They found that leaders who were rated low by others were more motivated to make change if they self-rated themselves higher, that is, if they over-rated themselves, than leaders who agreed with the low ratings bestowed by others. Morgan and his colleagues (2005) noted that, “The underpinning assumption in the adoption of 360° feedback is that it heightens an individual’s self-awareness by highlighting differences between how participants see themselves and how others see them. This statement implies that awareness motivates development and improves performance.” Their study found that this was not the case in that the desired self-awareness was not achieved in the organizational setting where the study was conducted.

Collecting assessment information from the perspectives represented by multiple others offers one way to gather a more complete picture of the learner’s skills.

Information at: http://www.acgme.org/outcome/assess/toolbox.asp

Atwater, L. E. & Brett, J. F. (2005). Antecedents and consequences of reactions to developmental 360-degree feedback. Journal of Vocational Behavior. 66: 532-48.

Morgan, A., Cannan, K., & Cullinane, J. (2005). 360-degree feedback: A critical enquiry. Personnel Review. 34(6): 663-80.

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Case Studies

Case studies provide a way to evaluate learners’ skills by use of standardized experiences that ask the learner to describe the ways in which she or he would respond to specific situations. Case studies could be useful in assessing the ability of learners to identify ethical dilemmas in the delivery of health care.

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