Top Things to Know: 2020 Consensus Conference on Professionalism and Ethics
Published: May 11, 2021
Prepared by Katherine A. Sheehan, PhD
- Building on their long history of collaboration to formally address issues of medical ethic and professionalism, the AHA and ACCF convened the 2020 Consensus Conference to update guidance from the 2004 Consensus, and to address important and timely topics including diversity, equity, inclusion and belonging, racial, ethnic and gender inequities, clinician well-being, data privacy, social justice, and modern health care delivery systems.
- This joint AHA/ACCF effort is based on the common ground of understanding put forward by the prior conferences, including the obligations of medicine’s social contract, the tenets of medical ethics, and the principles and commitments of medical professionalism, with the purpose of making specific recommendations to address contemporary issues.
- The consensus conference attendees represented a broad range of expertise in various aspects of cardiovascular medicine, with this report summarizing the discussions and recommendations of that conference. The writing committee consisted of a diverse group of cardiologists, internists, and associated professionals, organized into five Task Forces, each addressing a set of related topics. Invited partners included representatives from industry, the Heart Failure Society of America, the Preventive Cardiology Nurses Association, the American College of Preventive Medicine, the American Association for Thoracic Surgery, and the American College of Physicians.
- Task Force One addressed topics of Navigating Conflicts: Relationships with Industry and Conflicts of Interests in Teaching and Publications, Peer Review, Research Data, Technology, and Expert Testimony. The included guidance covers disclosure of RWI for educational activities and scientific publications, disclosure of associational and intellectual interests, management of external assessments, such as through CMS Open Payments. Also addressed are ethical issues associated with human subjects research (HSR), peer review and grant study sections, and expert testimony.
- Task Force Two looked at issues of diversity, equity, inclusion and belonging (DEIB), from the viewpoint of healthcare professionals and trainees, including recognition of problems of racial, ethnic, gender and other inequities in the cardiovascular community, followed by embracing and incentivizing change. A road map is presented for assessing the environment, providing trainings, and creating metrics, which together can form a framework for actively identifying and addressing these issues.
- Task Force Three addressed preventing burn-out through proactively enhancing the well-being of clinicians via organizational strategies and training programs for trainees and researchers to promote a work environment that actively supports and is accountable for the psychosocial health of their members. Guidance is provided for defining disruptive behavior, developing a code of behavior policies, as well as identifying and assisting the impaired or disruptive clinician, including confidential reporting of concerns, intervention, and rehabilitation.
- Task Force Four addressed contemporary issues of patient autonomy as it relates to clinical decision-making, privacy, data access, and transparency in the context of expanding research and electronic data, as well as social justice in medical education and clinical practice as it relates to the patient. Guidance is provided for shared decision making (SDM) processes, research protocol creation and registry, and best practices for use of electronic health record (EHR) data sets. Social justice and racism are addressed through awareness and education programs and metrics for ongoing evaluation planning and action.
- Task Force Five developed guidance for challenges to the clinician’s responsibility to patients and society in the context of modern health care delivery, and the employed clinician, including maintenance of altruistic behaviors, dedication to honesty and transparency, avoidance of conflicts of interest, focus on patient-centered care, and commitment to equity and fairness in a value-based model of care. Clinician financial interests in alternative sites of care are discussed as well as issues of balance between patient goals and quality metrics and challenges related to billing, coding, documentation and EHRs in the context of the Quadruple Aim; patient satisfaction, outcomes and quality, cost, and clinician satisfaction.
- This consensus conference report addresses current challenges in professionalism and ethics for clinicians in previously addressed topics such as conflict of interest and relationship with industry, and in areas with emerging challenges, such as diversity, equity, inclusion and belonging in cardiovascular care and the elimination of bias, discrimination, harassment and racism, clinician well-being and burnout, patient autonomy, privacy and social justice in health care, and challenges to patient-centered care for clinicians employed by health care systems.
- The updated guidance in this consensus conference report is intended to provide concise, timely and actionable steps for cardiovascular professionals, researchers, and educators, to support robust ethical personal and professional behaviors and organizational actions and policies within the context of the current healthcare and scientific environment.
Citation
Benjamin IJ, Valentine CM, Oetgen WJ, Sheehan KA, Brindis RG, Roach WH Jr, Harrington RA, Levine GN, Redberg RF, Broccolo BM, Hernandez AF, Douglas PS, Pina IL, Benjamin EJ, Coylewright MJ, Saucedo JF, Ferdinand KC, Hayes SN, Poppas A, Furie KL, Mehta LS, Erwin JP 3rd, Mieres JH, Murphy DJ Jr, Weissman G, West CP, Lawrence WE Jr, Masoudi FA, Jones CP, Matlock DD, Miller JE, Spertus JA, Todman L, Biga C, Chazal RA, Creager MA, Fry ET, Mack MJ, Yancy CW, Anderson RE. 2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: a consensus conference report [published online ahead of print May 11, 2021]. Circulation. doi: 10.1161/CIR.0000000000000963