1. Provide
the definition and basic concepts behind the following terms used in
medical ethics:
a.
Morality versus ethics (intent-based standards versus conduct-based
standards)
b.
Autonomy and surrogacy
c.
Beneficence
d.
Nonmaleficence
e. Truth
telling
f.
Distributive justice
g.
Fiduciary responsibility to patients
h.
Compassion
2.
Describe the ethical principles listed in the following key medical
documents:
a.
Hippocratic Oath1
b.
Declaration of Geneva2
c. Ethical
Code, International Council of Ophthalmology3
d. Code of
Ethics, American Academy of Ophthalmology4
3.
Describe the basics of ophthalmic practice management:
a. Partnership
arrangements
b. Income
distribution methods
c. Contractual
negotiations
d. Hiring
and supervising of employees
e. Basic
accounting
i. Profit/loss
statements
ii. Billing
iii. Collections
f. Financial
management
4.
Describe the basics of the health care system and reimbursement for
services as appropriate to the local, regional, and national market
of the trainee (eg, medical documentation, third party payers,
managed care, Medicare [USA], Medicaid [USA], private insurance,
nationalized health care systems [United Kingdom, Canada, and
others]).
Standard
Level Goals: Year 2
1. Describe
basic medical ethics in the ophthalmic practice, including:
a. Confidentiality
of health information
b. Professional
competence and maintenance of competence
c. Informed
consent
d. Responsibility
to report the unethical conduct of others
e. Adequate
patient assessment and avoidance of under/over treatment and
under/over testing
2. Identify
elements of effective physician-patient communication, including:
a. Relevant
cultural and linguistic differences that potentially influence
ethical delivery of services
3.
Describe advanced aspects of practice management (eg, business
models, documentation requirements and coding, privacy requirements,
accommodating patients or employees with disabilities).
4.
Describe advanced aspects of health care reimbursement (eg,
physicians' role in managed care organizations, administrative role,
third-party reimbursement, capitated programs).
5.
Describe the framework of patient-care quality as it relates to
patient safety, patient advocacy, effectiveness, efficiency,
timeliness, and equity.
6.
Describe how ophthalmologists are responsible for ensuring that all
those in the service area of the practice have access to affordable
eye care, and define how ophthalmologists are uniquely trained and
certified to do so.
7.
Identify the various missions of ophthalmology organizations with
respect to service to members, patients, clinical education, quality
of care. Define and mitigate the consequences of conflicting
missions.
8.
Identify how participation of ophthalmologists in ophthalmology
organizations serves the profession and society.
9.
Identify the responsibilities of ophthalmologists and ophthalmology
societies to ensure that everyone has the right to sight.
Advanced
Level Goals: Year 3
1. Recognize
and use advanced medical ethics in the ophthalmic practice:
a. Applicable
informed consent documents (eg, clinical research, off-label use
disclosures)
b. Management
(offering and rendering) of second opinions
c. Individual
and institutional responsibilities regarding impaired physicians
d. Responsibility
for postoperative care, including appropriate transfer of care to
other physicians
e. Appropriate
delegation to limited license auxiliaries
f. Fairness
of fees
g. Management
of conflicts of interest (clinical and nonclinical)
i. Disclosures
ii. Gifts
to physicians
h. Appropriate
advertising (and applicable laws)
i. Appropriate
conduct as a medical-expert witness in litigation
2. Describe
the ethical principles listed in the following key medical documents
regarding research involving human subjects:
a. Nuremburg
Code5
b. Declaration
of Helsinki6
c. Belmont
Report7
3. Identify
applicable insurance coverage responsibilities in a practice
situation.
4. Utilize
more advanced aspects of health care reimbursement in a clinical
practice (eg, denials of claims, hospital contracting, electronic
billing).
5. Work
within integrated eye care delivery systems (both within eye care
specialties and within general medicine and surgery).
6. Participate
in all of the foregoing aspects of practice management to the best
ability within a medical education setting.
7. Utilize
all of the foregoing ethical principles and knowledge in direct
patient care.
8. Describe
the responsibility of ophthalmologists to share their knowledge of
clinical arts and sciences for the benefit of patients, the
profession, and society.
Medical
Ethics Documents
1. Hippocratic
Oath
2. Declaration
of Geneva, World Medical Association
3. Ethical
Code, International Council of Ophthalmology
4. Code of
Ethics, American Academy of Ophthalmology
5. Nuremburg
Code
6. Declaration
of Helsinki, World Medical Association
7. Belmont
Report
*
* *
Note:
Inclusion of therapies and investigations in the ICO Residency
Curriculum does not imply that listings are all inclusive or that
methods are endorsed by the ICO. Appropriate levels of expertise and
knowledge should be achieved based on the care provided.
Practitioners should know of therapies and investigations not
available at their hospital or clinic, so that they can advise
patients who may be able to seek care elsewhere.
