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Liver Transplant Organ Quality Decision Aid: Would you consider a less than perfect liver? (Jan-16)

Imagine that you are a patient with end-stage liver disease and you are currently on the liver transplant waiting list.

Available donor livers are limited and vary in quality. Donor characteristics such as age and cause of death can make a difference between a 20% and a 40% rate of liver transplant (graft) failure by 3-years post-transplant.

Now imagine that you and your doctor are discussing the risks and benefits of a liver transplant and whether you might consider a “less than perfect” liver (with a higher risk for graft failure).  To help you in your decision making, you are provided with a decision aid to help you to consider the level of risk you would be willing to accept from a donated liver.

On the following page, consider an image representing your (pretend!) risk of dying or becoming too sick for a liver transplant within the next 3-months if you don’t get a transplant.

Funded by Patient Centered Outcomes Research Institute.

Funding Years: 2012-2014.

While substantial progress has occurred recognizing community expertise in research, and involving communities in decisions about research aims and methods, community influence on research priorities remains limited. Building on experience with developing, testing and using the award-winning CHAT (Choosing Healthplans All Together) tool, and propelled by a current project that is developing and evaluating a tool to engage minority and underserved communities in setting priorities for clinical and translational research, we plan to develop and test a method to engage the public and patients in deliberations about patient-centered outcomes research (PCOR) priorities. The proposed study expands public input on research priorities beyond the limited settings of advisory boards and disease advocates in which much public engagement currently functions and contribute to a more just and equitable system of PCOR. Importantly, by evaluating the tool this project will also add to the body of knowledge about methods, processes and outcomes of community engagement. For more information, visit PCORI.

PI(s): Susan Goold

Co-I(s): Lawrence An, Ray De Vries, Jennifer Griggs,  Myra Kim


Tue, February 06, 2018

Naomi Laventhal was recently interviewed for a Smithsonian Magazine article entitled, "Now You Can Genetically Test Your Child For Disease Risks. Should You?"  In this article, studies by several CBSSM faculty and staff were highlighted.

Medical Students

Systematizing the Teaching of Medical Ethics in the Undergraduate Medical Years

Medical students at the University of Michigan encounter ethical issues throughout their four years of training.  Some are obvious – decisions at the end of life, the allocation of scarce of medical resources, challenges to patient autonomy – others are less obvious – relationships between medical residents and medical students, problems with the “hidden curriculum,” and systemic discrimination in the provision of care.  Our goal is to make students aware of the variety of ethical problems in medical care and to equip them to respond to these problems in a wise and responsible manner.

To that end, our curriculum efforts focus on extending the existing curriculum and on making the medical ethics curriculum for undergraduate medical students at UM more systematic and explicit. Because we want students to become well-versed in thinking through ethical dilemmas before they encounter them in their clinical work we weave ethics into the curriculum throughout the 4 years of their undergraduate training. We use the expertise of our CBSSM faculty to create novel curricular components that incorporate our empirical work in bioethics with our particular expertise in decision science.

Increasing Opportunities for Ethics Teaching in the Clerkship Years

Discussions During Required Clinical Rotations

We facilitate regular ethics discussions for medical students at the end of their required clinical rotations in Obstetrics and Gynecology (in the third year) and Emergency Medicine (in the fourth year). To facilitate these discussions, students prepare short essays on ethical dilemmas encountered in these clerkships.  Students are given a summary of all the issues that came up that rotation, which is used as a starting point for a discussion facilitated by a clinical faculty member trained in ethics. In addition, the Internal Medicine subinternship (an option for fourth year students) includes an ethics discussion at the end of the rotation.

These discussions allow medical students to bring up concerns with ethical dilemmas in a safe environment, teach the students about approaches to ethics, and embed training in ethical decision-making in clinical practice. This is often the first time students learn about the role of the hospital ethics committee and how they can contact them if desired.

     “That was unexpectedly awesome!"  

-- Medical student after Ob/Gyn ethics discussion


Advanced Medical Therapeutics Ethics Module

All fourth year medical students are required to take an online Advanced Medical Therapeutics course. As part of the course, we created an ethics module that includes multiple cases that present ethical dilemmas.  Each case includes pre-recorded videos of faculty discussing the ethical aspects of the case and interactive components requiring students to choose possible solutions to the problem, after which they receive explanations of the pros and cons of their choice.

Medical Ethics Path of Excellence

CBSSM faculty work closely with the medical school to strengthen the medical ethics curriculum for Michigan medical students.  Our goal is to make students aware of the broad range of  ethical challenges facing 21st century medicine – challenges in clinical care, medical research and the design of health care delivery. Most recently, a team of CBSSM faculty developed the Medical Ethics Pathway of Excellence, an opportunity for students to receive mentored training in ethics throughout their four years of medical school.

Overview of Medical Ethics Pathway to Excellence:

  • Introduced in September 2013, the first 10 students were accepted in 2014. Twelve students joined in 2015.
  • Students apply to the Ethics Path of Excellence at the end of February during their M1 year, and continue their studies through their M4 year. Students in the POE learn to:
    • Identify ethical issues in the organization and delivery of health care
    • Implement tools and strategies to address ethical issues
    • Continue their professional education and development of the skills required for leadership
  • Highlights:
    • Before applying to the Ethics Path of Excellence, students have the opportunity to attend fourteen interactive lunchtime lectures that review various aspects of ethics in a healthcare setting. Applicants must attend a minimum of five of these lectures.
    • Students who want to serve on ethics committees and/or include ethics as part of an academic career are provided with specialized training.
    • All students participate in an individualized, independent study, culminating in a capstone project in the M4 year. Often this work includes field work at CBSSM.

Beginning in 2015, the Path of Excellence has been responsible for administering the core ethics curriculum for all of the M1 students. The Ethics Path of Excellence will continue to be a co-curricular activity until 2017 when all students will be required to choose one of the paths offered in the medical school.

“We really want to educate people to be the ethics committee consultants of the future. I think it's pretty unique to have the option of pursuing this extracurricular program because essentially it teaches you leadership skills and how to be a self-directed learner. These are skills you'll really need when you become faculty. Students can take their interest in ethics and pursue it further.”             
Lauren Smith, M.D., Associate Professor of Pathology

Lauren Smith is the Director of the Path of Excellence. Andrew Barnosky, Christian Vercler, Ed Goldman, Kathryn Moseley, Janice Firn, Sacha Montas, and Raymond De Vries are core faculty members.

Start Seeing Ethics Lunch Discussions

As part of the Medical Ethics Path of Excellence, we offer lunch time discussions of cutting-edge topics in ethics. The content of these discussions includes topics such as conscientious objection, mandatory vs. optional vaccinations, patient centered care and shared decision making.  We have also used these discussions to hold mock ethics committee meetings with discussion of a specific case. Facilitators provide a relaxed atmosphere in which students can feel comfortable asking questions and voicing opinions.


"It is exciting to see medical students engage with the ethical issues that arise in the clinic and the classroom.  With encouragement from us they are beginning to see that there is more to medical ethics than just the well-known issues at the beginning and end of life.  While these ethical issues are important, there are also moral consequences associated with the mundane aspects of being a student and working with patients." Raymond De Vries, PhD, Director, Ethics Education Initiative


Funded by Foundation for Informed Medical Decision Making

Funding Years: 2007 -2008


The National Survey of Medical Decisions (the DECISIONS study), co-led by CBDSM investigators Mick Couper (PI) and Brian Zikmund-Fisher (co-I), is a unique effort to collect nationally representative data about when and how middle-aged and older adults manage the medical decisions they face.

The DECISIONS study consisted of a random digit dial telephone survey of 3,010 adults over the age of 40 in the United States conducted between November 2006 and May 2007.  Participants were asked a series of screening questions to identify which of 10 common medical decisions they may have discussed with their health care providers in the previous two years and then completed 2-3 question modules regarding specific decisions that were relevant to each individual. 

Its initial screening module gathered highly generalizeable data regarding the prevalence of different types of common medical decisions in the experience of older Americans.  Its dynamically-administered modules then requested detailed information regarding how and when patients discuss key medical decisions with their health care providers and whether variations in decision-making processes may have influenced patients’ medical care. 

Funded by the Foundation for Informed Medical Decision Making (FIMDM), the DECISIONS project has been a highly collaborative project that has included investigators from Institute for Social Research and FIMDM, as well as CBDSM. In addition, FIMDM-affiliated researchers from around the country are analyzing DECISIONS data to inform their research. While the initial papers from the DECISIONS dataset will be by core investigators, the study team intends to make the dataset publicly available for more widespread use sometime in 2009.

Mick Couper (PI)

This month’s Bioethics Grand Rounds features Alan Tait, Ph.D., endowed professor and director of clinical research, Department of Anesthesiology.

He will present at the Ford Auditorium at noon on May 22.

Please feel free to bring your lunch and join us for a lively discussion of medical ethics. The Bioethics Grand Rounds is sponsored by the UMHS Adult Medical Ethics Committee and the Program of Society and Medicine. This educational session is open to all faculty and staff and members of the public.

CME and CEU credit is available.

Web Address:

Funded by Health and Human Services, Department of-Agency for Health Care Research and Quality

Funding Years: 2014-2016

This grant aims to engage communities, particularly underserved communities, in informed deliberations about current and potential changes to Medicaid eligibility, coverage, and cost-sharing. Building on community-based research partnerships state-wide, we will convene a Steering Committee including community leaders, researchers, decision makers in private healthplans and the Michigan Department of Community Health (MDCH) and other stakeholders. We will adapt an innovative, award-winning web-based simulation exercise, CHAT (CHoosing All Together, in which individuals and groups make tradeoffs between competing needs for limited resources. Options in Medicaid-CHAT may include variations in covered benefits; out-of-pocket spending; population health and public health programs; rewards for healthy behaviors; and quality improvement activities. We will facilitate deliberations throughout the state, disproportionately sampling medically underserved communities and balancing locale (urban, suburban, rural and remote rural) and sociodemographic characteristics, ensuring inclusion of particular perspectives, e.g., those with chronic illness and those who are or will soon be eligible for Medicaid coverage or dually eligible.

We will prepare policy briefs describing the views of Michigan citizens about Medicaid eligibility, coverage, and cost-sharing and implications for policy. We aim to communicate Medicaid priorities of communities and the policy implications to state leaders, community leaders, insurers, and other stakeholders. We will examine the impact of public engagement on participants’ knowledge, attitudes, and priorities, and explore the impact on policy decisions.

We will also evaluate the effect of deliberations including a key element of deliberative procedures – representation.

PI(s): Susan Goold, MD, MHSA, MA

Co-I(s): A. Mark Fendrick, MD; Hyungjin Kim, PhD; Richard Lichtenstein, MD

2012 CBSSM Research Colloquium

Fri, May 18, 2012 (All day)

The 2012 Research Colloquium presentations by U-M faculty, fellows and students highlighted research on medical decision making.  The colloquium presenters and their topics were as follows:

  • Melissa Constantine, PhD: Making a baby in the 21st century: An updated user manual
  • Vida Henderson, PharmD, MPH, MFA, and Deliana Ilarraza: Using community-based participatory research and user-centered design approaches in developing an interactive diabetes decision aid
  • Naomi Laventhal, MD, MA, and Stephanie Kukora, MD: Resident attitudes toward ethical and medical decision-making for neonates born at the limit of viability
  • Kathryn Moseley, MD, MPH: Distrust of pediatricians' sleep advice: Focus group results from the Project for African American Infant Safety
  • Laura Scherer, PhD: What's in a name? The effect of a disease label on parents' decision to medicate a colicky infant
  • Lauren Smith, MD: Cracking the code: Ethical issues involved in the decision to undergo genetic testing
  • Ralph Stern, MD: The myth of individual risk
  • Wendy Uhlmann, MS, CGC: The swinging gate: Genetic testing and ethical issues

Bioethics Grand Rounds with Jeffrey Punch, MD

Wed, September 24, 2014, 12:00pm to 1:00pm
Ford Auditorium

Grand Rounds

Box Lunches will be provided courtesy of the Center For Bioethics and Social Sciences in Medicine.

This month's grand rounds features Jeffrey Punch, MD.

Please join us for a lively discussion of medical ethics. The Bioethics Grand Rounds is sponsored by the UMHS Adult Medical Ethics Committee and the Program of Society and Medicine. This educational session is open to all faculty and staff and members of the public. CME and CEU credit is available.


Bioethics Grand Rounds with Aisha Langford, PhD

Wed, December 10, 2014, 12:00pm to 1:00pm
Ford Auditorium

Grand Rounds for December

Box Lunches will be provided courtesy of the Center For Bioethics and Social Sciences in Medicine.

This month's grand rounds features Aisha Langford, PhD.

Please join us for a lively discussion of medical ethics. The Bioethics Grand Rounds is sponsored by the UMHS Adult Medical Ethics Committee and the Program of Society and Medicine. This educational session is open to all faculty and staff and members of the public. CME and CEU credit is available.