This scenario is professionally challenging because it requires an Advanced Internal Medicine Consultant to balance the immediate demands of patient care with the long-term imperative of advancing medical knowledge and practice through research and quality improvement initiatives. The consultant must navigate the complexities of integrating new evidence into practice, ensuring patient safety, and contributing to the broader scientific community, all within a resource-constrained environment. Careful judgment is required to prioritize activities that yield the greatest benefit for both individual patients and the healthcare system. The best approach involves proactively identifying a specific clinical area with suboptimal outcomes or known evidence gaps within the consultant’s practice. This would then lead to the systematic design and implementation of a quality improvement project or a research study, leveraging simulation for training and skill development where appropriate. The findings from this initiative would then be rigorously translated back into clinical practice, potentially through updated protocols, educational sessions for colleagues, or presentations at professional forums. This aligns with the ethical obligation to provide the highest standard of care and contribute to the collective knowledge base of medicine, as expected in advanced credentialing frameworks that emphasize continuous learning and evidence-based practice. An incorrect approach would be to solely focus on individual patient management without a systematic effort to learn from or improve upon those cases. This neglects the responsibility to contribute to the advancement of medical science and the improvement of care for future patients. It fails to meet the expectations of advanced credentialing that require a commitment to research and quality improvement. Another incorrect approach would be to initiate research or quality improvement projects without a clear link to observed clinical needs or established evidence gaps. This can lead to inefficient use of resources and may not yield clinically relevant improvements. It also risks generating research that is not easily translatable into practice, thus failing to fulfill the research translation expectation. A further incorrect approach would be to rely solely on external research findings without actively participating in their generation or adaptation to the local context. While staying abreast of literature is crucial, advanced practitioners are expected to be active contributors to the evidence base and to critically evaluate and implement research findings in a way that is tailored to their specific patient population and healthcare setting. This passive approach misses opportunities for impactful local innovation and improvement. Professionals should employ a structured decision-making process that begins with a thorough assessment of their clinical environment to identify areas ripe for improvement or further investigation. This should be followed by a critical review of existing literature and guidelines. Once a focus is established, the consultant should consider the most effective methodologies, including simulation for skill acquisition, and develop a plan for rigorous data collection, analysis, and dissemination. The ultimate goal is to create a virtuous cycle of learning, improvement, and knowledge generation that benefits patients and the profession.

The monitoring system demonstrates a critical need for robust candidate preparation resources and timeline recommendations for the Global Advanced Internal Medicine Consultant Credentialing process. This scenario is professionally challenging because the credentialing body bears a significant responsibility to ensure that candidates are adequately prepared, thereby safeguarding patient safety and maintaining the integrity of the profession. Inadequate preparation can lead to unqualified individuals obtaining credentials, posing risks to public health and eroding trust in the credentialing process. Careful judgment is required to balance the need for thorough preparation with the practical realities of a candidate’s professional life. The best approach involves a multi-faceted strategy that provides comprehensive, structured, and adaptable preparation resources. This includes offering detailed syllabi outlining the scope of knowledge and skills assessed, curating a list of recommended, peer-reviewed study materials and practice assessments, and providing clear, realistic timeline recommendations that account for the typical demands on experienced internal medicine consultants. Furthermore, offering flexible access to these resources and support mechanisms, such as webinars or Q&A sessions with subject matter experts, ensures that candidates can tailor their preparation to their individual learning styles and existing commitments. This approach is correct because it directly addresses the core requirements of the credentialing process by equipping candidates with the necessary tools and guidance for success, thereby upholding the ethical obligation to ensure competence and patient safety. It aligns with best practices in professional development and credentialing, which emphasize support and clarity for candidates. An approach that relies solely on a generic list of textbooks without specific guidance on their relevance to the credentialing exam content is professionally unacceptable. This fails to provide targeted preparation, potentially leading candidates to waste time on irrelevant material and increasing the risk of them being underprepared. It neglects the ethical duty to facilitate effective preparation. Another professionally unacceptable approach is to provide overly aggressive and rigid timeline recommendations that do not account for the demanding schedules of practicing consultants. This can create undue stress and pressure, potentially leading to burnout or rushed, superficial preparation, which compromises the quality of assessment and the credentialing body’s commitment to ensuring genuine competence. Finally, an approach that offers minimal or outdated preparation resources, such as relying on anecdotal advice or non-peer-reviewed materials, is ethically flawed. This demonstrates a lack of commitment to the credentialing process’s integrity and fails to equip candidates with the most current and relevant knowledge, thereby jeopardizing patient care and the reputation of the credentialing body. The professional reasoning process for similar situations should involve a stakeholder-centric approach. This means actively considering the needs and challenges faced by the candidates (experienced consultants), the credentialing body’s mandate (ensuring competence and public safety), and the broader impact on the profession and patient care. A framework that prioritizes clarity, accessibility, and evidence-based support in resource and timeline recommendations will lead to a more effective and ethical credentialing process.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the need for timely and accurate diagnosis with the responsible use of healthcare resources and patient safety. The consultant must navigate potential biases, ensure appropriate utilization of advanced imaging, and maintain a high standard of diagnostic reasoning, all within the framework of established clinical guidelines and ethical practice. The pressure to provide a definitive diagnosis quickly can sometimes lead to premature or unnecessary investigations, impacting patient care and system efficiency. Correct Approach Analysis: The best professional practice involves a systematic, evidence-based approach to diagnostic reasoning that prioritizes clinical information and judicious imaging selection. This begins with a thorough history and physical examination to formulate a comprehensive differential diagnosis. Subsequent imaging should be selected based on the most likely diagnoses, considering the diagnostic yield, potential risks, and cost-effectiveness. Interpretation of imaging must be performed by qualified professionals, with clear communication of findings and their implications for patient management. This aligns with the ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm), as well as professional standards for diagnostic accuracy and resource stewardship. Incorrect Approaches Analysis: One incorrect approach involves immediately ordering the most advanced or comprehensive imaging modality available without a clear clinical indication or a well-defined differential diagnosis. This can lead to over-investigation, unnecessary radiation exposure or contrast agent risks for the patient, increased healthcare costs, and potential for incidental findings that cause further anxiety and investigation. It fails to adhere to the principle of proportionality in diagnostic workup. Another incorrect approach is to rely solely on imaging findings without integrating them with the patient’s clinical presentation. This can lead to misinterpretation of imaging results, especially in the presence of subtle findings or when imaging is performed without adequate clinical context. It bypasses the crucial step of clinical correlation, which is fundamental to accurate diagnosis and patient management. A further incorrect approach is to delegate the interpretation of complex imaging to individuals without the appropriate specialized training or credentialing. This compromises the accuracy of the interpretation, potentially leading to missed diagnoses or incorrect diagnoses, which directly impacts patient safety and the quality of care. Professional credentialing ensures that individuals possess the necessary expertise to interpret diagnostic information reliably. Professional Reasoning: Professionals should employ a structured diagnostic reasoning process. This involves: 1) gathering comprehensive clinical data (history, physical exam, initial investigations); 2) developing a prioritized differential diagnosis; 3) selecting the most appropriate diagnostic tests (including imaging) based on the differential, considering their diagnostic accuracy, risks, benefits, and cost; 4) interpreting test results in the context of the clinical picture; and 5) formulating a management plan based on the integrated findings. Continuous learning and adherence to professional guidelines are essential.

This scenario presents a professional challenge due to the inherent tension between the need for rapid, evidence-based intervention in acute care and the long-term, holistic management required for chronic conditions, all while integrating preventive strategies. The consultant must balance immediate patient needs with population health goals and resource allocation, demanding sophisticated clinical judgment and adherence to established professional standards. The best approach involves a comprehensive, integrated care plan that prioritizes immediate life-saving interventions for acute exacerbations, followed by the systematic development and implementation of evidence-based management strategies for chronic conditions. This includes proactive identification of risk factors and the integration of preventive measures tailored to the individual patient’s profile and the latest clinical guidelines. This approach is correct because it aligns with the core principles of evidence-based medicine, which mandates the use of the best available research to inform clinical decisions, thereby optimizing patient outcomes across the continuum of care. It also reflects ethical obligations to provide high-quality, patient-centered care that addresses both immediate suffering and long-term well-being. An approach that solely focuses on managing acute exacerbations without adequately addressing the underlying chronic conditions or incorporating preventive measures fails to provide holistic care. This neglects the long-term health trajectory of the patient and may lead to recurrent acute episodes, increased morbidity, and higher healthcare costs. It represents a failure to adhere to the principles of chronic disease management and preventive medicine, which are integral to comprehensive internal medicine. Another incorrect approach would be to prioritize preventive care to the exclusion of managing acute or chronic conditions. While prevention is crucial, ignoring immediate acute needs or failing to manage established chronic diseases can have severe, life-threatening consequences. This approach demonstrates a misunderstanding of the tiered nature of medical care and the immediate responsibilities of an internal medicine consultant. Finally, an approach that relies on anecdotal evidence or outdated practices rather than current, robust research is fundamentally flawed. Evidence-based management requires a commitment to staying abreast of the latest scientific literature and applying it judiciously. Deviating from this principle compromises patient safety and the quality of care, violating professional ethical standards. Professionals should employ a structured decision-making process that begins with a thorough assessment of the patient’s immediate needs, followed by an evaluation of their chronic conditions and risk factors for future illness. This assessment should be informed by the latest evidence-based guidelines and best practices. The development of a care plan should then integrate acute management, chronic disease control, and preventive strategies in a cohesive and prioritized manner, ensuring that all aspects of the patient’s health are addressed.

This scenario is professionally challenging because it requires a nuanced understanding of the purpose and eligibility criteria for advanced credentialing, balancing the needs of the healthcare system with the qualifications of individual practitioners. Misinterpreting these criteria can lead to suboptimal patient care, inefficient resource allocation, and potential regulatory non-compliance. Careful judgment is required to ensure that only truly qualified individuals achieve advanced consultant status, thereby upholding the integrity of the credentialing process and patient safety. The best approach involves a thorough review of the applicant’s comprehensive clinical experience, specialized training, and documented contributions to internal medicine, directly aligning with the stated objectives of the Global Advanced Internal Medicine Consultant Credentialing program. This includes verifying that their practice scope and demonstrated expertise meet the advanced competency standards set forth by the credentialing body, ensuring they are equipped to handle complex cases and contribute to the advancement of the field. This aligns with the program’s purpose of identifying and recognizing highly skilled practitioners who can elevate the standard of care globally. An approach that focuses solely on the number of years in practice without assessing the depth and breadth of experience or specialized competencies is professionally unacceptable. This fails to meet the program’s objective of identifying advanced consultants, potentially credentialing individuals who may not possess the necessary skills for complex internal medicine challenges. It overlooks the qualitative aspects of advanced practice and the program’s intent to recognize specialized expertise. Another professionally unacceptable approach is to prioritize an applicant’s affiliation with prestigious institutions over their individual qualifications and demonstrated competencies. While institutional reputation can be a positive indicator, it is not a substitute for rigorous assessment of an individual’s clinical skills, knowledge, and contributions. This approach risks overlooking highly qualified individuals from less renowned institutions and may not accurately reflect the applicant’s ability to meet the advanced credentialing standards. Finally, an approach that relies on anecdotal evidence or informal recommendations without seeking objective, verifiable data regarding the applicant’s performance and expertise is professionally unsound. The credentialing process demands a systematic and evidence-based evaluation. Relying on informal feedback bypasses the structured assessment required to ensure that candidates meet the rigorous standards for advanced consultant status, potentially compromising the credibility of the credentialing program. Professionals should employ a decision-making framework that prioritizes a holistic and evidence-based evaluation of each applicant against the clearly defined purpose and eligibility criteria of the credentialing program. This involves systematically gathering and assessing all relevant documentation, seeking objective performance data, and ensuring that the assessment process is fair, transparent, and consistently applied to all candidates.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the integrity of the credentialing process with the need to support a highly qualified candidate who may have encountered an unforeseen administrative hurdle. The credentialing body must uphold its established policies for blueprint weighting and scoring to ensure fairness and consistency for all applicants, while also considering the potential impact of a minor, non-substantive deviation on an otherwise exemplary candidate. Careful judgment is required to avoid both undue leniency and overly rigid adherence to policy that could disadvantage a deserving individual. Correct Approach Analysis: The best professional practice involves a thorough review of the candidate’s application and the specific circumstances surrounding the scoring anomaly. This approach prioritizes understanding the nature of the deviation from the established blueprint weighting and scoring policies. If the deviation is determined to be minor, administrative, and does not compromise the candidate’s demonstrated competency in core areas as assessed by the overall examination, then a recommendation for a conditional pass or a targeted re-evaluation of specific competencies, rather than a full retake, would be appropriate. This aligns with the ethical principle of fairness and proportionality, ensuring that the consequences of a minor issue are not disproportionate to the infraction, while still upholding the rigor of the credentialing standards. It also reflects a commitment to supporting the development of advanced internal medicine consultants when their overall qualifications are clearly met. Incorrect Approaches Analysis: One incorrect approach would be to automatically fail the candidate due to any deviation from the exact blueprint weighting, regardless of its nature or impact. This is professionally unacceptable because it demonstrates a lack of nuanced judgment and an overly rigid application of policy. It fails to consider the spirit of the credentialing process, which is to assess overall competency, not merely adherence to administrative minutiae. This approach could lead to the exclusion of highly qualified individuals based on minor, potentially correctable, administrative errors, thereby undermining the goal of advancing the field of internal medicine. Another incorrect approach would be to immediately grant the candidate a pass without any further investigation or consideration of the scoring anomaly. This is professionally unacceptable as it compromises the integrity and credibility of the credentialing process. It suggests that established policies regarding blueprint weighting and scoring can be disregarded for individual candidates, leading to perceptions of unfairness and favoritability among other applicants. This approach erodes trust in the credentialing body and could set a dangerous precedent for future applications. A further incorrect approach would be to mandate a full retake of the examination without exploring less burdensome alternatives. This is professionally unacceptable because it fails to acknowledge the candidate’s overall strong performance and the potential for a less disruptive resolution. A full retake can be a significant financial and time burden, and imposing it for a minor, non-substantive scoring issue is disproportionate and potentially punitive. It does not demonstrate a commitment to supporting the professional development of qualified individuals when alternative, equally effective, assessment methods exist. Professional Reasoning: Professionals should approach such situations by first understanding the specific policies and guidelines governing blueprint weighting, scoring, and retake procedures. They should then gather all relevant information about the candidate’s performance and the nature of any deviation. A critical step is to assess the impact of the deviation on the overall assessment of competency. Decision-making should be guided by principles of fairness, proportionality, and the overarching goal of ensuring competent practitioners. When possible, seeking clarification from policy-setting bodies or senior colleagues can provide valuable perspective. The aim is to achieve an outcome that upholds the standards of the profession while also being just and reasonable to the individual applicant.

The audit findings indicate a potential gap in the consultant’s adherence to established clinical and professional competencies, specifically concerning the management of complex patient cases and interdisciplinary collaboration. This scenario is professionally challenging because it requires the consultant to balance patient advocacy, evidence-based practice, and institutional protocols while navigating potential conflicts or differing opinions within the healthcare team. Careful judgment is required to ensure patient safety and optimal outcomes without compromising professional integrity or regulatory compliance. The best approach involves a structured, evidence-based decision-making framework that prioritizes patient well-being and adheres to professional ethical guidelines. This includes a thorough review of the patient’s condition, consultation with relevant specialists, and clear documentation of the rationale for treatment decisions. This approach is correct because it aligns with the fundamental principles of good medical practice, emphasizing patient-centered care, shared decision-making, and the pursuit of the highest standards of professional conduct as expected by credentialing bodies. It ensures that decisions are not arbitrary but are grounded in clinical evidence and collaborative input, thereby safeguarding against potential errors and promoting accountability. An approach that relies solely on personal experience without seeking further consultation or evidence is professionally unacceptable. This fails to acknowledge the evolving nature of medical knowledge and the potential for bias. It also neglects the ethical imperative to provide the best possible care, which often necessitates seeking diverse perspectives and up-to-date information. Such an approach could lead to suboptimal treatment or missed diagnoses, violating professional standards and potentially patient safety. Another unacceptable approach is to defer all complex decisions to senior colleagues without active participation or understanding of the rationale. While seeking guidance is appropriate, complete abdication of responsibility undermines the consultant’s own professional development and accountability. It suggests a lack of confidence or competence in their own judgment, which is contrary to the expectations of advanced credentialing. This can also lead to communication breakdowns within the team and a lack of cohesive care planning. Finally, an approach that prioritizes expediency or resource limitations over comprehensive patient assessment and management is ethically flawed. While resource management is a reality, it should never compromise the quality of care or lead to decisions that are not in the patient’s best interest. This approach neglects the primary duty of care and can result in inequitable treatment, violating professional and ethical obligations. Professionals should employ a decision-making framework that involves: 1) comprehensive data gathering and assessment; 2) identification of potential diagnoses and treatment options; 3) critical evaluation of evidence and risks/benefits for each option; 4) consultation with interdisciplinary teams and specialists as needed; 5) shared decision-making with the patient and/or their surrogate; 6) clear documentation of the decision-making process and rationale; and 7) ongoing monitoring and reassessment of the patient’s response to treatment.

This scenario is professionally challenging because it requires balancing the immediate need for specialized medical expertise with the established credentialing processes designed to ensure patient safety and quality of care. The pressure to admit a patient quickly can lead to shortcuts that bypass essential verification steps, potentially compromising patient outcomes and violating regulatory standards. Careful judgment is required to navigate these competing demands ethically and legally. The best approach involves initiating the patient’s care while simultaneously expediting the credentialing process through established emergency protocols. This means the admitting physician can provide immediate necessary treatment under a provisional or emergency credentialing status, which is typically granted for urgent situations where a physician has a pending application and is otherwise qualified. This approach prioritizes patient well-being by ensuring timely access to care from a physician who is in the process of being vetted, while still adhering to the spirit of the credentialing framework by actively pursuing full credentialing. This aligns with the ethical imperative to provide care and the regulatory requirement for physicians to be credentialed to practice independently. An incorrect approach involves admitting the patient and allowing the physician to practice without any form of provisional or emergency credentialing. This directly violates the principles of credentialing, which are in place to verify a physician’s qualifications, competence, and adherence to professional standards. Allowing practice without any formal or provisional approval exposes patients to potential harm from an unvetted practitioner and contravenes institutional policies and regulatory mandates that require physicians to be credentialed before independent practice. Another incorrect approach is to delay necessary patient care until the physician has completed the full, standard credentialing process. While adherence to credentialing is crucial, this approach fails to meet the ethical obligation to provide timely medical care, especially in urgent situations. It prioritizes administrative process over immediate patient need, which is contrary to the core mission of healthcare institutions and the ethical duties of medical professionals. Finally, an incorrect approach is to allow the physician to practice under the supervision of another fully credentialed physician without formalizing this arrangement through the credentialing committee or an emergency credentialing pathway. While supervision can be a temporary measure, practicing without explicit institutional approval, even under supervision, can create ambiguity regarding responsibility and liability, and may not fully comply with the institution’s credentialing policies and regulatory expectations for physician practice. The professional decision-making process for similar situations should involve a clear understanding of the institution’s credentialing policies, including provisions for emergency or provisional credentialing. When faced with a situation requiring immediate care from a physician with a pending application, the admitting physician should consult with hospital administration and the credentialing department to determine the most appropriate and compliant course of action. This typically involves activating emergency credentialing procedures, which allow for provisional privileges while the full credentialing process is completed. This ensures patient safety, regulatory compliance, and ethical practice.

The efficiency study reveals a concerning trend in the management of complex chronic conditions, highlighting a gap between foundational biomedical understanding and its consistent application in patient care pathways. This scenario is professionally challenging because it requires clinicians to not only possess deep knowledge of underlying pathophysiology but also to translate that knowledge into effective, evidence-based clinical decision-making frameworks that address the multifaceted nature of chronic diseases. The pressure to improve efficiency, often measured by throughput and resource utilization, can inadvertently lead to a reductionist approach, potentially overlooking the integrated nature of biomedical sciences and their impact on patient outcomes. Careful judgment is required to balance the demands of efficiency with the imperative of providing comprehensive, patient-centered care grounded in robust scientific principles. The best approach involves a systematic, evidence-based clinical reasoning process that integrates current biomedical knowledge with patient-specific factors. This entails a thorough assessment of the patient’s condition, considering the interplay of genetic predispositions, molecular mechanisms, cellular dysfunction, and organ system pathology as they manifest clinically. It requires the clinician to critically evaluate diagnostic data in light of this integrated understanding, formulate differential diagnoses, and develop a management plan that addresses the root causes and systemic effects of the disease, rather than just symptomatic relief. This approach is correct because it aligns with the core principles of internal medicine, emphasizing a holistic and scientifically informed approach to patient care. It is ethically mandated by the principle of beneficence, ensuring that patient care is based on the best available scientific evidence and tailored to individual needs. Furthermore, it upholds professional accountability by demonstrating a commitment to continuous learning and the application of advanced biomedical understanding to clinical practice. An approach that prioritizes rapid symptom management without a thorough investigation into the underlying biomedical drivers of the condition is professionally unacceptable. This failure stems from a disregard for the foundational biomedical sciences, potentially leading to misdiagnosis, delayed treatment of critical underlying pathology, and suboptimal long-term outcomes. It violates the principle of non-maleficence by risking harm through incomplete or incorrect management. Another professionally unacceptable approach is to rely solely on established clinical guidelines without critically appraising them against the latest biomedical research or considering individual patient variations. While guidelines are valuable, they represent a consensus and may not always reflect the most nuanced understanding of complex disease processes or accommodate unique patient presentations. This can lead to a rigid, protocol-driven approach that fails to leverage the full spectrum of biomedical knowledge for optimal patient benefit, potentially neglecting novel therapeutic targets or personalized treatment strategies. A third incorrect approach involves delegating complex diagnostic or management decisions to less experienced staff without adequate oversight or integration of the clinician’s own advanced biomedical knowledge. This can lead to fragmentation of care and a disconnect between the scientific understanding of the disease and its practical application, increasing the risk of errors and compromising the quality of care. It represents a failure of professional responsibility and leadership in ensuring that patient care is consistently informed by the highest standards of medical science. The professional reasoning process for similar situations should involve a structured approach: first, clearly define the clinical problem and its potential underlying biomedical mechanisms. Second, gather and critically appraise all relevant patient data, integrating it with foundational scientific knowledge. Third, formulate a differential diagnosis and consider the most likely pathophysiological explanations. Fourth, develop a management plan that is evidence-based, patient-centered, and addresses the integrated biomedical aspects of the disease. Finally, continuously monitor the patient’s response and reassess the diagnostic and therapeutic strategy based on new information and evolving biomedical understanding.

This scenario presents a significant professional challenge due to the inherent conflict between a patient’s autonomy, the physician’s duty of care, and the complexities of resource allocation within a health system. The physician must navigate these competing demands while upholding ethical principles and regulatory requirements. Careful judgment is required to ensure patient well-being is prioritized without compromising professional integrity or legal obligations. The best professional approach involves a thorough and documented discussion with the patient and their family regarding the proposed treatment, its risks, benefits, and alternatives, ensuring comprehension and obtaining voluntary, informed consent. This aligns with the fundamental ethical principle of patient autonomy, which mandates that competent individuals have the right to make decisions about their own medical care. Furthermore, regulatory frameworks governing medical practice universally emphasize the requirement for informed consent as a prerequisite for any medical intervention. This approach respects the patient’s right to self-determination and ensures that treatment decisions are collaborative and aligned with the patient’s values and preferences. An approach that proceeds with the treatment without fully ensuring the patient’s understanding of the risks and benefits, or without obtaining explicit consent, represents a failure to uphold the principle of informed consent. This could lead to ethical breaches and potential legal repercussions, as it undermines patient autonomy and the physician’s duty to inform. Another unacceptable approach would be to unilaterally decide on a different, less effective treatment based on perceived resource limitations without transparently discussing these concerns with the patient and exploring all available options, including potential financial assistance programs or alternative care pathways. This disregards the patient’s right to receive appropriate care and can be seen as paternalistic, failing to engage the patient as an active participant in their healthcare decisions. Finally, delaying or avoiding the discussion about treatment options due to administrative burdens or fear of patient refusal is professionally negligent. The physician has a clear ethical and professional obligation to engage in these discussions promptly and thoroughly, regardless of potential difficulties. The professional reasoning framework for such situations should involve: 1) Assessing patient capacity to consent. 2) Clearly and comprehensively explaining the diagnosis, proposed treatment, risks, benefits, and alternatives in understandable language. 3) Actively listening to and addressing patient concerns and values. 4) Documenting the informed consent process meticulously. 5) Consulting with colleagues or ethics committees if complex ethical dilemmas arise. 6) Advocating for the patient within the health system to ensure access to appropriate care.