Teaching ethics is crucial to health sciences education. Doing it well requires a willingness to engage contentious social issues. Those issues introduce conflict and risk, but avoiding them ignores moral diversity and renders the work of ethics education irrelevant. Therefore, when (not if) contentious issues and moral differences arise, they must be acknowledged and can be addressed with humility, collegiality, and openness to support learning. Faculty must risk moments when not everyone will “feel safe,” so the candor implied in psychological safety can emerge. The deliberative and social work of ethics education involves generous listening, wading into difference, and wondering together if our beliefs and arguments are as sound as we once thought. By forecasting the need for candid engagement with contentious issues and moral difference, establishing ground rules , and bolstering due process structures for faculty and students, a riskier and more relevant ethics pedagogy can emerge. Doing so will prepare everyone for the moral diversity they can expect in our common life and in practice.

Background The use of telemedicine (TELE) increased exponentially during the COVID-19 pandemic. While patient experience with TELE has been studied in other medical disciplines, its impact and applicability to integrative medicine practices remain unknown. Objective The aim of this study is to assess the impact of visit modality, TELE versus face-to-face (F2F) encounters, on patient experience at an integrative medicine practice at a single academic medical center. Given the significant role of the patient-physician relationship, therapeutic presence, and touch in integrative medicine, we hypothesized that TELE would result in reduced patient experience compared to traditional F2F encounters. Methods A retrospective examination of Press Ganey surveys at an academic, consultative, and integrative medicine practice was conducted. Anonymous surveys completed by patients, older than 18 years of age, who had TELE or F2F appointments from April 1, 2020, to March 31, 2023, were included. At our medical center, patients commonly travel in from out of state for complex care. We examined percentage “top box” scores (ie, the percentage of respondents who selected the most positive response category on the survey, “very good”), across a variety of experience metrics. ANOVA and chi-square analyses were completed, with a significance threshold of P<.05. Results Over the 36 months, a total of 1066 surveys were completed and returned (TELE: n=333; F2F: n=733). Overall, 73% (n=778) of respondents were female with an average age of 57.6 (SD 13.84) years. Most patients were English-speaking (n=728, 99.3%), White (n=1059, 92.7%), and not Hispanic or Latino (n=985, 92.4%). There was significantly higher satisfaction with access to care for TELE visits compared to F2F visits. There were no differences in satisfaction with the care provider or in overall experience. When examining the specific aspects of using technology during TELE visits, there were no differences in audio quality, visual quality, or ease of talking to the care provider based on sex. There was, however, a difference in video quality based on age, where those 80 years and older rated significantly lower video quality compared to all other age groups. Conclusions Top-level patient experience can be attained with TELE integrative medicine visits. Additional studies, particularly those correlating positive experience findings with specific behaviors used during TELE visits, would further our understanding of the integrative medicine patient experience. In the meantime, efforts should be made to ensure a policy that promotes the ongoing provision of TELE in integrative medicine.

Background: The use of telemedicine (TELE) increased exponentially during the COVID-19 pandemic. While patient experiencewith TELE has been studied in other medical disciplines, its impact and applicability to integrative medic ine practices remainunknown. Objective: The aim of this study is to assess the impact of visit modality, TELE versus face-to-face (F2F) encounters, on patientexperience at an integrative medicine practice at a single academic medical center. Given the significant role of the patient-physicianrelationship, therapeutic presence, and touch in integrative medicine, we hypothesized that TELE would result in reduced patientexperience compared to traditional F2F encounters. Methods: A retrospective examination of Press Ganey surveys at an academic, consultative, and integrative medicine practicewas conducted. Anonymous surveys completed by patients, older than 18 years of age, who had TELE or F2F appointments fromApril 1, 2020, to March 31, 2023, were included. At our medical center, patients commonly travel in from out of state for complexcare. We examined percentage "top box" scores (ie, the percentage of respondents who selected the most positive responsecategory on the survey, "very good"), across a variety of experience metrics. ANOVA and chi-square analyses were completed,with a significance threshold of P<.05. Results: Over the 36 months, a total of 1066 surveys were completed and returned (TELE: n=333; F2F: n=733). Overall, 73%(n=778) of respondents were female with an average age of 57.6 (SD 13.84) years. Most patients were English-speaking (n=728, 99.3%), White (n=1059, 92.7%), and not Hispanic or Latino (n=985, 92.4%). There was significantly higher satisfaction withaccess to care for TELE visits compared to F2F visits. There were no differences in satisfaction with the care provider or in overallexperience. When examining the specific aspects of using technology during TELE visits, there were no differences in audioquality, visual quality, or ease of talking to the care provider based on sex. There was, however, a difference in video qualitybased on age, where those 80 years and older rated significantly lower video quality compared to all other age groups. Conclusions: Top-level patient experience can be attained with TELE integrative medicine visits. Additional studies, particularlythose correlating positive experience findings with specific behaviors used during TELE visits, would further our understandingof the integrative medicine patient experience. In the meantime, efforts should be made to ensure a policy that promotes theongoing provision of TELE in integrative medicine.