Robert M. Arnold^1,2, Jin Ye Yeo³

¹Department of Geriatrics and Palliative Medicine at the ICAHN School of Medicine at Mount Sinai, New York, USA; ²Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Montefiore University Hospital, Pittsburgh, PA, USA; ³APM Editorial Office, AME Publishing Company

Correspondence to: Jin Ye Yeo. APM Editorial Office, AME Publishing Company. Email: apm@amepc.org.

Expert introduction

Prof. Robert M. Arnold (Figure 1) is currently the Vice Chair for faculty development in the Department of Geriatrics and Palliative Medicine at the ICAHN School of Medicine at Mount Sinai. He is Professor of Medicine and Chief of the Section of Palliative Care and Medical Ethics. He is also Director of Institute for Doctor-Patient Communication, Leo H Criep Chair in Patient Care and Medical Director of UPMC Palliative and Supportive Institute. Prof. Arnold got his BA in Biology and Philosophy and MD from the University of Missouri.

Prof. Arnold's research and educational activities focus on teaching ethics to residents, improving doctor-patient communication regarding palliative care, and changing the culture by developing educational programs in specialties ranging from oncology to critical care medicine. Prof. Arnold is currently developing a structured curriculum on doctor-patient communication for fellows in critical care and trying to better understand the communication barriers. His clinical activities focus on providing palliative care consults in the ambulatory and inpatient clinical areas. He was the president of the American Society of Bioethics and Humanities and of the American Association of Palliative and Hospice Medicine.

Figure 1 Prof. Robert M. Arnold

Interview

APM: What motivated you to pursue a career in medicine, particularly in the field of medical ethics and palliative care?

Prof. Arnold: I decided to become a doctor after my older brother died of leukemia when I was very young. I was able to get into a six-year BA/MD program and because I knew I was going to be a doctor, I majored in philosophy and became interested in bioethics. As my career progressed I saw the importance of communication skills in operationalizing ethical principles and thus my scholarly interest was in how to combine medicine, bioethics, and communication skills. My early career was focused on taking care of HIV-positive patients and palliative care became a natural fit.

APM: Can you discuss your approach to teaching ethics to residents? What concepts do you believe are essential for their training in palliative care?

Prof. Arnold: I think the most important thing in teaching ethics to residents is to help them be very good physicians. Good ethics depends on good facts, and that means that they need to understand their patients, their patient’s stories, and their illnesses. Secondly, physicians need to have virtues, such as compassion and curiosity, which are essential to providing good bioethical care to patients as they are to providing good palliative care. I think that ethical principles, such as autonomy, beneficence, and non-maleficence are crucial within the context of what it is to be a doctor.

APM: One of your research focuses is on changing the culture by developing educational programs across specialties like oncology and critical care medicine. Could you share some of these programs you have developed or are currently working on that have shown positive outcomes? How have these programs evolved in response to changing mindsets among patients?

Prof. Arnold: My career has focused on ensuring that all the clinicians who take care of seriously ill patients are able to talk with patients and their families about what matters the most, and help them cope with what they are going through. We are focused on teaching clinicians core skills, such as providing information, attending to emotions, and learning what matters the most, as skills that every clinician needs when they are caring for seriously ill patients. Given my view that most physicians want to do the right thing but often do not have the skills and have not practiced having these conversations, our core educational programs are communication-based and have helped physicians practice skills in safe settings. We have shown in a number of studies that physicians can learn these skills, and when they attend to emotions and give information clearly, patients have more trust in them and are more satisfied.

APM: What emerging trends and technologies in palliative care do you find most exciting, and how do you see them shaping the future of patient care and education development?

Prof. Arnold: I think what I find most exciting, is that palliative care has been embedded into general good patient care. I think that this is the core educational development that needs to occur so that palliative care is viewed as part of what it is to be a good clinician. Regardless of the technologies that are occurring in clinical care, at the core of medicine, are clinicians communicating with patients and their families.

There is also potential in using artificial intelligence and large-language models to build avatars to allow clinicians to practice these conversations in relatively high-fidelity spaces before they see patients. I think this is quite exciting, and we can use these technologies in addition to the face-to-face teaching that we are doing.

APM: What are your future research goals or projects that you hope will advance the field of palliative care in the long term?

Prof. Arnold: My current goal is to help junior physicians incorporate palliative care skills into their care of seriously ill patients. I think mentoring physicians and helping them learn the skills and mindsets of palliative care is how I can best advance the field.

APM: As an Editorial Board Member, what are your expectations for APM?

Prof. Arnold: My expectation for APM, is that it continues to publish articles that help clinicians take better care of seriously ill patients.