Prepared for practice? Law teaching and assessment in UK medical schools

Abstract

A revised core curriculum for medical ethics and law in UK medical schools has been published. The General Medical Council requires medical graduates to understand law and ethics and behave in accordance with ethical and legal principles. A parallel policy agenda emphasises accountability, the development of professionalism and patient safety. Given the renewed focus on teaching and learning law alongside medical ethics and the development of professional identity, this survey aimed to identify how medical schools are responding to the preparation of medical students for practice in the future. Questions were asked about the location, content and methods of teaching and assessment of law in undergraduate medical education. Examples of course documentation were requested to illustrate the approaches being taken. A 76% response rate was achieved. Most responding schools integrate law teaching with medical ethics, emphasising both the acquisition of knowledge and its application in a clinical context. Teaching, learning and assessment of law in clinical attachments is much less formalised than that in non-clinical education. Coverage of recommended topic areas varies, raising questions about the degree to which students can embed their knowledge and skills in actual practice. More positively, teaching does not rely on single individuals and clear descriptions were offered for problem-based and small group case-based learning. Further research is required to explore whether there are optimum ways of ensuring that legal knowledge, and skills in its use, form part of the development of professionalism among doctors in training.

Readiness for legally literate medical practice? Student perceptions of their undergraduate medico-legal education

“…The researchers developed the self audit with five law teachers from different medical programmes to ensure internal reliability and content validity. It covers both essential core content1 6 and other topics covered by some programmes 11. Essentially it is a self-efficacy scale, that is, a tool designed to provide an estimate of an individual's belief in their ability to meet a particular target or goal.…”

“…A recent survey of UK medical schools11 found varied coverage of recommended topics, and that teaching, learning and assessment of law in clinical attachments is much less developed than that in non-clinical education. This may partly explain why students report feeling inadequately prepared for the medico-legal aspects of practice 12–15.…”

The Secret Curriculum

“…Equally, both medical students (Cordingley et al 2007;Preston-Shoot & McKimm 2010) and social work students (Preston-Shoot & McKimm forthcoming) may not have the confidence to challenge their own agency's practice, or the procedures of another organisation, even where their legal knowledge was accurate. Over 90 per cent of medical students (n 01,154) surveyed had no or little confidence in challenging their own organisation, or other agencies, on their interpretation of the legal rules .…”

“…Teaching law and ethics in medicine and in social work illustrates this well. Students will, predominantly, have one module within the academic curriculum, with variable coverage in placements, which may explain why their confidence levels in their knowledge and skills are disappointingly low (Braye & Preston-Shoot et al 2005;Preston-Shoot & McKimm 2010;. Indeed, in one study (Braye & Preston-Shoot 2010) both tutors and students complain about the lack of time devoted to law learning, the more so when reflecting on the breadth, depth and complexity of law-in-theory and lawin-practice, and express doubts about whether it is consolidated in practice and reinforced across the taught curriculum.…”

“…Whilst undertaking a systematic literature review on teaching, learning and assessment of law in medical education, frequent references to a hidden or silent curriculum were uncovered . Law in medical education, unlike in social work education, is often taught alongside ethics (Preston-Shoot & McKimm 2010) and the hidden curriculum emerged from empirical research and conceptual discussion papers on the effectiveness of teaching ethics to medical undergraduates. It refers to the concern that ethical and medico-legal teaching can be undermined, if not eroded, within clinical attachments where there are pressures to conform to informal organisational cultures and to overlook colleagues' errors (Branch 2000;Kroll et al 2008).…”