MEDEV

School of Medical Sciences Education Development

Introduction

MEDEV and the UK Centre for Legal Education (UKCLE) Subject Centres jointly funded this project,¹ which includes a practice survey of how law is taught, learned and assessed in the 31 UK undergraduate medical programmes and a systematic literature review of law teaching in medical education complementing ethics works by the Institute of Medical Ethics.² The project, which builds on earlier work funded by an Academy National Teaching Fellowship (NTFS)³ awarded to Michael Preston-Shoot.

Findings from the project will be disseminated initially through publication of reports on the subject centre websites and a national workshop which will involve a wide group of those interested in how professionals ‘learn law’ and apply law in practice. One of the aims of this collaborative project is to share learning between subject disciplines and professions as to how law might be most effectively included in professional programmes.

Background

The drive towards integrated services and changing professional roles mean that different health and social care professionals need to be ever more confident and clear about their professional and legal responsibilities. The NTFS study compares teaching, learning and assessment of law in medical and social work education, involving eight social work schools and four medical schools. Preliminary data analysis indicated varying perceptions and understanding of the law and how it is used in practice within and between the two professional student groups, with evident implications for their future working together. Our research indicates variation in practice in how law is taught, learned and assessed in undergraduate medical education. These variations are not only between the medical education programmes offered by different institutions but also within medical programmes themselves, where law is sometimes taught as a discrete topic; is very commonly learned alongside ethics teaching; included as part of preparation as a professional practitioner but is often embedded within clinical attachments where the learning is often opportunistic and assumed.⁴, ⁵ We have found no evidence to date from the literature as to how law is systematically assessed in undergraduate medicine.

The medical profession is undergoing further reform (by the Department of Health, Postgraduate Medical Education and Training Board and General Medical Council) around ensuring fitness to practice, regulation and licensing and there is an increasing research and practice emphasis on professionalism. The GMC consultation on Tomorrow’s Doctors 2009⁶ (p39) includes a section on Doctor as Professional which notes:

The graduate will be able to behave according to ethical and legal principles…

• understand and accept the legal, moral and ethical responsibilities involved in protecting and promoting the health of individual patients, their dependants and the public including vulnerable groups such as children, older people and people with mental illnesses.
• demonstrate knowledge of laws, and systems of professional regulation through the GMC and others, relevant to medical practice, including the ability to complete relevant certificates or legal documents and liaise with the coroner or prosecutor fiscal where appropriate.

It is therefore timely to review and evaluate how medical students acquire their knowledge and understanding of the law relating to medical practice; legal rules, concepts and constructs, and the skills needed to apply the law in a range of potentially complex clinical and community situations, including consulting with and referring to other professionals.

Practice survey

The practice survey provides a baseline from which we can begin to examine the nature and the pedagogy of law teaching in undergraduate medical education, develop new research questions and identify areas for debate and discussion. It provides new knowledge for deepening understanding of how law teaching is conceptualised in medical curricula and, more importantly, how UK medical schools approach and address the teaching of law as it relates to professional medical practice. The practice survey describes how law is currently taught, learned and assessed in UK medical schools, identify common themes and approaches, and offer examples of good practice and challenges to teaching and learning law in medical education. We highlight implications for curriculum development and reveal variations in how curricula support medical students in developing a professional identity and ‘professionalism’ which incorporates a real understanding of law as distinct from personal values, attitudes, morals and beliefs and professional ethics and codes of practice.⁴

The practice survey also identifies the ‘profiles’ (background and expertise) of those involved in teaching and assessing law in medical education with a view to developing resources to support the professional development of those involved in law teaching. A detailed questionnaire has been circulated to teachers with an identified responsibility for law teaching in all UK schools. The questionnaire has been adapted from that used in a national practice survey of law in social work teaching, learning and assessment that was carried out in 2005.⁷ Survey responses were due back by March 2009, after which the results will be collated and analysed to provide a basis for interviews with key stakeholders. We will also be holding a national workshop where the results of the survey and linked research will be discussed and plans made for further development and research.

Systematic literature review

Generally the literature has not reported the quality, effectiveness or outcomes of different methods of teaching, learning and assessment of law in medical education. Understanding of the law tends to be coupled with medical ethics,³ introduced as part of the development of professionalism⁸, ⁹ or acquired during clinical attachments relating to different client groups. The focus to date has been much more on the ethical and regulatory dimensions of practice than the legal aspects which, in curriculum and learning terms, have tended to be assumed, tacit and implicit rather than overt and explicit. The systematic literature review will provide an evidence base from the published literature on law as it relates to medical education and to medical practice. This work will also contribute to the current debates and interest on all aspects of ‘professionalism’ and the development of professional identity.

This project has benefits for the wider community of healthcare educators as well as law teachers and practitioners, providing opportunities for sharing practice and approaches to the teaching and learning of law. Parallels will be drawn with the data already available on teaching law to social workers.¹⁰ Ultimately of course, it is patients and service users who will benefit from improvements to the way in which health and social care professionals learn and apply the law in practice.