A practice survey of the teaching, learning and assessment of law in undergraduate medical education

UKCLE PDF project

Project leader: Judy McKimm (e-mail: j.mckimm1@btinternet.com ) and Michael Preston-Shoot (Faculty of Health and Social Sciences, University of Bedfordshire)
Project summary: a systematic practice survey of undergraduate medical curricula relating to law
Completion date: September 2009
UKCLE funding: £3,500 + £1,500 from the Academy Subject Centre for Medicine, Dentistry & Veterinary Medicine (MEDEV)

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Project latest: Final project report (download available below) – “Teaching, learning and assessment of law in medical education” (mckimm.pdf: PDF, 98 pages) | Judy awarded a Senior Fellowship by the Higher Education Academy

The drive towards integrated services and changing professional roles mean that the professional and legal responsibilities of different health and social care professionals need to be ever more clearly defined, but we have little systematic understanding of where and how law is taught and assessed in undergraduate medical education. This one year project, consisting of 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, aimed to fill the gap.

For an overview of project outcomes see the slides embedded below.

Background

The project built on earlier work funded by an Academy National Teaching Fellowship (NTFS) awarded to Michael Preston-Shoot in 2005 comparing the teaching, learning and assessment of law in medical and social work education. 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. The research indicated variation in practice in how law is taught, learned and assessed in undergraduate medical education – not only between the medical education programmes offered by different programmes but also within medical programmes themselves, where law is sometimes taught as a discrete topic, sometimes alongside ethics teaching or as part of preparation as a professional practitioner, but, most commonly, embedded within clinical attachments where the learning is often opportunistic and assumed (Consensus Group, 1998; McKimm et al, 2008).

There was little evidence 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. It was 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.

The survey

The UKCLE funded practice survey provided data which allowed comparisons to be made with the literature review. The survey highlighted many areas of good practice and a high level of concern, development and engagement from teachers in ensuring students learn about the law in relation to future medical practice. However, the data raises some questions, in particular relating to adequate coverage of legal knowledge, the involvement of patients and carers in teaching and assessment of legal knowledge and application skills, and the presence within the practice curriculum of law teaching and assessment.

The survey described how law is currently taught, learned and assessed in UK medical schools, identified common themes and approaches and offered examples of good practice and challenges to teaching and learning law in medical education. It indicated that although medical schools appear to be addressing the need for students to learn legal and ethical principles and factual information and apply this to clinical scenarios, it is unclear how this teaching and assessment incorporates or relates to the development of professional identity and demonstration of professional behaviours. It also identified 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.

The literature review

Generally the literature has not reported the quality, effectiveness or outcomes of different methods of the teaching, learning and assessment of law in medical education. Understanding of the law tends to be coupled with medical ethics (Consensus Group, 1998), introduced as part of the development of professionalism (Goldie et al, 2007; Jha et al, 2007) or acquired during clinical attachments relating to different client groups. The systematic literature review funded by MEDEV provides an evidence base from the published literature on law as it relates to medical education and to medical practice. This work also contributes to the current debates and interest on all aspects of ‘professionalism’ and the development of professional identity. 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.

Project outputs

The 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 (Braye et al, 2006). 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.

The final practice survey report summarises how law is currently taught, learned and assessed in UK medical schools, identifying common themes and approaches, examples of good practice, barriers and challenges to teaching and learning law in medical education and staff development issues. Presentations about the project were made at the Quality Counts Conference, and the 2009 Higher Education Academy Conference (slides available). Findings will be disseminated through a national workshop involving a wide group of those interested in how professionals ‘learn law’ and apply law in practice.

References and key publications

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• Braye S & Preston-Shoot M, with Cull L, Johns R & Roche J (2005) Teaching, learning and assessment of law in social work education London: Social Care Institute for Excellence
• Braye S & Preston-Shoot M (2006) Learning, teaching and assessment of law in social work education: resource guide London: Social Care Institute for Excellence
• Braye S, Preston-Shoot M & Johns R (2006) ‘Lost in translation? Teaching law to non-lawyers: reviewing the evidence from social work’ The Law Teacher 40(2):131-150
• Consensus Group of Teachers of Medical Ethics and Law in UK Medical Schools (1998) ‘Teaching medical ethics and law within medical education: a model for the UK core curriculum’ Journal of Medical Ethics 24:188
• Goldie J, Dowie A, Cotton P & Morrison J (2007) ‘Teaching professionalism in the early years of a medical curriculum: a qualitative study’ Medical Education 41:610
• Jha V, Bekker H, Duffy S & Roberts T (2007) ‘A systematic review of studies assessing and facilitating attitudes towards professionalism in medicine’ Medical Education 41:822
• McKimm J, Preston-Shoot M & Morris C (2008) Teaching, learning and assessment of law in medical education: exploring medical students’ perceptions and understanding of law as it relates to professional practice and behaviour (poster presented at ASME/MEDEV conference, 5 June)
• McKimm J, Preston-Shoot M & Tomlinson S (2008) Learning the law: an exploration of how undergraduate medical students acquire understanding of law in relation to professional medical practice
• Preston-Shoot M & McKimm J (2008) Researching the outcomes of teaching, learning and assessment of law in social work education (paper at JSWEC: 2nd UK Social Work Research Conference)

Michael is also co-author of a set of e-learning objects on law and social work, and is evaluating their use in a project due to report in 2010.

 

Last Modified: 4 June 2010