Should I choose live client work or simulation?
This is an issue that has divided clinicians almost since the dawn of time, and the debate has sometimes generated a lot more heat than light. Broadly, of course, both have their merits. I suggest your choice can be framed in terms of priorities from a range of objectives, and your final decision will reflect your preferences balanced against any institutional imperatives or constraints. In particular you should consider the following:
| Public Service Motivations | Obviously if public service or pro bono motivations are a strong driver, then these can only be met by some form of live client programme. For an extra-curricular clinic, this does not raise any particular concerns, but if your clinic is integrated into the academic programme and awarding credits, you need to consider carefully how you balance the service orientation with the learning needs of your students. Not every case that comes through the door has the potential to provide the range of learning opportunities that you might be looking for. You may therefore want to create criteria, and a case screening, or ‘triage’, process for selecting cases on the basis of the learning opportunities they are likely to provide. |
| Understanding ‘Law in Context’ | Both live client and simulation clinics can encourage and enable students both to put the law into its practical context and to reflect ‘contextually’ on the practise of law. The live client context can be particularly good at providing students with opportunities to examine access to justice and quality of legal services issues. |
| Awareness of Ethics and Conduct Issues | Again, both types of clinic can support the development of ethical awareness and an understanding of professional conduct rules. One of the obvious advantages of simulation is the extent to which you can deliberately design ethical dilemmas into your case studies. Live client work, equally obviously, tends to raise the typical ethical problems that one encounters day to day in practice, but in a way, of course, that is not always predictable. The strength (and potential weakness, if the ethical issues are not identified) of live client work is also that students will be exposed to lawyers in practice who may provide a range of good, or not so good, ethical role models. |
| Realism (of Learning Environment) | Realism is obviously valuable in supporting intentional learning, and providing problems that offer the messiness and value conflict inherent in a lot of ‘real world’ problem solving. It is often assumed that this kind of realism can only be achieved by live client work. This is not necessarily so. With careful design (eg using realistic, detailed, problems, actors and well structured role play) simulation clinics can be surprisingly realistic. A lot of the emotionality and pressure present in live client work can exist in simulation too. |
| Learner Autonomy/tutor Control | In any kind of clinical work (as with any other learning environment) you need to consider how you balance learner autonomy (for example, opportunities for active and discovery-based learning) with tutor control (which needs to be at least sufficient to ensure learning outcomes are achievable). I suspect in a lot of learning environments we, as tutors, often tend to play safe and favour our control over learner autonomy. In live client clinics this evaluation is complicated by the need to ensure adequate service standards. Once you take on a case, client needs have to be met, and this requires sensitivity to the differing levels of supervision and control different students will need in order to maintain their casework at an acceptable standard. Obviously, this kind of control is less of an imperative with simulation. Simulation is thus a safer space in which to give students a high level of learner autonomy, though good quality supervision is still necessary to help students learn from their experience. At the same time, the large element of control over problem design, and hence also over learning outcomes, is something that many tutors value about clinical simulation. |
| Partiy of Experience | Is it important that all students have a broad parity of experience? This is quite a tricky one. If student experiences within the same cohort are too disparate, this can create problems; for example, students who perceive that they have lost out on ‘good’ or exciting cases may get demotivated. A widely different ‘quality’ of cases coming in may also make it harder for you to show parity of assessment between students. But the issue obviously begs the question how we gauge and ensure the quality of a learning experience. The learning objectives and outcomes of your module are a good starting point – you need to ensure that each student has (so far as practicable) equality of opportunity to fulfil those outcomes. This is relatively easy in a simulation, where you have control over the problems that all students work on. It is a little less easy in live client work, but it is possible through case screening and careful assessment against a set of outcomes that are designed so as not to be significantly affected by incidental disparities in work product. |
| Resourcing | Any kind of clinical work tends to be more resource intensive, and hence more expensive than traditional classroom teaching – see further question 7. Simulation tends to be the ‘cheaper’ option. However, the costs of live client work can be significantly reduced if you adopt an externship model rather than develop an in-house programme – see also question 5. |
In short then, as we would expect, clinical simulations are potentially very good at providing a consistent and comparable student-centred learning experience, across a range of outcomes. They can be less demanding of resources than live casework, although you should not underestimate the effort required to design realistic case studies. Live client clinics obviously have the edge on realism, but are likely to benefit from effective case selection, and require closer, and possibly more specialist, supervision.
Last Modified: 2 August 2010
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