Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-19T11:45:04.338Z Has data issue: false hasContentIssue false

Teaching Law in Medical Schools: First, Reflect

Published online by Cambridge University Press:  01 January 2021

Extract

[T]each the law to empower physicians individually and collectively to use the law and law colleagues to serve patients and promote public welfare; in short to better foster the goals of the medical profession.

And yet:

[A]ntipathy appears to be deeper and more pervasive than ever before, making it hard to imagine that relations between attorneys and physicians can get much worse.

It has long been recognized that an understanding of at least some core legal rules and concepts is an important piece of medical training. To address this, law is now typically part of the core medical school curriculum, often incorporated into bioethics and/or practice of medicine coursework — whether as part of a distinct course or series of courses or threaded through the curriculum (or both). While often this education focuses on rules, some have recommended that it also include fundamentals of legal reasoning, and go beyond knowledge to include skills, attitudes, and behaviors vis-à-vis the law.

Type
Independent
Copyright
Copyright © American Society of Law, Medicine and Ethics 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Williams, P. C. Winslade, W., “Educating Medical Students about Law and the Legal System,” Academic Medicine 70, no. 9 (1995): 777786, at 84 (emphasis added).Google Scholar
Jacobson, P. D. Bloche, M. G., “Improving Relations between Attorneys and Physicians,” JAMA 294, no. 16 (2005): 20832085, at 2083 (reference omitted).CrossRefGoogle Scholar
Schwartz, R. L., “Teaching Physicians and Lawyers to Understand Each Other,” Journal of Legal Medicine 2, no. 2 (1981): 131149.CrossRefGoogle Scholar
Olick, R. S., “It's Ethical, But Is It Legal? Teaching Ethics and Law in the Medical School Curriculum,” Anatomical Record 265, no. 1 (2001): 59; Lehmann, L. S. Kasoff, W. S. Koch, P. Federman, D. D., “A Survey of Medical Ethics Education at U.S. and Canadian Medical Schools,” Academic Medicine 79, no. 7 (2004): 682–689; DuBois, J. M. Burkemper, J., “Ethics Education in U.S. Medical Schools: A Study of Syllabi,” Academic Medicine 77, no. 5 (2002): 432–437.CrossRefGoogle Scholar
See Williams, Winslade, , supra note 1; Olick (id.); Powers, L. S., “Interprofessional Education and the Reduction of Medico-Legal Tensions,” Journal of Legal Education 17, no. 2 (1964–1965): 167183; Gibson, J. M. Schwartz, R. L., “Physicians and Lawyers: Science, Art and Conflict,” American Journal of Law and Medicine 6, no. 2 (1980–1981): 173–182.Google Scholar
See Williams, Winslade, , supra note 1; LeBlang, T. R. Henderson, M. D. Kolm, P. Paiva, R. E. A., “The Impact of Legal Medicine Education on Medical Students' Attitude towards Law,” Journal of Medical Education 60, no. 4 (1985): 279287; Stirrat, G. M. Johnston, C. Gillon, R. Boyd, K. et al. , “Medical Ethics and Law for Doctors of Tomorrow: The 1998 Consensus Statement Updated,” Journal of Medical Ethics 36, no. 1 (2010): 55–60.Google Scholar
Norton, M. L., “Development of an Interdisciplinary Program of Instruction in Medicine and Law,” Journal of Medical Education 46, no. 5 (1971): 405411; Naitove, B. J., “Note and Comment: Medicolegal Education and the Crisis in Interprofessional Relations,” American Journal of Law & Medicine 8 (Fall 1982): 293–304 (building on Norton article to discuss model interdisciplinary law and medicine course); Lawson, C. M., “Teaching Legal Medicine: An Interdisciplinary Seminar in Professional Ethics for Medical Students and Law Students,” Journal of Legal Medicine 8, no. 1 (1987): 123–133; Wilkins, D. B., “Redefining the ‘Professional’ in Professional Ethics: An Interdisciplinary Approach to Teaching Professionalism,” Law and Contemporary Problems 58, nos. 3 & 4 (1995): 241–258; Tobin Tyler, E., “Allies Not Adversaries: Teaching Collaboration to the Next Generation of Doctors and Lawyers to Address Social Inequality,” Journal of Health Care Law & Policy 11 (September 2008): 249–291; Apel, S. B., “Teaching Law and Medicine on the Interdisciplinary Cutting Edge: Assisted Reproductive Technologies,” Journal of Law, Medicine & Ethics (Summer 2010): 420–426; Tyler, E. T. Rodgers, M. A. Weintraub, D. L., “Bridging the Health and Legal Professions through Education and Training,” in Tyler, E. T. Lawton, E. Conroy, K. et al. , eds., Poverty, Health and Law: Readings and Case Studies for Medical-Legal Partnership (Durham, N.C.: Carolina Academic Press, 2011): 97–123, at 105–112.Google Scholar
See Tyler, (Allies Not Adversaries), supra note 7; Tyler, et al. (Bridging the Health and Legal Professions), supra note 7. See also the numerous articles describing the work of medical legal partnerships, an updated listing of which may be found on the website of the National Medical Legal Partnership (NMLP), available at <http://www.medical-legalpartnership.org/resources/academic-articles> (last visited December 30, 2011).+(last+visited+December+30,+2011).>Google Scholar
This section summarizes findings from the U.S. literature related to teaching law in medical schools. Its intent is to highlight key parts (as relevant to this article); readers desiring additional or more in-depth information are encouraged to read the full articles (see accompanying references).Google Scholar
See Olick, , supra note 4.Google Scholar
See Lehmann, et al. , supra note 4; DuBois, Burkemper, , supra note 4.Google Scholar
See Williams, Winslade, , supra note 1; Schwartz, , supra note 3; Olick, , supra note 4; Kapp, M. B., “Teaching Health Law: Health Law Teaching in Medical Schools: Balancing the Different Roles,” Journal of Law, Medicine & Ethics 54, no. 4 (2010): 863869.Google Scholar
Grumet, B. R., “Legal Medicine in Medical Schools: A Survey of the State of the Art,” Journal of Medical Education 54, no. 10 (1979): 755758; Felthous, A. R. Miller, R. D., “Health Law and Mental Health Law Courses in U.S. Medical Schools,” Bulletin of the American Academy of Psychiatry and the Law 15, no. 4 (1987): 319–327; Harry, B. Felthous, A. R. Miller, R. D., “A Multivariate Analysis of Health Law Education in American Medical Schools,” New Directions for Mental Health Services 1989, no. 41 (Spring 1989): 109–118; Persad, G. C. Elder, L. Sedig, L. Flores, L. Emanuel, E. J., “The Current State of Medical School Education in Bioethics, Health Law, and Health Economics,” Journal of Law, Medicine & Ethics 36, no. 1 (2008): 89–94; Preston-Shoot, M. McKimm, J., “Prepared for Practice? Law Teaching and Assessment in U.K. Medical Schools,” Journal of Medical Ethics 36, no. 11 (2010): 694–699.Google Scholar
See Olick, , supra note 4; LeBlang, et al. , supra note 6.Google Scholar
See Stirrat, et al. , supra note 6; Task Force on Health Law Curricula of the American Society of Law and Medicine, Health Law and Professional Education American Society of Law and Medicine, Boston, Massachusetts, 1985; Preston-Shoot, M. McKimm, J., “Teaching, Learning, and Assessment of Law in Medical Education,” Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine, and Higher Education Academy U.K. Centre for Legal Education, 2010; Braunack-Mayer, A. J. Gillam, L. H. Vance, E. F. et al. , “An Ethics Core Curriculum for Australasian Medical Schools,” Medical Journal of Australia 175, no. 4 (2001): 205–210.Google Scholar
That the literature comes primarily from legally-trained scholars highlights another need: To investigate what our medically-trained and -based colleagues consider the importance of legal training and why.Google Scholar
Kapp, M. B., “The Interface of Law and Medical Ethics in Medical Intensive Care,” Chest 136, no. 3 (2009): 904909.CrossRefGoogle Scholar
See Schwartz, , supra note 3; Kapp, , supra note 12; Task Force, supra note 15.Google Scholar
See Harry, et al. , supra note 13, at 111.Google Scholar
See Williams, Winslade, , supra note 1; Grumet, , supra note 13; Felthous, Miller, , supra note 13; Harry, et al. , supra note 13.Google Scholar
See Williams, Winslade, , supra note 1; Grumet, , supra note 13; Felthous, et al. , supra note 13; Harry, et al. , supra note 13.Google Scholar
See Felthous, Miller, , supra note 13; see also Williams, Winslade, , supra note 1.Google Scholar
See Williams, Winslade, , supra note 1, at 778.Google Scholar
See Harry, et al. , supra note 13; Task Force, supra note 15.Google Scholar
See Williams, Winslade, , supra note 1; Olick, , supra note 4; LeBlang, et al. , supra note 6; Stirrat, et al. , supra note 6.Google Scholar
See Williams, Winslade, , supra note 1; Grumet, , supra note 13; Harry, et al. , supra note 13.Google Scholar
See Williams, Winslade, , supra note 1; Stirrat, et al. , supra note 6.Google Scholar
See Williams, Winslade, , supra note 1; Olick, , supra note 4; Stirrat, et al. , supra note 6.Google Scholar
See Williams, Winslade, , supra note 1, at 783.Google Scholar
See Persad, et al. , supra note 13, at 93. The authors found an average of only 10 hours total for health law across all four years of medical school of the 59% of medical schools that require a health law unit (part of a larger course). Id.Google Scholar
See Olick, , supra note 4; Persad, et al. , supra note 13.Google Scholar
See Felthous, Miller, , supra note 13.Google Scholar
See Williams, Winslade, , supra note 1; Olick, , supra note 4.Google Scholar
See LeBlang, et al. , supra note 6.Google Scholar
See Schwartz, , supra note 3; Harry, et al. , supra note 13; Emanuel, E. J., “Changing Premed Requirements and the Medical Curriculum,” JAMA 296, no. 4 (2006): 11281131.Google Scholar
Zuckerman, B. Sandel, M. Smith, L. Lawton, E., “Why Pediatricians Need Lawyers to Keep Children Healthy,” Pediatrics 114, no. 1 (2004): 224228.CrossRefGoogle Scholar
See references at note 7.Google Scholar
See Schwartz, , supra note 3, at 139.Google Scholar
See Williams, Winslade, , supra note 1, at 783–784; Olick, , supra note 4; Kapp, , supra note 12; Task Force, supra note 15; Preston-Shoot and McKimm, , supra note 13.Google Scholar
See Williams, Winslade, , supra note 1; Grumet, , supra note 13.Google Scholar
Grumet, , supra note 13, at 756–757.Google Scholar
Id., at 758.Google Scholar
See Harry, et al. , supra note 13, at 116–117; Persad, et al. , supra note 13, at 93.Google Scholar
See Williams, Winslade, , supra note 1, at 783; Persad, et al. , supra note 13, at 93.Google Scholar
See Williams, Winslade, , supra note 1, at 781; Persad, et al. , supra note 13, at 93.Google Scholar
See Williams, Winslade, , supra note 1; Olick, , supra note 4; LeBlang, et al. , supra note 6.Google Scholar
Preston-Shoot, M. McKimm, J., “Towards Effective Outcomes in Teaching, Learning, and Assessment of Law in Medical Education,” Medical Education 45, no. 4 (2011): 339346; Preston-Shoot, McKimm, , supra note 15. For assessment methods in ethics, see Savulescu, J. Crisp, R. Fulford, K. W. M. Hope, T., “Evaluating Ethics Competence in Medical Education,” Journal of Medical Ethics 25, no. 5 (1999): 367–374.CrossRefGoogle Scholar
See Grumet, , supra note 13; Task Force, supra note 15.Google Scholar
See Jacobson, Bloche, , supra note 2; Schwartz, , supra note 3; Kapp, , supra note 17.Google Scholar
See Jacobson, Bloche, , supra note 2; Task Force, supra note 15; Kapp, , supra note 17. See also Tyler, Tobin (Allies Not Adversaries), supra note 7; see Tyler, Tobin et al. (Bridging the Health and Legal Professions), supra note 7; Zukerman, et al. , supra note 36.Google Scholar
See Williams, Winslade, , supra note 1.Google Scholar
Institute of Medical Ethics, “Institute of Medical Ethics Education Project,” available at <http://www.instituteofmedicalethics.org/educational.html> (last visited March 9, 2012).+(last+visited+March+9,+2012).>Google Scholar
Consensus statement by teachers of medical ethics and law in U.K. medical schools, “Teaching Medical Ethics and Law within Medical Education: A Model for the U.K. Core Curriculum,” Journal of Medical Ethics 24, no. 3 (1998): 188–192.CrossRefGoogle Scholar
See Stirrat, et al. , supra note 6.Google Scholar
Id., at 57.Google Scholar
Id., at 56.Google Scholar
Institute of Medical Ethics, Report of the Medical Education Working Group, “Supporting Teaching and Learning of Medical Ethics and Law in U.K. Medical Schools – A Three Programme,” available at <http://www.instituteofmedicalethics.org/edu_hist.html> (last visited June 29, 2011). More information on the project may be found in the IME Report of the Medical Education Working Group; the specific stakeholders included are identified in Appendix 2 of the 2010 Consensus Statement (see Stirrat, et al. , supra note 6, at 60).+(last+visited+June+29,+2011).+More+information+on+the+project+may+be+found+in+the+IME+Report+of+the+Medical+Education+Working+Group;+the+specific+stakeholders+included+are+identified+in+Appendix+2+of+the+2010+Consensus+Statement+(see+Stirrat,+,+supra+note+6,+at+60).>Google Scholar
U.K. Centre of Legal Education Project, “A Practice Survey of the Teaching, Learning, and Assessment of Law in Undergraduate Medical Education,” available at <http://www.ukcle.ac.uk/projects/pastprojects/mckimm> (last visited May 17, 2011).+(last+visited+May+17,+2011).>Google Scholar
See Preston-Shoot, McKimm, , supra note 49.Google Scholar
See Preston-Shoot, McKimm, , supra note 13.Google Scholar
See U.K. Centre, supra note 61.Google Scholar
See Preston-Shoot, McKimm, , supra note 49.Google Scholar
Id., at 343.Google Scholar
Id., at 344; see also Olick, , supra note 4.Google Scholar
See Preston-Shoot, McKimm, , supra note 49, at 344.Google Scholar
See Preston-Shoot, McKimm, , supra note 13.Google Scholar
Id., at 698.Google Scholar
A group process among leading educators was used in the U.S. to develop ethics curriculum core content, but this work had a more narrow inclusion and conferral process than the U.K. model. It is also recognized that the number and geographic spread of our medical schools may complicate a U.S. process. See Culver, C. M. Clouser, K. D. Gert, B. et al. , “Basic Curricular Goals in Medical Ethics,” New England Journal of Medicine 312, no. 4 (1985): 253256.CrossRefGoogle Scholar
Hafferty, F. W. Franks, R., “The Hidden Curriculum, Ethics Teaching, and the Structure of Medicine,” Academic Medicine 69, no. 11 (1994): 861871, at 861.CrossRefGoogle Scholar
See Preston-Shoot, McKimm, , supra note 49, at 343, citations omitted.Google Scholar
See Hafferty, Franks, , supra note 73.Google Scholar
Id., at 869 (bracketed words added). Other work posits, however, that professional education can positively impact behaviors; see, e.g., Bebeau, M. J., “The Defining Issues Test and the Four Component Model: Contributions to Professional Education,” Journal of Moral Education 31, no. 3 (2002): 271296.CrossRefGoogle Scholar
See Tyler Tobin (Allies Not Adversaries), supra note 7, at 285–286. Law curriculum reform discussions have also looked to the medical school curriculum for lessons; for recent musings on this, see, e.g., Chemerinsky, E., “Rethinking Legal Education,” Harvard Civil Rights-Civil Liberties Law Review 43, no. 2 (2008): 595598; Patrick, S. Coughlin, C. N. McElroy, L., “See One, Do One, Teach One: Dissecting the Use of Medical Education's Signature Pedagogy in the Law School Curriculum,” Georgia State University Law Review 26 (2010): 361–415; Bard, J. S., “Addressing the Challenge of Teaching Skills in Today's Law Schools: How Medical Schools Used to Have the Same Problems We Do and What We Can Learn from Their Efforts to Solve Them,” Working Paper Series (July 25, 2011), available at <http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1894498> (last visited January 3, 2012). These writings reinforce the symbiotic nature of the two professionals' training and indicates that each has something to learn from the other.Google Scholar
See references, supra note 7.Google Scholar
See Consortium for Culture and Medicine, available at <http://www.upstate.edu/ccm> (last visited March 9, 2012).+(last+visited+March+9,+2012).>Google Scholar
Syllabus on file with author.Google Scholar
Barrows, H. S., “Problem-Based Learning in Medicine and Beyond: A Brief Overview,” New Directions For Teaching and Learning, no. 68 (1996): 312; Wood, D. F., “ABC of Learning and Teaching in Medicine: Problem Based Learning,” BMJ 326 (2003): 328–330; Vernon, D. T. Blake, R. L., “Does Problem-Based Learning Work? A Meta-Analysis of Evaluative Research,” Academic Medicine 68, no. 7 (1993): 550–563; Colliver, J. A., “Effectiveness of Problem-Based Learning Curricula: Research and Theory,” Academic Medicine 75, no. 3 (2000): 259–266. See also Tobin, (Allies Not Adversaries), supra note 7; Tobin, et al. (Bridging the Health and Legal Professions), supra note 7. For a discussion of how PBL, in turn, was influenced by the case method developed in law schools, see Patrick, et al. , supra note 77, at 369.Google Scholar
See Tobin, (Allies Not Adversaries), supra note 7.Google Scholar
National Medical Legal Partnership, available at <http:/www.medical-legalpartnership.org/> (last visited March 9, 2012).+(last+visited+March+9,+2012).>Google Scholar
Campbell, A. T. Sicklick, J. Galowitz, P. Retkin, R. Fleishman, S. B., “How Bioethics Can Enrich Medical-Legal Collaborations,” Journal of Law, Medicine & Ethics 38, no. 4 (2010): 847862, at 847.CrossRefGoogle Scholar
National Medical Legal Partnership, “About Us,” available at <http://www.medical-legalpartnership.org/about-us> (last visited March 9, 2012).+(last+visited+March+9,+2012).>Google Scholar
See, e.g., see Tobin, Tyler et al. . (Bridging the Health and Legal Professions), supra note 7; see also references included in NMLP, supra note 8.Google Scholar
American Medical Association, Policy D-265.989, “Medical-Legal Partnerships to Improve Health and Well Being,” available at <https://ssl3.amaassn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fDIR%2fD-265.989.HTM> (last visited June 27, 2011).+(last+visited+June+27,+2011).>Google Scholar
American Bar Association, Policy 120A, “American Bar Association Medical-Legal Partnerships Pro Bono Support Project,” available at <http://www.americanbar.org/groups/probono_public_service/projects_awards/medical_legal_partnerships_pro_bono_project.html> (last visited March 9, 2012).+(last+visited+March+9,+2012).>Google Scholar
Pai, N. Miller, W. Chapman, L. A. Ford-Jones, E. L. NcNeill, T. Jackson, S. F., “Tipping the Scales: A Lawyer Joins the Health Care Team,” Paediatrics and Child Health 116, no. 6 (2011): 336.CrossRefGoogle Scholar
Florida State University College of Medicine, Center for Innovative Collaboration in Medicine and Law, available at <http://med.fsu.edu/?page=innovativeCollaboration.home> (last visited March 9, 2012).+(last+visited+March+9,+2012).>Google Scholar
Dulcie, D., “Enterprising New Academic Center at FSU: Leading the Country in Innovative Steps to Unite Medical Students + Law Students,” What's Going 'Round, a publication from Florida State University's Dean of Students Department's Office of New Student and Family Programs, November 2010, at 3.Google Scholar
Cohn, M., “Johns Hopkins, University of Baltimore Form Medical-Law Center,” Baltimore Sun, February 15, 2011, available at <http://articles.baltimoresun.com/2011-02-15/health/bs-hs-hopkins-ubalt-20110215_1_health-care-phillip-j-closius-medical-law> (last visited May 25, 2011).+(last+visited+May+25,+2011).>Google Scholar
Johns Hopkins Medicine Press Release, “Johns Hopkins, University of Baltimore Form New Center for Medicine and Law,” available at <http://www.hopkinsmedicine.org/news/media/releases/johns_hopkins_university_of_baltimore_form_new_center_for_medicine_and_law> (last visited March 9, 2012).+(last+visited+March+9,+2012).>Google Scholar
Wexler, D. B. Winick, B. J., eds., Law in a Therapeutic Key: Developments in Therapeutic Jurisprudence (Durham, North Carolina: Carolina Academic Press, 1997); Campbell, A. T., “Therapeutic Jurisprudence: A Framework for Evidence-Informed Health Care Policy Making,” International Journal of Law and Psychiatry 33, nos. 5–6 (2010): 281–292.Google Scholar
See Jacobson, Bloche, , supra note 2; Schwartz, , supra note 3; Tyler, (Allies Not Adversaries), supra note 7.Google Scholar
For readers interested in medical school curricula, a special supplement in Academic Medicine featured medical schools' reporting of recent curricular changes. See “Snapshot of Medical Student Education in the United States and Canada,” Academic Medicine 85, no. 9 (September Supplement 2010): S1–S614.CrossRefGoogle Scholar
This description builds on discussion among faculty colleagues in the Center for Bioethics and Humanities about the themes in this paper during a faculty work-in-progress by the author on September 21, 2011. The discussion led to a vision of how relationships that are more value-added vis-à-vis lawyers' value to/for doctors (as doctors may be seen as valuable to lawyers inasmuch as we all need medical care) may enhance collaboration across disciplines. Or, as put by Tyler, Elizabeth Tobin, “Interdisciplinary legal and medical education, focused on exploring common goals, also offers students a model of cooperation rather than hostility and distrust at a time when many doctors and lawyers view each other as adversaries rather than allies.” See Tyler, (Allies Not Adversaries), supra note 7, at 291.Google Scholar
These goals are adapted from ones put forward by Kathy Faber-Langendoen, M.D., based on this article's author-led discussion of potential goals during a faculty work-in-progress presentation, supra note 99.Google Scholar
Association of American Medical Colleges, available at <http://www.aamc.org/> (last visited March 9, 2012).+(last+visited+March+9,+2012).>Google Scholar
Association of American Law Schools, available at <http://www.aals.org/> (last visited March 9, 2012).+(last+visited+March+9,+2012).>Google Scholar
American Society of Law, Medicine & Ethics, available at <http://www.aslme.org/> (last visited March 9, 2012).+(last+visited+March+9,+2012).>Google Scholar
See Force, Task, supra note 15.Google Scholar
Resident education, i.e., graduate medical education, has its own core competencies as laid out in by the American College of Graduate Medical Education (ACGME). Stewart, M. G., AGCME Core Competencies, available at <http://www.acgme.org/acWebsite/RRC_280/280_coreComp.asp> (last visited March 9, 2012). These core competencies, notably the “professionalism” and “systems-based practice” standards, may be useful in developing standards for undergraduate medical education (medical students) inasmuch as a continuum of training is envisioned.+(last+visited+March+9,+2012).+These+core+competencies,+notably+the+“professionalism”+and+“systems-based+practice”+standards,+may+be+useful+in+developing+standards+for+undergraduate+medical+education+(medical+students)+inasmuch+as+a+continuum+of+training+is+envisioned.>Google Scholar
Future work will examine medical school curricula reform efforts and how law is reflected within such (if at all) – an update to earlier surveys to evaluate the current lay of the land for any trends or expressed goals behind approaches.Google Scholar
See Force, Task, supra note 15, at 24 (emphasis added).Google Scholar