Practicing Medicine and Studying Law”: How Medical Schools Used to Have the Same Problems We Do and What We Can Learn from Their Efforts to Solve Them
75 Pages Posted: 25 Jul 2011 Last revised: 18 Dec 2012
Date Written: July 25, 2011
This article seeks to help law schools develop their skills programs by highlighting the research medical schools have conducted in discovering the most effective methods of turning incoming students into practicing physicians. It also cautions that existing status inequalities at law schools between faculty who possess and can teach legal skills and those without such skills will make the task difficult and that these inequalities need to be appreciated in order to achieve effective results.
On 10 December of 2010 the American Society of Law Teachers (“SALT”) held its biannual conference in Honolulu, Hawaii. The title of the conference was Teaching in a Transformative Era: The Law School of the Future It was my honor to give a presentation on a panel devoted to teaching skills within the legal curriculum. My co-panelists ably and expertly presented information on how skills training was currently marginalized in law schools in that it was taught through the low status legal, writing, and research faculty rather than the more prestigious and scholarly doctrinal or casebook faculty. Through citation to literature and independent research they themselves had conducted they showed how the task of teaching skills had been delegated to primarily female faculty members who held non-tenured positions and were almost always paid considerably less. My talk presented the steps medical schools have taken over the past ten years when faced with similar pressure to teach skills directly in the undergraduate portion of medical training, while they are in medical school, rather than rely on students picking-them up through observation when during the last two years of medical school when they are doing clinical rotations or after they begin their residencies. This article contributes to the conversation by expanding on how medical schools faced the curricular challenge of moving direct skills training into the undergraduate years and what they are doing now to meet that challenge. In so doing, it builds and expands on observations I made in a 2008 column for the Journal of Law, Medicine and Ethics based on my experience as a full time faculty member at the University of Texas Medical Branch at Galveston’s medical school and as an adjunct faculty member at Texas Tech University’s Medical School.
Its goal is to provide a useful framework for legal educators as they work to integrate direct skills training throughout the law school curriculum. In so doing it not only gives examples of what medical schools are doing to teach skills but also how they developed these programs and what about their efforts are useful in the context of legal academe.
Before embarking on this project, however, it is important for those advocating change in the legal curriculum to understand that while the task facing medical educators was, and is, strikingly similar to that now faced by legal academe, there are important differences which must be understood before making effective use of their experiences. Medical training has substantial subsidization by the Federal Government through the Medicare program which allows it the luxury of time not available in legal education. Also, it has always designed the curriculum around one core value: patient care. Any addition to or subtraction from the medical school curriculum is judged by the standard of whether it will make a student a better or worse doctor. It is my contention, and not necessarily criticism, that the main difference between medical and legal education is that law schools do not embrace client service as their core value and instead see themselves as places where students come to learn the law - not represent clients. Compare the mission statements of Yale Law School, my alma mater, with that of Yale Medical School. The Law School does not find room for the word “client” in 170 words of text.
The primary educational purpose of Yale Law School is to train lawyers and to prepare its students for leadership positions in the public and private sectors both in the U.S. and globally. The primary scholarly role of Yale Law School is to encourage research in law and in interdisciplinary approaches to law and public policy. Throughout the school’s history, its teachers, students, and deans have taken a broad view of the role of law and lawyers in society. The school long has trained lawyers for public service and teaching as well as for private practice. Our students are expected to advance our knowledge and understanding of the law, to expand the reach of the law, and to inculcate knowledge about the central role that the rule of law plays in a free society. The professional orientation of the Law School is deeply enriched by an intellectual environment that embraces a wide variety of intellectual currents and is designed to produce lawyers who are creative, sensitive, and open to new ideas.
While the Medical School does not put patient care first, they are at least present. “The primary educational purpose of Yale Law School is to train lawyers and to prepare its students for leadership positions in the public and private sectors both in the U.S. and globally. The primary scholarly role of Yale Law School is to encourage research in law and in interdisciplinary approaches to law and public policy” with that of Yale Medical School, “As a preeminent academic medical center that supports the highest-quality education, research, and patient care, the Yale School of Medicine will (1) educate and inspire scholars and future leaders who will advance the practice of medicine and the biomedical sciences; (2) advance medical knowledge to sustain and improve health and to alleviate suffering caused by illness and disease; and (3) provide outstanding care and service for patients in a compassionate and respectful manner.”
These fundamental differences make it much harder for law schools to fully integrate skills training with the existing curriculum and it is not this article’s intent to minimize or evade the difficult of this task.
The article will start with a brief overview of why it is necessary for law schools to integrate skills training and then, after a brief overview of the structure of medical education, will discuss how medical schools came to the decision of moving schools training into the undergraduate curriculum and what actions they have taken to do so. It will then compare the effort in medical schools to that of law schools with the intent of making it easier for those interested in using the experience of medical schools to integrate skills training into the law school curriculum.
The purpose of this article was to provide resources for law school faculty members who want to integrate the skills of the practicing lawyer into today’s law school classroom by providing information about how medical schools have approached a similar task. In the last ten years, medical schools have been working to change a culture where skills were learned by observation and modeling into one where skills are taught intentionally and consistently starting in the first two years of medical school. This represents a significant change because even as medical school curriculum has evolved and changed over the past twenty-five years these pre-clinical years had focused on the acquisition of knowledge about the human body, not clinical skills. It has tried to present this information in the context of some significant differences between the resources available to medical schools which make the task of teaching skills earlier in the curriculum easier than the task will be for law schools. These advantages include a faculty which possesses current clinical skills and an extended period of subsidized apprenticeship.
Keywords: legal education, medical education, skills training, status, discrimination, sexism, racism, classism, curriculum design
Suggested Citation: Suggested Citation