When Will They Ever Learn? Learning and Teaching from Mistakes in the Clinical Context
Clinical Law Review, Fall 2006
37 Pages Posted: 6 Jan 2006
Making mistakes is not only part of human nature, but an important part of how we learn. However, there are many examples of people suffering significant adverse consequences as a result of attempts to cover up mistakes, rather than facing up to them and learning from them. In clinical education, students have the benefit of practical, hands on learning, rather than purely theoretical learning as is most common in their other law school endeavors. How should clinicians maximize teaching and learning from mistakes made in practice while ensuring the client's rights are protected?
In the field of clinical teaching, there is a paradox. Students who know little or nothing about the practice of law have significant responsibility in representing real clients. It is a given that clinic students (and their instructors) will make mistakes, and we want them to learn from mistakes, yet our clients expect that as professionals, we will not make mistakes that harm their interests. Clinicians are challenged to resolve this paradox in a manner that allows students and clinicians to engage in the positive discovery and learning that results from making mistakes, while avoiding the disasters that harm the client.
In this paper I will examine clinical pedagogy and the triangular relationship between the clinician, student, and client through the lens of the theory underpinning the study of human error. There is a significant push in the field of medicine to address physicians' mistakes in a forthright manner and to teach new physicians to own up to and learn from their mistakes. Similarly, clinicians ought to devote a part of their formal curriculum to teaching their students how to effectively deal with and learn from mistakes.
In Section I of this paper, I explore the theory regarding the psychological root of human error, including different types of error and how we learn from mistakes. Specifically, I examine the framework for understanding human error espoused by James Reason, Professor of Psychology at the University of Manchester, England. I also draw parallels between Reason's work on human error and the work of others in the field of professional education, including Donald Schon and John Dewey. In Section II, I discuss how the consequences of mistakes can most effectively be managed, and set forth a protocol for students for handling and learning from mistakes. In Section III, I apply Reason's theory to the clinical context, and discuss how mistakes, particularly the disastrous kind, can best be avoided. In Section IV, I discuss how latent errors inherent in the many systems we set up in our clinics might contribute to student error. I further argue that such systemic weaknesses must be identified and incorporated into the process of analyzing, preventing, and learning from mistakes. I conclude that learning from mistakes in practice and providing excellent service to clients are not mutually exclusive.
Keywords: clinical education, human error, learning, mistakes, pedagogy, supervision, apology
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