BOX 5 Three approaches to ethics and law in the curriculum Pragmatic
Strategic approaches to an ethics and law course
Embedded Theoretical (Adapted from Illingworth, 2004)
Within the constraints of the wider curriculum, a blended strategy could select from all three, as is the case in Chapters 3 and 4, or a more distinct approach might tend to favour one according to its educational benefits and costs. The pragmatic approach offers frameworks for practice according to regulatory and legal standards, though when bounded within its own horizon is potentially silent on situations not anticipated in guidelines. Embedding ethics and law in a professional and personal development theme is effective for situating learning in clinical contexts, though if concentrated into a discrete zone of the timetable can lead students to associate the theme purely with certain teachers and learning activities. A focus on theory provides an analytical foundation for ethico-legal reasoning, though it is beyond the scope of the medical curriculum to grapple with what is a highly specialised literature, and in order to provide clinical relevance for students requires an explicit linkage with patient management.
Whichever approach is taken, a key strategy in developing the ethics and law theme is its integration within the curriculum (Harden et al., 1984; Parker et al., 1997). To what extent the theme is handled in modular form, which may be stand-alone to a greater or lesser degree, and to what extent it is delivered transversally (Claudot et al., 2007) are key questions. Core modules allow an in-depth treatment of ethics and law through their sustained focus, but this concentration of curricular time may be countervailing to a longitudinal quality of student learning. Alternatively, integration distributes the theme around the curriculum, both systemically (across specialties, horizontal integration) and diachronically (across year groupings, vertical integration).
Horizontal integration allows students to relate the theme to a variety of clinical contexts, but this breadth of coverage can potentially be at the cost of depth or continuity, especially as it is contingent on systems conveners being either disposed or at all able to contribute a proportion of their timetable to ethics and law. It can also be more outside of your direct control as theme leader, and become somewhat diffuse with a loss of visibility both to you and the students. Vertical integration through successive year groups provides the opportunity to develop a spiral curriculum that is matched progressively to the stage of clinical learning and students’ developing capacities. However, the educational opportunities of the clerkship years
...a key strategy in
developing the ethics and law theme is its integration within the curriculum.
Vertical integration through successive year groups provides the opportunity to develop a spiral
curriculum that is matched progressively to the stage of clinical learning and students’ developing capacities.
Guide 53: Ethics and Law in the Medical Curriculum
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