Turning first to the campus setting, the programme of your medical school may well incorporate a professional studies strand, possibly including communication skills, as a vertical theme that runs throughout the degree, and this can potentially offer a conduit that is capable of carrying ethico- legal learning far within the curriculum (Goldie et al., 2001). A major advantage of mediating law and ethics as part of a professional studies theme comes from the small group settings in which it is often delivered. While interactive lecturing can be effective in combination with other instructional approaches (UK Consensus Group, 1998; Fyrenius et al., 2005; van Berkel & Schmidt, 2005), as a single method it is unsuited for enabling students to acquire skills, form values, or develop higher-order competencies (Cantillon, 2003). Instead, small group sessions can be more advantageous for campus-based professional learning (Jaques, 2003). As Goldie (2004) notes, “Evaluation evidence suggests that small group, case-based teaching is the most effective format for formal ethics teaching”. Problem-based learning that deploys naturalistic scenarios can readily incorporate ethico-legal outcomes, or scenarios may be wholly constructed around these (Tysinger et al., 1997), although as discussed in Chapter 3 it would be a disservice to convey to our students the notion that the theme of ethics and law is primarily concerned with problems or dilemmas rather than everyday professional practice (compare with Christakis & Feudtner, 1993).
Miles et al. (1989) note that case discussion is highly compatible with the goals of learning in professional ethics:
“It teaches sensitivity to the moral aspects of medicine, illustrates the application of humanistic or legal concepts to medical practice, and shows physicians acting as responsible moral agents”.
In legal education, discussion in small groups is a standard classroom format for students to think about why cases were decided in a particular direction, to explore the perspectives of the various parties involved, and to examine the ethico-legal reasoning exercised by judges. Preston-Shoot & McKimm (2010) also comment on the usefulness of small group methods in medical law “through which reasoning, policy and values may be probed”. With larger groups, and even whole classes, the mock trial or court inquiry is a highly engaging way in medical education to learn about legal aspects of a clinical case as well as the dynamics of court procedure.
Small group learning demands significant resources in terms of tutor availability, briefing, and support, though ideally it can provide students with a supportive, non-threatening environment where they can be encouraged to discuss personal experiences, air their ethical views (which can be challenged, if necessary), consider different perspectives, and with the facilitation of the group tutor bring critical reflection individually to their sense of self in the progression towards developing professional identity (Goldie et al., 2000, 2007). However, the higher-order aspects of learning in small groups, especially relating to formation in ethical reasoning and professional identity, require sufficient allocation of curriculum time, found in one study to be above 20 hours (Self et al., 1998a). Clarkeburn et al. (2002) comment on the evidence from the literature that without significant timetabling of small group learning, there is “only a very moderate link between ethical sensitivity and moral reasoning skills”.
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Guide 53: Ethics and Law in the Medical Curriculum
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