Medical schools failing to teach the necessary legal skills to practice medicine

May 16, 2011, British Medical Journal

Most medical students feel they lack the skills and legal knowledge required to challenge poor clinical practice and promote better patient care, reveals research published ahead of print in the Journal of Medical Ethics.

This suggests more time and emphasis needs to be put on legal skills in the formal medical curriculum and that these need to be practised and honed during clinical training, the authors say.

The authors surveyed 1,154 first, second and final year at two UK medical schools on their knowledge and understanding of medico-legal rules and their of the law.

The students agreed that a sound understanding of law is essential to being a good doctor and in general had confidence in a range of skills, but were anxious about using legal rules and about challenging observed deficiencies in clinical practice.

In only one skill - working in partnership with patients - did more than one third of students feel reasonably or fully confident before graduating, and in only three knowledge areas - principles of consent, assessing mental capacity and . Confidence was notably low in the areas of the Coroners Act and working in court room settings, where knowledge and skill would be needed once qualified.

More students felt they knew more about the legal principles relating to negligence than to the NHS complaints procedure. The authors comment: "In practice, complaints are much more common than negligence cases, suggesting that the focus of teaching in this area may benefit from a change of emphasis."

There was little difference in the level of knowledge of first year and final year students in some legal areas, including the Bolitho principle (which is used to determine whether medical negligence has taken place), and race relations. These topics are covered early in the curriculum, and the authors suggest that students might benefit from additional teaching on these topics in later years.

The authors conclude that greater attention and time should be given to the practical application of legal knowledge in clinical training, saying: "If young doctors do not feel confident, they are unlikely to challenge poor practice or show leadership in promoting better patient care through using legal rules and an understanding of how law relates to and underpins good medical practice."

They add that structured law teaching is required throughout qualifying programmes, and that this needs to be reinforced and practised in clinical attachments and continuing professional development, otherwise, knowledge and skills, even when acquired, may decay.

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