Learning from Medical School–Pre-tests for Legal Skills?

As part of the collaborative project on joint training for medical residents and law students about domestic violence, the group had decided to use standardized patients to “pre-test” skills.  The idea is that the pre-test would help us determine the effectiveness of the training.  The group designed two problems for the pretest, one involving a woman living in her car with her two kids because she had left an abusive relationship and her apartment.   The other involved a pregnant undocumented woman living with a U.S. citizen boyfriend who had hit her in the abdomen.  They were difficult problems, legally and emotionally.  The standardized patient/clients were trained by the excellent staff of the Assessment and Learning Department. I skipped the material on domestic violence in the textbook.   The staff from Assessment and Learning Department of the Medical School set everything up for the students to be videotaped while conducting the ½ hour interviews.  As a clinical teacher, it felt REALLY strange to send students to an appointment without any training at all (even if the person they would interact with was an actor and not a real client.)  However, I had decided to go with the flow in this medical/ collaboration.  The design of our collaboration included a pre-test.

The medical residents seemed to take the pre-test in stride.  They knew it didn’t count and they would get feedback about the experience and they would get training and then they would have a chance to examine a new standardized patient and to improve on their skills.   Many of the law students were very nervous about going into a situation unprepared.  I assured them that I would not grade them on their performance, they would get a video of the interview to review and they would get some sort of feedback. I told them it was simply to get a baseline of their present skills.  The class members were good sports about the experience and did not mutiny.  But many of them (particularly those who had not previously taken clinic and did not otherwise have interviewing or domestic violence experience) were really angry after meeting the standardized clients.  The actors were very realistic and the students felt horrible not having the skills and information to assist them.   They felt like they were set up.  And, since they are used to being compared to each other and evaluated they were really uncomfortable about whether I really wouldn’t judge their performance.   I felt terrible about doing this to them.   I wondered whether I had done the right thing, and I wondered about the value of a pre-test with no training.

An interesting thing happened after the pre-test.  The students became hungry for information about domestic violence.  The Women’s Law Caucus happened to have a table on domestic violence that week and a member of the Women’s Law Caucus asked me why my students were so interested.  She wanted to know what I did.  Several students demanded that I talk about the problem in class, so I did.  The interest level in the training was higher than I had ever seen it.  When Dr. Crandall came to our class to discuss the medical issues, my students were visibly engaged.  (This is in contrast to my presentation to the medical residents who were polite, but I definitely felt that they were not quite as interested in the legal issues as my students were in the medical issues.)    Several students engaged me in out of class discussion about the domestic violence issues, and many wondered aloud why we don’t offer a whole course on domestic violence.  Attendance at all of the domestic violence sessions was excellent.   I couldn’t help but think that the experience with a standardized patient whetted their interest in domestic violence in a way that class discussions did not.

Does that mean I think the pre-test is a good thing?   No, I do not.  I think it would have been better to provide some training on interviewing and counseling as well as some course work on domestic violence before the first session with the standardized patient.  Then, upon reviewing their performance with them, I could develop additional training that responded to issues raised by their performance.    I think that their heightened interest was a demonstration of the power of experiential learning as educational method.   So incorporating standardized patients can be a very valuable aspect of legal education, I don’t think that using them in a pre-test is a good idea.

More on my next post!

One Response

  1. One of the things that I have found most interesting about this series of posts is the law/med collaboration. In my clinic (securities arbitration), we often deal with elderly clients. Research suggests that these clients tend to blame themselves for financial losses, and therefore are less likely to complain/ seek help. (I can forward a link to studies on this, if anyone is interested). A small number of these clients also may have medical issues that can make representation difficult. To help sensitize students to these issues, we brought in someone from a local school of social work. This guest speaker spoke with students about non-obvious signs of senior financial abuse. The students commented favorably on this class, and I’ve seen them use what they learned when interviewing and representing clients.

    I’d love comments from others who have used cross-school collaborations. How much/ how little? What has worked? And thanks to Annette for her wonderful posts on this issue!

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