For many years now, clinical physicians and medical researchers have faced a growing need to understand a wide variety of legal issues that impact their work. At the same time, there has been an equally compelling need for lawyers to approach this problem from the other side – to understand the medical and scientific issues involved, as well as the perspectives of people trained in these disciplines.
Unfortunately, there have historically been few opportunities for most MD or JD students to gain practical experience with these issues before they enter the working world as newly minted physicians and lawyers.
A unique course taught at the University of North Carolina at Chapel Hill by two UNC School of Law professors, to a class composed of roughly equal numbers of both MD and JD students, aims to change that.
The course, “Current Issues in Law & Medicine,” is taught by Professors Joan H. Krause and Richard S. Saver. It is jointly offered as a professional development seminar through the Department of Social Medicine in the School of Medicine and an upper-level seminar in the School of Law. During the Fall 2015 semester the class met in the School of Medicine’s Bondurant Hall.
“Consideration of the complex interaction between law and medicine is essential to understanding current health care debates, yet medical and law students have few opportunities to share classrooms on equal footing,” Professor Krause said. “Medical school classes generally are not open to law students. While some medical students — especially those jointly pursuing the MPH degree — do enroll in health law courses at the School of Law, those courses are targeted primarily toward the JD audience.”
“This course, in contrast, is designed as an interdisciplinary offering that draws on materials from both law and medicine and demands that students from different — and at times opposing — disciplines work together to address current health care issues. Through group exercises, discussions, and analysis of both legal and medical materials, we hope to foster a deeper understanding of the complexity of these issues, as well as a willingness to work across traditional disciplinary boundaries,” Krause said.
To facilitate interdisciplinary connections, teams of MD and JD students work together on in-class presentations and other group projects that explore the legal and medical considerations surrounding a subject. In addition, both MD and JD students are required to write research papers on topics such as the controversy over coverage of contraceptives under the Affordable Care Act, legal aspects of health care issues affecting people with disabilities, and legal issues surrounding informed consent for a person’s participation in a medical research study, to name just a few examples.
To facilitate interdisciplinary connections, teams of MD and JD students work together on in-class presentations and other group projects that explore the legal and medical considerations surrounding a subject.
In one recent class session led by Professor Saver, groups of four students – each with two JD and two MD students — participated in a mock institutional review board (IRB) deliberation about a proposed consent form and study protocol for a breast cancer clinical trial. These materials were based on a real-life study that received regulatory scrutiny. Students prepared in advance for this class session with readings that included a law review article and select federal research regulations dealing with IRB approval and consent requirements for federally-funded research.
Rebecca Gittelson, a JD student and an MPH candidate in the UNC Gillings School of Global Public Health, said that by working together the JD and MD students “have not only been able to learn from each other but also to overcome stereotypes. In an exercise in our first class session, the medical students thought lawyers were ‘greedy,’ while the law students thought doctors had ‘a God Complex.’ I think we have moved far beyond those negative stereotypes by collaborating for a whole semester.”
Medical student Yi Yang said she found the small group discussions to be “very eye-opening, because working through the cases was not simply about deciding who is right and who is wrong. Instead, the cases require us to analyze and consider what is ethical and how can policies be adapted to improve care for people in the future. “
Professor Saver says that these problem-based exercises “challenge the students to apply their differing expertise and skill sets toward a common goal. To work through an exercise together, for example, the law students may need to explain the nuances of a statute while the medical students may need to explain the relevant clinical information involved in an episode of care. This is good training, we hope, in critical analysis while avoiding technical jargon – something important not only to working with other professionals but also for communicating with future clients and future patients.”
“We also try to simulate situations where physicians and lawyers actually do work together in the real world, such as serving on advisory and review committees together or developing institutional policies. Finally, our aim is to introduce the medical students to the full breadth of health law. Many medical students initially view health law as solely involving medical malpractice. While we do cover some liability, we also include regulatory and transactional topics, previewing the many different legal issues that future physicians can expect to encounter in practice,” Saver said.
“Our aim is to introduce the medical students to the full breadth of health law.”
Jonathan Oberlander, PhD, Chair of Social Medicine in the UNC School of Medicine, says the course “embodies the ideal of inter-professional education.”
“The reaction to the class from students has been fantastic,” he said. “This course, which represents a collaboration between the School of Law and School of Medicine, is truly unique — it is the rare partnership that turns the promise of inter-professional education into a reality. It is as a model not only at UNC, but nationally,” Oberlander said.
Christine Lopez, an MD student who took the course this fall, said she “thoroughly enjoyed the opportunity to work with the law students because their education emphasizes a different type of critical thinking than my own, which has made class very interesting. We often work through cases in class that call principles of law, ethics, and medicine into play. By working together we are able to form very strong arguments and learn new principles which are applicable to both our future professions.”
Trevor Presler, an attorney who took the class while he was in law school, said “the insights I was exposed to in the current issues class helped inform my understanding of the unique concerns facing physicians and other medical practitioners.”
“It was among the most interesting of my law school classes and, as a recently-licensed attorney focusing on health care regulatory matters, it has proved to be one of the most useful as well,” Presler said.