July 2003 Reporter Home

AAMC Panel releases Report on Bioterrorism Education

Lawsuit Filed Against Princeton Review

Containing SARS: University of Toronto Rises to the Challenge

Nanotechnology: The Science of the Very Small

Innovations in Medical Education: Doctor in the Court

A Word from the President: Clinical Investigators for a Global Future

Viewpoint: Summer School, NIH Style

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Managing Editor Scott Harris sharris@aamc.org Staff Writer Elissa Fuchs efuchs@aamc.org

Innovations in Medical Education: Doctor in the Court

UC Davis medical students learn legalities through a mock malpractice trial

This is the seventh installment in a 2003 series of columns that will examine efforts to break new ground in medical education curricula.

Making the case: Los Angeles-based attorney Thomas G. Minder presents arguments at the UC Davis mock malpractice trial, while attorney Paul R. Kiesel (seated, end of table) and spectators look on. Photo: Jose Vilegas, UC Davis School of Medicine

Gone are the days when all doctors needed to know were the tricks of their own trade. In an era when medical malpractice lawsuits abound, physicians' professional success may often depend on how well versed they are with concepts that, until recently, were the sole purview of attorneys.

With that in mind, UC Davis School of Medicine decided to stage a mock malpractice trial in May, complete with a California Superior Court judge, two professional malpractice attorneys, a 12-member jury, and actors playing the case's plaintiffs. Nearly 100 third-year medical students sat in on the mock trial, held in the Sacramento County Superior Courthouse.

The case was a typical malpractice scenario in which the wife sues after her husband is misdiagnosed and left severely disabled. The medical students sitting in court were already familiar with the man and his health condition, since he was a standardized patient whom they had been caring for over the course of the academic year.

When the husband visits his doctor complaining that his recurrent migraine is a little more severe than usual, the doctor opts to increase the dosage of his medicine. Less than a week later, the patient collapses and is sent to the hospital, where staff discover that he has a subdural bleed. After a month in ICU and intense rehabilitation, he is sent home without any speech or cognitive abilities.

"The mock trial was interesting in that we were really able to see many sides of the issue in a legal setting," said UC Davis third-year medical student Alan Miller. "Part of me sided with the doctor in that it appeared that the evidence he was presented pointed toward a migraine. But to see the final outcome on the patient and the family really pointed out how important the decisions we make are, and the ramifications they can have."

Defensive medicine

The idea for the trial was developed by Michael Wilkes, M.D., vice dean of UC Davis School of Medicine, and Jerome Hoffman, MD, from the David Geffen School of Medicine at UCLA. "We realized that there were all kinds of misconceptions about what malpractice was, and the advantages and disadvantages to both society and physicians," Dr. Wilkes said.

"We thought that rather than having a lecture or doing a problem-based exercise around this case, having the students really get to know the patient, the doctor, and the context of the situation would make them much more passionate and invested in understanding how the legal system responded to this doctor's error."

The mock trial was part of UC Davis's 'Doctoring Program,' which is the result of a broad-based effort to rejuvenate the medical school curriculum at the school. The doctoring curriculum was piloted in 2001, and is replete with small-group and interdisciplinary learning opportunities for students in all four years of medical school. It introduces a variety of topics, such as doctor-patient communication, clinical reasoning, ethics, and end-of-life care, exposing students to the realities of being doctors in today's environment.

"Like it or not, [medical malpractice] is part of what medicine is all about, and perhaps the most important part of this exercise took place after the trial, when we spent time talking about what we would have done differently and the students began to look at the concept of 'defensive medicine,'" Dr. Wilkes said. Defensive medicine, or the prospect that medical students, residents, and doctors play it safe by ordering lots of tests, costs an estimated 5 percent of the total healthcare budget, according to Dr. Wilkes.

The mock trial made an impression on UC Davis student Miller. "I think that more than anything, the mock trial basically scared me into writing more complete notes," says Miller. "I've made a point to improve my notes since then, even though I may get home 10 minutes later each day. Though I hope that it will never happen, I believe it will be worth it if some day I see my notes projected to 10 by 12 feet on a courtroom screen."

- Suria Santana

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