New Directions in Medicolegal Education
GS Medical Group believe on the contrary and are firmly of the view that subject to certain conditions and provided they are adequately supervised Doctors in training, whom they call “Junior Experts” can make excellent expert witnesses in the medicolegal system and should be able to regularly act as Expert Witnesses as a matter of course and in most jurisdictions (Box 7).
GS Medical Group are also entirely of the view that provided they are suitably supervised “Junior Experts”
rather than experienced Consultants should be used as the expert of choice in most legal proceedings except in the most complex cases (Spoto, 2020).
With regard to the training of Experts GS Medical group are also firmly of the view that training should be practice based (Box 8), as opposed to didactic as it is now widely accepted that in the clinical settings didactic teaching is entirely unsuitable (De Cossart and Fish ,2005)
(Box 8) Practice based learning as an alternative to classroom work hailed as “New Ways of Teaching and learning” by KSS Deanery, was first introduced in Postgraduate Medical Education under the banner of Liberating Learning, (KSS Deanery 2007), believed then to be hijacked by the European Working Time Directive.
The lack until recently of practice-based approaches to medical education in the clinical settings is thought to be a hangover from practice in the London Teaching Hospital going way back to the 18C.
Historically for example in the London Teaching Hospital students may be observed to be allowed to walk the walk but the lecture is king (Heaman, 2003).
Unlike other training organisations which today fail to make training available to less experienced Experts, GS Medical Group for the first time in the UK seeks to train less experienced Experts such as Consultants that have been newly appointed and higher psychiatric trainees.
(Box 9 ) In some training organisations, a form of practice-based teaching is available in the form of “mock” Court room practice but teaching based on real cases is not available
Despite services being provided in settings that are essentially clinical, namely the Expert’s Consulting room, Medicolegal Education in the UK is still largely based in the classroom resulting in seriously adverse consequences for service provision and the delivery of Justice.
Furthermore, and again contrary to other training organisations where the training available is to this day essentially didactic and therefore entirely out of date (Box 9) GS Medical Group champions up to date ways of teaching and learning in Medicolegal Education and does so deliberately and in a systematic way
(Box 10).
(Box 10 )The place where learners engage in supervised practice away from the classroom is called a “Practicum “ , a safe place where practice is the priority rather than the Lecture The term “Practicum” was originally introduced in undergraduate education , as a place where the real world of professional practice is simulated
In the clinical settings the “Practicum” was originally introduced in the training of Surgeons at the start of the Century (De Cossart and Fish, 2005). The concept of a “Practicum “in the medicolegal system is unknown.
Under GS Medical Group didactic teaching is disallowed and a practice-based approach to teaching and learning is rigorously enforced (Box 11) including Supervision. The Group also provides opportunities for Experts to engage in CbD’s and Mentoring is available as part of the scheme.
The Expert is also expected to reflect on their practice engaging in reflections both “in action” and “on action” (Schon 1987) Other forms of Active Learning which are regularly updated are also implemented and very strongly encouraged at every stage.
(Box 11) The model which under GS Medical Group is strictly adhered to hails back to Vygotsky’s idea of “scaffolding “(Vygotsky 1978) which demands complete abstinence from any kind of classroom work. The model regards any attempts by either the learner or the Teacher to go back to the lecture as the model “reverting to type “and they are forcefully resisted.
Vygotsky also introduced the idea of a zone of “proximal development “and Bruner thought that learning requires appropriate frameworks of social interaction (Bruner ,1978).
Uniquely, and again for the first time in the medicolegal system GS Medical Group provides Experts with access to a Library of medicolegal reports and other training materials for their personal use thus further enhancing the training experience (Box 12 ). Members of the Group are indeed required to upload their report to the Library as a condition of their membership
A Forum is also available for Members to engage in dialogue and access to the Forum is a further benefit of membership.
Unlike other training organisations Assessment under GS Medical Group is regularly undertaken and formative and summative instruments are used at regular intervals underpinning training progression, supported by other well-known tools of educational practice such as the Learner’s Journal (Monn 2002).
(Box 12) Supervision is still a novel way of teaching and learning in medicine. At the start of the NHS when Consultants agreed to undertake teaching responsibility largely undergraduate in the Teaching Hospital in exchange for services undertaken by their academic colleagues, they did so provided support by a Junior Doctor under supervision was available. The arrangement was known as the Firm.
Interestingly. this is to this day always a contentious issue in other medical specialties and although once a week supervision in Psychiatry is mandatory, this is only a recent development.
By contrast Supervision has always been a central feature in the training of Lawyers. Barristers for example who are based in chambers are required to undertake duties under supervision for several years before being called to the Bar, a system known as “pupillage “.
Interestingly the correct title of a Barrister is that of a “Junior Barrister “until they become a KC The process known as “taking silk”.
