If you’re involved in teaching medical or social work students I really recommend you get your hands on a paper called ‘Exploring UK medical and social work students’ legal literacy: comparisons, contrasts and implications’ by Michael Preston-Shoot and Judy McKimm, published in the journal Health and Social Care in the Community. It tracks the legal knowledge and skills of medical and social work students during their studies, measuring their knowledge and confidence in those areas of law which impact upon their work. It’s a very interesting read. A few findings stood out to me, which say a lot about the way law is taught to these students and how their perceptions of it change:
- Both medical and social work students had positive perceptions of law.
- Medical students were anxious about ‘litigation, defensive practice and the potential for tensions between professional values and the legal rules’; social work students were anxious about ‘instructing lawyers, challenging decisions and practices in their own and other agencies, and using statutory authority when this ran counter to service users’ wishes.’ I wish there were a bit more qualitative detail about these sources of anxiety. Both suggest a perceived potential conflict between professional values and the law – but what is the nature of this conflict?
- They found that ‘Medical students appeared to become more anxious and social work students less anxious as their studies progressed about keeping abreast of the legal rules.’ For both groups, the authors suggest that insufficient time was devoted to law learning.
- By their final year, social work students were more likely to regard the law positively ‘with respect to inequality, resolving welfare issues and protecting vulnerable people.’, but were also less likely to be positive ‘about legal rules as a vehicle for change and meeting people’s needs.’ Final year medical students were more positive about the law in some areas than first year student, but ‘were less positive about the law’s support for professional values and meeting people’s needs’. I’d love to know a bit more about what influenced these changing perceptions during their training. Was it that the content of the law was a disappointment to them when they learned about it? What were the attitudes of those teaching law and those they shadowed during their training towards the law?
- The authors found that ‘medical students were more positive about lawyers than social work students’, suggesting that this might reflect ‘power, prestige and standing among different professional groupings’. I think I would like a bit more detail on why they drew this conclusion.
- One finding that I thought was especially fascinating was that social work students became more confident in their legal knowledge as their training progressed, whereas medical students became less confident. The same pattern was replicated for their confidence in their legal skills. This may not mean that social work students have better legal training; social work students might have misplaced confidence in their legal knowledge, and medical students might be more aware of the ‘known unknowns’. It would have been nice to have matched these self-reports with assessments of actual legal knowledge of both groups.
But for me, one of the most interesting findings in this research was contained within a table (Table 2), which reported students’ confidence in their knowledge of various statutes or areas of law. I’ve put some of the table in a chart which I’ve jiggled about a bit (see the original paper for N and Z-statistics); the vertical axis is the ‘percentage of students who report no knowledge or a little knowledge’:
‘The Act’s definition of lacking capacity means that an estimated two million adults in England and Wales are unable on a daily basis to make decisions for themselves. This means in turn that three million paid social care and healthcare staff and three million people who care for people lacking capacity, typically family and friends, are required to make daily best interests decisions on their behalf. ‘ 
It strikes me that social work courses are in real danger of neglecting the needs of this population, and there can be absolutely no justification for this. If children are worth teaching students about the Children Acts in so much detail, then social work students should be learning about the extremely complex legal issues which arise in adult care and protection.
The other thing I noticed is that by the final year of their training, the Mental Capacity Act appears to be the only area where medical students feel more confident about their legal knowledge than their counterparts in social work. It is also the area of law that medical students feel most confident about.
I wonder why this has happened – how it is that medical schools seem to have taken ownership of the Mental Capacity Act in a way that social work courses have not? I would like to see more research on the reasons for this, but even more than that, I’d like to see no medical or social work students graduating feeling that they have no or little knowledge of laws which are fundamental to ensuring they do not breach the rights of patients and service users.