Monday, March 12, 2012

Considering the Med School Analogy

Posted by Jeff Lipshaw

Bill is as usual too kind, but indeed we have been friends since that fateful lunch in Bloomington six IMG_0230years ago this month.  I'm immensely flattered that Bill and Andy have seen fit to hand me the dry erase marker, and the first thing I did with it was draw a far more accurate self-portrait than the picture Bill managed to dig out of some P.R. file somewhere.

I flew out to San Francisco from Boston yesterday.  About an hour into the flight, the flight attendant asked over the PA whether there was a medical professional on board, and I saw somebody up near the front of the plane hit the call button.  I had been discussing this very situation with my third-year medical student son a couple weeks ago, reacting to a post from my friend Howard Wasserman at PrawfsBlawg.  Howard told the story of a newly-graduated doctor flying in fear of being called on in such a situation, believing that she didn't have the practice skills to intervene.  Howard's point, if I can restate it, was that pointing to medical education as the model for "practice-ready" lawyers was a mistake, and that newly-minted doctors were just as "unpractice-ready" as newly-minted lawyers.

I wouldn't want a newly-minted doctor to perform neurosurgery on anybody I liked, but I thought Howard had overplayed the meaning of the anecdote.  My son advises me that invariably what you need on an airplane is an EMT, not a doctor.  (He tells me all med students are CPR-trained, but he'd be far more competent to diagnose a cough or a rash than to apply the CPR.)  If the only person on the plane to step up was a third year med student, I'd still think that person was more qualified to act as a GP doctor, relatively speaking, than the typical doctrinally-trained law grad would be to act as a GP lawyer.  Others may feel differently.

Having said that, and having observed my own education, my son's, and the education I'm now employed to help provide, I am still convinced that medical education, apart from internship and residency, effectively creates "doctors" by the time med students are in their third year. The great bulk of medical education takes place in three years - the first two in the classroom (culminating in the USMLE Step 1 exam), and the fourth being largely devoted to rotations in specialties and the residency placement process. The third year is the one that is brutally intense. On a outpatient service, the students spend something 10.5 hours a day, five days a week in the clinic, then go home and study for 2-3 hours more. On inpatient rotations, they go from 6:30 am to 5:00 pm in the hospital, and again go home to study for 2-3 hours. They have an exam at the end of each rotation.

There is an important institutional difference in medical education.  There's no doubt that med students get the benefit of public and private funding of the health care systems, but they are also care providers - they do things that if they didn't others would have to do.  Finding legal institutions capable of replicating this kind of intensity for law students is a problem (particularly for non-litigating lawyers), but the point is that no law student is going to approach the kind of practice readiness I perceive in a med student of equivalent tenure by doing fifteen credit hours (three hours a day of class time) a semester of even the most pragmatic skills oriented course work. Are students, faculties, administrators, law firms, courts, corporations prepared to create the kind of full-time (I mean thirteen hours a day) experience for the final two years of law school that might well leave one thinking "that's somebody who's a lawyer"? Because to do both the theory and the practice (as the med students do) would take that kind of commitment from all concerned.

(Cross-posted at Legal Profession Blog)

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From my article What Law Schools Should Teach Future Transactional Lawyers: Perspectives from Practice (

"Any attempt by law school to replicate real practice will necessarily be much too artificial. This is one area where attempts to compare legal education to medical education break down. A teaching hospital is a real hospital. A medical student is able to imitate the performance of an expert doctor in a real life situation on a real patient while the expert provides feedback to guide the student in making the activity his or her own. This is simply not the case at law schools. Another area where the analogy breaks down is that, to get into medical school, a student has to have already taken a significant number of substantive courses. For example, most medical schools require applicants to have completed at least one full year of each of Biology and Physics and two full years of Chemistry (including Organic Chemistry), together with associated lab work. In law school, many students are, in effect, starting from scratch, with no prior legal or business training or experience. As a result, more substantive training is necessary, leaving less time for practical training. In addition, those holding medical school up as a model of hands-on practical training that law school should follow often skip over the fact that medical school is four years, the first two of which are devoted to teaching substantive courses."

Posted by: MAW | Mar 12, 2012 11:33:02 AM

Mike, I think we are both expressing skepticism about the analogy, and agree that the med student is indeed providing care.

My only quibbles about this: at least in our son's experience, the third year is far more intense than the fourth year. The fourth year is for more specialized rotations, and they get a lot of time to pursue their residencies. Also, those first two years of med school classroom work extend well beyond basic undergraduate sciences. To put it another way, it's in the third year that the analogy breaks down in terms of institutional parallels, hands-on experience, and commitment of time to study and practice.

Posted by: Jeff Lipshaw | Mar 12, 2012 2:18:33 PM

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