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The simulated client initiative:A portrait of the outsider as teacher
Paul MahargOsgoode Hall Law School, York University, Toronto
preview1. What is the Simulated Client Initiative (SCI), and what are SCs?
2. Current uses & SC training
3. Why would we want to do this?
4. Methodological implications
Slides available at: http://paulmaharg.com/slides
http://zeugma.typepad.com/sci
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Simulated Client Initiative (SCI):our hypothesis back in 2005
With proper training and carefully designed assessment procedures, Standardised or Simulated Clients (SCs) can assess important aspects of client interviewing with validity and reliability comparable to assessment by law teachers.
aims• develop a practical and cost-effective method to assess the effectiveness
of lawyer-client communication which correlates assessment with the degree of client satisfaction & confidence.
• ie answer the following questions…1. Is our current system of teaching and assessing interviewing skills
sufficiently reliable and valid?2. Can the Simulated Patient method be translated successfully to the
legal domain?3. Is the method of Simulated Client training and assessment more
reliable, valid and cost-effective than the current system?
results from Strathclyde University pilotQuestions Results
1 Is our current system of teaching and assessing interviewing skills sufficiently 1. reliable? 2. valid?
1.No2.No
2 Can the Simulated Patient method be translated successfully to the legal domain?
Yes
3 Is the method of Simulated Client training and assessment more1.reliable, 2.valid3.cost-effective than the current system?
1.Yes2.Yes3.Yes
what changed…?• We make what the client thinks important in the most salient way for the
student: an assessment where most of the grade is given by the client• We do not conclude that all aspects of client interviewing can be
assessed by SCs– We focus the assessment on aspects we believe can be accurately
evaluated by non-lawyers– We focus the assessment on initial interview (which has been
extended at one centre to an advice-giving interview)• This has changed the way we enable students, trainees and lawyers to
learn interviewing & client-facing ethical behaviour
eg assessment criterion 22. I felt the student lawyer listened to me.
This item is designed to assess the degree to which the lawyer can listen carefully to you. These criteria focus especially on the early part of the meeting when the client should be encouraged to tell their story and concerns in their own words. This entails active listening – where it is necessary for the interview structure or the lawyer’s understanding of your narrative. The lawyer will not interrupt, cut you off, talk over you or rush you in conversation. The lawyer reacts to your responses appropriately. The lawyer may take notes where appropriate, but if the lawyer does so, the lawyer should not lose much eye contact with you. To some extent in this item we are concerned with what the lawyer does not do that facilitates the interview.
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1 2 3 4 5Lawyer prevents you from talking by interrupting, cutting off, talking over, rushing you. Takes over the conversation prematurely as if the lawyer already knows all the answers.
Lawyer limits your opportunity to talk by interrupting, cutting you off, etc. You are allowed to answer specific questions but are not allowed to expand on topics.
Lawyer rarely interrupts or cuts off or rushes you.The lawyer reacts to your responses appropriately in order to allow you to tell your story. More interested in notes taken than in eye-contact with you.
The lawyer is clearly listening closely to you.If the lawyer interrupts, it is only to assist you in telling the story more effectively.Lawyer provides opportunities for you to lead the discussion where appropriate. Good eye contact and non-verbal clues.
The lawyer is an excellent listener and speaks only when it is clearly helpful to your telling your story. Lawyer uses silence and other non-verbal facilitators to give you an opportunity to expand. Excellent eye contact and non-verbal cues.
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1 2 3 4 5Lawyer prevents you from talking by interrupting, cutting off, talking over, rushing you. Takes over the conversation prematurely as if the lawyer already knows all the answers.
Lawyer limits your opportunity to talk by interrupting, cutting you off, etc. You are allowed to answer specific questions but are not allowed to expand on topics.
Lawyer rarely interrupts or cuts off or rushes you.The lawyer reacts to your responses appropriately in order to allow you to tell your story. More interested in notes taken than in eye-contact with you.
The lawyer is clearly listening closely to you.If the lawyer interrupts, it is only to assist you in telling the story more effectively.Lawyer provides opportunities for you to lead the discussion where appropriate. Good eye contact and non-verbal clues.
The lawyer is an excellent listener and speaks only when it is clearly helpful to your telling your story. Lawyer uses silence and other non-verbal facilitators to give you an opportunity to expand. Excellent eye contact and non-verbal cues.
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current status of SCIUniversity of Strathclyde Law School WS (Writers to the Signet) Society, Edinburgh
University of New Hampshire Law School The Australian National University College of Law
Northumbria University Law School Kwansei Gakuin University Law School (Osaka)
SRA – Qualifying Lawyer Transfer Scheme Law Society of Ireland
Hong Kong University Faculty of Law Adelaide University Law School
The Chinese University of Hong Kong Faculty of Law
National Centre for Skills in Social Care, London
Nottingham Trent University Law School Next…?
independent studies…
Gerkman, A., Harman, E., Bond, L., Sullivan, .M. (2015). Ahead of the Curve: Turning Law Students into Lawyers. A Study of the Daniel Webster Honors Program. IAALS, Denver.
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training of SCs
‘The best way to learn how to do standardized patients is to do it along side of someone who has already done it before. It’s [the] apprenticeship system.’
Wallace, P. (1997) Following the threads of an innovation: the history of standardized patients in medical education, Caduceus, A Humanities Journal for Medicine and the Health Sciences, Department of Medical Humanities, Southern Illinois University School of Medicine, 13, 2, 5-28.
SC training 1: script conference • read script as group• discuss their roles• discuss their feelings, reactions • clear up ambiguities re role of lawyer• facilitator uses SC feedback to modify the scenario
SC training 2: practising the role There’s a need for the SCs to calibrate:• Body language• Tone of voice• Attitudinal swings• Dealing with the lawyer’s open questions…• Improvising on the lawyer’s closed questions…• Performance analysis on video review: ‘What prompted you to say…?’ ‘How did
you feel…?’
And to:• Be aware of their orientation towards lawyer at first sight• Respond congruently to the lawyer• Consult their internal ‘invigilator’…
SC training 3: assessing lawyers• We discuss the marking system, and form a common
understanding of it• SCs view and mark videos, comparing to ‘standard’• SCs view each other’s ‘live’ performances and mark them• Process repeated until everyone has role-played at least once• Comment on performance• Marks are collated in the room (suspense factor…)
after initial training?• SCs role-play clients with students, real lawyers and other professionals• SCs are given refresher training on the scenario• If they are trained on a new scenario they will have the same pattern of
training• They should form a community of practice with two core members of staff
– ideally, admin + academic to:– improve practice– suggest ways they may be used inside or outside the law school
2000 Research Study Law Society of England & Wales
• Interviewed 44 clients of 21 different solicitors in the north of England.
• 50% said that they had previously used a solicitor whom they did not like.
• The most common complaint was lack of respect, followed by a lack of interest in the client, and then poor communication.
Hillary Sommerlad & David Wall: Legally Aided Clients and Their Solicitors: Qualitative Perspectives on Quality and Legal Aid, 2-6 (Research Study No. 34 The Law Society
2000)
Study
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2000 Research Study Law Society of England & WalesS
tudy
1Clients talking about their solicitors:
‘I sent my former solicitor packing because she wouldn’t listen. That is absolutely fundamental; this was my case, only I knew the full circumstances’.
‘I went to [my current solicitor] because of her reputation and expertise… She is a part-time Registrar and has a big reputation as a specialist in this area but she just doesn’t listen’.
2000 Research Study Law Society of England & WalesS
tudy
1‘She listens for part of what I have to say, and then interrupts, saying something like “OK, I’ve got the picture, what we’ll do is ...” and she hasn’t really got the picture, she’s only got half the facts.
I think it’s partly because she so busy and also because she’s simply not used to giving clients a voice. What’s more she has actually made me frightened of expressing my views.
I am about to change to another solicitor’.
[continued]
2000 Research Study Law Society of England & WalesS
tudy
1• ‘I like my current solicitor because I can have a chat with her, I trust
her ... ... The other solicitor — I was just a file for him, but for [her current solicitor] I’m a real person and that comes across in court’.
• ‘I wanted the law to be explained. ... The way the solicitor views the client is important. He has to be interested in our views’.
• ‘They must be able to give you time. If solicitors haven’t got enough time, they can’t get enough out of you. You have to have time to be able to tell your story’.
• ‘I never liked him. ... we couldn’t have had a solicitor like him for this [matter]; I think he was perfectly competent, but there was no sympathy’.
summary: clients and their solicitors
• For many clients, their engagement with the law was not simply about achieving a result.
• Their responses indicated that the process itself was important.
• Empathy and respect were not luxury items: they were fundamental to the role and the service.
summary: what do clients dislike?• Inaccessibility• Lack of communication• Lack of empathy and understanding• Lack of respect
competence in client communication• Study by Sherr:• 143 actual 1st interviews
– 24 % trainee solicitors– 76% experienced solicitors
• 70% at least 6 years• 23% more than 11 years
• High percentages of ineffective interviews• Experienced solicitors generally no better than trainee solicitors
Paterson, Alan and Moorhead, R. and Sherr, A. (2003) What clients know: client perspectives and legal competence. International Journal of the Legal Profession, 10 (1). pp. 5-35
Study
2
Study
2• 51% failed to get client agreement to advice or plan of
action• 76% failed to confirm with client the solicitor’s
understanding of the facts• 85% failed to ask before ending whether there was
anything else the client wanted to discuss
competence in client communication
Study
2• Experienced solicitors:
– Used less legalese– Better at “filling in the gaps”– Rated their own interview performance higher than did
trainee solicitors • But the clients saw no difference in performance between
trainees and experienced solicitors
competence in client communication
2‘Being ‘‘client centred,’’ … is about paying attention to the practical and emotional needs of the client, not necessarily agreeing with the client’s motives, policy or philosophy and not necessarily doing what the client says they want. The client centred lawyer will listen to the client in order to advise on all options, as well as showing what they think is best for the client’.
Paterson, Alan and Moorhead, R. and Sherr, A. (2003) What clients know: client perspectives and legal competence . International Journal of the Legal Profession, 10 (1). pp. 5-35, 12.
See also Felstiner, W.L.F., Pettit, B. (2002) Paternalism, power and respect in lawyer-client relations, in Sanders, J., Hamilton, V.L., eds, Handbook of Justice Research in Law, Kluwer Academic Publishers, New York, 135-154.
Study
SCs: people as co-producers, co-designersThe SC approach challenges:
1. Curriculum methods
2. Ethics of the client encounter
3. The cognitive poverty of conventional law school assessment
4. Law school as a self-regarding, monolithic construct
5. Law school categories of employment
6. The curricular isolation of clinic within law schools
7. Hollowed-out skills rhetoric
8. Conventional forms of regulation by regulatory bodies
9. The role of regulator, as encourager of innovation & radical reform…?
10.Disciplinary boundaries – what about a SC Unit that’s interdisciplinary?
11.Local jurisdictional practices: how might such a project work globally?
Debra Nestel, Diana Tabak, Tanya Tierney, Carine Layat-Burn, Anja Robb, Susan Clark, Tracy Morrison, Norma Jones, Rachel Ellis, Cathy Smith, Nancy McNaughton, Kerry Knickle, Jenny Higham and Roger Kneebone. Key challenges in simulated patient programs: An international comparative case study. BMC Medical Education 2011 11:69.
ResultsAlthough programs shared challenges in SP methodology they also experienced differences. Key challenges common to programs included systematic quality assurance and the opportunity for research. There were differences in the terminology used to describe SPs, in their recruitment and training. Other differences reflected local conditions and demands in organisational structure, funding relationships with the host institution and national trends, especially in assessments.
Level 1: comparisons within the heuristic
Axtell, S., Avery, M., and Westra, B. (2010). Incorporating Cultural Competence Content Into Graduate Nursing Curricula Through Community – University Collaboration. Journal of Transcultural Nursing, 21(2), 183-191.
Aeder, L., Altshuler, L., Kachur, E., Barrett, S., Hilfer, A., Koepfer, S., Schaeffer, H. and Shelov, S. (2007). The “Culture OSCE” – Introducing a Formative Assessment into a Postgraduate Program. Education for Health, 20(1), 11. http://www.educationforhealth.net/text.asp?2007/20/1/11/101637
Altshuler, L. and Kachur, E. (2001). A Culture OSCE: Teaching Residents to Bridge Different Worlds. Academic Medicine, 76(5), 514.
http://transculturalcare.net/standardized-patients-simulation-and-cultural-competence/
Level 2: comparators of culture within and around the heuristic
Wilson Chow, Michael Ng (2015). Legal education without the law – lay clients as teachers and assessors in communication skills. International Journal of the Legal Profession, 22, 1, 103-25.
Our analysis confirms the reliability and validity of using standardized clients as assessors of interviewing skills. It also reveals the necessity of modification of the original design of standardized client program, particularly in relation to the assessment aspect of it, according to specific cultural and commercial needs in an Asian business city like Hong Kong.
Level 2: comparators of culture within and around the heuristic
Carr, A.J. Higginson, I.J. (2001). Are quality of life measures patient centred? British Medical Journal, June 2, 1357.
Chevannes, M. (2002). Issues in educating health professionals to meet the diverse needs of patients and other service users from ethnic minority groups. Journal of Advanced Nursing, 39, 3, 290-98.
Level 3: comparators of values, cultures and identity that challenge the basis of the heuristic
more information…1. Websites:
1. See Simulated Client Initiative, http://zeugma.typepad.com/sci
2. these slides @ http://paulmaharg.com.
2. Barton, K., Cunningham, C.D., Jones, G.T., Maharg, P. (2006). Valuing what clients think: standardized clients and the assessment of communicative competence. Clinical Law Review, 13, 1, 1-65.
3. Maharg, P. (2007). Transforming Legal Education: Learning and Teaching the Law in the Early Twenty-first Century. Aldershot, Ashgate Publishing, chapter 2, 64-67.
4. Garvey, J.B. (2010). New Hampshire’s performance-based variant of the Bar Examination, http://www.ncbex.org/uploads/user_docrepos/790210_Garvey.pdf
5. Barton, K., Garvey, J.B., Maharg (2013). ‘You are here’: learning law, practice and professionalism in the academy. In Bankowski, Z., Maharg, P. del Mar, M., editors, The Arts and the Legal Academy. Beyond Text in Legal Education, vol 1. Routledge.
