Exploring the Impact of Courtroom Observations on the Awareness of Professional Risk Among Medical Students of Different Specialties: A Single-Center Controlled Study

Exploring the Impact of Courtroom Observations on the Awareness of Professional Risk Among Medical Students of Different Specialties: A Single-Center Controlled Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring the Impact of Courtroom Observations on the Awareness of Professional Risk Among Medical Students of Different Specialties: A Single-Center Controlled Study Yuan Da, Liu Haishuo, Lin Yulv, Huang Li, Chen Zheng, Peng Hua, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6969998/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To explore the role of courtroom observation in cultivating the risk awareness of medical graduate students, to optimize teaching methods, and also to provide a reference for other medical schools to carry out similar teaching reforms. Methods In this study, a self-prepared questionnaire survey was conducted on clinical and non-clinical medicine students after the completion of the " Risk of Medical Practice " course, that is, before the courtroom observations and after, including the general information of the students' gender and major, as well as the legal cognition and evaluation of the course before and after participating in the courtroom observations. SPSS27.0 was used to perform the t or χ2 test on the data. Statistical significance was defined as p<0.05. Results A total of 72 medical students were surveyed, including 32 in clinical medicine and 40 in non-clinical medicine. After participating in the courtroom observation, there were statistically significant differences in the self-evaluation of the degree of legal awareness, the self-evaluation of the importance of future practice, and the role of practice risk prevention. In the setting of the course " Risk of Medical Practice " as a compulsory course, the degree of course recommendation has increased, but there is no statistical difference. The students' expectations for courtroom observations again and the score of setting courtroom observations as part of the course were both 9.0 or above. Conclusion The results demonstrate that courtroom observation is an effective teaching method. By participating as spectators in litigation, medical students not only enhance their awareness of medical law and practice risk prevention but also develop a more proactive attitude toward related courses. As far as the teaching mode of courtroom observations is concerned, medical students are also highly recognized and actively participated. In conclusion, this study provides empirical data for medical schools in terms of medical students' legal education and practice risk awareness cultivation, and provides a new scheme for optimizing medical education methods, demonstrating the potential value of courtroom observation methods, and the need for a more active attitude. Courtroom Observation Medical Education Professional Risk Legal Awareness Curriculum Innovation Introduction The limitations, risks and human errors of medical technology inevitably lead to adverse medical events and even medical disputes. Some studies have shown that after being caught in medical disputes, medical personnel are often accompanied by anxiety, low spirits, depression and other emotions, which affect their physical and mental health and work [1] . Medical students, especially clinical medical students, are similarly affected by doctor-patient disputes during clinical practice. Such negative influences can lead to a decrease in their enthusiasm for learning, regret for choosing a medical specialty, reluctance to engage in clinical work and a lack of future career security [2-4] . Therefore, strengthening medical students' understanding of medical disputes, which can, on the one hand, establish the awareness of complying with the obligations of diagnosis and treatment and safeguarding patient safety, and, on the other hand, enhance the ability to cope with medical disputes. Unfortunately, medical schools in China have not yet realized the importance of legal quality education for medical students, and there are fewer medical-related legal courses. In order to achieve the goal of cultivating medical students' job competence and allowing medical students to experience medical litigation cases in court through first-hand experience in order to enhance their legal awareness and ability, recognize the risks in practice, strengthen the concept of patient safety, and safeguard the quality of medical care, the Peking Union Medical College (PUMC) has opened a course of "Risks of Medical Practice", and has arranged for hands-on experience of courtroom observation. Based on the above considerations, this study investigated the before and after effect questionnaires of students attending courtroom observation to assess the role on medical students' awareness of risks in medical practice, and also expects that this study can provide a reference for other medical schools to offer related courses. Information and methodology 1.1 Subject of the study Graduate students, including first-year master's and doctoral degree students, who completed the course of "Risks of Medical Practice" at Peking Union Medical College from September to December 2024 and participated in the courtroom observation of Dongcheng District People's Court, Beijing, were selected for this study. Inclusion criteria:①completion of all courses; ②full participation in the courtroom observation; ③consent to participate in this study. Exclusion Criteria: Due to personal reasons, students did not complete all the courses or participate in the whole courtroom observation. All students gave informed consent to the content of this study. 1.2 Research methodology 1.2.1 Ethical approval and consent to participate This study was conducted under the guidance of the Declaration of Helsinki and the Principles of Ethics in Medical Research. In accordance with the document "Measures for Ethical Review of Life Science and Medical Research Involving Human Beings" developed by the Health Commission of the People's Republic of China, the Ministry of Education and other departments, the Ethics Committee of the Peking Union Medical College Hospital decided to approve the exemption (I-25ZM0039). Informed consent was provided by the participants, who were informed that the data would be used for scientific purposes and would be kept confidential and anonymous. All methods were performed in accordance with relevant guidelines and regulations. 1.2.2 Questionnaire design The questionnaire was designed by three teachers who were randomly involved in teaching the course and included general information about the study participants, such as grade level and specialty; evaluation of legal awareness of medical practice risks; and evaluation of the necessity of the courtroom observation. An electronic questionnaire as well as an anonymized form was used to distribute to the study participants. Participation in the questionnaire was voluntary for all study subjects. Each participant could submit the questionnaire only once. The entire content of the questionnaire was set as mandatory in order to increase the efficiency of the retrieval. The questionnaire was administered twice, at the end of the course, before the courtroom observation ("before") and after the courtroom observation ("after"). After completing the questionnaire, the data were double-checked and cleaned. Most questions were rated on a 10 point scale, with 1 meaning "strongly disagree/not at all concerned/not useful at all" and 10 meaning "strongly agree/very concerned/very useful." 1.2.3 Grouping The study population was divided into clinical medicine and non-clinical according to their specialties, and the results of the questionnaire were compared before and after. Both groups received the same teaching content and assessments to minimize confounding variables. 1.2.4 Course content The course " Risks of Medical Practice" of Peking Union Medical College (PUMC) covers the contents of medical practice licensing, medical management, doctor-patient communication, and medical law, etc. It is developed from three modules, namely, establishing the concept of patient safety and legal education, enhancing the awareness of medical risks, and improving the ability of dispute handling and doctor-patient communication, in order to introduce to the medical students, the causes and types of disputes occurring in the clinical and medical activities as well as the measures to prevent and handle them. In addition to theoretical courses, practical courses are added: by organizing medical students to observe medical litigation cases in the People's Court of Dongcheng District, Beijing, the aim is to give medical students a clearer and deeper understanding and knowledge of medical disputes, legal knowledge and litigation process through immersive litigation experience. 1.3 Statistical methods Data were entered using EXCEL 2021 and collected data were analyzed and processed using SPSS 27.0. Count data were expressed as frequencies and percentages n (%) were expressed using χ2 test. Normally distributed measurements were expressed as mean ± SD using t-test. Non-normally distributed data were tested using non- parametric tests (K-W test or M-W test). Statistical significance was achieved when p<0.05. Results 2.1 General information A total of 72 electronic questionnaires were recovered from the 72 study participants, with a 100% recovery rate. There were 32 clinical medicine majors, including 13 males and 19 who are in the first year of doctoral studies; 40 non-clinical medicine majors, including 11 males and 10 who are in the first year of doctoral studies. The details are shown in Table 1. Table 1 General profile of the study population (n=72) Events Clinical medicine (n=32) Non-clinical medicine (n=40) Number of persons (n) Percentage (%) Number of persons (n) Percentage (%) Sexes male 13 40.6% 11 27.5% Female 19 59.4% 29 72.5% Grade The first year of master's degree 13 40.6% 30 75.0% The first year of doctoral studies 19 59.4% 10 25.0% 2.2 Legal Awareness and Perceived Practice Risks There was no statistical difference between clinical and non-clinical medical students before and after courtroom observation in terms of self-assessment of doctor-patient relationship apprehension, self-assessment of legal awareness, and self-assessment of importance to the practice of medicine. However, after courtroom observation, clinical students exhibited a significantly higher recognition of courtroom observation’s role in risk prevention compared to non-clinical students (p=0.025). Further within-group analysis revealed that self-assessment of the degree of legal awareness of clinical medical students decreased after courtroom observation, the phenomenon that also occurred among non-clinical medical students. For non-clinical medical students, there was a statistically significant increase in their self-assessment of the degree of doctor-patient relationship apprehension, their self-assessment of the importance of practicing law, and their self-assessment of practice risk prevention after the courtroom observation, which was statistically significant. The details are shown in Table 2. Table 2 The results of self-assessment item Investigation time Level of doctor-patient relationship worries (10 points) Level of legal awareness (10 points) Importance to the practice (10 points) Role in practice risk prevention (10 points) Clinical medicine Non-clinical medicine a Clinical medicine b Non-clinical medicine c Clinical medicine Non-clinical medicine d Clinical medicine f Non-clinical medicine g before 6.94±2.50 6.23±2.45 8.44±1.72 8.20±1.70 9.16±1.22 9.05±1.24 9.16±1.25 8.80±1.32 after 7.47±1.85 6.63±1.96 7.78±2.27 7.88±1.74 9.44±0.98 9.45±0.90 9.75±0.57e 9.38±0.77 Annotation: a: Self-assessment items of doctor-patient relationship apprehension, before vs. after within non-clinical specialty group, p=0.008 b: Self-assessment items of legal awareness level, before vs. after within clinical specialty group, p=0.01 c: Self-assessment item of legal awareness level, before vs. after within the non-clinical specialty group p=0.02 d: Importance to future practice item, before vs. after within the non-clinical specialty group p<0.001 e: Role in practice risk Prevention program, clinical medicine vs. non-clinical medicine after courtroom observation, p=0.025 f: Role in practice risk prevention program, before vs. after within clinical specialty group, p=0.01 g: Role in practice risk prevention items, before vs. after within non-clinical specialty group, p=0.02 2.3 Curriculum and evaluation Before the courtroom observation, the percentage of non-clinical medical students who supported that the course should be made mandatory was 67.5% (27/40), which was significantly higher than the 37.5% (12/32) of clinical medical students, with a statistically significant difference of p=0.01. However, after the courtroom observation, the clinical medical students increased the importance of the course, and the percentage of those who believed that the course should be made mandatory, the percentage of people increased to 59.4% (19/32). Interestingly, clinical medical students rated lower scores than non-clinical medical students on the necessity of setting courtroom observation as a course component, but rated higher on the level of recommendation for this course and the level of anticipation of attending courtroom observation again. This can be seen in Table 3. Table 3 The evaluation results of the course Investigation time Curriculum Degree of recommendation Level of anticipation of attending courtroom observation again The necessity of making courtroom observation part of the course compulsory course optional course clinical medicine non-clinical medicine clinical medicine non-clinical medicine clinical medicine non-clinical medicine clinical medicine non-clinical medicine clinical medicine non-clinical medicine Before a 12 27 20 13 9.21±1.41 9.00±1.34 - - - - After 19 19 13 21 9.53±0.92 9.35±1.05 9.50±0.95 9.40±0.96 9.06±1.64 9.23±1.10 Annotation: a: Curriculum, clinical medicine vs. non-clinical medicine before courtroom observation, p=0.01 Discussion and conclusions 3.1 Courtroom observation increases medical students' practice anxiety and solidify their legal awareness assessment The results of the study showed that the courtroom observation increases the level of medical students' apprehension about the doctor-patient relationship and increase practice anxiety. According to our previous study has shown that the theoretical learning through this course reduce medical students' practice anxiety. It can be seen that there is still a certain difference between theoretical learning and practical reality. After the courtroom observation, medical students can deeply realize the reality of medical practice risk, uphold the responsibility of patient safety. This finding is consistent with the study of Gupta et al. in 2013, whose paper similarly noted that medical students' fear decreases significantly with more visits [5] . In addition, there was a statistically significant decrease in the self-rated scores of the degree of legal awareness of medical students after courtroom observation (p=0.01 within the clinical medicine group; p=0.02 within the non-clinical medicine group). This result suggests that courtroom observation can make medical students realize their lack of legal knowledge. This is consistent with Xing Yao's findings that medical students usually have a more one-sided understanding of legal knowledge, and that through practical education, medical students are able to more deeply recognize the importance of legal literacy in their daily diagnosis and treatment [6] . It can be seen that the educational approach of practical case presentations can effectively reveal students' blind spots in their professional knowledge, thus motivating them to strengthen their learning in related fields in their future studies and careers. At the same time, this result is instructive for medical school education policy makers, suggesting the need for greater integration of practical instruction, especially in legal education, into curriculum design to enhance students' ability to deal with legal challenges in the real world. 3.2 Courtroom observation raises medical students' awareness of the importance of the course Courtroom observation as a practice session in the risks of medical practice course promotes medical students to pay more attention to the course. The results of the study showed that after the courtroom observation, medical students' scores on the self-assessment of the importance of the course to their future practice, the self-assessment of the role of practice risk prevention, and their willingness to recommend the course to other students increased significantly. This suggests that the court hearing bystanders enhanced the importance of medical students' medical law- related courses to a certain extent. The results are consistent with the study of Xu Guangya et al., that legal education emphasizing practicality can effectively enhance students' awareness of the practical application and importance of legal knowledge, and help them to better integrate theoretical knowledge with actual cases [7] . However, on the issue of whether the course should be set as a compulsory or optional course, the concepts of clinical medical students and non-clinical medical students were completely different, and most clinical medical students (19/32) preferred that the course be set as a compulsory course. This may be due to the fact that clinical medical students have been directly or indirectly exposed to medical disputes in their clinical practice, have a stronger need for medical legal knowledge themselves, and are more likely to feel the practical application value of the course and the potential threat of practice risk after participating in the courtroom observation as spectators. This phenomenon fits with the findings of Cao Wei et al., that the observation of actual cases can help students gain a deeper understanding of the practical role of the law, whereas theoretical knowledge is often difficult to produce a deep understanding if it has not been verified in practice [8] . Through courtroom observation, medical students can directly observe the whole process of medical disputes, thus creating a more intuitive perception of it. Therefore, if the courtroom observation is arranged before the theory course, it may be able to further enhance the teaching effect. 3.3 Medical students highly approve of courtroom observation, but more flexibility is needed in the form of arrangements This study also found that medical students highly recognized the innovative teaching method of courtroom observation. The mean score for " anticipation of attending courtroom observation again" was close to 9.5. The researcher has not yet found any literature on the evaluation of Chinese medical students' participation in courtroom observation, and it is difficult to compare whether this practice program is also applicable in other medical schools. However, compared with traditional classroom teaching, such a vivid form of practice as courtroom observation can not only enhance medical students' legal literacy, but also make them feel the urgency and complexity of medical dispute handling, thus increasing the importance of legal education. Therefore, incorporating the practical course of court hearing into the curriculum education of medical students can enable medical students to quickly understand the real situation from theoretical learning, and can help them to sort out the awareness of risk in the future practice and pay more attention to the awareness of medical quality and patient safety. In terms of the necessity of setting courtroom observation as part of the course content, the mean score of medical students was above 9.0, but the mean value of the ratings of non-clinical medical students was 0.2 points higher than that of clinical medical students. As for the level of anticipation of attending courtroom observation, clinical medical students were 0.1 points higher than non-clinical medical students. This may be due to the fact that clinical medicine students are still required to be on duty in their clinical practice, and the random nature of courtroom observation times does not facilitate clinical medicine students to take time off from work. Therefore, courtroom observation, which is an uncertain practice course, is more favorable for clinical medicine students to participate in a voluntary choice manner. Summary Currently, there are fewer studies on medical disputes and education in China, with an annual average of only three articles, and fewer medical schools offering related courses [9] . At the same time, few medical schools in China provide medical students with the opportunity to sit in on medical dispute litigation cases in court. It is of exploratory significance for Peking Union Medical College to try to make courtroom observation as a regular practice course on the basis of the “Risks of Medical Practice” course. According to the results of this study, although courtroom observation increases medical students' practice anxiety, it can also make them realize their lack of legal knowledge, enhance their attention to the course, and participate in the relevant courses with a more positive attitude. In addition, medical students also highly recognize the active participation in the teaching mode of courtroom observation, but the form of participation needs to be flexibly adjusted according to the type of students' specialties. Of course, Limitations of this study include its single-center design, small sample size, and short-term follow-up. Future studies could extend the follow-up period to explore the effects of this teaching method on the long- term practice behavior and legal awareness of medical students, with a view to providing more in-depth insights into the reform of medical education. In conclusion, courtroom observation, as an innovative teaching strategy in medical education, can effectively enhance medical students' legal cognition and practice risk prevention awareness, as well as improve the attractiveness and educational effect of the course. Although the feedback from clinical and non-clinical medical students differed, overall, courtroom observation had a positive impact on medical students' improved legal awareness and enhanced risk prevention ability. This result provides a useful reference for medical education reform, especially in improving medical students' legal literacy and risk awareness, which has important practical significance. Declarations Acknowledgements: We would like to thank Peking Union Medical College Hospital for allowing us to conduct this study. We would also like to thank the students who participated in the " Risks of Medical Practice" course and courtroom observation for their willingness to participate in this study. Special thanks to the Beijing Dongcheng District People's Court and the judges, represented by Judge Qi Hongmei of the Second Civil Court, for giving the students the opportunity to participate. This immersive experience will help the students to pay more attention to the quality of medical care and patient safety in their future practice, and to protect the legitimate rights and interests of both doctors and patients in accordance with the law. Author Contributions: Yuan Da mainly designed and implemented this study. Liu Hai-Shuo and Lin Yu-Lv analyzed and wrote the data for the paper. Huang Li, Chen Zheng, and Peng Hua participated in designing this research program and participated in the survey. Ma Xiaojun considered and revised this paper. Conflict of Interest: The authors declare no competing interests. Funding Declaration: No funding supports. Data Availability: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. References Li Xiumei. The psychological impact of medical disputes on medical workers [J]. Journal of International Psychiatry, 2019, 46(06):978-981. Liu Qiongyao, Wang Yan, Zhou Xiaohua, et al. The Studys on the Psychological Impacts of Medical Disputes on Medical Students[J]. Chinese Medical Ethics, 2015, 28(06):999-1001. Zhu Wenqing, Zeng Ying, Su Na, et al. Analysis on influence of current doctor-patient relationship on career choices of medical students and young doctors[J]. Surgical research and new technique, 2018, 7(4):271-275. Lan Wanning, Li Danyun, Feng Jingru, et al. Impact of the current doctor-patient relationship on the psychology and career planning of medical students-A case study of medical schools in Guang zhou[J]. Guangdong Education (Vocational Education Edition), 2021(12):41-42. Gupta S, Phatak A, Panchal D. Courtroom exposure to medical students: a practical approach to legal procedures in Indian scenario[J]. Journal of Forensic & Legal Medicine, 2013, 20(6):767-769. Xing Yao. Exploration of medical students' legal knowledge education[J]. Henan Education, 2012, (02):58-59. Xu Guangya, Li Bin, Wang Ting. Research on medical students' legal education[J]. Curriculum Education Research, 2017, (33):229-230. Cao Wei, Shen Xuning, Yu Huijie, et al. Application effect of moot court in the standardized training and teaching of emergency department residents[J]. Chinese Journal of Graduate Medical Education, 2024, 8(03):194-198. Wen Hongxia. Design of the Medical Dispute Course in Medical Universities Based on CiteSpace[J]. China Continuing Medical Education, 2024, 16(17):193-198. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6969998","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":476555545,"identity":"7de2b695-266d-4b01-814b-43d39abe859a","order_by":0,"name":"Yuan Da","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYBACfvaG9A+Sf2zqgQwitUj2HHjGYNmQlgBkEKnF4EbiM4bKhsMJBjcSiLWlITntwc0dzHkGNx9vvMFQYxNNUAs/w7F0w5ln2Iolb6cVWzAcS8ttIGhLY0+CtAQbD2Pf7RwzCcaGw4S1GBzm/yD9hw2o+OYZYrUcY0iTkGwzSJxwg4dILZI9DMkGEmcSjCV7gH5JIMYv/PIPEh9IVPyX42c/vPHGhxobwlpQHCmRQIpyiBZSdYyCUTAKRsHIAABkMETPe2dubwAAAABJRU5ErkJggg==","orcid":"","institution":"Chinese Academy of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Yuan","middleName":"","lastName":"Da","suffix":""},{"id":476555546,"identity":"9b26a600-ceba-493c-9bbb-cadff44c85bb","order_by":1,"name":"Liu Haishuo","email":"","orcid":"","institution":"Tsinghua University International Graduate School of Tsinghua University","correspondingAuthor":false,"prefix":"","firstName":"Liu","middleName":"","lastName":"Haishuo","suffix":""},{"id":476555547,"identity":"f20cb806-0f78-4ff9-ab94-9f8af8c1a95c","order_by":2,"name":"Lin Yulv","email":"","orcid":"","institution":"Tsinghua University International Graduate School of Tsinghua University","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Yulv","suffix":""},{"id":476555548,"identity":"a4b52d9d-fbb1-4f02-a39d-d5b130787d31","order_by":3,"name":"Huang Li","email":"","orcid":"","institution":"Chinese Academy of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Huang","middleName":"","lastName":"Li","suffix":""},{"id":476555549,"identity":"2c411b4e-1c10-4cf3-8de2-12a4204fce7c","order_by":4,"name":"Chen Zheng","email":"","orcid":"","institution":"Chinese Academy of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Chen","middleName":"","lastName":"Zheng","suffix":""},{"id":476555550,"identity":"5d08e56f-8564-47ce-b8e4-054505eff8b5","order_by":5,"name":"Peng Hua","email":"","orcid":"","institution":"Chinese Academy of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Peng","middleName":"","lastName":"Hua","suffix":""},{"id":476555551,"identity":"1554d6aa-4904-43d8-8767-8a05111e79fa","order_by":6,"name":"Ma Xiaojun","email":"","orcid":"","institution":"Chinese Academy of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ma","middleName":"","lastName":"Xiaojun","suffix":""}],"badges":[],"createdAt":"2025-06-25 03:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6969998/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6969998/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85702718,"identity":"6c06bb3d-ef38-42de-999e-ec21c0b251a5","added_by":"auto","created_at":"2025-06-30 21:31:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":385168,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6969998/v1/803c1bda-9e5e-4f76-983a-60446ec4b791.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring the Impact of Courtroom Observations on the Awareness of Professional Risk Among Medical Students of Different Specialties: A Single-Center Controlled Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe limitations, risks and human errors of medical technology inevitably lead to adverse medical events and even medical disputes. Some studies have shown that after being caught in medical disputes, medical personnel are often accompanied by anxiety, low spirits, depression and other emotions, which affect their physical and mental health and work\u003csup\u003e[1]\u003c/sup\u003e. Medical students, especially clinical medical students, are similarly affected by doctor-patient disputes during clinical practice. Such negative influences can lead to a decrease in their enthusiasm for learning, regret for choosing a medical specialty, reluctance to engage in clinical work and a lack of future career security\u003csup\u003e[2-4]\u003c/sup\u003e. Therefore, strengthening medical students' understanding of medical disputes, which can, on the one hand, establish the awareness of complying with the obligations of diagnosis and treatment and safeguarding patient safety, and, on the other hand, enhance the ability to cope with medical disputes. Unfortunately, medical schools in China have not yet realized the importance of legal quality education for medical students, and there are fewer medical-related legal courses. In order to achieve the goal of cultivating medical students' job competence and allowing medical students to experience medical litigation cases in court through first-hand experience in order to enhance their legal awareness and ability, recognize the risks in practice, strengthen the concept of patient safety, and safeguard the quality of medical care, the Peking Union Medical College (PUMC) has opened a course of \"Risks of Medical Practice\", and has arranged for hands-on experience of courtroom observation. Based on the above considerations, this study investigated the before and after effect questionnaires of students attending courtroom observation to assess the role on medical students' awareness of risks in medical practice, and also expects that this study can provide a reference for other medical schools to offer related courses.\u003c/p\u003e"},{"header":"Information and methodology","content":"\u003cp\u003e1.1\u0026nbsp; \u0026nbsp; \u0026nbsp;Subject of the study\u003c/p\u003e\n\u003cp\u003eGraduate students, including first-year master's and doctoral degree students, who completed the course of \"Risks of Medical Practice\" at Peking Union Medical College from September to December 2024 and participated in the courtroom observation of Dongcheng District People's Court, Beijing, were selected for this study. Inclusion criteria:①completion of all courses;\u0026nbsp;②full participation in the courtroom observation;\u0026nbsp;③consent to participate in this study. Exclusion Criteria: Due to personal reasons, students did not complete all the courses or participate in the whole courtroom observation. All students gave informed consent to the content of this study.\u003c/p\u003e\n\u003cp\u003e1.2\u0026nbsp; \u0026nbsp; \u0026nbsp;Research methodology\u003c/p\u003e\n\u003cp\u003e1.2.1 Ethical approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was conducted under the guidance of the Declaration of Helsinki and the Principles of Ethics in Medical Research. In accordance with the document \"Measures for Ethical Review of Life Science and Medical Research Involving Human Beings\" developed by the Health Commission of the People's Republic of China, the Ministry of Education and other departments, the Ethics Committee of the Peking Union Medical College Hospital decided to approve the exemption (I-25ZM0039). Informed consent was provided by the participants, who were informed that the data would be used for scientific purposes and would be kept confidential and anonymous. All methods were performed in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e1.2.2\u0026nbsp;\u0026nbsp;Questionnaire design\u003c/p\u003e\n\u003cp\u003eThe questionnaire was designed by three teachers who were randomly involved in teaching the course and included general information about the study participants, such as grade level and specialty; evaluation of legal awareness of medical practice risks; and evaluation of the necessity of the courtroom observation. An electronic questionnaire as well as an anonymized form was used to distribute to the study participants. Participation in the questionnaire was voluntary for all study subjects. Each \u0026nbsp;participant could submit the questionnaire only once. The entire content of the questionnaire was set as mandatory in order to increase the efficiency of the retrieval. The questionnaire was administered twice, at the end of the course, before the courtroom observation (\"before\") and after the courtroom observation (\"after\"). After completing the questionnaire, the data were double-checked and cleaned. Most questions were rated on a 10 point scale, with 1 meaning \"strongly disagree/not at all concerned/not useful at all\" and 10 meaning \"strongly agree/very concerned/very useful.\"\u003c/p\u003e\n\u003cp\u003e1.2.3\u0026nbsp;\u0026nbsp;Grouping\u003c/p\u003e\n\u003cp\u003eThe study population was divided into clinical medicine and non-clinical according to their specialties, and the results of the questionnaire were compared before and after. Both groups received the same teaching content and assessments to minimize confounding variables.\u003c/p\u003e\n\u003cp\u003e1.2.4\u0026nbsp;\u0026nbsp;Course content\u003c/p\u003e\n\u003cp\u003eThe course \" Risks of Medical Practice\" of Peking Union Medical College (PUMC) covers the contents of medical practice licensing, medical management, doctor-patient communication, and medical law, etc. It is developed from three modules, namely, establishing the concept of patient safety and legal education, enhancing the awareness of medical risks, and improving the ability of dispute handling and doctor-patient communication, in order to introduce to the medical students, the causes and types of disputes occurring in the clinical and medical activities as well as the measures to prevent and handle them.\u003c/p\u003e\n\u003cp\u003eIn addition to theoretical courses, practical courses are added: by organizing medical students to observe medical litigation cases in the People's Court of Dongcheng District, Beijing, the aim is to give medical students a clearer and deeper understanding and knowledge of medical disputes, legal knowledge and litigation process through immersive litigation experience.\u003c/p\u003e\n\u003cp\u003e1.3\u0026nbsp; \u0026nbsp; \u0026nbsp;Statistical methods\u003c/p\u003e\n\u003cp\u003eData were entered using EXCEL 2021 and collected data were analyzed and processed using SPSS 27.0. Count data were expressed as frequencies and percentages n (%) were expressed using χ2 test. Normally distributed measurements were expressed as mean ± SD using t-test. Non-normally distributed data were tested using non- parametric tests (K-W test or M-W test). Statistical significance was achieved when p\u0026lt;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e2.1\u0026nbsp; \u0026nbsp; \u0026nbsp;General information\u003c/p\u003e\n\u003cp\u003eA total of 72 electronic questionnaires were recovered from the 72 study participants, with a 100% recovery rate. There were 32 clinical medicine majors, including 13 males and 19 who are in the first year of doctoral studies; 40 non-clinical medicine majors, including 11 males and 10 who are in the first year of doctoral studies. The details are shown in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1 General profile of the study population (n=72)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"520\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd rowspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003eEvents\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" style=\"width: 179px;\"\u003e\n \u003cp\u003eClinical medicine (n=32)\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" style=\"width: 218px;\"\u003e\n \u003cp\u003eNon-clinical medicine (n=40)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eNumber of persons (n)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eNumber of persons (n)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eSexes\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 95px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e40.6%\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e27.5%\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e59.4%\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e72.5%\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eGrade\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 95px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003ctd style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003ctd style=\"width: 97px;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eThe first year of master's degree\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e40.6%\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eThe first year of doctoral studies\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e59.4%\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e25.0%\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n\u003cp\u003e2.2 \u0026nbsp; \u0026nbsp; Legal Awareness and Perceived Practice Risks\u003c/p\u003e\n\u003cp\u003eThere was no statistical difference between clinical and non-clinical medical students before and after courtroom observation in terms of self-assessment of doctor-patient relationship apprehension, self-assessment of legal awareness, and self-assessment of importance to the practice of medicine. However, after courtroom observation, clinical students exhibited a significantly higher recognition of courtroom observation’s role in risk prevention compared to non-clinical students (p=0.025). Further within-group analysis revealed that self-assessment of the degree of legal awareness of clinical medical students decreased after courtroom observation, the phenomenon that also occurred among non-clinical medical students. For non-clinical medical students, there was a statistically significant increase in their self-assessment of the degree of doctor-patient relationship apprehension, their self-assessment of the importance of practicing law, and their self-assessment of practice risk prevention after the courtroom observation, which was statistically significant. The details are shown in Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2 The results of self-assessment item\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"671\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd rowspan=\"3\" style=\"width: 89px;\"\u003e\n \u003cp\u003eInvestigation time\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 144px;\"\u003e\n \u003cp\u003eLevel of doctor-patient relationship worries (10 points)\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 21.1624%;\"\u003e\n \u003cp\u003eLevel of legal awareness (10 points)\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 144px;\"\u003e\n \u003cp\u003eImportance to the practice (10 points)\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 150px;\"\u003e\n \u003cp\u003eRole in practice risk prevention (10 points)\u003c/p\u003e\n \u003c/td\u003e\u003ctd height=\"21\" style=\"width: 0.8942%;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd height=\"21\" style=\"width: 0.8942%;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eClinical medicine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eNon-clinical medicine a\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 10.5812%;\"\u003e\n \u003cp\u003eClinical medicine b\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eNon-clinical medicine c\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eClinical medicine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eNon-clinical medicine d\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003eClinical medicine f\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eNon-clinical medicine g\u003c/p\u003e\n \u003c/td\u003e\u003ctd height=\"28\" style=\"width: 0.8942%;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003ebefore\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6.94±2.50\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6.23±2.45\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 10.5812%;\"\u003e\n \u003cp\u003e8.44±1.72\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e8.20±1.70\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9.16±1.22\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9.05±1.24\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e9.16±1.25\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e8.80±1.32\u003c/p\u003e\n \u003c/td\u003e\u003ctd height=\"7\" style=\"width: 0.8942%;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eafter\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e7.47±1.85\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6.63±1.96\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 10.5812%;\"\u003e\n \u003cp\u003e7.78±2.27\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e7.88±1.74\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9.44±0.98\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9.45±0.90\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e9.75±0.57e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9.38±0.77\u003c/p\u003e\n \u003c/td\u003e\u003ctd height=\"15\" style=\"width: 0.8942%;\"\u003e\u003cbr\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n\u003cp\u003eAnnotation:\u003c/p\u003e\n\u003cp\u003ea: Self-assessment items of doctor-patient relationship apprehension, before vs. after within non-clinical specialty group, p=0.008\u003c/p\u003e\n\u003cp\u003eb: Self-assessment items of legal awareness level, before vs. after within clinical specialty group, p=0.01\u003c/p\u003e\n\u003cp\u003ec: Self-assessment item of legal awareness level, before vs. after within the non-clinical specialty group p=0.02\u003c/p\u003e\n\u003cp\u003ed: Importance to future practice item, before vs. after within the non-clinical specialty group p\u0026lt;0.001\u003c/p\u003e\n\u003cp\u003ee: Role in practice risk Prevention program, clinical medicine vs. non-clinical medicine after courtroom observation, p=0.025\u003c/p\u003e\n\u003cp\u003ef: Role in practice risk prevention program, before vs. after within clinical specialty group, p=0.01\u003c/p\u003e\n\u003cp\u003eg: Role in practice risk prevention items, before vs. after within non-clinical specialty group, p=0.02\u003c/p\u003e\n\u003cp\u003e2.3 \u0026nbsp; \u0026nbsp; Curriculum and evaluation\u003c/p\u003e\n\u003cp\u003eBefore the courtroom observation, the percentage of non-clinical medical students who supported that the course should be made mandatory was 67.5% (27/40), which was significantly higher than the 37.5% (12/32) of clinical medical students, with a statistically significant difference of p=0.01. However, after the courtroom observation, the clinical medical students increased the importance of the course, and the percentage of those who believed that the course should be made mandatory, the percentage of people increased to 59.4% (19/32). Interestingly, clinical medical students rated lower scores than non-clinical medical students on the necessity of setting courtroom observation as a course component, but rated higher on the level of recommendation for this course and the level of anticipation of attending courtroom observation again. This can be seen in Table 3.\u003c/p\u003e\n\u003cp\u003eTable 3 The evaluation results of the course\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"763\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd rowspan=\"3\" style=\"width: 66px;\"\u003e\n \u003cp\u003eInvestigation time\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"4\" style=\"width: 271px;\"\u003e\n \u003cp\u003eCurriculum\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 148px;\"\u003e\n \u003cp\u003eDegree of recommendation\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 141px;\"\u003e\n \u003cp\u003eLevel of anticipation of attending courtroom observation again\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 138px;\"\u003e\n \u003cp\u003eThe necessity of making courtroom observation part of the course\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"2\" style=\"width: 140px;\"\u003e\n \u003cp\u003ecompulsory course\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" style=\"width: 131px;\"\u003e\n \u003cp\u003eoptional course\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eclinical medicine\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003enon-clinical medicine\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eclinical medicine\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003enon-clinical medicine\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eclinical medicine\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003enon-clinical medicine\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eclinical medicine\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003enon-clinical medicine\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eclinical medicine\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003enon-clinical medicine\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eBefore a\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e9.21±1.41\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e9.00±1.34\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eAfter\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e9.53±0.92\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e9.35±1.05\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9.50±0.95\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e9.40±0.96\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e9.06±1.64\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e9.23±1.10\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n\u003cp\u003eAnnotation:\u003c/p\u003e\n\u003cp\u003ea: Curriculum, clinical medicine vs. non-clinical medicine before courtroom observation, p=0.01\u003c/p\u003e\n\n\n\n\n\n\n\n"},{"header":"Discussion and conclusions","content":"\u003cp\u003e3.1\u0026nbsp; \u0026nbsp; \u0026nbsp;Courtroom observation increases medical students' practice anxiety and solidify their legal awareness assessment\u003c/p\u003e\u003cp\u003eThe results of the study showed that the courtroom observation increases the level of medical students' apprehension about the doctor-patient relationship and increase practice anxiety. According to our previous study has shown that the theoretical learning through this course reduce medical students' practice anxiety. It can be seen that there is still a certain difference between theoretical learning and practical reality. After the courtroom observation, medical students can deeply realize the reality of medical practice risk, uphold the responsibility of patient safety. This finding is consistent with the study of Gupta et al. in 2013, whose paper similarly noted that medical students' fear decreases significantly with more visits \u003csup\u003e[5]\u003c/sup\u003e. In addition, there was a statistically significant decrease in the self-rated scores of the degree of legal awareness of medical students after courtroom observation (p=0.01 within the clinical medicine group; p=0.02 within the non-clinical medicine group). This result suggests that courtroom observation can make medical students realize their lack of legal knowledge. This is consistent with Xing Yao's findings that medical students usually have a more one-sided understanding of legal knowledge, and that through practical education, medical students are able to more deeply recognize the importance of legal literacy in their daily diagnosis and treatment \u003csup\u003e[6]\u003c/sup\u003e. It can be seen that the educational approach of practical case presentations can effectively reveal students' blind spots in their professional knowledge, thus motivating them to strengthen their learning in related fields in their future studies and careers. At the same time, this result is instructive for medical school education policy makers, suggesting the need for greater integration of practical instruction, especially in legal education, into curriculum design to enhance students' ability to deal with legal challenges in the real world.\u003c/p\u003e\u003cp\u003e3.2\u0026nbsp; \u0026nbsp; \u0026nbsp;Courtroom observation raises medical students' awareness of the importance of the course\u003c/p\u003e\u003cp\u003eCourtroom observation as a practice session in the risks of medical practice course promotes medical students to pay more attention to the course. The results of the study showed that after the courtroom observation, medical students' scores on the self-assessment of the importance of the course to their future practice, the self-assessment of the role of practice risk prevention, and their willingness to recommend the course to other students increased significantly. This suggests that the court hearing bystanders enhanced the importance of medical students' medical law- related courses to a certain extent. The results are consistent with the study of Xu Guangya et al., that legal education emphasizing practicality can effectively enhance students' awareness of the practical application and importance of legal knowledge, and help them to better integrate theoretical knowledge with actual cases \u003csup\u003e[7]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHowever, on the issue of whether the course should be set as a compulsory or optional course, the concepts of clinical medical students and non-clinical medical students were completely different, and most clinical medical students (19/32) preferred that the course be set as a compulsory course. This may be due to the fact that clinical medical students have been directly or indirectly exposed to medical disputes in their clinical practice, have a stronger need for medical legal knowledge themselves, and are more likely to feel the practical application value of the course and the potential threat of practice risk after participating in the courtroom observation as spectators. This phenomenon fits with the findings of Cao Wei et al., that the observation of actual cases can help students gain a deeper understanding of the practical role of the law, whereas theoretical knowledge is often difficult to produce a deep understanding if it has not been verified in practice \u003csup\u003e[8]\u003c/sup\u003e. Through courtroom observation, medical students can directly observe the whole process of medical disputes, thus creating a more intuitive perception of it. Therefore, if the courtroom observation is arranged before the theory course, it may be able to further enhance the teaching effect.\u003c/p\u003e\u003cp\u003e3.3\u0026nbsp; \u0026nbsp; \u0026nbsp;Medical students highly approve of courtroom observation, but more flexibility is needed in the form of arrangements\u003c/p\u003e\u003cp\u003eThis study also found that medical students highly recognized the innovative teaching method of courtroom observation. The mean score for \" anticipation of attending courtroom observation again\" was close to 9.5. The researcher has not yet found any literature on the evaluation of Chinese medical students' participation in courtroom observation, and it is difficult to compare whether this practice program is also applicable in other medical schools. However, compared with traditional classroom teaching, such a vivid form of practice as courtroom observation can not only enhance medical students' legal literacy, but also make them feel the urgency and complexity of medical dispute handling, thus increasing the importance of legal education. Therefore, incorporating the practical course of court hearing into the curriculum education of medical students can enable medical students to quickly understand the real situation from theoretical learning, and can help them to sort out the awareness of risk in the future practice and pay more attention to the awareness of medical quality and patient safety. In terms of the necessity of setting courtroom observation as part of the course content, the mean score of medical students was above 9.0, but the mean value of the ratings of non-clinical medical students was 0.2 points higher than that of clinical medical students. As for the level of anticipation of attending courtroom observation, clinical medical students were 0.1 points higher than non-clinical medical students. This may be due to the fact that clinical medicine students are still required to be on duty in their clinical practice, and the random nature of courtroom observation times does not facilitate clinical medicine students to take time off from work. Therefore, courtroom observation, which is an uncertain practice course, is more favorable for clinical medicine students to participate in a voluntary choice manner.\u003c/p\u003e"},{"header":"Summary","content":"\u003cp\u003eCurrently, there are fewer studies on medical disputes and education in China, with an annual average of only three articles, and fewer medical schools offering related courses \u003csup\u003e[9]\u003c/sup\u003e. At the same time, few medical schools in China provide medical students with the opportunity to sit in on medical dispute litigation cases in court. It is of exploratory significance for Peking Union Medical College to try to make courtroom observation as a regular practice course on the basis of the “Risks of Medical Practice” course. According to the results of this study, although courtroom observation increases medical students' practice anxiety, it can also make them realize their lack of legal knowledge, enhance their attention to the course, and participate in the relevant courses with a more positive attitude. In addition, medical students also highly recognize the active participation in the teaching mode of courtroom observation, but the form of participation needs to be flexibly adjusted according to the type of students' specialties.\u003c/p\u003e\n\u003cp\u003eOf course, Limitations of this study include its single-center design, small sample size, and short-term follow-up. Future studies could extend the follow-up period to explore the effects of this teaching method on the long- term practice behavior and legal awareness of medical students, with a view to providing more in-depth insights into the reform of medical education.\u003c/p\u003e\n\u003cp\u003eIn conclusion, courtroom observation, as an innovative teaching strategy in medical education, can effectively enhance medical students' legal cognition and practice risk prevention awareness, as well as improve the attractiveness and educational effect of the course. Although the feedback from clinical and non-clinical medical students differed, overall, courtroom observation had a positive impact on medical students' improved legal awareness and enhanced risk prevention ability. This result provides a useful reference for medical education reform, especially in improving medical students' legal literacy and risk awareness, which has important practical significance.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements:\u003c/p\u003e\n\u003cp\u003eWe would like to thank Peking Union Medical College Hospital for allowing us to conduct this study. We would also like to thank the students who participated in the \" Risks of Medical Practice\" course and courtroom observation for their willingness to participate in this study. Special thanks to the Beijing Dongcheng District People's Court and the judges, represented by Judge Qi Hongmei of the Second Civil Court, for giving the students the opportunity to participate. This immersive experience will help the students to pay more attention to the quality of medical care and patient safety in their future practice, and to protect the legitimate rights and interests of both doctors and patients in accordance with the law.\u003c/p\u003e\n\u003cp\u003eAuthor Contributions:\u003c/p\u003e\n\u003cp\u003eYuan Da mainly designed and implemented this study. Liu Hai-Shuo and Lin Yu-Lv analyzed and wrote the data for the paper. Huang Li, Chen Zheng, and Peng Hua participated in designing this research program and participated in the survey. Ma Xiaojun considered and revised this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConflict of Interest:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding Declaration:\u003c/p\u003e\n\u003cp\u003eNo funding supports.\u003c/p\u003e\n\u003cp\u003eData Availability:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLi Xiumei. The psychological impact of medical disputes on medical workers [J]. Journal of International Psychiatry, 2019, 46(06):978-981. \u003c/li\u003e\n\u003cli\u003eLiu Qiongyao, Wang Yan, Zhou Xiaohua, et al. The Studys on the Psychological Impacts of Medical Disputes on Medical Students[J]. Chinese Medical Ethics, 2015, 28(06):999-1001.\u003c/li\u003e\n\u003cli\u003eZhu Wenqing, Zeng Ying, Su Na, et al. Analysis on influence of current doctor-patient relationship on career choices of medical students and young doctors[J]. Surgical research and new technique, 2018, 7(4):271-275. \u003c/li\u003e\n\u003cli\u003eLan Wanning, Li Danyun, Feng Jingru, et al. Impact of the current doctor-patient relationship on the psychology and career planning of medical students-A case study of medical schools in Guang zhou[J]. Guangdong Education (Vocational Education Edition), 2021(12):41-42.\u003c/li\u003e\n\u003cli\u003eGupta S, Phatak A, Panchal D. Courtroom exposure to medical students: a practical approach to legal procedures in Indian scenario[J]. Journal of Forensic \u0026amp; Legal Medicine, 2013, 20(6):767-769. \u003c/li\u003e\n\u003cli\u003eXing Yao. Exploration of medical students\u0026apos; legal knowledge education[J]. Henan Education, 2012, (02):58-59.\u003c/li\u003e\n\u003cli\u003eXu Guangya, Li Bin, Wang Ting. Research on medical students\u0026apos; legal education[J]. Curriculum Education Research, 2017, (33):229-230.\u003c/li\u003e\n\u003cli\u003eCao Wei, Shen Xuning, Yu Huijie, et al. Application effect of moot court in the standardized training and teaching of emergency department residents[J]. Chinese Journal of Graduate Medical Education, 2024, 8(03):194-198.\u003c/li\u003e\n\u003cli\u003eWen Hongxia. Design of the Medical Dispute Course in Medical Universities Based on CiteSpace[J]. China Continuing Medical Education, 2024, 16(17):193-198.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Courtroom Observation, Medical Education, Professional Risk, Legal Awareness, Curriculum Innovation","lastPublishedDoi":"10.21203/rs.3.rs-6969998/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6969998/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e To explore the role of courtroom observation in cultivating the risk awareness of medical graduate students, to optimize teaching methods, and also to provide a reference for other medical schools to carry out similar teaching reforms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e In this study, a self-prepared questionnaire survey was conducted on clinical and non-clinical medicine students after the completion of the \" Risk of Medical Practice \" course, that is, before the courtroom observations and after, including the general information of the students' gender and major, as well as the legal cognition and evaluation of the course before and after participating in the courtroom observations. SPSS27.0 was used to perform the t or χ2 test on the data. Statistical significance was defined as p\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e A total of 72 medical students were surveyed, including 32 in clinical medicine and 40 in non-clinical medicine. After participating in the courtroom observation, there were statistically significant differences in the self-evaluation of the degree of legal awareness, the self-evaluation of the importance of future practice, and the role of practice risk prevention. In the setting of the course \" Risk of Medical Practice \" as a compulsory course, the degree of course recommendation has increased, but there is no statistical difference. The students' expectations for courtroom observations again and the score of setting courtroom observations as part of the course were both 9.0 or above.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eThe results demonstrate that courtroom observation is an effective teaching method. By participating as spectators in litigation, medical students not only enhance their awareness of medical law and practice risk prevention but also develop a more proactive attitude toward related courses. As far as the teaching mode of courtroom observations is concerned, medical students are also highly recognized and actively participated. In conclusion, this study provides empirical data for medical schools in terms of medical students' legal education and practice risk awareness cultivation, and provides a new scheme for optimizing medical education methods, demonstrating the potential value of courtroom observation methods, and the need for a more active attitude.\u003c/p\u003e","manuscriptTitle":"Exploring the Impact of Courtroom Observations on the Awareness of Professional Risk Among Medical Students of Different Specialties: A Single-Center Controlled Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-26 07:17:16","doi":"10.21203/rs.3.rs-6969998/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e4c90afb-56f1-4281-a2f4-9fec60d271f2","owner":[],"postedDate":"June 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-30T21:23:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-26 07:17:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6969998","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6969998","identity":"rs-6969998","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}