Case-Based Health Law Teaching for Undergraduate Rehabilitation Therapy Students: A Single-Group Pre-Post Educational Intervention Study

Technical Summary: Case-Based Health Law Teaching for Undergraduate Rehabilitation Therapy Students

Problem Statement
Undergraduate rehabilitation therapy programs traditionally prioritize clinical knowledge and technical competence, often leaving students underprepared for the legal and ethical dimensions of clinical practice. While students must manage informed consent, risk disclosure, patient privacy, documentation, and dispute resolution, they frequently lack the ability to apply abstract legal principles to specific, situated clinical scenarios. Rehabilitation therapy presents unique legal risk profiles compared to other medical disciplines due to its longitudinal nature, repeated physical interactions, and heavy reliance on patient cooperation and family communication. Existing literature indicates a gap in discipline-specific health law education for rehabilitation students, who are often treated as a subgroup of general medical education rather than a distinct learner population with unique clinical roles and supervision patterns.

Methodology
The authors conducted a single-group pre-post educational intervention study at Guizhou Medical University and its affiliated hospital in Guiyang, China.

• Participants: 102 undergraduate rehabilitation therapy students (39 third-year students; 63 fourth-year students or interns).
• Intervention: An 18-hour case-based health law teaching module. The curriculum covered six core areas: informed consent, medical risk disclosure, patient privacy, medical damage liability, therapist practice boundaries, and legal risk management in rehabilitation disputes. The content was aligned with current Chinese civil law provisions.
• Pedagogy: The module utilized a structured case-based learning approach where students analyzed realistic clinical scenarios (e.g., inadequate risk disclosure, privacy breaches, treatment goal disagreements). The teaching sequence involved reviewing scenarios, connecting them to legal principles, discussing responses in small groups, and synthesizing legal risk points with routine practice.
• Outcomes:
  • Primary: Legal knowledge score (0–100) and clinical legal risk identification score (0–100).
  • Secondary: Learning attitude and course satisfaction (1–5 Likert scale).
  • Mastery: Defined as achieving a score ≥70.
• Analysis: Data were analyzed using paired t-tests for continuous outcomes, with Wilcoxon signed-rank tests as sensitivity analyses. Exact McNemar tests were used to compare mastery rates. Effect sizes were calculated using Cohen's dz.

Key Results
The intervention yielded statistically significant improvements across all measured domains:

• Legal Knowledge: Scores increased from a mean of 50.76 (SD 13.03) pre-intervention to 80.64 (SD 12.29) post-intervention (mean difference: 29.89; p<0.001; Cohen's dz = 3.86).
• Risk Identification: Scores rose from 50.03 (SD 10.36) to 76.85 (SD 10.79) (mean difference: 26.82; p<0.001; Cohen's dz = 3.68).
• Mastery Rates: The proportion of students achieving mastery (≥70) in legal knowledge jumped from 5.9% to 80.4%. For risk identification, it increased from 2.9% to 77.5%.
• Attitude and Satisfaction: Learning attitude improved from 3.48 to 4.30, and course satisfaction from 3.39 to 4.26 (both p<0.001).
• Subgroup Analysis: Exploratory analysis showed similar improvement patterns between third-year students and fourth-year/intern students, suggesting the module's efficacy was consistent across these stages.

Significance and Claims
The paper claims that a focused, case-based health law module is a feasible and effective method for improving legal literacy and risk identification skills among rehabilitation therapy students. The authors argue that clinically situated teaching helps bridge the gap between abstract legal rules and practical application, particularly for students transitioning to clinical internships.

The study positions the 18-hour module as a practical curriculum addition that can be embedded into existing programs without requiring a full-semester course. It suggests that legal education is most effective when delivered close to clinical exposure, allowing students to connect legal rules with actual patient care scenarios.

Limitations and Modesty of Claims
The authors explicitly frame their findings as evidence of "short-term course-aligned learning" rather than proof of durable clinical competence or behavioral change. They acknowledge several limitations:

• Design: The single-group pre-post design cannot rule out alternative explanations such as test familiarity, maturation, or the Hawthorne effect.
• Generalizability: The study was conducted at a single institution.
• Measurement: Outcomes were measured immediately post-intervention; the durability of learning is unknown. The assessment instrument was course-aligned and requires further validation (e.g., internal consistency, external expert review).
• Transfer: The study did not measure actual clinical behavior, such as the quality of risk disclosure or documentation in real-world settings.
• Comparison: Without a control group, the study could not compare case-based teaching against lecture-only or routine teaching methods.

Consequently, the authors conclude that while the intervention is associated with substantial short-term gains, controlled multi-institutional studies are necessary to evaluate the long-term retention of knowledge, transfer to clinical behavior, and generalizability of the findings.