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Radiography (2008) 14, 32e38

Enhancing the learning experience of studentradiographers with dyslexia

Irene Foster*

Cranfield University, Centre for Radiographic and Medical Studies, RMCS, Shrivenham, Swindon, SN6 8LA, UK

Received 3 November 2005; accepted 23 May 2006Available online 23 August 2006

KEYWORDSTeaching and learningstrategies;Group learning;Active learning;Action research;Student centredlearning;Dyslexia

Abstract Widening participation policies and increased awareness of dyslexia has resulted ina marked increase in the numbers of students with dyslexia being identified in higher educa-tion in recent years. This study was conducted to not only gain a greater understanding ofteaching and learning strategies, but also provide opportunities for improved learning experi-ences and achievement of students who do not respond well to written forms of assessment.Although a small scale study, the outcomes demonstrate a useful pilot for future scrutiny andbasis for further study.ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Introduction

In recent years, the university system has changed frombeing an educational system available to the elite, to onethat has become more accessible to the wider population.Widening participation is supported by the Learning andSkills Council1 and the white paper ‘Widening Participationin Higher Education’. This recommends that individuals inlower social classes be given equal access to higher educa-tion, indicating that ‘‘The evidence suggests that theprinciple barriers to access are attainment, aspiration

* University of West of England, Faculty of Health and SocialCare, Glenside Campus, Blackberry Hill, Stapleton, Bristol, BS161DD, UK. Tel.: þ44 0117 3288920; fax: þ44 0117 3288408.

E-mail addresses: irene.foster@uwe.ac.uk, timothymfoster@hotmail.com

1078-8174/$ - see front matter ª 2006 The College of Radiographers.doi:10.1016/j.radi.2006.05.004

and application.’’2 (p. 5) This policy does however fall shortin recognition of other social groups with restricted accessand fails to recognise that individuals for reasons of ‘‘eth-nicity and disability’’ be ‘‘afforded greater opportunitywithin the ‘knowledge society’.’’3 (p. 7)

In recognition of this deficit, the Institute of LearningDisability, urges universities to be more proactive in theirprovision for individuals with learning difficulties.4

Growing numbers of students with dyslexia are enteringuniversities, due to widening participation policies, increasedawareness and increased funding.5 This indicates an in-creased need for research that identifies reliable indicatorsof adult dyslexia, since it would seem that poor spelling con-tinues into adulthood, but also that poor reading perfor-mance is not a defining characteristic of dyslexia.6

Coupled with policies for widening participation, itbecomes increasingly important for universities to re-examine teaching strategies, that take account of thevaried educational background and abilities of current

Published by Elsevier Ltd. All rights reserved.

Learning experience of student radiographers with dyslexia 33

student cohorts. Osbourne3 corroborates the importance ofharnessing student centred learning, which fosters learnerresponsibility by recognising that ‘‘Improving access is onething, but ensuring progression both within and beyondhigher education is another.’’ (p. 18) His beliefs validateKnowles7 conceptualisation of andragogy, which statesthat adult education involves:

� Knowing why they need to know� Being internally motivated� Being ready to learn� Taking responsibility for their own learning� Using life-centred, problem centred approaches

However, irrespective of qualifications, many studentsentering higher education do not have the skills necessaryto engage in higher order thinking or critical reasoningassociated with this educational level. Walker8 suggeststhat students should be introduced to varying teachingmethods, which challenges their thinking processes andfacilitates critical thinking.

There is increasing pressure on universities to work inpartnership with other agencies to produce a well-educatedworkforce, during a time of rapid technological change andinnovation. These demands have focussed increased atten-tion on the quality of teaching and learning. The outcomeof strategies employed should not only demonstrateinclusion, but also improved learning experiences ofstudents for all learning abilities. Institutions have a statu-tory obligation to establish if an individual has some form ofdisability, which includes dyslexia. They should thereforemake reasonable adjustments to teaching practice (withoutcompromising academic standards), so that these studentsare not at a disadvantage. Staff are expected to be awareof how to respond to the needs of students with disabilityand where possible to adjust assessment methods todemonstrate the learning of students.9e11

The problem

A vast majority of individuals within the student group usedrote learning, and did just enough work to meet the basiccriteria of the course. Whilst these methods may beadequate in achieving a pass grade, they usually result insurface learning. Simister12 confirmed similar observationsin very able students not achieving high grades, due toa failure to coping with higher order questions. Sheconducted a study which concluded that quality thinkingcould be taught.

Health care workers within the NHS are increasinglyexpected to be critical and strategic thinkers, as well asreflective practitioners. These demands would be moreeasily met if students were to adopt a deeper approach tolearning, to not only develop the necessary skills but to alsogain an understanding, as well as being able to relate thatunderstanding to other subject areas.

The author undertook to closely monitor not only thelearning outcomes of the module, but also individualperformance of students relative to teaching and learningmethods employed. A subsequent research of teaching andlearning methods, revealed problem based learning (PBL)

as an appropriate student led approach. During the pursu-ing sessions it became increasingly apparent, that not onlydid students have very different learning needs, but alsovery different learning styles. These considerations are notusually factored into traditional lesson planning or assess-ment within higher education.

Of particular note was the unexpected improved perfor-mance of a dyslexic student (identified as Student A), whoon reflection, articulated well and performed more confi-dently through this ‘non-written’ medium. This confidencein achievement was not reflected as well in the writtenmethods of assessment used.

Students with learning difficulties constituted 30% of thisstudent group and teaching or assessing methods had notbeen modified to take account of this.

Exploration of alternate methods of assessment was thussought that would exploit the strengths of all students.Particular emphasis was placed on those individuals withspecific learning difficulties, aimed to improve their learn-ing outcome.

Methodology

The aim of the research was to introduce a teaching andlearning strategy that incorporated flexibility in accommo-dating to some extent, the preferred learning styles of thestudent group. Varying the methods of assessment would gosome way to acknowledging the varied learning needs ofstudents within the group. ‘Levelling the playing field’,invites opportunities for individuals to strive towardsachieving their personal goals.13

The method within this study was chosen to observe theoutcomes within a single module and therefore neededto facilitate a cyclical approach whereby the literatureinforms the process, and reflection and evaluation indicatesthe change.

‘‘If individual teachers tackle issues within their individu-ally taught courses using a cyclical, reflective approach, itseems appropriate to conclude that they are conductingaction research. If they wish to solve a problem or intro-duce an innovation, within their own classroom, it iseminently sensible to utilize the methodology of actionresearch to do so.’’14 (p. 28)

As such the process that followed was15:

� Identification of the problem� Collection and organisation of the evidence (data)� Interpretation of data� Action based on the data� Reflection

Problem based learning was initially introduced to thestudent group, followed by structured debate. The use ofdebate as a learning tool was audited, since existingassessment criteria could be modified for its use.

Students were randomly assigned to one of two groupsand given specific roles within the scenario of the debatetopic. Time was allocated for facilitated and non-facilitatedgroup work, as well as independent study. Students aremotivated to learn, when they have a clear understanding

34 I. Foster

of the relevance the set task has to their learning. Thusa discussion of aims, objectives and framework for theassessment was undertaken prior to the group disbandingfor discussions within their teams.

Rust16 believes that provision of explicit assessment cri-teria does not in itself lead to improved learning outcomes.He advocates dedicated time for explanation and discussionof such criteria, to ensure the students understanding ofthe requirements.

Facilitated meetings were held with individual groupsand free time given for research or for use as the studentsrequired.

The debate was staged to an audience consisting of staffand other student radiographers at varying stages of theirtraining.

Observation and reflection of the outcome was alsoassessed through verbal feedback and written summariesfrom the student group. The use of triangulation was notonly to enhance credibility but also to promote improvedunderstanding of the usefulness of these strategies.17

The systematic review18 that followed emulated thefunctions of action research as described by Kember14:

� Aimed towards improvement� A cyclic process� Pursued by systematic enquiry� A reflective process� Participative� Determined by the practitioners

Discussion

The criteria used for the choice of teaching and learningstrategies within this study, were that it challenged andstimulated, whilst at the same time realising the potentialof most of the students with learning difficulties.

Critical reflection is a vehicle for changes in attitude andunderstanding, which Mezirow (1981, cited in Kember14)refers to as self-realization, influencing past assumptionsand knowledge constraints. This process is considered tobe a crucial element and intrinsic factor of professionalismwhere ‘‘Reflective practice unites discussion of criticalthinking with experiential learning ..’’19 (p. 539). Brook-field20 stresses that not only does peer support underpincritical thinking, but diversity in approach to such teachingis equally essential. Both the approaches used, PBL anddebate, were heavily reliant on group and team work.This environment encouraged group members to exploretheir ideas, test theories and bounce ideas off each other.PBL was particularly productive in nurturing self-directedlearning where an andragogical culture promoted learnerresponsibility through facilitation rather than direction oflearning. ‘‘PBL integrates knowledge across conventionalboundaries and within ‘clinical context’ . fostering ac-tive, reflective and meaningful learning ..’’19 (p. 541).

Although feedback resulting from this approach wasencouraging in terms of learning outcomes, no markingcriteria was available for use as a formal measurement ofoutcomes.

It was evident to the author that students were able topass examinations and assessments without understanding

key basic concepts. It was also noted that students’response to questions was not always reflective of materialtaught and answers were usually based on a framework ofnaı̈ve concepts, even when more complex theories hadbeen taught. Leathwood21 endorses this observation,attributing this to modularity and the students’ judgmentof what is required to meet assessment criteria.

‘‘. modularity transforms knowledge into a commodity,to be consumed as a leisure activity, a matter of gatheringand reproducing information: you learn; you write up whatyou have learnt; have it assessed; forget it; and go on toconsume the next goblet.’’ (Brecher 2002, cited in Leath-wood,21 p. 319)

The conventional teaching approach of knowledge trans-mission tends to lack the stimulus for deep learning andthus the facilitation approach to learning was exploredwithin this study, to minimise this surface learning.

The use of debate as a learning tool embraces theconcept of deep learning by engaging critical thinking andreasoning. Students were thus encouraged to examinea topical issue within a flexible framework. Students aremore likely to be motivated to learn if they have a choice inthe assessment task.16 They were thus given the freedom toset justifiable boundaries within the scenario which wouldallow them to assimilate theory within real-life situations.This engagement in active learning is widely documen-ted22e24 as ‘‘powerful and effective learning environmentsby forcing students to take risks and express their views oncomplex and controversial issues.’’ (Lamy 2000, cited inLantis,25 p. 119)

Use of PBL enhanced the students’ skills of enquiry andargument, proving to be a valuable precursor to the debatemethod. Debate promotes a deeper understanding andincreased perspective of the chosen topic. Teaching stu-dents to ‘think’ in this way has an added advantage of notonly developing their critical reasoning skills, but also theircommunication skills.

Results

Fig. 1 illustrates the profile of grades achieved by dyslexicstudents in written assessments numbered 1e3. The perfor-mance for students A and C remained largely unaltered,whilst a marked increase in the performance of student Bwas apparent following the first assessment. The resultfor the fourth assessment (the debate) shows a marked dif-ference in the achievement for student A.

0

20

40

60

80

100

1 3 4

Assessment Number

%

StA

StB

StC

2

Figure 1 Profile of assessment achievements.

Learning experience of student radiographers with dyslexia 35

Although the author believes that the result achieved isa true reflection of student A’s ability, caution is neededwhen interpreting assessment results since the markingschemes for written, practical or presentation work usedifferent criteria. Also, since only one such assessment hasbeen evaluated, similar subsequent assessments may not beconsistent with results shown. It may be that this assessmentmethod did not suit student B, or that longer adjustmentwould be needed for significant results to be seen.

Notable progression in some dyslexic students is highlydependent upon the types of assessment used as ‘‘Sometests have very steep gradients and will not pick up im-provements.’’26 (p. 13) Some students progress very slowly,which will not become evident since most assessmentmethods are not sensitive to small changes in progress(note student C in Fig. 1). Although no evidence exists tosubstantiate any progress made, the author would suggestthat there may be an association between the timing ofdiagnosis and improvement in academic performance.This point in question may be demonstrated by the factthat students A and B were diagnosed at times betweenassessment 1and 2, whereas student C was not diagnoseduntil shortly before assessment 4.

Sensitive feedback from assessments should provideopportunities for the student to analyse mistakes and beinstrumental in their progression. The author found studentmentoring to be effective in establishing or improvinglearning strategies and building self-esteem, but wouldemphasise that responsibility for their own learning beplaced firmly with the student. The one to one tutoringconducted, fostered a positive learning environment, butthere is a danger that the student becomes too reliant onthe tutor. Rack et al.26 suggests that by setting the studenta task on which to work independently would encourageautonomy.

There is also evidence to show that adults with dyslexiaapproach studies with reduced self-confidence thatimproves with achievement27 although they may progressinto the working environment feeling unfulfilled.26 Thishas been true in the author’s experience with dyslexic stu-dents, although Riddick et al.27 also indicate that highlevels of anxiety continue to exist due to the ‘high-literacysituation’ of adult education. Although the author haswitnessed sustained levels of frustration, this has notbeen reflected in the levels of anxiety.

The performance of the dyslexic students was comparedwith those of non-dyslexics within the group. As a point ofillustration, a sample of students were randomly selectedand illustrated in Fig. 2. A similar pattern in response to

0

20

40

60

80

100

1 3 4

Assessment Number

%

StD

StE

StF

StG

2

Figure 2 Profiles of non-dyslexic students.

assessment 4 was seen, in that this method was not suitedto all students.

Reasons for underachievement may be complex, but it isincreasingly being recognised that the result of examina-tions ‘‘does not necessarily provide a complete guide to thepotential of a student to succeed in higher education. Forexample mature students are often accepted without hav-ing A level passes at the required grades so long as they candemonstrate e perhaps through written work or throughsuccessfully completing a recognised access course e theirability to benefit from higher education.’’2 (p. 18)

The additional support given to students diagnosed withspecific learning difficulties is instrumental in realisingpotential. For example, although dyslexic students mayappear to show little difficulty in reading words, they doappear to have a reduced comprehension of text.6 Thisevidence may thus go some way to explaining why theauthor found some dyslexic students would have difficultyin understanding written instructions and would faremuch better when verbal clarification of tasks were pro-vided. Rosebraugh28 cautions that students with learningdifficulties do not fit into one simple taxonomy, and there-fore what works for one student may not necessarily applyto others. Differences in the learning styles of studentshave been recognised for some time. There is thereforea danger of educators applying a blanket approach to allstudents, and especially those diagnosed with a specificlearning difficulty.

Lantis25 endorses the merits of group and collaborativelearning that provides students with a wide variety of set-ting for engaging in the learning process. This sentimentwas echoed during a plenary session held following thestaging of the debate. Students were encouraged to reflecton their own learning experiences in terms of subject mat-ter, team interaction and learning/teaching strategies. Theresponses were largely positive. They were surprised byhow enjoyable the whole experience was and even moresurprised by how much they had learnt from each other.The negative aspect was reported as being the frustrationfelt when some group members appeared to be less com-mitted, or failed to attend strategy meetings.

The enthusiastic feedback was a strong indication thatthe chosen method was both a success and enjoyablelearning experience. For some it stimulated further interestin the topic, but largely demonstrated that learning doesnot have to be formalised and can be fun.

A written assessment (assessment 5) was also submitted.Students were expected to utilise the literature from theirresearch that had been conducted for the debate toevaluate their thinking, reasoning and decision- making.No dedicated assessment tool was available to evaluatethese specific skills,29 but achievement was judged by thestudent being able to demonstrate the reflective andanalytical processes involved.

Fig. 3 shows the results of this written summary of thedebate. An improvement is shown for students B and Cwhen compared with that of assessment 4, and a sustainedlevel for student A.

This is the best result student A has received for anywritten assessment. Peer and group learning proved to bebeneficial,30,31 helping these students to formulate ideasand present with literature well integrated to substantiate

36 I. Foster

their argument. These dyslexic students were known tomake good use of the academic support offered on campus,which may account for improved grades received in writtenassessments (Figs. 1 and 3). Daly32 warns educators aboutexpecting too much too soon from students, since thismethod of teaching is a slow and time consuming process.

Conclusion

The continuous cycle of action and reflection is beneficialto us as teachers, since continual review of teachingstrategies and learning outcomes can only improve thelearning experience and achievement of students. Manyeducational issues are outside of our influence, but ‘‘aseducation continues through the reform process teachersmust have a say in how they change their own practices’’.15

(p. 21) Many teachers are best placed to know what worksbest in their own environments.

Evaluation of action research is based on the ‘‘authenticinsights, grounded in participants’ own circumstances andexperience’’33 (p. 185) with the ‘‘aim of influencing educa-tional practices through influencing local or systemwidepolicies about curriculum and pedagogy.’’33 (p. 188)

In this respect action research may be akin to Kolb’sfour stage model of learning; concrete experience, reflec-tive observation, abstract conceptualisation and activeexperimentation.34

Thus, action research is not only beneficial to bringabout change but also encourages teachers to scrutinisetheir own practice.

The results of the assessments illustrated in Figs. 1e3,indicate that students have different learning styles,responding more positively when methods are more varied.

‘‘Active learners learnt primarily by manipulating the en-vironment, while reflective individuals typically learnedby introspection and internal reflection on the externalworld.’’35 (p. 54)

Support of students with dyslexia, as indeed all studentsshould be tailored towards their individual strengths andweaknesses. Many adults with specific learning difficultieshave usually learnt to compensate for some weaknessesand therefore their learning difficulty may not be asblatantly obvious as expected. Steps should therefore betaken to ensure that students from all groups are providedwith equal opportunity to be able to achieve to the highestlevels.21 Results of the different assessment types indicate

0

20

40%

60

80

4

Assessment Number

StA

StB

StC

5

Figure 3 Comparison between assessments 4 and 5 for dys-lexic students.

a gradual improvement in results being obtained in thewritten form of assessments. Attainment resulting fromthe debate shows the most marked differences in achieve-ment. This method was not favoured by the learning stylesof some students, but did provide an opportunity for othersto shine. Not only would improved results reflect favourablyon the programme, but also on the institution.

Our interest as educationalists should extend beyondthe traditional transfer of knowledge. We should aim toengender an interest and desire for life long learning whichemerges from enjoyed learning experiences. Teachers arein a position to offer improved learning experiences bycontinuous engagement of formal or informal review ofstudent outcomes, through the observation-reflection-action-evaluation cyclic process. This process empowersself-control of our own practice and liberates practitionersfrom theory driven models to involvement of more practicaland sensitive schemes. As educators, we are responsible formeeting the needs and demands of our students andstakeholders, and as such should seek to engage appropriatestrategies.

This study has highlighted not only the need forutilization of various teaching and learning strategies, butalso the need for assessing and understanding studentspreferred learning styles. Future work may consider theuse of the ‘Study Process Questionnaire’ used by otherresearches,36,37 that purports to measure ‘‘the extent towhich students endorse different approaches to learning,by identifying motives and strategies which compromisethese approaches.’’35 (p. 62) Additionally, tools for gainingimproved insight into the learning styles of students withina group, validates the teaching methods being employed.38

Widening participation in higher education inevitablymeans that increasing numbers of students with learningdifficulties will grasp opportunities of gaining higher qual-ifications. These individuals are usually of higher thanaverage intelligence who have thus far developed effectivecoping strategies ‘‘but the volume and pace of materialthey encounter in medical school exposes their disabil-ity.’’28 (p. 995)

Widening participation policies also encourages manyadults who enter higher education through unconventionalroutes, to seek a ‘second chance’ of realising their personalgoal. The adult lifestyle and its complexities are rarelyaccounted for in a youth orientated domain and as such ‘‘donot support the growth, development and well-being ofadult learners.’’39 (p. 21) However, increasing numbers ofadults entering higher education will increase expectationsof a course. Most adults learners have a clearer vision oftheir goals and are more likely to raise concerns if theirexpectations are not met. Engaging a learning group withmixed educational backgrounds and expectations becomesan increasingly but necessary challenge for teachers inhigher education. It is vital that while seeking to enhancelearning experiences, that teachers and institutions donot lose sight of one of the main motivators in active learn-ing, peer support. Cotton40 warns that ‘‘Nowadays, withflexible learning, continuous assessment and distancelearning there are no clear endings, so learners drift inand out of study, often alone and missing the human inter-action and support of a determined, coherent group drivingtheir work to a successful group ending.’’ (p. 66)

Learning experience of student radiographers with dyslexia 37

The results of the strategies employed in group learningduring this study were interesting and thought provoking.The author recognises that the size and duration of thestudy questions validity and reliability of the results. Thestudy does however indicate the need to vary teaching aswell as assessment methods within a student cohort. Mostimportantly, the study identifies emphasis on the learningexperience of the student, to promote an investment inlifelong learning.

The main issue highlighted was for the need forimproved robustness of the methodology, manifesting asimproved effectiveness of strategies employed. Thus fur-ther work related to this study should examine specifichighlighted areas:

� monitoring of effectiveness of other assessmentmethods� formulation of appropriate assessment criteria� mentoring of the whole student group� improved assessment of students study/learning styles� increased use of student led approaches

Key recommendations

Enhancing the learning experience of students could havea profound impact, not only on the level of their personalachievements, but also on their engagement in lifelonglearning. These outcomes reflect favourably on all individ-uals involved, as well as on the status of the educationalinstitution and profession. It would seem pertinent thatwith rising expectations of widening participation, that aseducators we:

� take ownership of our own practice� audit teaching and learning strategies being employed� recognise our ability to influence the learning experi-

ences of our students� become active in enhancing and stimulating the learn-

ing environment� become increasingly aware of the more common issues

associated with specific learning difficulties� be mindful of the needs of students with specific learn-

ing difficulties� recognise and support ‘slow’ learners� ensure student/staff use appropriate support networks

within the institution are maximised� have a nominated person as key contact within the de-

partment/school for students with learning difficulties

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