Inclusive clinical education: myth or reality?

AHEAD Conference

University College Dublin

March 16th 2011

Presenters: Jane Owen Hutchinson and Karen Atkinson

Introductions• Jane Owen Hutchinson, Manager

Allied Health Professions Support Service (RNIB)

• Karen Atkinson, Manager RNIB Resource Centre, Senior Lecturer, University of East London

NHS Employers state :

• “Equality and diversity are at the heart of the NHS strategy. Investing in the NHS workforce allows us to deliver a better service and improve patient care in the NHS.”

• “Equality is about creating a fairer society in which everyone has the opportunity to fulfil their potential. Diversity is about recognising and valuing difference in its broadest sense.”

The reality• One clinical manager actually

formally asked the programme to stop recruiting disabled students as they “could not be fit for practice”

• “..the person who was going to be my supervisor…was absolutely scared out of her mind about what to do with me…”

• “..I was told that there wasn’t any other assistant available…I’d have to go it alone…and it was a case of oh well you’re just going to have to cope”

• “…I became a dependent…I felt dependent…..I felt that they began to feel that I was dependent on them…”

• “I felt…totally disarmed and disempowered and just 2nd class”

• “My line manager has never asked me, ever, how I’m managing from the sight point of view…has never asked me if I need support…has never even mentioned Access to Work to me”

• “I felt under quite a lot of pressure at the time so...you know I ended up working a lot later than I needed to or should have been doing ……to try and to cover the work that was expected of me”

Educational Context• Significant proportion of the

education of health care professionals takes place in the clinical setting

• Universities generally becoming more inclusive

• Clinical placements – experiences very variable for students

Professional Context• Professional socialisation – “a

subconscious process whereby persons internalise behavioural norms and standards and form a sense of identity” (Weidman et al 2001)

• Challenging stereotypical beliefs

Disability Context

• Perceived limitations

• Less equal

• Defined in terms of problem

• Disabled students – unintentional collusion

Barriers: contributing factors• Inadequate communication

• Reluctance to disclose

• Failure to implement reasonable adjustments

• Variable student engagement

• Attitudinal issues

Inadequate communication

• Judith – a visually impaired student arrived on placement having not informed her supervisor/educator of her access requirements. She had not contacted the university disability service to organise a support worker or assistive technology. The university assumed she would take responsibility for this.

Key factors• Organisational issues– lack of knowledge about clinical

environment/associated pressures– lack of insight into the implications of

impairments

• Reluctance to disclose

• Duty of care – university

• Clinical supervisor

Reluctance to disclose• Nadia – this student has mental

health issues. Her medication meant that she was drowsy in the morning and she was challenged by the idea of working a full day. She did not disclose these issues but negotiated privately with her supervisor to work a shorter day on the pretext of a long journey and family illness

Key factors

• The university is aware of her issues

• Fear and anxiety especially in relation to responses to mental health issues

• A wish to ‘pass’ as normal

• Exposure

• Implementation of support

Failure to implement reasonable adjustments• Anne – a visually impaired

student negotiated with her university clinical placement manager that all placements would be easily accessible by public transport. This was rarely taken into consideration

Key factors

• University duty of care

• Student responsibility vs not wanting to be perceived as a problem

Variable student engagement• Students who have dyslexia:

comparisons• A student contacts and visits the clinical area in

advance and organises all necessary adjustments

• A student goes onto placement with no support and has issues with time management, orgqnisation and documentation

• A student does not even consider himself to be disabled

Attitudinal issues• One clinician was reported as saying:

“How can you be a physiotherapist if you can’t see?”

• “…they were actually looking forward to it because then they could get taught skills like I’ve got that they don’t have…the sensitiveness of your hands they were actually interested to see what they could get out of it as well…”

Conclusions• VI history – expectations of success

• Unfulfilled

• Other impairments – greater barriers

• A clinical educator actually said: “She’s not got dyslexia, she’s got a severe personality disorder”

• Inclusive clinical education – still a myth

Thank you for your attention

Any questions?

Contact details• Jane Owen Hutchinson, Manager Allied Health

Professions Support Service (RNIB)• Mob: 07748657457• Email: jane.owenhutchinson@rnib.org.uk• Karen Atkinson, Manager RNIB Resource Centre,

Senior Physiotherapy Lecturer, School of Health and Bioscience, University of East London

• Tel: ++44 (0)2082234950• Email: k.a.atkinson@uel.ac.uk