252 .Session 5.7

SHARING LEARNING THROUGH NARRATIVE COMMUNICATION

Martin Cortazzi’, Lixian Jin’, Debbie Wall’ and Sue Cavendish3

Department of Education, Brunel University, 300 St Margaret’s Road Twickenham, Middlesex TW1 lPT’, De Montfort University’ and University of

Leices ter’ email: martin.cortkzi%brunel.ac.uk

This paper examines key aspects of the learning experiences of ten speech and language therapy (SLT) students on clinical placements, as revealed by an analysis of 102 narrative accounts. We argue that when students on placements tell stories of their learning experiences the process of recounting them can help them to reflect on and consolidate what they have learned and to have th~s learning validated by peer, clinician or tutor audiences. Thus, sharing learning through narrative communication is itself further learning from the original experience. We show how students evaluate their learning experiences, how their growing confidence is mediated by clinicians and how such narratives are shared in normal student interaction. Tutors might use the insights fiom narrative learning to raise students’ awareness of their own learning, and thus to improve it.

Introduction

The learning experiences of SLT students on clinical placements are of immdate interest to other students and to university tutors concerned with SLT courses but they are also of wider interest to the profession as a whole. Socialization into the profession through clinical placements (as through academic and professional courses) plays a key role in the continuation and transformation of the profession. This kind of learning is therefore a professional concern to all clinicians, especially to those who have a mentoring role for students on placements. Student learning is normally monitored through observation, course assessments and through students’ own feedback and evaluations, often on questionnaires. This paper suggests an alternative, i.e. that student learning can be monitored as it is shared through narrative communication, in formal seminars or in informal talk. Further, the sharing of learning experiences through narrative is itself a normal experience. Many students reported that they phone each other to exchange stories and news of placement happenings: to commiserate (often about clinicians, rather than about difficult clients) or to congratulate each others’ acluevements. This sharing helps to interpret the events recounted, to pick out the important aspects and reflect upon them and so this narrative communication is itself another kind of learning which is validated through communication with peers, mentors or tutors.

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The narrative data

Our data derive from ten SLT students at a university in the Midlands who were interviewed at the end of their second year about their learning on clinical placements (we will interview them again in their present third year). Students were asked about the clinical settings they had been in. what they had learned there. how they had learned and how they had shared such learning as well as which experiences stood out in their minds. Interviews were recorded. with consent, and much of the transcribed material can be seen to be in narratwe form. Between them the ten participants gave 102 narratives, often dramatically recounted, which cover a wide range of placements and learning events. Comments show that at least seven narratives had already been shared with friends, others had been told in a seminar, several were relayed tellings of stones heard from friends. This reveals an informal network of narrative communication: formally, in regular meetings in clinical settings with tutors, clinicians, sometimes with interdisciplinq team members and informally, in conversation at home with flat-mates or by phone with peers. University seminars, where narrative sharing has an important semi-formal role in group feedback discussion, and informal peer discussion on paired placements are also part of this narrative network. Since narratives are by definition newsworthy accounts of past events (in this case of personal learning experiences) they tend to capture crises, problems, peaks and turning points of learning. and often epiphanal moments of professional development. These are the life-blood of the narrative circulation systems which our research interviews seek to sample.

Learning through narrative communication

Most social and medical sciences have now begun to study narrative for the human involvement in reporting and evaluating experience and for the key concept that through telling stories of events both teller and audience can come to know and understand experience holistically (Polkinghome 1988, Cortazzi 1993). Narratives help to organize, interpret, and give meaning to experience (Br~ner 1990). Thus patients’ accounts of chronic disease and illness can help health care practitioners to enter the patient’s cultural world and understand their condition (Greenhalgh and Hurwitz 1998, Madjar and Walton 1999). Through the experience of telling or writing narratives, clients, together with the help of therapists, can construct or ‘emplot’ both past and future trajectories of their treatment (Mattingly 1998). The telling of narratives by health care professionals themselves is held to assist the development of empowerment through reflection (Ghaye el a/. 2000). Hence when SLT students communicate stones of personal experiences of learning in clinical placements this helps share the meaning of the experience, gives participants a sense that their voice matters and can be heard and legitimates the human qualities and affective aspects that readily emerge in narratives, but which are often excluded in professional discourse. Narrative analysis (Cortazzi 1993, Linde 1993, Riessman 1993) can be used to investigate the students’ interpretations of recounted events by distinguishing event structures (which report happenings), description structures (which detail time, place, people and context) and evaluation structures (which give the point by presenting the speaker’s perspective, feeling or judgement). Evaluations, for example, are rhetorical underlinings, distinguished from the immediate storyline by dramatic uses of adjectives, adverbs, images and metaphors, exclamations and affective language.

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Sharing learning

Students einphasised how narrative discussion is a highly social means to help each other in planning, retrospectively evaluating, thmking, learning, remembering, coping and handling or overcoming stress. ‘The actual saying ojanything makes you think about it and when you ‘re telling someone else it S just automatic that they’ll throw back questions at you, so their questions will make you have a diferent perspective on what you’ve said. You can learn through talking. ‘It makes you realise what you ’ve remembered Ifyou tell someone else. ’ ‘I think that it’s important, lf you’ve done something good, just to talk it through and say? Y feel really good’ or to talk through something that wasn’t so good ’. ‘I sometimes think that the reason we talk about things, ajier, is as a way of unstressing yowseg Maybe f y o u think you’ve done something wrong and you’re not sure f that was the right thing to do .. <so you get people S feedback, who say, ‘Yes, I would have done that’ or ‘God8 no, I wouldn’t have dreamt ojdoing that ’ and then you can go to sleep at night. ’ ‘You can crack yourselves together and chew the jat; we used to share a lot ... what worked, what didn’t work ’ ‘We were always sounding each other out. More should be done like that. ’ ‘Bouncing things of each other really helps, dejinitely. ’ ‘Youjust bounce ideas off each other and I think you’re more willing to talk about things like queries and stuffwith yourpeers than with a clinician, I think ... sometimes. ’

Narrative exchanges of learning most obviously took place between students. ‘It’s just sharing ideas and you’d be surprised. She (peer) can say just one simple thing and from that a massive big idea will grow ... she was telling me what sort of therapy this (clinician) did. I was like, ‘Ooh, I never thought of that. ’ And you just pick up bits from everywhere. People do share. ’ Evidently, students who are the audience for narratives can learn vicariously from them in relayed accounts. This learning seems to have several hallmarks: it is highly interactive, verbalised recalled experience, with (for tellers and audiences) cognitively and affectively engaging content, which may be dramatically performed. Through such stones students learn from their peers. ‘(I 1earnt)fionr them saying, ‘Oh 1 saw this person, this is what happened and then there was this scenario. ’ So I’ve learnt from it as well because I t e been listening, because it’,s different when your fiiends tell you something. ’ Some narrative exchanges took the form of organised seininars at the university and again the audience learnt from the telling, mediated by the tutor. ‘She (university tutor) said, ‘I want you to tell us one thing that you’ve learnt in therapy, ’ So I start like wetting myseIj‘laughing because the only thing that sticks out is the bad story I told you (researcher) and I thought I’d just tell it ... so I told everyone the story and (university tutor) goes, ‘Well, I think we ’ve all learnt a lessonfiom that. ’ ’

Crucially, the students’ accounts show that while they clearly learn much from experienced clinicians and tutors (and each other) thls learning is not in only one direction. Sometimes the clinicians learn from the student’s explanation (yet explaining helped the student, too). ‘It was a cog-neuro model. I was using it and (clinician) didn’t know anything about it. It was a really new thing and it was really good because it helped my understanding of what I was having to explain to her, so that was really usejul. ’ Sometimes there is a feeling (as in the following example) that tutors, too, are learning from the students’ perspectives but again this is not a simple role reversal - the student narrators are also clearly learning, hence some narrative accounts suggest mutual student- tutor learning bonds.

‘I really like, you know, counselling ... on one placement ... it was people who had had laryngectomies and we had to go to this chap 4 house and this chap, basically, he just wanted to talk about his problems and I remember sitting down and both (university

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tutor) and I were talking to him and it was all to do with finance and the future, and we were there for about forty minutes and most of the time we were just talkng about his problems. And we came out, I was driving and I remember (university tutor) was going, Oh, I don’t feel I’ve taught you anything. ’And I went, ‘Yes, you have because you’ve like counselled that guy. You’ve probably given him more than anyone will in that we sat down and listened to his problems. ’ And I think that was really memorable because I remember coming away and thinking we hadn’t actually done any therapy but what we had done had really made a di8erence to him. But she hadn’t seen that, which was really weird. I’d just finished the counselling module and I thought (whispered disparaging comment on course) but seeing that guy just sitting down talking to her has really made me think, ‘God, yes, that s really important. ’ And the fact that she hadn ’t seen it as well, that she just dismissed what she’d done, and I was saying, ‘No, itS really important. What you’ve done has really helped that chap today. ’

There are many interesting aspects of the above account: the recalled words and thoughts; the underlined memorability of how the student saw the tutor workmg and the tutor-client interaction; the whispered comment on the module about which the narrator has clearly changed her mind; the use of ‘go’ as a vivid reporting verb; and the student’s amazement at the tutor’s apparent lack of realisation of the effectiveness of the session (but this may in fact be modesty or the unconscious competence of the expert tutor who demonstrates rather than explains) and finally the interesting implication that, in fact, the tutor has also helped the student in her understanding of the role of counselling. These and other features give us a picture of a quite vivid turning point in aspects of the student’s professional development. Since this is all shared in the interview narrative and the teller is still reflecting on the incident and arguably coming to understand it at different levels, this seems a good example of sharing learning through narrative communication.

Clinicians mediate learning: confidence and feedback

Many narratives revealed that a major outcome of clinical experiences was increasing confidence, coupled with the ability to relate theory to practice in assessments and therapy sessions. Relationships with particular clinicians, and to a lesser extent, with university tutors were ’luck of the draw’ or ‘they vary so much’ but they mediated confidence according to the clinician’s sensitivity to achieve an appropriate balance between students’ needs for observation, demonstration, familiarisation (as novices) and their need for autonomy and to try thmgs out uninterrupted or unobserved. ‘It really does depend on the clinician and your relationshtp with them. ‘I learnt because she made me do it, she was great, she’d make me go and do things which other clinicians just wouldn ’t. ’ Students’ ability to seek advice or ask clinicians questions may be limited by fear of appearing ignorant. ‘I don ’t think clinicians realise we don ’t know ... but you think that they think that you should, ’ yet there is a strong expressed need for supportive comments and praise, where warranted. The clinician’s mediating ability may be threatened if students believe there is a lack of sympathetic interest or if students see conflicting approaches being advocated by clinicians compared to tutors. These threats become more manifest when tlungs go wrong on placements and when blame is assigned, wrongly in these narratives, to a student. The pedagogic mdat ion is further constrained by the clinician’s assessment function to mark students performance, which some narratives highllght as a dilemma. Some clinicians are seen as not wanting to risk clients through exposure to novices, which reinforces any lack of confidence.

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Although clinicians have themselves been through similar placements, they may not be fully aware of the strong effect of their comments on students’ performance. Comments can be morale-boosting confidence enhancers or they can be quite devastating. ‘The professional relationship I had between ny clinical tutor, instead of’ giving constructive criticism, .she was very much like, ‘That ‘.v wrong, that :r wrong, thal s wrong,’ which then caused me to think I can’t do this.’ ‘She was giving permanent negative jeedback, which was really demoralizing. ’ Yet some negative feedback can illuminate learning, ‘ I think it only dawned on me how much I learnt,from it when I was actually criticized,for it. ’ Students’ stories showed how they valued balanced criticism: ‘They looked at the pros and cons of everything and that really helped my way of thinking. ’ ‘The clinician would set aside half an hour ... to talk about what happened, what I did well and what I didn’t do well, which was brilliant jor me and really benqficial. ’ Tutors also mediate students’ confidence through their feedback and, occasionally, by sorting out perceived difficulties in clinician-student relationships. Students also mediate each others’ learning by ‘bouncing ideas offeach other’ or asking each other questions. And yet amid such complex mediations narrative images of learning are among the most powerful to generate confidence. ‘Once you ‘ve done something, you’ve got it stored in your head haven‘t you.? It’s very much there and you think back to the chap last week who had a similar problem. I t ‘s just there in your head and you ’ve got an image rather than a load of words on a piece ofpaper ... it does your conjdence a world a good ... I came away thinking I had learnt a lot ... I wasjust much more conscious of the learning. ’

Evaluations in narratives

Evaluations often mark the high points of narratives and may show strong feelings which were felt at the time of the event and perhaps later in the telling. These feelings are often negative: ‘I f i l t quite insecure ’, ‘that was really daunting ’r ‘I felt like I was walking on eggshell,^', ‘that just totally threw me’* ‘I went into this blind panic’, ‘I was terrrfied, absolutely terr@ed: ‘I was just sat there completely shell shocked’. Such negative expressions are often preceded by a recounting of the student being given a challenging task. Significantly, they are generally followed by expressions of success, joy, and professionalism. ‘I,felt so good that I Id done it ’. ‘It wasjust brilliant, really good,fun. ’ ‘I remember thinking afier I ‘d.finished ‘God, that was.fantastic. ’ ‘I was like, ‘yes, yes, yes, yes, it worked!’ ‘I felt more profesional. ’ ‘I felt like a proper speech and language therapist.’ ‘I was saying, ‘I actually did it, I actually did it, I’m a proper speech therapist. ’ Clearly, the evaluations mark breakthroughs in feelings of confidence and competence: ‘It S just really rewarding and the breakthrough about that is even more the fact that you know why you’re on the course’. ‘It was absolutely brilliant. It was absolutely the best thing I’ve learntfiom any ofmy clinical experience. ’

Conclusion

In this database of 102 SLT students’ narratives collected so far there is a great richness which we hope we have indicated by sketching a few aspects. From the narrative evidence, it seems that the learning of students on clinical placements is in part mediated by important others: clinicians, tutors, peers, and clients. While clinicians and tutors are familiar with this role, it is unlikely that many peers and clients are consciously aware of how through narrative and other means they are helping others to learn. More

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interestingly, in our examination of tlus shared communication through narratives it has become evident that these narratives themselves mediate learning. The retelling of significant experiences of learning to others is itself a reflective way for both teller and audience to learn more about that experience by interactively weaving together theory and practice with huinane threads. ‘We ’ire obviously reflected back on what we ’ve learnt or the sorts ofpeople we ‘ve .seen in clinic and we use rhat to think about what we’re learning aboui. ’ ‘I’ll talk about it and they ’11 gel interesied (peers) and it does help, absolutely9 it really helpsjust because you’ve got it sorted out in your head hefbre you go and do it. ’ Our identification of narrative networks shows how potentially this shared learning may be socially transmitted and reconstructed in informal contexts as audiences themselves become further retellers. These networks are to some extent legitimated in tutor-student or clinician-student group feedback sessions. If tutors and clinicians develop sensitivity to narrative functions and the ways in which narratives generate meanings (on cognitive, social and affective levels, both personally and professionally) they will be better placed to develop group reflection on these narratives when they occur. Further, tutors and clinicians might actively seek out crucial examples of narrative learning to use them in discussion in an explicit approach which highlights students’ experiential learning. Here, we have examined only the students’ points of view but clearly tutors and clinicians could add into dwussion their own (or clients’) narratives, with the adhtional function of giving crucial insights into the different points of view of all those engaged in developing students’ professional confidence and competence in clinical contexts.

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