Reflections on teaching with health service users for the first time

community-engegement

As teachers, we are being asked to include service users, including students or members of the local community, in our teaching and learning activities more and more; however this isn’t necessarily a straightforward process. I wanted to share a recent experience in teaching with service users which I found challenging and from which I learnt a lot.

I was recently asked by a colleague in another division to lead a teaching session for a group of fourth year speech and language therapy students in her absence. The session in question was on providing safe services to people with learning disabilities with a focus on capacity to consent and the Mental Capacity Act. The teaching for this session is normally provided by two service users with learning disabilities, co-teaching with a member of academic staff from City. The session is additionally supported by a worker from the voluntary organisation the service users attend, The Advocacy Project, usually someone who knows the service users well. I was asked to cover the academic element of the teaching as I have recently taken on chairing the School of Health Sciences’ Community Engagement Committee, and had never taught with health service users before. Leading this session would therefore be of mutual benefit and interest.

The students (around 35) had been given some resources on Moodle to read and reflect on before the session; some of these were summaries of key legislation in relation to working with people with learning disabilities on consent such as the Mental Capacity Act 2007 and the Equality Act 2010. They were also provided with the Winterbourne View Care Home enquiry report, which detailed poor practice at this care home, some of which led to the premature death of a number of patients with severe learning disabilities.

I started the session by asking students to tell us and each other how they were feeling about the session but without using words. Students at first struggled to express themselves using only gestures but then became more comfortable as a series of commonly used gestures and symbols were established in the room. I then asked students to reflect in pairs on how that had felt and how relevant they thought being asked to do this was. Students fed back that they had found this quite hard and scary and were struck by how difficult and intimidating it must be for patients with learning or speech difficulties to explain how they are feeling to a healthcare professional.

My role was to provide key information on the relevant legislation, deal with issues and queries on these as they came up, address key learning points, make links and identify areas for further independent study. I felt this would be reasonably straightforward but my inexperience with teaching with service users became quite clear to me by the middle of the session. The two service users gave fantastic examples of times in which they felt they had not been given information by their healthcare providers in a way which enabled them to consent to care or treatment. Some of these were quite distressing to hear and many of us in the room found this very moving, some students were clearly in tears. I asked the two service users a number of questions relating to the experiences they had just described but their inability to answer these made it clear that I had used words and terms they did not entirely understand. I had additionally inadvertently structured a question which included at least two concepts: they just could not understand what I was actually asking. One example was when I thought I was asking one of the service users why she thought that people with learning disabilities might die prematurely in hospital. She understood that ‘premature’ meant early as she had had a child who was born prematurely, but she was only able to apply the term to birth and not to death. It took me a while to recognise my error and correct it, but I also realised that I had made other assumptions in my use of questions and what service users would consider jargon during the first half of the session. Conversely, the worker from the Advocacy Project asked clear, short, open questions, using language which did not include any jargon at all; these questions elicited appropriate answers from the service users.

The lesson for me in this teaching session was that I was as inexperienced at speaking to and understanding the needs of service users in teaching as the students are in a clinical context. I used words that I felt were commonly understood: as a non-clinician I just assumed everyone would understand them. In fact I didn’t even think about it, I am so immersed in the healthcare culture that I have forgotten what it is like to not know what ‘acute’ means. The Advocacy Project kindly shared some top tips for working with service users, particularly those with learning disabilities, as well as a jargon buster, but I imagine that these could be applicable to working with as well as teaching with any service user/carer/local community member.

 Do:                                                                                                                                                                        

  • talk about one idea at a time
  • break big ideas down into several smaller ones
  • plan ahead: think about how you can make things easy to understand
  • slow down! Give people time to take in each idea
  • check for understanding as you go
  • give people time to speak
  • listen
  • use easy words and watch out for jargon
  • speak to adults like they are adults
  • use pictures or drawings: be creative when needed
  • remember that everyone has different needs
  • ask what support people need
  • make sure people feel confident asking for your support

Don’t

  • give lots of information at once
  • speak about people with a learning disability/older person as if they are not there, eg: addressing a carer
  • speak to them and include them in the conversation
  • worry if you have to try to explain something a few times
  • rush: people will miss out on information and having their say
  • use colloquial language such as “in a nutshell”
  • forget that remembering can be hard work for people. Reflect on what you can do to help people remember

Jargon busting is equally important: these are clinical examples below but I am sure this principle would apply to other professional areas: business, law, journalism, etc: we all have our own professional language and culture and if we are going to involve service users and the local community more in our teaching activities we need to consider how best to include these colleagues.

Acute, admission, care plan, chronic, consent, discharge (both meanings!), dressing, inpatient, outpatient, recovery, surgery, triage…..

I used at least three of these (as well as others) in the teaching session: no wonder the service users were unable to answer my questions easily! An extremely valuable and humbling lesson for me…..

 

 

Rosa Benato

Senior Lecturer (Education Development)

School of Health Sciences

 

 

 

 

 

 

 

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14 thoughts on “Reflections on teaching with health service users for the first time

  1. Thank you very much for sharing this experience, Rosa – it sounds like it was quite a profound one.

    I thought you had a very interesting opening to the session in getting the students to communicate without words. A very good way to engender empathy.

    In the jargon busting section at the end, you mentioned a list of vocabulary common to health care then suggest that the principle of ‘jargon busting’ could apply as equally to other professional areas as to health care. I’d go a step further and suggest that your dos and don’ts list are a great set of general principles to teach by!

  2. Thanks Dominic,
    I do agree with the latter but didn’t want to prescribe such thoughts! See, cant help myself, more medical terminology….

    It was a very profound learning experience for me, I too was almost in tears a couple of times in the session, that has never happened to me before in teaching.

    cheers

    1. That makes it all the more generous of you for sharing 🙂

      Teaching for me has always been about learning as much as it has about teaching, and I hope it’s not too outrageous a thing to say that the best teachers recognise that.

  3. Hi Rosa,

    Thanks for this informative and honest post, I second Dom’s comments in that this approach could be applied to most settings and be a helpful aid for those new and old in teaching practice. I also thought that this reflection was commendable and one that I will use for dissemination in the law school.

  4. thanks to you both, very thoughtful comments and I am delighted to see that Law may take on some of the issues, thanks so much Rae.

  5. Great blog Rosa and lovely insights. I even wonder whether sometimes whether people who work regularly with people who have learning or communication difficulties are really aware of these subtle adjustments we need to make to our language and approach. I realise that is the case in most places, but not all, and I do hope this is read widely 🙂

    Rae, you also might be interested in Lucy Henry’s (LCS, City) work on intermediaries and child witnesses (with and without autism)?

    Thanks for sharing this.

  6. A lovely blog Rosa, thank you. I really appreciated your ability and willingness to notice and then reflect on how you felt about what had gone on and to think about how that might be affecting others. I wonder if, in an ideal world, we might share such personal reflections with our students, thereby modeling the very essence of being a reflective practitioner?

    Thank you very much,

    Alan

  7. thanks very much Alan, I did exactly that with that group of students yesterday. I felt it was important for them as well as me to debrief on the session: how we felt at the time and after, what we felt had gone well, what could have been done differently as well as discussions around how to remember your training and not take short cuts in communication or empathy when things get stressful and busy in practice/teaching. (Not always easy). I showed them the blog and encouraged them to read it. It was quite an intense discussion but I found it really helpful, I hope the students did too
    thanks again
    Rosa

  8. Dear Rosa, Thank you for posting your very important insights for us to read. I have sent the students a link for it as well, as I received many positive emails and face to face comments from students after the session. This is a project I am very proud of, and have worked hard over the years to develop. I was unable to do the session this year, but very happy you could do this, Rosa, so thank you. Maybe if I am still at City next year we can do the session together.
    I am really pleased that this teaching continues to have impact not just for students, but for staff as well.
    Thank you, Celia H.

  9. Hello Rosa,

    I am a service user with MS. I give talks to trianee adult nurses at City Uni and other places on physical long term conditions. A different area of health care but a lot of what you said is as relevant to me as it is to you. Avoid jargon and engage with the student. I thought the do’s and don’ts apply to every body who does teaching or public speaking.

    Thankyou for sharing the information. I will try to put it into practice

  10. thank you Patrick, very useful to hear!
    NB: we know each other, I am on the SUCAB with you here at City!

    cheers

  11. thank you Celia, that’s brilliant.,
    the students are so lucky to have this session, planned and entirely organized by you! It is a fantastic achievement to have built such a great relationship with the Advocacy Project over the years and have their input. The success of the session, as I see it, is down to that relationship.

    I would love to do the session with you next year and learn from you and Saboohi from the AP if you will have me.

    thank you again
    Rosa

  12. Dear Rosa,
    Thank you so much for sharing your reflections. I found reading through helpful. I will take note for my own occasional teaching in health and social care to carers of learning disabilities people. I also appreciated reading the ensuing conversation. Thank you Rosa and thank you all.
    Linda

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