Reflections on teaching with health service users for the first time

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