MEDEV

School of Medical Sciences Education Development

Introduction

The Partners in Practice project is developing a curriculum framework for teaching disability equality to healthcare professionals. This article reports on progress and the completion of a major consultation.

"Interesting, but what on earth does it have to do with me becoming a doctor?"

This comment was made by third year medical student at the University of Bristol after a day spent learning how to communicate effectively with people who are deaf, visually impaired, have a speech impairment or learning difficulties. To many non-disabled people it might seem an incredible attitude for a would-be doctor to have, however most disabled people routinely experience a lack of disability equality in healthcare.

Students come to medicine and dentistry with varied experiences of disability and to a large extent their attitudes reflect society's general anxiety and assumptions about disabled people. Consequently, disability equality teaching is particularly sensitive and susceptible to cognitive dissonance, while experience has shown that too many students learn only at a superficial level.

The consultation

Partners in Practice is developing a curriculum framework designed to embed disability equality in healthcare education. Last summer we reported the start of a major consultation process involving disabled people, educators and healthcare professionals with the aim of identifying essential learning outcomes for the new curriculum framework. The consultation has now been completed and initial results are revealing.

Over 150 people took part, of whom almost half identified themselves as disabled. The consultation used the Delphi process, which enables a large number of people to take part at a distance, to express their views in confidence, to change their mind in the light of other people's responses and thereby to reach consensus.

The consultation document consisted of 12 major learning outcomes grouped into 3 overarching categories - attitudes, skills and knowledge.

The learning outcomes were then divided into 39 descriptors that broke each learning outcome down into its constituent parts (the document can be viewed on our website at: http://www.bristol.ac.uk/pip. Participants were asked to score each descriptor on a scale of 0-9, with 0 indicating that it was not an important learning outcome and 9 indicating it to be an essential learning outcome.

We worked closely with disabled people to ensure that the consultation process itself was accessible.

They worked alongside educators and healthcare professionals devising and drafting the consultation document, while information on how to participate was disseminated via disability organisations and support networks, GP's surgeries, email groups and advertising in the disability press. The form itself was available in a range of formats and could be completed online, by email, phone or post. Since three different specialist constituencies were involved in creating the document - disabled people, educators and healthcare workers - banishing jargon entirely proved impossible.

Even after the language was simplified, there were still two groups of people for whom the document's structure and language was inaccessible, namely adults with learning difficulties and Deaf British Sign Language (BSL) users.

Since both these groups face particular barriers to accessing healthcare, it was essential that their voices were heard.

Recruitment

A series of small, tailor-made workshops were held at the University of Bristol, the University of Glamorgan and the Circles Network in Bristol, recruiting participants via existing community, social and support groups.

The first workshop was for people with learning difficulties and held at Circles Network, a voluntary organisation that supports disabled people and people at risk of social exclusion. We worked with Circles staff and clients to re-format and re-write the document and then during the workshop, a graphic artist supported the discussion by illustrating each point as it was raised. The illustrated version of the consultation document and the revised text was then used to support subsequent workshops and is available on our website at: http://www.bristol.ac.uk/pip.

Two separate workshops were held for deaf BSL users at the University of Bristol, one for older deaf adults and the other for deaf graduates. Working with an interpreter, deaf participants could discuss terminology that was unclear to them with project staff before completing the document.

Results

Data from the consultation is still being analysed, but initial results show a clear consensus of opinion, with issues relating to attitude consistently scoring highly.

Taking those descriptors that scored an 8 or 9 with more than 80% of respondents, the following issues are revealed to be the most important, ranked in order of priority:

• An understanding that disabled people with long-term conditions are often experts on their medical problems and lifestyle issues.
• A recognition that different disabled people have different needs, identities and preferences.
• A recognition that not all problems have a medical solution.
• A recognition of the danger of excluding other diagnoses based on preconceptions about people with an impairment.
• An ability to see a disabled person as capable of making rational life decisions.

The challenge now is to ensure that the new curriculum framework is flexible enough to suit the different teaching methods used by the different branches of healthcare education.

We will be running a teaching pilot in September with student doctors and allied health professionals designed to assess the effectiveness of different teaching formats and delivery methods, focussing on the top 15 learning outcomes from the consultation.

For all the obstacles that the project foresees, there are encouraging signs that today's and tomorrow's healthcare professionals are increasingly receptive to disability equality issues. In addition to the negative feedback, other medical students are more positive about the teaching and aware of its importance, as one first year put it:

It challenged views I didn't even know I had.