Accessing the curriculum; university based learning experiences of visually impaired physiotherapy students

Introduction

This paper discusses the learning experiences of four visually impaired physiotherapy students from four different universities in the UK, focusing on their experiences of university and classroom-based learning. This study built upon an exploratory study of three visually impaired physiotherapy students within a single UK university (Frank et al., 2014).

Physiotherapy has a unique history in the education and inclusion of visually impaired people who have long been accepted and valued as physiotherapists. Historically, student physiotherapists undertook their training at the RNIB School of Physiotherapy in London (Barclay, 1994; Atkinson and Owen-Hutchinson 2005, 2013; Owen-Hutchinson and Atkinson, 2010). Since its closure in 1995, visually impaired students have chosen where they would like to study physiotherapy, reflecting student choice and principles of inclusive higher education.

All registered healthcare professions offer approved and validated pre-registration university education courses, to ensure that appropriate standards are met for practice. The HCPC (Health and Care Professions Council) who approve physiotherapy courses, and the NMC (Standards Framework for Nursing and Midwifery Education) have specific standards and requirements to ensure that student and registered healthcare professionals are treated fairly and equitably within the premise of the Equality Act (Legislation govuk, 2010, The Equality Act, 2010), during their professional pre-registration education, and in practice, once they qualify (HCPC, 2015). The Equality Act (2010), guidance from the Quality Assurance Agency (UK Quality Code 2013) and a recent paper from the Department for Education (2017) all state that the provision of anticipatory reasonable adjustments ensures that disabled students can access Higher Education (HE) where registered healthcare professionals such as nurses, midwives, physiotherapists, occupational therapists, paramedics, and others gain their qualifications.

Healthcare students are encouraged by their regulators (HCPC, 2015, Nursing and Midwifery Council, 2018) to disclose any disability to their HEI, to ensure that support can be provided in university classroom-based and practice-based education; access to education should not be limited by disability (Moran, 2009; Veck, 2007). About nursing, Hargreaves and Walker (2014 p.1752) suggest that disabled students should not pose any greater difficulty in demonstrating “fitness to practice” provided that disclosure is made, and support and reasonable adjustments provided. Indeed, the Nursing and Midwifery Council (2018), HCPC (Clouder, 2013; HCPC, 2015) and the Chartered Society of Physiotherapy (CSP, 2012) have published guidance to enhance inclusion and support for disabled students, including those who are visually impaired (Owen-Hutchinson and Atkinson, 2010). However, despite this, barriers to entry and practice as a healthcare professional for disabled students remain.

“Barriers and enablers” are terms that feature in the International Classification of Functioning, Disability, and Health (ICF) (WHO 2010). Unlike the social model that suggests that disability is caused by society, culture, economic constraints and the environment (French and Swain, 2008 p.28), the ICF considers how both impairments and environmental factors act as barriers and/or enablers, affecting participation in society for disabled people, which includes going to university and training for a career (WHO, 2010), such as physiotherapy. The ICF provided an underpinning theory of participation for this study, enabling exploration of the factors that affected participation in university and classroom-based learning for the participants.

The experiences of disabled students in HE has received a great deal of attention in recent years, especially about dyslexia and specific learning difficulties (MacCullagh et al., 2016) with a recent study reiterated that students were still experiencing challenges with disclosure and identity, and were facing negative experiences of higher education (Kendall, 2016). As there is evidence to suggest that more students are disclosing disabilities in healthcare education (Ryder and Norwich, 2018) this poses a potential problem for healthcare students, who are choosing to enter, and are the future of the healthcare professions. Specific research into the experiences, barriers, and enablers of disabled students in different professions such as Medicine (Miller et al., 2009), Occupational Therapy (Gitlow, 2012) and Nursing (Ryan, 2011; Wray et al., 2013; Tee and Cowan, 2010) exists, identifying many barriers and enablers to learning. About healthcare education, disabled nursing students continued to face poor attitudes towards them from their colleagues (Shpigelman et al., 2016), supporting previous claims of inadequate inclusion in higher education (Claiborne et al., 2011, Papadopoulis and Goudiras, 2004; Kioko and Makoelle, 2014). The literature has also shown that disabled students require additional time and an “emotional” effort to study, suggesting that their experiences in learning are challenging and more time-consuming than non-disabled students (Goode, 2007; Mullins and Preyde, 2013; Magnus and Tossebro, 2014). Whilst this is a significant problem for the students, it has ramifications for educators in university who must provide inclusive and accessible learning for students (Department for Education, 2017). About physiotherapy, Frank et al. (2014) identified that visually impaired physiotherapy students needed to be highly motivated and strategic with their time and effort to complete their studies. Although little research has specifically considered visually impaired students in HE (Bishop and Rhind, 2011; Reed and Curtis, 2012), and only one has considered physiotherapy students (Frank et al., 2014), all three authors confirmed that barriers to learning were encountered. These were specifically about visual teaching methods, reliance on reading, difficulty using adaptive technologies, and access to demonstrations or visual media. These authors also suggested that support was inadequate, indicating that resources and staff attitudes were poor, supporting the findings of Shpigelman et al. (2016). However, there was also evidence of enablers which supported participation in higher education reflecting the ICF. This study, therefore, sought to explore both barriers and enablers in university and classroom-based education, to offer insight into the experiences of four visually impaired physiotherapy students to facilitate inclusion in physiotherapy education. The following research questions were posed:

1. What barriers do visually impaired physiotherapy students experience in university-based learning?
2. What are the individual strategies, factors, or behaviors that enable learning physiotherapy for visually impaired student physiotherapists in university and the classroom?

Whilst the participants were unique to physiotherapy, the author was interested in inclusion and participation, hence the underpinning of the ICF. The discussion considers to what extent the findings from this group of students can be reflected in wider higher and healthcare education, to facilitate inclusion and accessibility for all.

Conclusion

These findings show the existence of both barriers to and enablers for learning physiotherapy within the university setting. The barriers prevented students from fully participating and accessing the curriculum effectively, despite support and reasonable adjustments being put in place. However, some excellent practices ensured participation and access to the curriculum in both theoretical and practical teaching and learning, reinforced by strong “human” and compassionate support.

These findings support previous research into the experiences of disabled and visually impaired students in the university, suggesting that physiotherapy education is not unique. Despite the physiotherapy profession being open and supportive of visually impaired therapists, there are still barriers that ultimately result in students having to work harder and longer to access the curriculum to achieve their educational goals. However, if barriers can be identified and addressed through open, collaborative relationships and reasonable adjustments, access to the curriculum can be enabled, and full participation in physiotherapy education can be achieved.