Expectations of the university

Participants were uncertain as to what support they could expect from universities that sent students to them. While input from academic staff was welcomed, dissatisfaction with the relationships between the clinical setting, students and universities was evident and instances cited when support was not forthcoming. Preparation for disabled students was hampered by lack of communication with students and academic staff. All participants seemed unsure of their positioning within this dynamic and there was uncertainty about processes involved:

“whether the university and the tutors would be able to disclose something...if there’s some sort of a pre-placement consent to the sharing of information...to discuss this particular student...knowing whether there is support in place

already...being able to have access to support from the educator’s point of view...it would be nice to have some…contact...to discuss any issues”P4

107 Although they wanted this information, participants had varying understandings of student confidentiality relating to information the university could provide and the need for

student permission:

“and the university won’t disclose it either will they, it’s up to the individual to disclose it”P1

“I know confidentiality-wise the university can’t advise us unless the student wants to disclose it”P7

If students did not share information (or were unaware that they needed to) and the university did not communicate it, this was felt to present a substantial barrier to the educators’ preparation. They expected universities to be proactive, providing

comprehensive support structures:

“I would expect to have…considerable… support from the university in terms of advice…to be given sufficient notice so I could prepare myself...as much as is possible…that would be the thing that would be the most helpful”P3

They wanted generic information that covered a range of disabilities and the strategies that might be useful:

“maybe the colleges could make us aware of the type of disabled students…the sorts of things that have helped them...what works, what doesn’t

work…information on where to find info”P2

Lack of engagement was noted on the part of academic staff and questions raised as to whether they were positioned to support the disabled student any more effectively than the practice educator:

“their university tutor, do they have those skills?…It’s a very…specialist area”P6 As noted, all participants wanted notice and information about the student to enable planning, however, most noted that this was rarely provided; this was when problems occurred:

“if that information isn’t passed on to us prior to the placement, so that we’re aware of what we’re going to have to deal with, that seems to be when the problems arise”P6

108 “[it’s] unfair for the educators to go into a placement blind and not know that there is some sort of a disability”P4

During placement participants reported difficulty contacting tutors who did not always appear to have appropriate levels of awareness of disability issues and/or individual student requirements:

“his university tutor wasn’t really aware…of how severe the problem was”P6 “the main issues for me have been...that the university was waiting to see...you’re never quite sure if it’s a problem...then you’re halfway through the placement and then you’re getting the university involved”P3

Questioning

Most participants expressed surprise when disabled students arrived without support in place. They observed that students were not performing well and suspected that this could be related to an impairment; accounts indicated disbelief that universities were not aware of these issues:

“sometimes these students come and you think “Well, haven’t the university picked up on this...why has it got to us in their second year? What’s been happening before this?””P6

They suspected that academic staff knew about disabled students’ requirements but had not considered their effect on performance on placement. Whatever the reason, the consequence was that reasonable adjustments were more difficult to organise. Feelings of disbelief and irritation were apparent when one participant found that academic staff knew that a student needed support but had taken no steps to facilitate this:

“the student…let us know, when it became apparent...at that point we said,“…are you happy for us to discuss it with the university?” And they were, like, “Oh, yes, that’s fine,” and we spoke to the university. And they were, like, “Oh, yes, we knew that.” And we’re, like, “Well…!!”P8

This lack of communication was sometimes felt to be purposeful and unfair; academic tutors avoiding the issues and relying on the challenges of the clinical setting to act as a trigger for subsequent action rather than proactively dealing with disabled students’ support needs:

“I don’t feel that’s fair necessarily...I think the university has used us quite a lot here…I suppose sometimes they’ve wanted someone else to have that conversation with the student rather than them. That’s how it feels”P5

109 Staff at the university in question reportedly admitted taking this approach. There may have been many reasons for this, but it could cause extra stress for both educator and student:

“they’ve held their hands up on a couple of occasions, where they’ve had someone difficult, and they’ve put them here…and they’ll go on that to address the issue”P5 Although academic staff were sometimes identified as being at fault, there was reference to lack of honesty on the part of the student possibly indicating intent to deceive.

Participants did not feel that teasing this out should be their responsibility:

“I think it’s about giving evidence to their concerns really…they perhaps aren’t quite so sure the student has...been open and honest with them...it would...be nicer...if it wasn’t always landing on our doorstep”P5

Academics’ awareness

One participant felt that academic staff had little awareness of the pressures faced by educators meaning they were unable to provide realistic advice about supporting disabled students in the clinical setting:

“a lot of the academic staff don’t work in the NHS and that is a problem…it’s very different now and I don’t think…they understand the pressures”P1

While academics not being immersed in the NHS environment did not necessarily mean that they were unable to understand the issues, there was, however, a reported lack of communication. It was questioned whether more collaborative work between the university, educators and students was needed to facilitate the development of equitable solutions:

“should there be more interaction…between clinical staff and academic staff so that they know what’s real world and what we expect and what they expect?”P1

Participants expected support from academic staff regarding disabled students throughout placements but there was uncertainty:

“we don’t always get the answers that we want...it all comes back down to what is acceptable and what’s not and what should we be accepting them to do”P1

““This is what this student’s needs are,”…is there perhaps some negotiation with the university? While we can accommodate this but…that would be difficult to accommodate, and negotiating it. But, again, it’s difficult… because what is a reasonable adjustment?”P3

110 Educators had clear expectations of the support they required from universities prior to and during placements to prepare and carry out their teaching effectively. While some communication was mentioned, most participants indicated that this was at best,

inconsistent and at worst, absent. Any advice provided did not necessarily fulfil educators’ expectations, in terms of being too late in the placement or in relation to what was ‘reasonable’ in the ‘real world’ of the NHS.

Participants’ accounts indicated that in most cases, they did not feel well supported by their local university teams; this felt unfair and undermined their confidence. This illuminates tensions apparent as a result of relationships between students, staff in HEIs and practice educators themselves. While the issues noted in this section specifically concern links with HEIs, many of them also have ‘a need for disclosure’ as an underlying premise; explored further in section 7.5.