Practice educators and disabled students

Physiotherapists are perceived as compassionate individuals, skilled in adapting

environments and working with disabled clients to enable optimum function. As such it might be expected that they would be enthusiastic in their support of disabled students (Hirneth and Mackenzie 2004). There is evidence, however, that health professionals often have negative attitudes and may perceive disabled people as having a ‘medical disease’ that makes them unfit for practice (Dale and Aiken 2007). Anecdotal evidence exists that

68 disabled employees regularly encounter prejudice and discrimination in the NHS (as

suggested by the accounts of participants in my previous research (Atkinson 2010)). Stanley et al (2011) found that in teaching, nursing and social work, fitness to practice standards discriminated against disabled people and led to individuals concealing their impairments and in some cases leaving their profession. There is also evidence that some professional prerequisites (inherent requirements, competencies, technical standards) required for entry to healthcare professions have been developed with little or no acknowledgement of disability so erecting more, generally unnecessary, barriers which particularly affect disabled students who may need a more flexible approach to be successful (Griffiths et al 2010, Johnston et al 2016, Matt et al 2015).

There is little evidence of research directly considering physiotherapy practice educators’ experiences of supporting disabled students. Opie and Taylor (2008) noted that lack of awareness and inexperience regarding disability led to feelings of vulnerability in

educators, so erecting barriers to disabled students’ full participation in the placement. It is suggested that more support and training for the staff involved could ameliorate these feelings to some degree (Botham and Nicholson 2014). It is perhaps doubtful that this type of support could be consistently enacted, however, given the general situation in relation to training of practice educators as noted earlier and the apparently infrequent appearance of disabled students in the practice education setting.

In nursing some practitioners express concern about disabled students undertaking programmes, assuming negative effects concerning competence and client safety (Ryan and Struhs 2007). In certain vocational fields, questions continue to be raised as to whether disabled individuals can ever be considered as fit for practice (Griffiths et al 2010, Riddell and Weedon 2014). Professional and regulatory bodies have benchmarks against which individuals in all health-related professions are measured in relation to competence. This can generate tension for practice educators as to whether, in their educational roles, they are expected to meet the needs of the student or those of the profession (Carey 2012). Further complications arise when considering the requirements of other stakeholders including HEIs and employers. Practice educators work within what could be considered a contested terrain comprising different expectations and demands and yet still need to provide a relevant and quality educational experience (Bessant 2012).

69 A third of physiotherapy students’ education occurs in the workplace and yet limited guidance is provided for practice educators regarding their support. Appraisal of student performance often includes subjective elements which may not be ‘bona fide’ occupational requirements but rather social interpretations of desirable attributes (Williams-Whitt and Taras 2010). Generally disabled students report feeling more supported in academic settings than in the practice environment (Carey 2012) although there is evidence that academic staff may perceive disabled students as “an added drain on precious time and resources, someone they efficiently and kindly (if not always equitably) deal with” (Bargerhuff et al 2012,186).

4.4.1 Views about disabled students

Given earlier discussions on ableism, it is perhaps not surprising that educators tend to view disabled students through the deficit model. Medical discourse positions them as intrinsically problematic, ‘other’, the main concern being ‘what they can’t do’; typically passively constructed as ‘acted upon’ rather than ‘acting’ (Adams and Brown 2006, Ryan and Struhs 2007, Renshaw et al 2014). Resistance, negative attitudes and lack of awareness of disability issues are factors that need to be addressed (Seale 2006) as they often lead to disabled students and employees being managed through the medical model.

Physiotherapy is influenced by notions of able-bodiedness; disability being viewed as needing remediation. This normative ontology and hegemony of ableness can result in a ‘one size fits all’ approach so perpetuating unequal or oppressive social relations (Ryan and Struhs 2007) which can act as significant barriers to inclusion in practice placements. Titchkosky (2007,106) notes that an unchallenged medicalised approach to sense-making leads to the following conclusion:

“.... disability easily becomes meaningful as a type of problem a community would be better off not to have in its midst”

Research in nursing identified considerable hostility to the idea of disabled people entering the profession (Ryan and Struhs 2007); disability was considered by some as incompatible with a career as a nurse. Nothing of this nature has been identified in physiotherapy literature (although in my professional experience, some individuals hold similar views). There is evidence to suggest that disabled employees are rated more harshly even when working at the same level as their non-disabled peers. Arguably this indicates that employers may have particular beliefs about disabled individuals based on negative stereotypes resulting in discriminatory practice (Williams-Whitt and Taras 2010). Again,

70 these beliefs and behaviours are mirrored in the feminist, BME and LGBT literature (e.g. Harris 2014, Mirza 2014/15, Somerville 2015) in relation to individuals from other minority groups.

Sometimes adjustments for disabled students are ignored or refused; possibly due to a lack of knowledge or understanding about particular disabilities, or alternatively, related to prejudicial views. When adjustments are provided, queries may arise as to whether these compromise professional standards (Hirneth and Mackenzie 2004). Non-disabled

individuals may talk about a disabled person looking ‘normal’ and noting that ‘there is nothing wrong with him/her’. Assumptions may therefore be made that disabled students are wasting time or not engaging with learning and their impairments may not be

considered legitimate.

Shier et al (2009) noted that individuals who share information about their disabilities experience discrimination and labelling by employers involving negation or disregard of ability, skills and training, having a significant impact on self-esteem. Differing experiences were reported in teaching, nursing and social work, with regard to ‘declaration’ of

disability, ranging from positive and supportive to stigmatising and unhelpful (Stanley et al 2011). In the light of this it is perhaps not surprising that many disabled students may be reluctant to talk about disability with their practice educators. Legislation has resulted in significant constitutional protection and institutional support for disabled students and those moving into employment. Given that legal definitions of disability are based on the medical model (Bargerhuff et al 2012), however, much of the work that has been carried out in this area is based on compliance with the law rather than on engagement with the socio-political and emancipatory issues relating to disability.

To conclude, it is clear that this is a complex picture involving the fields of both education and healthcare. Academic and practice-based staff are embedded within, and to an extent across, these fields and must balance their different roles and requirements at the same time as providing an effective learning experience. The roles explored are complicated, but in relation to students, arguably it is that of practice educators that is most challenging given the stakeholders to whom they are accountable and for whom they are responsible. The presence of impairment brings another layer of complexity into the picture which may be variably managed depending upon the knowledge, awareness, experience and resources of the educators and their disabled students, and the support available to them.

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