How to interpret and manage learning needs on placement

Sarah Illingworth & Louise Goff

Specific Learning Difficulties (SplDs)• SplDs affect the way information is learned and

processed• They are neurological (rather than psychological),

usually hereditary and occur independently of intelligence

• They include:– Dyslexia, – Dyspraxia or Development Co-ordination Disorder, – Dyscalculia, – Attention Deficit Disorder

• Highly variable profile• Strengths and weaknesses

Common difficulties in SplDs

Information processing

Memory & concentration

Communication skills

Literacy

Organisation & time management

Direction & navigation

Sensory sensitivity

Information processing

• Difficulties with taking in information efficiently (this could be written or auditory)

• Slow speed of information processing - a 'penny dropping' delay between hearing something and understanding and responding to it

Information processing

Memory & concentration• Poor short term memory for

facts, times, dates• Poor working memory -

difficulty holding several pieces of information while undertaking a task e.g. taking notes as you listen.

• Mistakes with routine information

• Inability to hold on to information without referring to notes.

Memory & concentration

Memory & concentration

• Weak listening skills, a limited attention span, problems maintaining focus

• A tendency to be easily distracted, inability to remain focused

Memory & concentration

Communication skills• Lack of verbal fluency or precision

in speech• Word-finding problems• Inability to work out what to say

quickly enough• Misunderstandings or

misinterpretations during oral exchanges

• Over-loud speech or murmuring that cannot be clearly heard

• Sometimes mispronunciations or a speech impediment may be evident

Communication skills

Literacy• Lateness or difficulty in

acquiring reading and writing skills

• Erratic spelling, difficulty extracting the sense from written material, difficulty with unfamiliar words, an inability to scan text

• Particular difficulty with unfamiliar types of language such as technical terminology, acronyms

Literacy

Organisation & time management

• Difficulty presenting a sequence of events in a logical, structured way

• Incorrect sequencing of number and letter strings

• Tendency to misplace items• Chronic disorganisation• Poor time management:

particular difficulties in estimating the passage of time

Organisation & time

management

Direction & navigation

• Difficulty with finding the way to places or navigating the way round an unfamiliar building

Direction & navigation

Sensory sensitivity

• A heightened sensitivity to noise and visual stimuli

• Impaired ability to screen out background noise or movement

• Sensations of mental overload / switching off

Sensory sensitivity

Visual Stress

Visual Stress

• Some people with dyslexic difficulties may experience visual stress when reading

• Text can appear distorted and words or letters appear to move or become blurred

• White paper or backgrounds can appear too dazzling and make print hard to decipher

One size does NOT fit all…• Individuals vary greatly in their profile• Key variables are the severity of the difficulties and the

ability of the individual to identify and understand their difficulties

• Key is to develop and implement coping strategies• Strategies included: technology, reliance on others and

an array of self-help mechanisms - the operation of which require sustained effort and energy

• Strategies are prone to break down under stressful conditions which impinge on areas of weakness

Stress

• People with Specific Learning Difficulties are particularly susceptible to stress, compared with the ordinary population

• Leads to impairments becoming more pronounced

• As a result many people with Specific Learning Difficulties have little confidence and low self-esteem

Areas of Strength• Specific Learning Difficulties are linked to a range of skills:

– 'big picture' thinking– problem-solving – lateral thinking abilities– instinctive understanding of how things work– originality & creativity – exceptional visual-spatial skills

• Not all people with SplDs will have outstanding talents, but all will have comparative strengths and often demonstrate great perseverance and determination

Case Study 1

• Undergraduate student who has disclosed that she has dyslexia

• She was diagnosed at school and is engaged with her learning needs

• She has had little contact with disability support whilst at university and has not discussed her learning needs with her university lecturers

Case study 1

• The university disability support service has assessed that she requires the following adjustments:– 25% additional time for examinations– Examinations to be carried out in a separate room.– Two week extended hand-in for assessed

coursework– Lecture notes to be available one week in advance

Case Study 1

• What reasonable adjustments would you suggest for this student on their second placement ?

Case Study 2

• A student is half way through C placement and isn’t progressing as well as you would expect

• She ‘can’t quite pull it together’ and you have no idea why

• Her pre-placement form states that she achieves an average academic performance

• Her performance on B placement was unremarkable.

Case Study 2

• During a visit by the university tutor you identify the following as areas that need improvement:

• Lacking consistency in gathering and interpreting patient information required to perform an assessment

• Difficultly in remembering key facts. Your concerned that the student has knowledge gaps/deficiencies

Case Study 2

• The student seems very disorganised. Work is sometimes handed in late, the student is often late or in the wrong place

• Her portfolio is poorly organised and lacks sufficient evidence demonstrating clinical and reflective skills

• She finds recording information challenging, making many errors and this process is very time consuming

• She is very, very stressed and anxious at times which limits her ability to perform

Case Study 2

• What do you think the problem is ?• How are you going to manage it ?

Case Study 2• What will the university do ?– Arrange diagnostic tests for a possible specific

learning disability– Work with the placement site to develop

reasonable adjustments– Work with the student to support them– Facilitate stress management support at the

University– Provide additional contact for both the student

and the placement site– Facilitate post-placement discussions of

experiences

Case Study 2

• What do you have to do:– Facilitate and support reasonable adjustments– Reasonable adjustments have to be agreed by the

placement site, student, university– Document your decisions and rationale

Reading strategies• Allow extra time for reading.• Present essential reading well in advance of meetings –

highlighting important parts if appropriate.• Provide opportunities to discuss reading.• Make word processed documents ‘dyslexia friendly’:

– write in a logical sequence– avoid small print (use font size 12 or above)– use a dyslexia friendly font (arial, verdana, tahoma or lucinda sans are best)– use bullet points in preference to sentences where possible– use simple words/avoid overuse of jargon or uncommon words– do not justify the right hand margin – this makes the spaces between words

uneven and harder to read if you are dyslexic– space the information so it is not cramped, use short paragraphs to break up

dense text– where possible print documents on off white/cream paper

Writing strategies

• Allow individuals enough time to write up their notes.

• Try not to disturb individuals when they are concentrating on their documentation.

• Allow them to write a rough draft on scrap paper which you can check before they write it into the notes.

• Help students to devise a checklist of key areas to include in certain types of documentation.

• Consider devising a ‘sample’ or ‘model’ for different types of documentation to show them the level and content expected

• Allow word processing of reports etc where possible

Memory Strategies• Help the student to invent and use mnemonics.• Encourage the individual to use ‘to do’ lists rather

than trying to remember.• Don’t give too many instructions at once.• Prepare printed ‘handover sheets’ covering core

information – the individual can add to these but it will reduce the amount they need to write down and avoids things being missed.

• Help a colleague to draw up a plan highlighting important tasks/ deadlines.

Memory Strategies• Set clear, measurable targets.• Allow enough time for the person to grasp key

information, try not to rush them.• In the case of procedures allow the person a chance

to practice (ideally as close as possible to when you explained it or demonstrated it).

• Explain things more than once if required.• Where possible give instructions in written and

verbal form (you could consider using a digital voice recorder to record sets of instructions).

Liaising with colleagues

• Try to create an environment which helps colleagues to feel comfortable• anxiety will only make problems worse.

• Don’t let people draw attention to mispronounced words, even inadvertently

• Try not to use abbreviations as some people find them difficult to interpret and they may mean different things to different people

Useful resources

• http://www.bdadyslexia.org.uk/about-dyslexia/adults-and-business/dyslexia-and-specific-learning-difficulties-in-adu.html

• Dyslexia, dyspraxia and dyscalculia: a toolkit for nursing staff http://www.rcn.org.uk/__data/assets/pdf_file/0003/333534/003835.pdf