Dr Fiona McCullough

Director of Dietetics

University of Nottingham

Experience of Dyslexia within Dietetics

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Students present within each cohort

1 in 25 of the population are seriously affected 1 in 10 of the population are affected to some

extent What is dyslexia?? Dys = difficulty Lexia = with words (reading, writing, spelling) Over 500 definitions of dyslexia exist

First student issue encountered

10 years ago First cohort of students on clinical placement

for 28 weeks Student had not declared condition on pre-

placement form Started to muddle numbers in medical records Placement staff contacted the University

extremely dissatisfied

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Disability statement

“The University of Nottingham welcomes applications from all students. We aim to provide a high level of support from the moment you first enquire until the moment you graduate.”

Health programme commissioners expect Widening Participation

Legal requirement to make reasonable adjustment

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The legal framework

Subject areas such as law, medicine, education, engineering are also bound by the standards of their professional bodies, though these bodies are now subject to the legislation.

Safe and competent practice HPC Standards of Proficiency and Standards

of Conduct, Performance and Ethics

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Within University coping strategies are delivered

Inputting information– reading, listening

Outputting information – writing, speaking

short term/working memory problems fine motor difficulties Usual reasonable adjustment- 25% or 33% extra

time; proof reading; extra time for assignment submission if required

Staff need to manage student expectations

Extra time with course work submission Staff team became aware students “playing the

system” and always asking for long extensions Last academic year agreed 5 days extra would be

the norm Students often diagnosed during year 1 of

university “when the staff have my academic referral sorted

out everything with be fine” attitude7

When something goes wrong

Multi-factorial situation (dyslexia+ average academic ability+ family responsibilities + PT job + travel + mental health or other issues

Difficult to establish which factors are greatest contributor

E.g. student with poor attendance and academic fails

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Aim to maintain student progression

Need to be simmering and not come to the point of boiling over

At boiled over stage, takes longer to get back to simmer (massive impact)

Possible outcomes include -

low self-esteem and confidence

anxiety and panic attacks

depression 9

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Common indicators in HE – try to address these in relation to HEI and placement setting

Generating oral language Time estimation Difficulty with orientation/finding way Left/right confusions Short-term and working memory difficulties Difficulty recalling and generating sequences

of words, ideas Difficulty synthesising information

Challenges with Clinical Placements

So what’s the problem if

the legal requirements also apply to hospitals?

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Work Placements

At university….. Strategies

Support – personal tutor - Academic Support tutor - friends/family

Reasonable adjustments agreed with school Aware of strengths and weaknesses

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Work Placements

New situation……..

Stress – makes things worse. Confidence / self-esteem – insecure, fragile, over talkative, over sensitive Vulnerable – unfamiliar environment, isolated from support network, strategies Information Overload – exhausted!

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Work Placements

Orientation – finding way around

Left/right confusions – with directions, working in

the mirror image

Co-ordination - clumsy, misjudge distances

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Work Placements

Time to read and process information Communication – verbal – misunderstand, word

retrieval

- written – slow, legibility issues,

spelling Time management/organisation – estimation, no system, prioritising, overworked Multi tasking - listening and taking notes, task sequence

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Work Placements

Short-term and working memory problems – names, details, spelling, pronunciation, phone message, sequence of tasks, ID number, key code, log on password

Initially may appear slow/ not competent?

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Work Placements – need to make anticipatory arrangements

Pre-placement visit Shadowing/observations Consistency – staff, systems, forms, timetable Strategies – review regularly with the student Fair, equitable and agreed extra time – 2 weeks on a 12

week placement. Student placed near Nottingham (if possible) so can

access Academic Support if required Extra meeting with academic support pre-placement and

provisional dates in diary during placement

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Work Placements

Regular feedback One change at a time and avoid unnecessary

changes or variety Feedback given by same person or in same

structure and style if possible 2 weeks run in/acclimatisation at the beginning Information in advance

Support for practice educators

Training Awareness raising Case study discussion Strategy with managers around what would

be classified as reasonable adjustment within the NHS

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Unresolved issues

Students who don’t progress tend to blame supervision style, feedback and other issues

Students who struggle on course are often reassessed and given extra RA

Comes a point where all placements cannot or will not offer same level of RA (so differences experienced between placements B and C)

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HOWEVER:

Dyslexia can be managed Many dyslexic students find effective

strategies Dyslexic students can be the most careful

Dyslexia does not affect: Reasoning, problem solving, creativity or

intuition Standard to be achieved