Enhancing student learning through Service User Involvement

Simon Horton, Kathleen Lane, Becky BakerUniversity of East Anglia

Centre for the Advancement of Interprofessional Education

CAIPE Chair’s EventFriday, 7th November 2014

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Introduction• The drive for Service User involvement has come from • Service Users and the public• the health-care professions and regulatory bodies• government policy aiming to create a more “patient-led”

NHS• Involvement in the education of health and social care

professionals• Service Users and carers provide invaluable insights • educating current and future professionals to be responsive

to the needs of those they serve

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Service User involvement at UEA• Involvement of Service Users in the design, delivery,

assessment and evaluation of health care education • required for accreditation of health and social care

programmes (HCPC; NMC etc.)

• There is evidence of involvement and good practice at UEA …but• Evidence for impact on the quality of student experience

and performance is limited and inconsistent

• Our paper adds to the context of what is happening in our institution and in institutions elsewhere 3

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Aims and Methods• Teaching Fellowship awarded 2012-2013 to investigate

the impact of Service User Involvement on pre-registration student learning in the Faculty:• School of Rehabilitation Sciences• School of Nursing Sciences• Norwich Medical School

• Methods: focus groups with students (N=15) and staff (N=8) from the three FMH Schools and with Service Users (N=6) with experience on teaching programmes in the Faculty

• Analysis: themes were drawn from the data4

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Main Findings

• UNDERSTANDINGS OF THE TERM, “Service User”

• IMPACT OF SERVICE USER INVOLVEMENT

• PREPARATION FOR PRACTICE

• CHALLENGES IN SERVICE USER INVOLVEMENT

• SUGGESTIONS FOR CHANGE

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“Service User”• understandings of the term varied among student groups

I’d actually never heard of “the Service User” before today. (Student)

• different definitionsWe’re still referring to them as patients… (Student)We refer to people as Service Users because they’re not necessarily ill but they’re accessing treatment (Student)

• student sensitivity to the vocabulary they employedIf you talk to people you can generally get a feel of whether they want to be referred to as a patient or [a Service User] (Student)

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IMPACT of SERVICE USER INVOLVEMENTMaking learning effectiveExposure to the lived experienceDiminishing stigmas and stereotypesDeveloping empathyInspiring and motivating studentsContributing to development of professional identity

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Making learning effective[Service Users’ stories] always stimulate more interest and more engagement… it’s what makes learning memorable.(Student)

If you teach somebody right from the start, at grass-roots level, then hopefully they will grab it and take it in and digest it for life. (Service User)

It’s not enhancing learning; I think that it is integral to learning.(Student) 8

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Making learning effective, cont’dI’m a practical learner, a visual learner, [didn’t] learn from books very well.(Student)

I feel that [students] meeting people who represent the people they’ll be helping later in life illustrates that textbook. (Service User)

It’s more effective to talk to people and find out things in your own way and in your own learning style.(Student) 9

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Exposure to the lived experienceIt makes it more real when you’ve actually got a live patient in front of you.(Student)

When Service Users come in and talk about their life, you get a bigger understanding that it is wider… it affects their family, their home life.(Student)

Service Users provide students with powerful, authentic experiences. (Staff)

[Students realise] we are real people, not just a case.(Service User)

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Diminishing stigmas and stereotypes

It brought home to me that anyone could get breast cancer and I think I’d always thought it was a lifestyle thing.(Student)

Then you meet the person and they’re not as bad as you think; …they’re people. (Student)

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Developing empathy[You] get an insight of what a patient would be feeling in that position through talking to someone who has been through it.(Student)

You can learn all the EBL [Enquiry-Based Learning] you like… but you don’t understand about how people feel. (Student)

The stories of coping and living with illness and disability… make a shift in the way that students view the theory that we teach. It helps them put themselves into another’s shoes. (Staff)

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Inspiring and motivating students[Interacting with Service Users] helped reaffirm my love for nursing.(Student)

A Service User’s testimony was inspirational; it helps you understand the person… rather than the straightforward facts.(Student)

Students actually want to hear what Service Users have got to say and Service Users sense that it reinforces the students’ commitment. (Staff)

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Developing professional identityIt’s very empowering for us to understand what our roles are from Service Users.(Student)

[I gained] a very good insight into what is expected from us as nurses. (Student)

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PREPARATION for PRACTICE

Safe environmentPractising with Service Users

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Safe environmentYou know you are not going to do any harm because the Service User has been brought there for you to learn.(Student)

You’d make more serious mistakes if you weren’t allowed to make the silly mistakes. (Student)

It’s about giving people permission… to ask questions.(Service User)

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Practising with Service UsersIt improves your skill as a therapist… you need to know how to hold a conversation with a real person.(Student)

It makes us just more confident in everything, confident to give it a go. (Student)

It’s really challenging to have to think on the spot.(Student)

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Practising with SUs, cont’dIf you don’t start in uni by listening and asking patients how you’re doing, what can we improve, how can we make things better, then it’s going to be a massive shock when you start working.(Student)

Service User involvement is a good way of finding out what it [the NHS] really is like at this moment because it’s very different from a year or two years ago. (Staff)

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CHALLENGES in SERVICE USER INVOLVEMENTIt’s about keeping an open mind [that each patient’s experience is individual].(Student)

…just because the person has a label, they don’t respond in the same way [as someone else]. (Service User)

Sometimes a Service User might be pushed to be involved or do things out of being nice. (Student)

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CHALLENGES, cont’dSupporting and preparing Service Users must include finding out what Service Users want to get out of whatever they’re doing.(Staff)

After a learning session, it can be quite traumatic to go away unsupported. Even a phone call a few days later. It’s just about how you look at supporting Service Users. (Service User)

Both Service Users and students have a role to play in preparing for the learning that takes place.(Student)

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SUGGESTIONS for CHANGEIf we can be treated not as a case study… but as an individual.(Service User)

Small groups go down very well for the students to learn about real people and you can throw ideas around, discuss it. (Service User)

Bring five examples [of people who have experienced a brain injury] and let us see different perspectives.(Student)

We need feedback about how to make intimate examinations as acceptable as possible to a patient. (Student)

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REFLECTIONSService User involvement is like gold dust. We don’t get enough of it… [and there should be] more involvement.(Student)

It’s not about just wheeling in our Service Users… but giving their involvement equal weight to other providers of education. (Staff)

Being able to co-develop, co-produce and co-deliver learning is definitely the way forward.(Service User)

We need to give time and priority to these experiences, because unless we do, the students won’t.(Staff)

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DISCUSSIONReflective practice is essential in maximising the impact of Service User involvement on student learning

Cultural and attitudinal changes needed to further embed Service User involvement across the curriculum

Service Users as the “centre of the curriculum” or equal partners in an Interprofessional team? 23

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ACKNOWLEDGEMENTSThis study was supported by a UEA-funded Teaching Fellowship.

We acknowledge the input of our colleagues Susanne Lindqvist, Laura Bowater and Steve Wilkinson.

Thank you for attending our session.

We welcome your thoughts, questions and discussion.

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