Dr Fiona McCullough Director of Dietetics University of Nottingham Experience of Dyslexia within Dietetics 1

2 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 3

4 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

5 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

6 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” attitude 7

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 8

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

10 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?

12 Work Placements At university….. Strategies Support – personal tutor - Academic Support tutor - friends/family Reasonable adjustments agreed with school Aware of strengths and weaknesses

13 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!

14 Work Placements Orientation – finding way around Left/right confusions – with directions, working in the mirror image Co-ordination - clumsy, misjudge distances

15 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

16 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?

17 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

18 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 19

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) 20

21 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