James Boylan, Curriculum Manager, Middlesex Hospital Tuition Unit, Westminster City Council, London

James.boylan.uclh.org

Developing a Culture of Inquiry in a Hospital School Setting

Paper presented at the ESRC Teaching and Learning Research Programme First Annual Conference - University of Leicester, November 2000

Introduction

A significant number of patients admitted to the Middlesex Hospital have been diagnosed as having cancer, primarily bone tumours and leukaemias. The Middlesex Hospital Tuition Unit is undertaking research into the needs of schools faced with the news that one of their pupils or students has been diagnosed with cancer. It is hoped that the information provided will enable the Tuition Unit to develop its service and to support the home schools of pupils admitted to the hospital, as well as the children and young people themselves. It is this inquiry which will provide an example of research underpinning practice in a hospital educational setting.

Contexts

The Middlesex Hospital Tuition Unit

Education at the Middlesex Hospital is provided by Westminster City Council. An education service is provided for children and young people on three wards : The Middlesex Adolescent Unit, The Teenage Cancer Trust Unit, and Carousel paediatric Ward, as well as for day-patients. Teaching and learning takes place in designated teaching areas, by bedsides and in cubicles.

The Middlesex Hospital Tuition Unit offers a wide spectrum of provision, for rising fives to those studying for A Levels or pursuing studies in Further Education colleges. Home Tuition is also arranged for children and young people unable to attend school for medical reasons.

The organisation of teaching and learning reflects the diverse needs of the wards served. In each case, however, educational staff work closely with Health colleagues, as well as with children and young people, their parents or carers, and home schools in order to create an individualised learning programme during a period of admission. The curriculum operates at two levels : a structured, differentiated and formal curriculum prepared by Tuition Unit staff; and an informal curriculum based on work provided by partner schools. For most pupils and students education provision combines both strands.

Creative and cultural education is at the heart of our curriculum, as an integral aspect of individual subjects, as well as through the wider multidisciplinary curriculum and links established with cultural groups and organisations.

The curriculum reflects the National Curriculum but is not constrained by it, and ultimately seeks to be part of an integrated, multidisciplinary approach to promoting recovery in children and young people. The multidisciplinary approach is reflected in three areas : management of the curriculum, curriculum development, and practice.

Education provision is informed by a number of frameworks :

  • The National Curriculum (1999)
  • The National Literacy Strategy (1998)
  • The National Numeracy Strategy (1999)
  • Circular 12/94 – The Education of Sick Children (1994)
  • Welfare of Children and Young People in Hospital – Department of Health (1991)
  • The Report of the Working Party on the Needs and Care of Adolescents – Royal College of Paediatrics and Child Health (1985)
  • Youth Matters (1998)
  • The Connexions Strategy (2000)

Youth Work and Social Inclusion

The Youth Work curriculum aims to provide a range of opportunities to complement and extend the traditional curriculum. The Tuition Unit’s Youth Worker provides support relating to education, employment and training opportunities, organises leisure and social activities, jointly leads the Activities Programme during school holidays and half-term breaks, leads the Youth Achievement Programme and Youth Club activities twice a week. In addition, The Youth Worker plays a leading role in the development of the Personal, Social and Health Education and Citizenship curriculum

The Multidisciplinary Team

In the Middlesex Hospital, Physiotherapists, Social Workers, Occupational Therapists, Clinical Psychologists, Child and Adolescent Psychiatrists, Play and Activities Staff, Dieticians, Nursing and Clinical professionals, and Education staff work together as a dedicated multidisciplinary teams. The multidisciplinary teams provide a holistic approach to the needs of children and adolescents.

As part of the multidisciplinary team a number of collaborative projects have taken place :

  • Management of the curriculum with Nurse Managers
  • The development of a Personal, Social and Health Education module with Clinical Psychology colleagues
  • Areas of the curriculum delivered by Play and Activities colleagues : Drama, Food Technology and Technology
  • The development of a school re-integration programme with Occupational Therapy colleagues
  • Half-term, and Easter and Summer Break programmes with Play and Activities colleagues

The Middlesex Hospital : a scientific culture

Middlesex Hospital Tuition Unit staff work within a clinical and scientific culture which places research at the forefront of developing practice. This is seen in the work of all multidisciplinary staff.

The Role of Teaching in a Hospital Setting

Circular 12/94 – The Education of Sick Children states :

‘ The primary aim of hospital education is to minimise as far as possible the interruption and disruption to a child’s normal schooling by continuing education as normally as the child’s illness or incapacity allows.’

It goes on :

‘It is part of the role of the teacher to re-establish learning and to keep education alive in the child’s life ….’

According to Viner and Keane (1998), education in a hospital setting fulfils a number of roles :

  • providing a maintenance of educational experience
  • facilitating the socialisation of young people
  • providing a degree of normalisation during a period of hospitalisation
  • teachers becoming role models or confidantes
  • providing opportunities for vocational guidance and work-related education

The Social Policy Research Unit (1998) identifies a number of reasons as to why school is important in a child’s life :

  • a welcome distraction from pain and treatment
  • a positive impact on recovery
  • the provision of a context in which children can succeed and experience friendship

As well as seeking to put these objectives into effect, the Middlesex Hospital Tuition Unit additionally sets out to :

  • ensure a continuity of education provision through regular communication with schools and colleges
  • facilitate a return to school, college, training provider or community setting after a period of hospitalisation

Developing a Culture of Inquiry in a Hospital School Setting

Pedagogy in a Hospital School Setting

Pedagogy is a contested arena. How pedagogy is enacted by teachers and experienced by children and young people – even defined – is influenced by views of the learner and the purpose of learning.

Two competing views see pedagogy as either a science underpinned by research and experiment, or as an art – a conversation between theory and practice which requires the teacher to reflect analytically on the assumptions underpinning his/her practice.

For Simon (1981) and Shulman (1987) pedagogy should focus on a search for a scientifically-based pedagogy, subject to general principles which can be observed and applied.

Schon (1987) has popularised the notion of pedagogy as art through the concept of the reflective practitioner. For Schon, coining the expression ‘professional artistry’ there should be a constant dialogue between thought and action. Stenhouse (1985) describes the teacher’s art as expressed through performance. From this perspective, pedagogy is a creative venture with reflective practice leading to new avenues of enquiry and ways of thinking.

Developing a Culture of Inquiry

Inquiry in the Middlesex Hospital aims to promote curriculum validity and effectiveness, as well as to provide support for partner schools. Inquiry takes a number of forms :

  • Institutional – through local government processes such as Best Value
  • Professional – through the monitoring of professional practice
  • Curriculum – through evaluation of programmes of study
  • Learner-centred – through educational-medical-specific studies

Learner-centred inquiry

The Middlesex Hospital Tuition Unit, as part of a collaborative Nursing – Education venture is seeking to develop its support for young people with cancer, and in particular, its support for schools who have young people with cancer. Entitled ‘Survivorship : A Study of the Needs of Adolescents withCancer’, the project has the aim of :

‘Empowering teachers in the community to meet the learning needs of adolescents with cancer in a safe environment using nursing and teaching perspectives to promote survivorship in the adolescent.’

The study falls within a scientific paradigm and seeks to provide an objective and rigorous analysis of the educational needs of adolescents, their schools and teachers. In particular, the study aims to :

  • evaluate the support and information given to schools regarding cancer and its treatment
  • reassess the needs of schools with regard to support and information

The research focuses on adolescents, with information being derived from an anonymous questionnaire. The outcomes of the inquiry will guide practice development within the Middlesex Hospital Tuition Unit, and will be published on the Middlesex Hospital Tuition Unit’s website :

The study charts the way ahead for the Middlesex Hospital Tuition Unit as it attempts to weave together a practice combining professional reflection underpinned by rigour and objectivity. Such a study provides an objective basis for the development of practice. In the case of the Middlesex Hospital Tuition Unit a culture of inquiry :

  • mirrors the practice of health proffesionals
  • gives professional credibility in a clinical culture
  • promotes multidisciplinary practices
  • provides an objective foundation for the development of the curriculum
  • enables the Middlesex Hospital Tuition Unit to extend its expected role and to construct collaborative relationships with home schools
  • develops an awareness of illness and disease
  • identifies the broader educational needs of young people with chronic and life-threatening illnesses and diseases
  • requires schools and teachers to develop their knowledge of illness and disease
  • extends support for young people into their home schools
  • encourages an inclusive approach to education : that young people with chronic illness and disease should be expected, where their medical conditions allow, to attend school
  • conveys a message that despite illness and disease, attendance at school is a normal aspect of life
  • develops new professional skills, attitudes, motivation and experiences

Conclusion

Educational practice is a dynamic between curriculum, assessment and pedagogy. The challenge of turning theory into practice is a very real one – both exciting and daunting at the same time. Hospital educational provision has the opportunity to create responsive and integrated multidisciplinary curricula. A multidisciplinary approach, through involving a range of professionals in curriculum practice and development, enables the creation of something that is imaginative and innovative.

The development of a culture of inquiry within establishments such as the Middlesex Hospital Tuition Unit provides an intellectually-rigorous basis for the development of the curriculum and, moreover, provides an opportunity to develop supportive strategies to enable young people with chronic illness and disease to continue their education as normally as possible in their home schools.

However, teaching is more than scientific endeavour. Teaching remains a reflective and creative practice. The challenge for teachers is to find a pragmatic synthesis between the two competing views of pedagogy as an art and pedagogy as a science. Effective teaching and learning requires both approaches to adopted by the teacher.

References

DFEECircular 12/94 – The Education of Sick Children, London, 1994

Viner R & Keane MYouth Matters,

Page 43,

Action for Sick Children, London, 1998

Lightfoot J et al Service Support for Children with a chronic illness or physical disability attending mainstream schools

Page 14,

Social Policy Research Unit, University of York,

York, 1998

Schon DEducating the reflective practitioner

Jossey Bass, San Francisco, 1987

Shulman LThose who understand : knowledge and growth in teaching

Educational Researcher, 1986

Simon BSome problems of pedagogy revisited

in The State and Educational Change Essays and the History of Education and Pedagogy,

Lawrence and Wishart, London, 1994