Zainab hussein conf_10

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  • This study is part of a large scale project being conducted across Allied Health Professions in one university to include nursing, orthoptics, physiotherapy and occupational therapy undergraduate students to investigate attrition and student experiences. The study incorporates questionnaires and focus groups that include all students. The preliminary findings for students on the radiography and radiotherapy degree programmes who are carers are presented in this paper.

  • There are now greater numbers of mature students undertaking higher education (HE) programmes in the U.K. In the last decade the number of students aged 21 to 24 years and 25 to 39 years increased from 26,000 to 54,000 and 26,000 to 40,000 respectively(1). The admission profiles for undergraduate medical and dentistry programmes also demonstrates this change. In 1999 9.8% of students on these programmes were aged 21 years or above and by 2008 this had increased to 22.3%(1). Currently national statistics are not available on the number of students who are carers; however it is likely that the number of students with carer responsibilities has also increased. A carer is defined as a student who has responsibility for the care of children, partners, parents, grandparents or other family members. The admissions profile of undergraduate diagnostic radiography and radiotherapy programmes also reflects these demographic changes (Figure 1). This mixed methods study aims to explore the experiences of students who are carers undertaking BSc (Hons) diagnostic radiography and radiotherapy undergraduate programmes at one university in the UK.
  • Ross et al has reported that the subject choices of mature students were concentrated into a narrower selection of subjects when compared to younger students. There were differences in the most popular choices between 1996 and 2000. In 1996 the social studies group was most popular at 17.2% for mature students with education being second at 10.6 and allied health third at 7.3 %. By 2000 social studies remained the highest in popularity at 15.5 % but allied health had increased to second place at 13.7%. The popularity of the Allied Health Profession continues to rise with almost 16% of students aged 25-39 years choosing allied health. (Table 2)
  • The admissions profile of undergraduate diagnostic radiography and radiotherapy programmes also reflects these demographic changes (Figure 1). This mixed methods study aims to explore the experiences of students who are carers undertaking BSc (Hons) diagnostic radiography and radiotherapy undergraduate programmes at one university in the UK.

    Give slide a title and there is no legend on axis for DR
  • It has been reported that students who are carers often feel isolated and less likely to engage with university procedures for raising their concerns (2). There has been a growing awareness of the needs of this group (2) which has resulted in positive changes. The Department of Education and Skills has modernised the student support system to include the introduction of targeted support, such as childcare grants. This initiative may have influenced the recent increase in full-time participation by mature students (3).
     
  • Returning to education, and in particular, full time education can have negative consequences on family relationships (3). Mature students and women with childcare responsibilities have higher levels of debt than younger students (4,5). Importantly,
    mature students with children often discontinue their studies due to a combination of childcare and financial problems (6). Crosling et al 2008 (9) agreed with these observations and further suggest that students with multiple personal problems such as a marriage breakdown were more likely to withdraw from programmes. Maynard and Pearsell 1994 (7) found that males returning to study were treated more positively by their families and received more encouragement than females.
  • The Society and College of Radiographers 2008 (11) reported that attrition rates were 36.6% for diagnostic students and 42.7% for radiotherapy students. Although these figures fall below national HE attrition rates they are significantly higher than other allied health professional programmes (12). This represents considerable disinvestment to the individual student, the institution, and the Strategic Health Authorities. If policy and practice to increase recruitment, retention and to improve the student experience are to be developed, clearly, this must be done with consideration of the needs of students with carer responsibilities. The aim of this study was to actively engage this student group and report their opinions and experiences.
     
  • If policy and practice to increase recruitment, retention and to improve the student experience are to be developed, clearly, this must be done with consideration of the needs of students with carer responsibilities. The aim of this study was to actively engage this student group and report their opinions and experiences.
     
  • Questions covered subjects including demographic details, academic and clinical timetabling and identification of students with carer responsibilities. Those with carer responsibilities were further asked if they were a single parent, if they were the main carer and whether they considered they had suffered any physical or mental illness due to their carer responsibilities. Year 3 and Year 2 student carers were then invited to participate in focus group sessions. Year 1 students were not included in this part of the study as these students had not undergone a full year of academic and clinical study at the time of data collection.
     Students who had indicated that they were carers were then invited to take part in focus groups The groups comprised 4-8 members and followed an open ended approach with prompting questions (Table 2). This approach allowed students to discuss and respond to ideas raised by other group members and served to clarify responses allowing for identification of common student issues and themes. To try to ensure all voices were heard and reduce ‘group think’ (13), students were also asked to write key points and ideas relating to issues raised on post it notes. These were collated and utilised in the discussion and also The duration of the focus groups was approximately 2 hour and were digitally recorded and transcribed verbatim by a professional transcriber.
  • Open questions used.
  • 217 students responded to the questionnaire. Age, sex and carer status for the two student samples are shown in Tables 3 and 4. Admissions data on the 122 diagnostic students and the 93 radiotherapy students, demonstrated that 42% and 52 % of students respectively were aged over 21 years on entry with 20% and 24% aged over 26 years. All students who were carers had gained entry to the programme via Access qualifications. A significant number of students (n=30) identified themselves as carers; 19% were diagnostic radiography students and 8% radiotherapy. 83% of carers were female. 27% of carers were single parents and 77% described themselves as the main carer. 24 cared for children, 6 cared for a parent or grandparent and one student had multiple carer responsibilities. Of the 5 male participants , only one identified themselves as being the main carer. 30% of carers indicated that they had suffered from a physical or mental illness due to their carer responsibilities. Over three quarters of the student carers indicated that the structure of clinical and/or academic timetables were problematic with regard to their carer responsibilities.
  • 215 students responded to the questionnaire. Age, sex and carer status for the two student samples are shown in Tables 3 and 4. Admissions data on the 122 diagnostic students and the 93 radiotherapy students, demonstrated that 42% and 52 % of students respectively were aged over 21 years on entry with 20% and 24% aged over 26 years. All students who were carers had gained entry to the programme via Access qualifications. A significant number of students (n=30) identified themselves as carers; 19% were diagnostic radiography students and 8% radiotherapy. 83% of carers were female. 27% of carers were single parents and 77% described themselves as the main carer. 24 cared for children, 6 cared for a parent or grandparent and one student had multiple carer responsibilities. Of the 5 male participants , only one identified themselves as being the main carer. 30% of carers indicated that they had suffered from a physical or mental illness due to their carer responsibilities. Over three quarters of the student carers indicated that the structure of clinical and/or academic timetables were problematic with regard to their carer responsibilities.
  • Combining technical/clinical expertise with a caring profession was cited as an attraction to radiography/radiotherapy. All students reported that the fact that they were not required to pay tuition fees for the programme was a major contributory factor.
     
    ‘The fact that I didn’t have to worry about fees was important to me at this stage of my life. I have given up a job to do this and also the family have made sacrifices. I don’t think I would be here if I had to pay back the fees.’
     
    Location and the practicality of being able to attend a local University was another key aspect. The programme structure and content had not been a consideration.
  • A significant number of students reported that the programme was more demanding than expected. Many felt that although Access courses provided a good foundation, some subjects were reported as more problematic for a small number of students.
     
    ‘I felt OK with most things on the course but the physics was difficult for me. This was not covered on my Access course so I felt out of my depth to begin with. Some of it is still difficult for me now.’
     
    Students also found academic and reflective writing difficult. Although study skills sessions had been delivered in year 1, students felt that they had not had the opportunity to practice these skills formatively
     
    ‘A lecture on how to reference or do a literature search is not really that helpful. I would rather have to do it in some way and then have where I’ve gone wrong pointed out.
     
     
  • Most students found the personal (academic) tutor scheme helpful. However many stated that the clinical tutor was their first choice of contact when they had any personal or academic issues. Family support was noted as being crucial, with grandparents frequently providing childcare and financial support. Female students felt that their partners did not fully appreciate the study commitment required for the programme; this often led to tensions within the relationship. Female students reported that they remained responsible for the majority of caring and household responsibilities. Male students did not report these issues.
    Most students who were carers tended to socialise in their own group and students felt that the mutual support and empathy was one of the best aspects of university life. However, students did not feel part of the wider student community and were not able to participate fully in social activities or indeed take part in clubs or societies, due to conflicting demands on their time.
     
    ‘We (carers) tend to hang around together. There’s quite a few of us and we all help each other. We understand what it’s like.’
     
    ‘We don’t have time really to socialise and go out a lot like the other students. I don’t really get involved in anything at university apart from what I have to do’.
     
    Some students were not aware of financial support that might be available. Some found the process of applying for grants confusing and extremely time consuming.
     
  • Most students who were carers tended to socialise in their own group and students felt that the mutual support and empathy was one of the best aspects of university life. However, students did not feel part of the wider student community and were not able to participate fully in social activities or indeed take part in clubs or societies, due to conflicting demands on their time.
     
    ‘We (carers) tend to hang around together. There’s quite a few of us and we all help each other. We understand what it’s like.’
     
    ‘We don’t have time really to socialise and go out a lot like the other students. I don’t really get involved in anything at university apart from what I have to do’.
     
    Some students were not aware of financial support that might be available. Some found the process of applying for grants confusing and extremely time consuming.
     
  • A variety of timetabling issues were reported as problematic. In particular, nine o’ clock start times were incompatible with many childcare arrangements, and to a lesser degree, late afternoon lectures were difficult to manage. Students indicated that a start time of nine thirty would be more reasonable.Timetabling changes at short noticed posed problems for those who need to organise caring arrangements in advance.
     
    Within the re-developed curriculum, students undertake a 13 week continuous clinical placement block in year two. Whilst this clearly allows students to consolidate their knowledge in the clinical field; the placement takes place from early July through to September. Carers found this to be both an emotional strain and financial burden. The placement takes up the whole of the school summer holidays and causes additional childcare costs.
     
    ‘I really felt like leaving. I felt guilty not having any time with the kids during the summer. I relied heavily on parents and friends and felt guilty about that. The childcare grant does not go anywhere in covering holidays especially when you have more than one child.’
     
    Students reported that adaptation was possible, with most clinical staff perceived as being understanding of these issues. Most students felt able to make a request to their clinical tutor for a later start with a shorter lunch break. It was also reported that some students had managed to make individual arrangements to alleviate the problems during the school holidays. Not all students requested these changes, fearing that it might disadvantage them in the future.
     
    ‘I don’t want to start asking for special arrangements. They might think I can’t cope and not give me a job later on. At least when I’m working I can afford proper childcare, choose my holidays within reason and get some flexibility then.’
  •  
     
    Students reported that adaptation was possible, with most clinical staff perceived as being understanding of these issues. Most students felt able to make a request to their clinical tutor for a later start with a shorter lunch break. It was also reported that some students had managed to make individual arrangements to alleviate the problems during the school holidays. Not all students requested these changes, fearing that it might disadvantage them in the future.
     
    ‘I don’t want to start asking for special arrangements. They might think I can’t cope and not give me a job later on. At least when I’m working I can afford proper childcare, choose my holidays within reason and get some flexibility then.’
  •  Commitment to the programme
    Most students reported that they had at some time considered leaving the programme. One of the main reasons cited for this was academic failure. Students felt a lack of confidence, and had questioned whether the sacrifices they had made had been worth it. Although students knew that academic support was available, there was some reluctance to seek this.
     
    ‘I think I don’t ask because I feel you just have to get on with it. I’m used to coping since that’s what is like when you’re a single mum.’
     
     
    That said, all students were pleased with their career choice and looked forward to being professionals in their chosen field. All students felt supported when on clinical placement, and enjoyed this aspect of the programme; they felt confident in their clinical abilities. The sacrifices made by themselves and often their families heightened the sense of obligation to continue on the programme. Most students recognised that despite the challenges, a professional career would mean a better future for themselves and their families.
     
     
  • Absence
    Student reported concerns that absence due to attending healthcare appointments with family members may be detrimental to their overall attendance record. Some students also stated that they had at times, taken sick leave rather than request authorised absence for their carer responsibilities as they felt uncomfortable requesting time off.
     
    Needing to ‘catch up’ on missed lectures was not perceived as an issue. However, students felt strongly that ‘carers absence’ should not be reported as a ‘general absence’. Students suggested that there should be an agreed ‘carers leave’ so that they were not disadvantaged in terms of their absence rates being disclosed to future employers.
     
    Student perceived that they did not work to the same flexible working policies and practice available to NHS and University staff.
     
    ‘You know there is flexibility when you work in the NHS. They have got family friendly working hours. Staff at the university get that too. Shouldn’t we be entitled to some carer days?’
     
    Students perceived that despite their additional responsibilities, the general attendance level of carers was higher than that of those students without carer responsibilities.
     

     Commitment to the programme
    Most students reported that they had at some time considered leaving the programme. One of the main reasons cited for this was academic failure. Students felt a lack of confidence, and had questioned whether the sacrifices they had made had been worth it. Although students knew that academic support was available, there was some reluctance to seek this.
     
    ‘I think I don’t ask because I feel you just have to get on with it. I’m used to coping since that’s what is like when you’re a single mum.’
     
     
    That said, all students were pleased with their career choice and looked forward to being professionals in their chosen field. All students felt supported when on clinical placement, and enjoyed this aspect of the programme; they felt confident in their clinical abilities. The sacrifices made by themselves and often their families heightened the sense of obligation to continue on the programme. Most students recognised that despite the challenges, a professional career would mean a better future for themselves and their families.
     
     
  • Absence
    Student reported concerns that absence due to attending healthcare appointments with family members may be detrimental to their overall attendance record. Some students also stated that they had at times, taken sick leave rather than request authorised absence for their carer responsibilities as they felt uncomfortable requesting time off.
     
    Needing to ‘catch up’ on missed lectures was not perceived as an issue. However, students felt strongly that ‘carers absence’ should not be reported as a ‘general absence’. Students suggested that there should be an agreed ‘carers leave’ so that they were not disadvantaged in terms of their absence rates being disclosed to future employers.
     
    Student perceived that they did not work to the same flexible working policies and practice available to NHS and University staff.
     
    ‘You know there is flexibility when you work in the NHS. They have got family friendly working hours. Staff at the university get that too. Shouldn’t we be entitled to some carer days?’
     
    Students perceived that despite their additional responsibilities, the general attendance level of carers was higher than that of those students without carer responsibilities.
     

     
  • Exploration of absence rates for carers and non-carers.
    In response to the issues raised by students on attendance, absence data on the 122 diagnostic radiography students and the 93 radiotherapy students were collected from directorate records and analysed using SPSS Version 16. A Poisson log linear model was applied with the number of absences as the response variable and the carer status as a predictor variable. The year of study was a fixed factor and students within the cohort were a random factor. This analysis generates a test that is more appropriate than a two-sample t-test and more powerful than a Mann-Whitney test.(15) P values are quoted at the 5% level. For the diagnostic radiography programme the absence for carers was significantly lower than that of non-carers (p=0.000). For the radiotherapy programme there were no significant differences between absence for carers and non-carers (p=0.105) (Figure 2).
  • It was reassuring that most students were pleased with their choice of career. This is important, given that the SHA funded tuition fees was a motivating factor. Had students not been happy with their career choice, it might be argued that the shift in choice toward AHP programmes(16) was based on financial considerations alone.
     
    The need for embedding effective study skills into the curriculum was highlighted by all students particularly with regard to Year 1. Although it was acknowledged that the programme delivered these skills; it was felt that the need for more practical based teaching of academic skills and the use of formative assessment would be beneficial. Many students felt that Access courses provided a good foundation but did not fully prepare them for some aspects of the degree course. The main areas mentioned were reflective writing skills and physics, particularly if their Access course had not included this subject. This has also been highlighted by the Society of Radiographers.(11)
     
    It is of concern that students did not examine programme structures before application. Academic and clinical programme structure should be fully discussed at open and selection days so that students, particularly those with carer responsibilities are fully aware of the commitments required for their chosen programme and university.

     Students considered leaving the course following academic failure. The use of student support groups after academic failure and proactive support from academic staff have been shown to improve attrition after failure (17). These strategies have also been recommended by a recent report on student retention conducted by the Society of Radiographers(11).The need for intensive targeted support for all students has also been highlighted by the Department of Health in 2006 (18). Yorke 2005 (19) reported that students felt alienated when support from staff was lacking and that this had a negative effect on attrition.
     
    A large study carried out at Brunel University (21) reported that student carers often experienced a feeling of isolation and non-involvement (2,22). Lack of social and academic integration were cited as reasons for attrition by Cullen (1994) (23). Furthermore, McGivney 2003 (24) suggested that a sense of inclusion or exclusion was particularly important for students with children. Interestingly, in the current study, although student carers felt excluded from the wider university community, they unanimously agreed that peer support was a positive aspect of university life and also a source of motivation to stay on the course. It should be noted however that currently there are a large number of student carers within these programmes, thus these findings are not necessarily transferable elsewhere
  • It was reassuring that most students were pleased with their choice of career. This is important, given that the SHA funded tuition fees was a motivating factor. Had students not been happy with their career choice, it might be argued that the shift in choice toward AHP programmes(16) was based on financial considerations alone.
     
    The need for embedding effective study skills into the curriculum was highlighted by all students particularly with regard to Year 1. Although it was acknowledged that the programme delivered these skills; it was felt that the need for more practical based teaching of academic skills and the use of formative assessment would be beneficial. Many students felt that Access courses provided a good foundation but did not fully prepare them for some aspects of the degree course. The main areas mentioned were reflective writing skills and physics, particularly if their Access course had not included this subject. This has also been highlighted by the Society of Radiographers.(11)
     
    It is of concern that students did not examine programme structures before application. Academic and clinical programme structure should be fully discussed at open and selection days so that students, particularly those with carer responsibilities are fully aware of the commitments required for their chosen programme and university.

     Students considered leaving the course following academic failure. The use of student support groups after academic failure and proactive support from academic staff have been shown to improve attrition after failure (17). These strategies have also been recommended by a recent report on student retention conducted by the Society of Radiographers(11).The need for intensive targeted support for all students has also been highlighted by the Department of Health in 2006 (18). Yorke 2005 (19) reported that students felt alienated when support from staff was lacking and that this had a negative effect on attrition.
     
    A large study carried out at Brunel University (21) reported that student carers often experienced a feeling of isolation and non-involvement (2,22). Lack of social and academic integration were cited as reasons for attrition by Cullen (1994) (23). Furthermore, McGivney 2003 (24) suggested that a sense of inclusion or exclusion was particularly important for students with children. Interestingly, in the current study, although student carers felt excluded from the wider university community, they unanimously agreed that peer support was a positive aspect of university life and also a source of motivation to stay on the course. It should be noted however that currently there are a large number of student carers within these programmes, thus these findings are not necessarily transferable elsewhere
  •  
    Students in this study were unanimous in reporting a feeling of being well supported on clinical placement; furthermore the clinical tutor was often seen as a first point of contact. The importance of clinical tutors in student support has also been reported in a recent study with mature diagnostic radiography students (20). This further reinforces the need for effective partnerships between academic and clinical departments. However, despite these positive relationships, some students expressed reluctance to request flexibility in placement areas even when experiencing difficulties. Offering some flexibility (where possible) would reduce stress for student carers, and potentially improve the learning experience. A more proactive stance for a coherent, transparent and consistent approach to meeting the needs of carers needs to be adopted by programme management teams.
  •  
    .
    Some carers reported that they had felt the need to take sick leave to cover their carer responsibilities, rather than seek authorised absence. However examination of the absence rates demonstrated that in fact diagnostic radiography students who were carers had significantly lower absence rates than the rest of the cohort and for radiotherapy there were no significant differences. Attendance has previously been identified as a direct determinant of academic performance and attainment (30). Attendance is also arguably a measure of a student’s motivation. The data collected in this study confirms that carers are highly motivated and determined to succeed; their good attendance despite additional demands is congruent with this. Academic departments should not only monitor attendance but also encourage attendance by making their academic and clinical programme structure, where possible, more accessible to all students. An agreed number of carer days for evidenced absence for carer responsibilities would also promote fairness and equity.
     

     
  • There was a lack of awareness of the financial support available to students, and the application process was not clear. This is in agreement with the report conducted by the National Union of Students (2) in which only 14% of students with children felt that they have been given enough information about childcare facilities, and only 18% received enough information about financial support. The NHS student bursary allowance pays a net maximum amount of £123.25 per week for one child. For two or more eligible children the weekly net maximum is £182.75. (25). Thus the financial implications of clinical placements that extend throughout the summer vacation period are considerable, particularly for those students with more than one child. This was raised as a major concern and reason for considering leaving the course in this study.
  • The Equality Bill (31) means that higher education institutions will have to consider how their policies, programmes and service delivery affect people with protected characteristics. The Bill allows for positive actions: if a particular group of students need support, the institution will be able to lawfully target that support in a proportionate way. The Bill is expected to come into force in 2010 and consequently higher education institutions need to be working towards developing inclusive practices
  • The NHS has recognised the need to support its’ workers that are carers and has recommended the use of staff surveys to identify the proportion of staff who have caring responsibilities. Furthermore, the population is ageing(26) and more people will find themselves having the responsibility for providing care for elderly parents without the support of a non-working spouse (26). In response to this the NHS has adopted family friendly and flexible working polices (27). The majority of managers who have introduced flexible working believe that this has improved recruitment and retention (28). Employment legislation supports these practices (35,36,37). Surely therefore, HEIs should adopt such practices. According to the Department of Health, attrition for allied health professions programmes should not be above 10% and attrition amongst ethnic minority group students should not exceed the average attrition rate for a programme (29). It is therefore reasonable to suggest that this should apply to students who are carers.
    . The NHS has a stated commitment to equality and diversity; furthermore the NHS workforce, must be reflective of the community it serves. The ultimate outcome is to ensure that by having a diverse workforce, the needs of the local population are met (32). Those responsible for delivering medical and allied health professional programmes thus have a duty to ensure that they recruit and retain a diverse student population.
  • It is essential that the needs of carers are recognised. Programme structure should be designed with consideration to this group
    Students should be actively encouraged to discuss their carer responsibilities at the earliest opportunity so that flexible arrangements particularly with regard to clinical placements can be implemented where possible.
    Programme leaders and admissions tutors should be explicit about the structure of the programme (academic and clinical) so that students are made fully aware of the commitments required before accepting places on a programme.
    There should also be targeted financial advice with regard to funding such as childcare allowances and access to learning.
    The student absence policy is currently being reviewed to introduce an agreed carer’s leave allowance for all allied health professional undergraduates at this university.

    This study is also contributing at faculty and institutional level to the discussion on developing inclusive practice. In addition the study also adds to opinion that carer status should be collected along with other demographic data for all students in higher education7. Due to the fact that we have been able to identify students who are carers will enable us to study attrition and attainment in these cohorts for the next stage of the project.


  • Zainab hussein conf_10

    1. 1. Who cares about the carers?: An analysis of the experiences of Radiography and Radiotherapy students who are carers Zainab Hussain, Vicki Pickering, Dave Percy, Julie Abbott & Jan Bogg.
    2. 2. The Study  This study is part of a large scale project being conducted across Allied Health Professions  The preliminary findings for students on the radiography and radiotherapy degree programmes who are carers are presented
    3. 3. Why?  There are now greater numbers of mature students undertaking higher education (HE) programmes  Currently national statistics are not available on the number of students who are carers Age 1999 2003 2004 2005 2006 2007 2008 20 and under 245,626 290,160 293,795 316,457 305,121 323,220 350,263 21-24 25,804 44,184 44,259 46,441 44,844 47,949 54,921 25-39 25,789 32,256 31,981 34,304 32,764 33,692 40,698 40+ 5,846 7,707 7,509 8,167 8,161 8,569 10,745 Total 303,065 374,307 377,544 405,369 390,890 413,430 456,627 Accepted applicants to higher education (UCAS accessed 2009)
    4. 4. Why? Percentage of full-time students studying selected subjects, by age on enrolment 2007 (Only the top 5 choices for mature students are shown. (Source: UCAS) Age 20 and under 21 to 24 25 to 39 40 + Total Social Studies 6.56 8.59 14.91 17.61 28027 Subjects Allied to Medicine 5.57 8.49 15.99 16.13 25289 Creative Arts & Design 11.74 14.71 9.76 15.3 43597 Business & Admin studies 11.08 12.26 8.27 4.18 39425 Education 3.33 4.21 6.32 8.62 13783
    5. 5. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Entrybypercentage 1996-2006 Radiotherapy Entry by Age Category Under21 21-25 Over 26 0% 10% 20% 30% 40% 50% 60% 70% 80% 1996-2006 Diagnostic Entry by Age Category Under21 21-25 Over 26 Entrybypercentage Entry by age to radiotherapy & diagnostic radiography programmes 1996-2006
    6. 6. Background There has been a growing awareness of the needs of carers  The Department for Business Innovation & Skills has modernised the student support system  This initiative may have influenced the recent increase in full-time participation by mature students
    7. 7. Background  Returning to full time education can have negative consequences on family relationships  Mature students and women with children have higher debt levels than younger students  Mature students with children often discontinue their studies.  Males returning to study have been shown to be treated more positively by their families and received more encouragement than females.
    8. 8. Attrition  The Society and College of Radiographers 2008 reported that national attrition rates were 37% for diagnostic students and 43% for radiotherapy students.  These figures fall below national HE attrition rates but are significantly higher than other allied health programmes.
    9. 9. Aim of study The aim of this study was to actively engage student carers and report their opinions and experiences
    10. 10. Method  Diagnostic radiography and radiotherapy students (n= 227) were invited to complete a short questionnaire and 215 responded (122 diagnostic students and the 93 radiotherapy .  Students who identified themselves as carers were invited to participate in focus group sessions.  From the findings of the focus groups absence rates were also investigated.
    11. 11. Why did you choose to do radiography/radiotherapy? Why did you choose this university? Has the programme turned out to be what you expected? What have you enjoyed most about your programme and university? Did you feel prepared for university study? Do you feel you are supported? What difficulties have you encountered? Have you ever felt like leaving and why? What makes you stay? What have you gained from higher education? Given your time again would you still choose this programme at this university? Questions for discussion at focus groups
    12. 12. Results (Questionnaire)  28% of students were male, 78% female  45% of students were aged over 21 years on entry to the programmes  23% of students were aged 26+ years on entry
    13. 13. Results (Questionnaire) 0 10 20 30 40 50 60 70 80 90 100 non carer DR carers DR non carer RT carers RT Carers & non - carers by programme A significant number of students (n=30, 14%) identified themselves as carers.
    14. 14. Results (Questionnaire)  All students who were carers had gained entry via access  83% of carers were aged 26+ years  83% of carers were female.  27% of carers were single parents  77% described themselves as the main carer. (Of the 5 males, one identified themselves as being the main carer)  24 cared for children, 6 cared for a parent or grandparent and one student had multiple carer responsibilities.  77% of student carers indicated that the structure of clinical and/or academic timetables were problematic
    15. 15. Results Focus group findings Of the thirty 30 carers, 18 (60%) agreed to take part in the focus groups (5 radiotherapy and 13 diagnostic radiography students). The following key themes were identified.  Choice of programme  Expectations  Support  Timetabling issues  Commitment to the programme  Absence
    16. 16. Results Focus group findings Choice of programme  Combining technical/clinical expertise  Financial considerations ‘The fact that I didn’t have to worry about fees was important to me at this stage of my life. I have given up a job to do this and also the family have made sacrifices. I don’t think I would be here if I had to pay back the fees.’  Location – more important than anything else.
    17. 17. Results Focus group findings Expectations  Students reported that the programme was more demanding than expected.  Students found physics, academic and reflective writing difficult. ‘I felt OK with most things on the course but the physics was difficult for me. This was not covered on my access course Some of it is still difficult for me now.’ ‘A lecture on how to reference or do a literature search is not really that helpful. I would rather have to do it in some way and then have where I’ve gone wrong pointed out.
    18. 18. Results Focus group findings Support  Most students found the personal (academic) tutor scheme helpful. However many stated that the clinical tutor at the clinical placement site was their first choice of contact  Family support was noted as being crucial.  Female students felt that their partners did not fully appreciate the commitment required
    19. 19. Results Focus group findings Support  Most students who were carers tended to socialise in their own group and were unanimous in reporting this support as a source of motivation to stay on the course ‘We (carers) tend to hang around together. There’s quite a few of us and we all help each other. We understand what it’s like.’  Students did not feel part of the wider student community ‘We don’t have time really to socialise and go out a lot like the other students. I don’t really get involved in anything at university apart from what I have to do’.  Some students were not aware of financial support that might be available.
    20. 20. Results Focus group findings Timetabling A variety of timetabling issues were reported as problematic  9 am starts (academic & clinical) were incompatible with many childcare arrangements  Academic timetabling changes at short notice  For diagnostic students - 13 week continuous clinical placement block in year two ‘I really felt like leaving. I felt guilty not having any time with the kids during the summer. I relied heavily on parents and friends and felt guilty about that. The childcare grant does not go anywhere in covering holidays especially when you have more than one child.’
    21. 21. Results Focus group findings Timetabling  Students reported that flexibility on clinical placement was possible. With most clinical staff understanding the issues.  Some students had managed to make individual arrangements for clinical placement to alleviate the problems during school holidays. Not all students requested these changes ‘I don’t want to start asking for special arrangements. They might think I can’t cope and not give me a job later on. At least when I’m working I can afford proper childcare, choose my holidays within reason and get some flexibility then.’
    22. 22. Results Focus group findings Commitment to the programme  Most students (14/18) reported that they had at some time considered leaving the programme. The main reasons cited for this was academic failure, financial difficulties and for diagnostic students the timing of the clinical placement block in year 2.  All students were pleased with their career choice  Despite the sacrifices, a professional career would mean a better future for themselves and their families
    23. 23. Results Focus group findings Absence  Student reported concerns that absence due to attending healthcare appointments with family members may be detrimental to their overall attendance record.  Some students also stated that they had at times, taken sick leave rather than request authorised absence as they felt uncomfortable requesting time off.
    24. 24. Results Focus group findings Absence  Students suggested that there should be an agreed ‘carers leave’ so that they were not disadvantaged  Students felt they did not work to the same flexible working policies and practice available to NHS and University staff. ‘You know there’s flexibility when you work in the NHS. They’ve got family friendly working hours. Staff at the university get that too. Shouldn’t we be entitled to some carer days?’  Students perceived the attendance of carers was higher than students without carer responsibilities.
    25. 25. Results Exploration of absence rates for carers and non-carers.  In response to the issues raised by students on attendance, absence data on the 122 diagnostic radiography students and the 93 radiotherapy students were collected from directorate records and analysed using SPSS Version 16.  Diagnostic Radiography programme absence for carers was significantly lower than that of non-carers. For the radiotherapy programme there were no significant differences between absence for carers and non-carers
    26. 26.  It was reassuring that most students were pleased with their career choice.  It is of concern that students did not examine programme structures before application as location was the decisive factor  The need for embedding effective study skills into the curriculum was highlighted by all students particularly with regard to Year 1  Students considered leaving the course following academic failure. Discussion
    27. 27.  Student carers felt excluded from the wider university community,  Lack of social and academic integration have been reported as reasons for attrition (Cullen 1994, NUS Survey 2009)  McGivney 2003 suggested that a sense of inclusion or exclusion was particularly important for students with children  Support they received from their peer group was one of the most positive aspects of university life which may explain why students in this study did not report feelings of isolation. Discussion
    28. 28.  Students felt well supported on clinical placement;  Despite these positive relationships, some students expressed reluctance to request flexibility in placement areas even when experiencing difficulties.  The fact that students would rather take time off as ‘sick’ rather than request authorised absence is worrying.  Transparent procedures would be beneficial to students and staff Discussion
    29. 29.  Attendance has been identified as a determinant of academic performance and attainment (Newman 2008).  Academic departments should not only monitor attendance but also encourage it by making their academic and clinical programme structure, where possible, more accessible to all students. Discussion
    30. 30.  There was a lack of awareness of the financial support available to students, and the application process was not clear. This is in agreement with a recent national study on student parents conducted by the NUS.  The NHS student bursary allowance pays a net maximum amount of £123.25 per week for one child. For two or more eligible children the weekly net maximum is £182.75. Finance
    31. 31.  Department of Health - attrition for allied health professions programmes should not exceed 10% and attrition amongst ethnic minority group students should not exceed the average attrition rate. It is therefore reasonable to suggest that this should apply to students who are carers  The Equality Act 2010 – HEIs will have to consider how their policies, programmes and service delivery affect people with protected characteristics. Policy & Practice
    32. 32.  The NHS has adopted family friendly, flexible working polices  The NHS has a stated commitment to equality and by having a diverse workforce, needs of local populations are met.  Thus those responsible for delivering medical and allied health programmes have a duty to ensure they recruit and retain a diverse student population. Policy & Practice
    33. 33.  Programme structure should be designed with consideration for this group  Students should be actively encouraged to discuss their carer responsibilities at the earliest opportunity  Programme leaders and admissions tutors should be explicit about the structure of the programme  There should also be targeted financial advice  The student absence policy is currently being reviewed for all allied health professional undergraduates at this university.  This study is also contributing at faculty and institutional level to the discussion on developing inclusive practice Recommendations
    34. 34. Acknowledgements  Thanks to Helen Orton, Bev Ball, Flora Al- Samarraie, Jo sharp and Joy Burrill for help in the facilitation of the large scale study, and to all students who took part.
    35. 35. References  Universities and Colleges Admissions Service: Available from,< http://www.ucas.ac.uk/> [accessed 09/09, 2009].  Ross A, Archer L, Thomson D, Hutchings M, Gilchrist R, Charine J, et al. Potential mature student recruitment to higher education. Department for Education  National Union of Students. Meet the parents: The experience of students with children in further and higher education, January 2009  Cullen MA. Weighing it up: A case study of discontinuing access students. University of Edinburgh, Centre for Continuing Education Research Report 1994; Occasional Paper Series 2(1)  Society of Radiographers. Improving student retention guidelines and good practice 2008. Available at: http://doc-lib.sor.org/improving-student-retention- guidelines-and-good-practice/5-retention-radiography-courses  Maynard E, Pearsall S. What about male mature students? A comparison of the experiences of men and women students. Journal of Access Studies 1994;9:229- 229.

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