Our talk at IgniteGuelph seems to have revitalized discussion surrounding the benefits of experiential teaching methods such as empathetic models and simulation exercises, and the opposition to these by many in the disability community which I hope to address here.
Our session at the University of Guelph on Accessibility Education a month after the IgniteGuelph event looked at a dozen and a half examples of accessibility curriculums. The majority of which included experiential teaching methods, and all of those lauded the benefits as well. In fact, in the medical education system, where accessibility and disability education has enjoyed the longest history, the use of standardized patients is now a “mainstay” and the “substantial majority of medical schools use the standardized patient exercise to teach clinical skills and / or to assess clinical competence” and “the strengths render the standardized patient approach particularly well suited for teaching students about disability”.
The reasons for including experiential methods when teaching disability to medical students are numerous. One Occupational Therapy program used the days students spent in wheelchairs to both see what future patients encounter in terms of barriers but also to which muscles are required to maneuver and use the chair itself. But perhaps the two most important benefits of including experiential methods to teach disability to medical students is that the “allow for “teachable moments to be created, rather than waited for” and “reinforce role of patient as authoritative source of knowledge”.
Two of the biggest arguments against experiential teaching methods are that they focus primarily on the limitations of disabilities and that disability can’t be taught.
Now I could use dozens of quotations extolling the virtues of experiential education by scholars, staff, and students but prefer instead to deal with my own personal experiences and motivations. What follows is not meant to be a justification, simply an explanation of our motivations for using them and what we see as the benefit.
I think that it is the objective of the teaching that is the most important factor in the debate, not the actual use of techniques themselves. At Roll a Mile, our use of such training methods is to increase awareness about accessibility and barriers to access. We are not attempting to teach about disability, we are trying to increase accessibility. Awareness is key to doing this, and while a few minutes spent ‘rolling a mile’ in a wheelchair will never get close to illuminating all of the accommodations, adaptations and barriers faced on a daily basis by someone who uses a wheelchair regularly, but it can raise awareness. And raising awareness is a good thing when it comes to barrier removal and increasing accessibility. I suppose my motives are selfish really, by raising awareness and increasing accessibility, I can more readily buy toothpaste.
I agree that disability is difficult to teach. To accurately simulate chronic-pain one would have to inflict constant, yet random, blows to the body with a baseball bat all the while having young children scream continuously in their ear. According to a jury-of-my-peers, this is not permissible. But seriously, using chronic, debilitating pain as an example, it would take years to properly simulate. Literally years. Years of slowly having every aspect of one’s life affected. Of losing family, friends and worst of all, your ability. Years to go through the stages of grief as you mourn the life you thought you would have, the functions you’ve lost. Years of losing your job(s), your savings, your car, your house, and your independence. Years of learning acceptance, adaptation and working within limitations. Years of adjusting to frequent medical visits to be poked and prodded, to have fluids removed and injected. Years of tests, and doctors, and the whole dysfunctional healthcare system. It would take years to properly convey to someone what living with chronic pain is like. Truly replicating any disability is impossible. Especially considering every disability is as unique as the individual with them.
And as for the concern that empathetic models tend to focus on the limitations of disability, I cannot help but strongly disagree. In my experience, anyone that ascends a ramp using a manual wheelchair, cannot help but gain a new awareness, appreciation and even admiration for anyone who does so on a regular basis. However, the use of terms like “capability-compromising exercises” does not serve to help the cause. At Roll a Mile we use “differing circumstance” models and simulation exercises that, rather than only exposing limitations, focus on adaptations and accommodations while providing firsthand familiarity with barriers to access. And it is this first-hand experience that we feel enable our participants to not only learn more, but to retain and engage more.
Teaching the rules and regulations of accessibility and the A.O.D.A. are important, but so to is ‘going beyond the building code’ to understanding the rationale behind the regulation. Accessibility needs to be presented from more than just that of policies, procedures and physical structures. We go beyond compliance as legislated accessibility is not actual accessibility.
Unfortunately, unless personally affected, most simply aren’t aware of issues of accessibility. And the truth is that most barriers to access exist simply as a lack of understanding, not an act of malice. The example I like to give for that is a local medical facility that had put a small table to act as a sanitation-station outside the entrance to an office. In this instance, the Building Code required clear-space, but really, doctors and nurses cannot be expected to know the Building Code, let alone how much additional effort is required by a person using a manual wheelchair or walker to gain entry when there is no clear space. Simply bringing this to the attention of the correct person resulted in removal of the barrier. Awareness is key to accessibility. And first-hand experiences can raise awareness significantly.
At Roll a Mile, our desired outcome is not to teach disability, but to increase awareness about accessibility and barriers to access. Our sessions and scenarios are tailored to reflect workplace realities so staff are able to provide proactive, adaptive, accommodating service and strive for understanding and awareness over empathy or pity. And we use empathetic models and simulation exercises to do it, because we truly believe their benefits outweigh their negatives.