At sea with disability! Transformative learning in medical undergraduates voyaging with disabled sailors

Abstract

CONTEXT Attitudinal objectives are difficult to formulate, teach and assess; yet good attitudes are fundamental to good practice. For instance, studies highlight negative attitudes to disability in the medical student community that contrast with the self-conceptions of disabled persons. This study was designed to better understand attitudinal learning, inadequately addressed by contemporary programmes, through the application of Mezirow's 'transformative learning theory' (TLT) to a novel educational intervention.METHODS Participating students went to sea, for voyages of 5-7 days, in tall ships operated by the Jubilee Sailing Trust. Each student was buddied with another sailor living with disability. Disabilities included cerebral palsy, loss of sight, loss of limbs and paraplegia. Students recorded their experiences using audio diaries, written logs, formal voyage reports and art work and in post-voyage seminars. The data were analysed using interpretive phenomenological analysis, and the results are considered under five themes suggested by Mezirow.RESULTS Sixteen students were recruited, with four students sailing on each of four separate voyages. Each student recorded audiodiary entries, which had a total duration of between 10 and 212 minutes. For seven of the 16 students, the five key elements of TLT were demonstrable, suggesting that transformative learning, as described by Mezirow, was occurring. Drawing on diverse qualitative data, insights into different aspects of this transformation are provided.CONCLUSIONS TLT can be used to characterise, and thus design, educational interventions to meet attitudinal learning objectives. Students can be helped to discover their less helpful frames of reference. In safe environments these frames can be challenged and subjected to personal and communal reflection. Drawing on audio diaries and other evidence, and in answer to critiques of contemporary medical teaching on disability, we demonstrate such transformation in students 'at sea with disability', highlighting elements that could potentially be transferred to the mainstream curriculum.

Transformative learning as pedagogy for the health professions: a scoping review

“…Common pedagogies and approaches to teaching and learning were those that required active engagement with communities that appeared to be different to what the students knew . These engagements in less familiar communities included working in rural or underserved communities, travelling abroad, service learning at mental health institutions, visiting homes for marginalised and otherwise disadvantaged persons, or caring for patients at the end of their lives …”

“…Several studies described specific events or conditions that acted as ‘triggers’ for TL. Mezirow's notion of a ‘disorienting dilemma’, the first of his 10 phases of transformative learning, featured strongly . Often this was linked to a particular event or experience, typically the ‘authentic’ experiences mentioned above, and could be associated with feelings of guilt and fear .…”

“…20 A dominant theme across a large number of the included studies emphasised that for TL to occur there has to be an opportunity for questioning existing frames of reference, and for reassessing one's beliefs, habits of mind and prejudices before entering a less-known environment where the knowledge and values upon which these beliefs and prejudices are founded might be questioned. 16,18,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Enablers for TL are therefore becoming aware of one's prior assumptions and having one's world view challenged. [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] In addition, 'liberating learning environments' or 'those conducive to developing autonomous thinking and self-empowerment' 54,55 were described as necessary for reinterpreting experiences.…”

Pitching Perspectives on Disability: Voyage Experiences of Disabled Sailors on Tall Ships

“…Some of the medical students accompanying the disabled sailors also experienced differences in their physical functioning, and felt that the adapted ship facilitated their ability to 'fit' into the sailing experience (Garland-Thomson 2011). The idea of misfitting is not necessarily something which divides humanity into the 'misfits' and the 'fits', since there are ways in which we all may misfit at certain times (Thompson et al, 2016). Blue et al (2016, 24) suggest that access to new social practices may provide the 'missing' link where inequalities are mediated and maintained within public health.…”

“…The experiences of the medical students were discussed and theorized in an educational journal (Thompson et al, 2016). The current paper by contrast focuses directly on the accounts of disabled sailors on two voyages in 2013.…”