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Teaching Sociology within the Speech and Language Therapy Curriculum
Abstract
In the United Kingdom, the Royal College of Speech and Language Therapists suggests that sociology should be included within the speech and language therapy curriculum. However, in spite of this, sociology is seldom given priority. Although the role of sociology with the curricula of other professions has been discussed, the role of sociology within speech and language therapy has not. Given the contemporary climate of competence-based training, the position of subjects such as sociology is being compromised. This paper sets out three reasons in support of including sociology within speech and language therapy by drawing on the distinction between a "personal education" and a "semantic conjunction" model of the relationship between theory and professional practice. First, it is argued that sociology makes a valid contribution to an holistic approach to care--which is rapidly becoming the cornerstone of speech and language therapy practice. Second, this paper suggests that the inherent reflexivity within the discipline provides health professionals with an invaluable tool with which to engage in reflexive practice. Finally, it is argued that given the global emphasis on evidence-based practice, the study of sociology and sociological research methods equips therapists to interpret and conduct empirical research. This paper concludes by arguing that sociology should be viewed as an essential component of the speech and language therapy curriculum.
Sociology teachers often encounter students studying to be future health professionals; sociology content can assist students to increase their understanding of patients, the social context of health and illness, and the social determinants of health. Engaging these students in sociological thinking can be challenging because of their diverse social locations and their identification with their future profession, which may emphasize clinical competence over broader reflective skills. In this conversation piece, we encourage critical reflection on the assumptions that underpin the teaching of sociology to aspiring health professionals. Through case studies of nursing, medicine, and speech-language pathology, we consider differences in the social locations of students and how sociological ideas are received by these professions. We argue that sociology teachers can assist health professions students to gain more from sociology by understanding these student cohorts and by reflexively considering power relations between teachers and students and between disciplines and professions.
Background: Indigenous health matters have largely been neglected in the speech-language pathology literature and have particular import for the aphasia clinician. The influence of culture on people’s experiences and expectations after an event such as stroke can vary widely and there is a need to understand the impact of context on assessment and therapy. Standard approaches may not be adequate or relevant, nor always ethical to apply. Examination of aphasia in contexts with Indigenous populations provides an opportunity to explore methods and approaches with socially complex and marginalised communities and to expand our understanding of the lived experience of aphasia.
Aims: The goal of this paper is to explore the role of culture in aphasia in Indigenous populations and drawing from a body of emerging research, highlight relevant dimensions of understanding and practice for the aphasia clinician.
Main Contribution: A series of qualitative studies undertaken with Indigenous people with aphasia in two separate contexts – Australia and South Africa – will be described and their findings considered along several dimensions. A consideration of methods of approach and understanding will be provided, followed by discussion of some central constructs. A series of conceptual and clinical propositions for culturally safe research and practice in aphasia will be derived from this evidence. Models of collaboration are derived which are decolonising and potentially transformative and supplement models of knowledge and intervention in a local community. Particular attention is paid to temporal and spatial issues, the role of family, identity and community, the notion of resilience in such communities and addressing some of the specific challenges that may be involved such as working with cultural brokers. A series of recommendations is provided which allows for a critical engagement with interdisciplinary frameworks of understanding aphasia in context.
Conclusion: As a reflective piece, this paper has enabled a collation of knowledge about aphasia in two Indigenous cultures and has helped consolidate some novel principles and insights and the need for expanded skills, attitudes, insights, explanations and methodologies – ones that acknowledge and accommodate diversity and difference, and that are relevant to Indigenous communities. Language difficulties are only one cause of social exclusion and issues such as poverty and identity make a huge impact on the lives of our clients and their families, and on the approach we adopt. A shift from the primary framework of our profession is required to accommodate the central role of culture in communication.
The world is changing and so are our caseloads. In the context of increasing cultural and linguistic diversity, clinicians and educators face multiple, complex challenges. We should be able to develop the skills and attitudes needed to greet such diversity, adopt new techniques that allow for ecologically valid service delivery, provide relevant and ethical service with confidence and sensitivity, recognize the influence of culture on the disorders we treat, and understand both facilitators and barriers to care in multiple clinical contexts.
Locally and internationally, there have been renewed calls for equitable access to healthcare services. Simultaneously, caseloads have become more challenging and contexts more complex, which may be overwhelming to new graduates. The South African context offers a particularly interesting example of these challenges. Educators need to use innovative ways to ensure that curricula adequately prepare students for rural community work, while developing a sense of leadership that links clinical practice to theory, policy, ethics and social responsibility. Rural practica offer opportunities for sensitizing and equipping students for working in underserviced communities and a number of international studies have documented their potential usefulness. There is limited research, however, that examines how exposure to rural community work may shape students' responses to the realities of working in such contexts. This study aimed to explore the processes underlying a group of South African speech-language therapy and audiology students' appreciation and understanding of the realities of work in a rural community after a rural practicum.
A four-day practicum took place in a rural community in South Africa. The practicum incorporated basic audiological tasks and structured observations. Twenty-five third-year students completed anonymous pre- and post-practicum open-ended questionnaires. The questionnaires explored their expectations and perceptions of the practicum, perceived challenges and benefits of working in rural community areas, and considerations that might need to be taken into account. The questionnaires were analysed and compared using thematic analysis principles.
Results revealed a distinction between students' emotional and personal expectations of, and responses to, the practicum compared to their clinical expectations and responses. Before the practicum, students indicated a number of anxieties such as not feeling emotionally prepared or feeling anxious about infection control. The rural practicum appeared to provide a powerful teaching tool that led to growth in students' empathy and awareness of community needs and contextual issues through a shift from an intrapersonal to an interpersonal focus in their responses. A lack of growth was noted in some areas after the practicum, however, such as students' ideas about implementing appropriate therapy and making modifications to materials.
This study holds significant implications for preparing students to work in challenging contexts and rural communities both in South Africa and abroad. The results suggest that a one-off practicum is not sufficient to sensitize students to the challenges of rural work and enable them to overcome anxieties. Rather, a sustained commitment to rural community work should be introduced early on in the curriculum and educators should be encouraged to reflect on their own attitudes, experiences, biases and anxieties towards community work.
The research on which this article is based has been stimulated by debates on whether sociology should be included in the curricula of the allied health professions. This article examines the role of sociology within midwifery education by drawing on a study of 29 providers of pre and post-registration midwifery education in England who participated in a survey conducted by postal questionnaire. Questionnaires explored how sociology was integrated into the curriculum focusing on course delivery, content and organisation. Overall attitudes to the role of sociology within midwifery education were also examined. Analysis of the questionnaires reveals that sociology teaching is most likely to be delivered by lecturers in midwifery with a special interest in sociology, or related discipline. The role of sociology within the curriculum is valued although it is thought that student midwives can find the subject 'difficult' or 'uninteresting'. The research also demonstrates that sociology teaching focuses more on 'social problems', rather than on 'sociological concerns' and that it is most likely to be integrated within the curriculum rather than delivered as a subject in its own right.
Behavioural studies form an essential component of the Speech and Language Therapy (SLT) undergraduate degree.
This study aimed to produce online teaching material in behavioural studies suitable for undergraduate SLT students, explore students' views on the online material, record their performance when taught through this innovative method and compare their performance to a group taught through the traditional lecture based method. Finally, it aimed to explore the relationship between engagement with the module and performance.
SLT students completed an online health psychology/sociology module and their performance was compared to students who completed a traditional lecture based course. Student evaluations of the online course were also recorded as was their engagement with the online module.
Results suggested that there was no significant difference between students taught through an online medium compared to those taught through "traditional lectures". An evaluation survey suggested that students appeared to enjoy the material although there was some reluctance to develop an independent learning style.
Online learning has a great deal to offer SLT education. However, material has to be developed that can both engage and motivate learners, thereby enhancing student independent learning.
Concepts of health and disease are changing rapidly. This is particularly true in Canada, where a combination of health care reform, changing mandates for public health agencies, and the abrupt introduction of principles of managed care are expressions of fundamental changes in health care and the role of the physician. The future practice of medicine will be profoundly affected by current trends toward managed care, the implications of the 'population health' model, and a renewed emphasis on biomedical ethics, among other developments. Managed care is a widespread movement to promote presumably more efficient organization and administration of health services by imposing restrictions, guidelines, and financial incentives on practising physicians and health care institutions. The population health model is an approach to public health, population health status and individual health care that borrows from economics and sociology and has become very influential in Canada. A new medical curriculum that prepares the student for this future is required. A model curriculum is proposed that would integrate contextual subjects in medicine, with minimal reductions in mastery of biomedical topics through increased efficiencies in education. The proposed alternative curriculum would also redistribute clinical training time from inpatient to outpatient settings. It may be useful either as a blueprint for curriculum change or as a conceptual tool for rethinking the medical curriculum.
"Must be judged as a landmark in medical sociology."âNorman Denzin, Journal of Health and Social Behavior "Profession of Medicine is a challenging monograph; the ideas presented are stimulating and thought provoking. . . . Given the expanding domain of what illness is and the contentions of physicians about their rights as professionals, Freidson wonders aloud whether expertise is becoming a mask for privilege and power. . . . Profession of Medicine is a landmark in the sociological analysis of the professions in modern society."âRon Miller, Sociological Quarterly "This is the first book that I know of to go to the root of the matter by laying open to view the fundamental nature of the professional claim, and the structure of professional institutions."âEverett C. Hughes, Science
This paper reflects on selected aspects of the work of Eliot Freidson and is based mainly on his three latest books--Profession of Medicine, Professional Dominance, and Doctoring Together--in which he draws together his various contributions and elaborates a substantial argument concerning the dominant position of physicians within the institution of medicine in particular and, more generally, their unique position within the broader society. Freidson's work is considered from the perspective of political economy. The paper discusses, on a broad level, some of the assumptions underlying his analysis, the adequacy of his theoretical orientation and level of analysis for understanding the House of Medicine in the United States, and some implications that follow.
One of the consequences of the expansion of degree, and diploma level Project 2000 courses in nursing, has been that students are now exposed to a significant amount of material from academic disciplines other than nursing, at a relatively advanced level. In this paper, one such discipline, sociology, is considered, and its relevance to the nursing curriculum is assessed. Following a consideration of two theoretical models of the relationship between academic disciplines and professional practice (the 'personal education' and 'semantic conjunction' models), it is argued that whilst the implicit rationale for the inclusion of sociology in the nursing curriculum can best be understood in relation to the latter, neither model offers a convincing reason as to why we should teach sociology to nurses. It is argued instead that the nature of sociological knowledge is inherently multi-paradigmatic, and hence reflexive, and so cannot in principle provide a knowledge base for action-oriented conduct such as nursing work.
This paper examines the arguments in favour of the inclusion of sociology in the nursing curriculum. It contains an analysis of the literature on sociology teaching in nursing education and briefly compares this with sociology teaching in the medical curriculum. The discussion draws attention to the ways in which the professional concerns and ambitions of nursing constrain the content and organisation of the sociology curriculum. Finally it argues for a more critical and theoretically informed sociology for nurses.
This paper is a response to the challenges laid down by Hannah Cooke in a paper in the Journal of Advanced Nursing entitled "Boundary work in the nursing curriculum: the case of sociology' (Cooke 1993a). In her paper, Cooke noted that the outlook of nursing and sociology are inimicable because nursing's concentration on individuals is at variance with sociology's concern with wider social issues. We argue that it is possible for nursing research to give due attention to social structures without losing its focus on individuals. One methodology that could facilitate this broadening of nursing's epistemological boundaries is critical realist ethnography, which works under the assumption that the relationship between social structures and individual actors involves a two-way process, in that while the enablements and constraints imposed by structures influence individual actions, those actions in turn either maintain or transform social structures. To demonstrate how such a methodology could be applied in nursing research, we work through a case study concerning the theory-practice gap, arguing that the gap is neither the result of clinicians' ignorance of nor antipathy to theory, but is largely generated by the lack of resources enjoyed by nurses, which in turn is a reflection of the social structure of capitalism within which nurses operate.
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