Speech and language therapy students: how do those with ‘non traditional’ university entry qualifications perform?

Introduction

Entry into the profession of speech and language therapy/pathology or logopaedics is by either undergraduate or master's-level degree, or their equivalents. The majority of people gain entry to university through the qualifications secured at school. For some, however, academic achievement at school does not reflect their actual academic ability or their potential for clinical performance (e.g. Poussaint 1999). For them, university entrance can be gained through alternative qualifications achieved post-schooling such as foundation degrees or Access to Higher Education courses and extended medical degrees (e.g. Garlick and Brown 2008).

These routes are seen as providing an important means of diversifying the student population (Mathers et al. 2011) and, subsequently, the healthcare workforce. Increasing diversity is a major issue internationally (e.g. Cohen and Steinecke 2006, Jackson and Daly 2004) and in the UK has been a government driver for several years, with the requirement that ‘National Health Service organisations [and] education providers […] must shape and influence education and training so as to open up opportunities to the whole of the community’ (Department of Health (DoH) 2001: 14). Diversity is important not only for reasons of social justice, but also to meet the needs of an increasingly diverse population in many countries. Research has shown that some degree programmes are making small but as yet non-significant gains in terms of increasing diversity among students (e.g. Mathers et al. 2011), but there remains untapped potential for recruiting from courses which are completed post-schooling, such as Access courses (Greenwood et al. 2007).

Access courses are designed primarily for people who would like to study at university but who left school without the usual qualifications for university entry, thus providing a sort of ‘second-chance’ education (McFadden 1995). They include a combination of modules covering subject-specific knowledge and generic study skills components. Methods of module assessment vary between courses and are validated on a programme-specific basis, but students’ learning is typically assessed by a combination of coursework, presentations, reports, essays, in-class tests and/or examinations. Courses are usually completed in one year of full-time study (or two years part-time).

Access courses primarily attract older students (aged 21 or over) and/or those with no or few previous formal academic qualifications, and those who have previously been unable to benefit from the education system (e.g. Burke 2004). This student group is culturally diverse, more likely to come from more deprived areas and includes a high proportion of women (The Quality Assurance Agency for Higher Education (QAA) 2012). They also come from a wide range of backgrounds in terms of social class (Reay et al. 2002, Ross 2003).

There is a small body of published research which explores whether students entering university—including those undertaking training in the healthcare professions—via a non-traditional academic route (e.g. an Access to Higher Education course) perform as well as their counterparts from traditional routes. Wharrad et al. (2003) determined the relationship between pre-entry qualifications and academic outcomes on an undergraduate degree in nursing at a British university. Students entering the course with non-traditional qualifications were found to achieve slightly lower marks throughout the course and had a higher rate of attrition than those who had traditional qualifications. This pattern is mirrored by earlier research carried out by Kevern et al. (1999). They found that nursing students entering with Access qualifications accounted for the highest proportion of students who withdrew from study, and that they achieved the lowest scores in assessment of theoretical knowledge: entry qualification was found to be the first predictor variable for success on the programme. They raised the issue of ensuring that support systems are targeted appropriately for students who have entered university via Access courses, and commented that more work was required to determine how this might be done. Ofori's (2000) study examined the performance of students with and without conventional school qualifications on three modules on a pre-registration diploma in nursing and, in contrast to the studies mentioned above, found no significant difference in performance between students with an Access qualification and their peers. Similarly, Garlick and Brown (2008) determined that the final scores of a group of students on an extended medical degree programme were indistinguishable from those of their peers who entered the degree with the qualifications from school. The students on the extended programme had achieved lower grades in their school examinations than would usually be acceptable for entry to medical school.

This rather mixed picture is perhaps unsurprising given the variation both in outcomes measured (marks for specific modules, average marks for a whole degree, etc.), and in degree programmes examined, and as yet no detailed profile has been presented of the relative strengths and weaknesses of students with non-traditional pre-entry qualifications in performance across the whole range of assessment in a professional training programme. In the field of SLT training, while there have been studies which have explored under-represented groups such as men and people from ethnic minorities (e.g. Greenwood et al. 2006, Boyd and Hewlett 2001, Stapleford and Todd 1998), little is known about the outcomes for non-traditional entry SLT students from the perspective of their academic and professional achievement. Such information may assist healthcare education providers in providing the kind of tailored support which previous research has highlighted as important.

The study reported here aims to provide such detailed information by exploring the performance of students who have entered a four-year undergraduate degree via Access courses in comparison with those entering via a ‘traditional’ route, i.e. school qualifications. The four-year BSc (Hons) degree in Speech Sciences at University College London (UCL) offers a direct pathway into the profession of speech and language therapy.1

The aims of this study were (1) to examine the success of the non-traditional academic entry route students in terms of individual modules across the degree and (2) to examine the eligibility of these students to work as SLTs and their success in terms of securing employment as an SLT.

Methods

Ethical approval for this study was granted by the Research Ethics board in Psychology and Language Sciences at UCL. The project was registered with the Data Protection Officer and data were stored anonymously and securely.

Results

Discussion

Students enter the UCL Speech Sciences programme with the goal of obtaining a bachelor's degree and being eligible to work as an SLT. This study demonstrates that students who enter from non-traditional academic backgrounds can be successful in achieving this goal. However, the average non-Access student performs significantly better than Access students, both overall on the degree and in several of the individual modules, matching previous research in nursing (e.g. Wharrad et al. 2003). The difference may be due to the predominance of written examinations in the degree (only three modules out of a total of 19 do not involve an examination) and differences between the groups of students were particularly marked on this type of assessment. Given the lack of focus on written examinations in Access courses, it is possible that this group of students is less experienced with this method of assessment; it may simply be that Access students perform less well in this kind of assessment and especially in the later years of the course when examinations focus on the consideration of case studies in the abstract rather than factual understanding. Students in the first year of study on our BSc course are provided with study skills sessions on time management, note taking, essay writing, and revision and examination technique, and support is provided throughout the course. These sessions are well attended, especially by ex-Access students, but it is possible that they would benefit from more on-going tailored support. This study reports the results from one institution, and the picture may be different in other institutions offering SLT training. The main factors which are likely to impact on differences across institutions are not only the level of support provided to students on admission and throughout their programme of study, but also the emphasis on examinations compared with coursework (i.e. the number of examinations and how heavily they contribute towards individual module marks and overall degree classification) as well as differing entry requirements between institutions.

In contrast to written examinations, the data here reveal that the Access students perform on a par with their peers (and sometimes slightly better) on the other types of assessment, which include data analysis and case studies. Students may benefit from these types of assessment for a number of reasons: their familiarity from previous study; the environment in which the assessment is completed (i.e. at home rather than a high-pressured examination situation); the length of time they have to reflect on what they have done (typically students are given up to a month to complete coursework assignments); the opportunity provided (and indeed encouraged) to engage with fellow students about the task and the nature of the task itself (e.g. engaging directly with data, presenting actual cases of clients with communication difficulties, rather than discussing abstract cases as in written examinations). Students entering via the non-traditional route also perform similarly to other students on practical examinations, such as clinical placements and presentations. The only exception here is the viva examination in the third year of the course, in which the performance of the Access students was significantly worse than that of their peers. The main focus of these examinations is on three unseen questions relating to aspects of clinical management and, with two examiners present, the viva examination—particularly the first one taken in Year 3—can be particularly stressful for the student.

These findings underline the need, which has been noted before (e.g. Christie et al. 2007), for those working with students on SLT training courses to be alert to the potential difficulties of transferring learning skills from one setting to another. An awareness of this may impact on (1) the way in which students are assessed: coursework may be better at tapping the kinds of abilities these students have; and (2) the way in which students entering without traditional qualifications are supported: as well as pastoral care and support with practical considerations such as the time to study, this group of students may need particular help with preparation for written examinations, above what is generally offered to students. They may also benefit particularly from support which helps them to identify areas of relative strength in terms of assessment and on recognizing where to focus their energies. This help may be most valuable if offered in the first year of study (Lowe and Cook 2003), though this group of students may require more than just the initial ‘stepping stones’ into higher education and university staff may need to ensure support remains in place throughout the training (Elliot and Brna 2009).

An alternative—or additional—factor affecting the non-traditional students’ performance may be that since a lower second-class degree (i.e. a final weighted average of 50–59%) provides straightforward access to their chosen profession, they may simply be content with that outcome. In the case of those students who are juggling competing demands on their time (e.g. Osborne et al. 2004), they may deliberately do ‘enough’ rather than as well as they can, and this may be particularly the case with tasks that are less enjoyable (e.g. examination revision).

Also of note in the profile of students was the relatively high rate of attrition amongst the Access students (see also Kevern et al. 1999). Attrition for both Access and non-Access students was higher than the national average. This is not entirely unsurprising because of the nature and length of the course, and it is not uncommon for students to decide that the course is not suitable for them after beginning their studies, especially once clinical placements have begun, at which point they gain clearer—first-hand—knowledge of the extent of the roles and responsibilities of an SLT. Indeed, higher attrition rates are reported for courses that lead to professional qualifications than for non-vocational undergraduate programmes (Hinton and Jinks 2009). Interestingly, none of the non-traditional entry students left the programme because they did not feel that SLT was the correct choice for them. This would suggest that these students have researched the profession and have a good understanding of the work an SLT does. This cohort of students, from both non-traditional and traditional academic backgrounds, includes students who are older than the typical university entry at 18 or 19 years old. These older students may have additional pressures on their time such as paid employment (Christie et al. 2002) and family/domestic responsibilities (Osborne et al. 2004) in addition to university work. This is an area which would benefit from additional study.

The information on first destination of the students post-graduation, though limited by the response rate of graduates, suggests that students who begin their SLT training without the traditional entry requirements and who successfully qualify go on to succeed also in gaining employment as an SLT. From the numbers that we have, they appear to do no worse than traditional students in this respect. Arguably, this is the outcome that matters most to the students themselves. More research in the area of the employment destinations of different groups of students (including graduates of both undergraduate and postgraduate programmes) would be particularly useful, especially in the current context of significant changes to the funding and organization of healthcare and training in the UK.

A note of caution is of course required in the interpretation of the findings of this relatively small-scale study. As with previous research in this area (e.g. Wharrad et al. 2003), only one degree programme was considered, and although the study explored data from ten years’ worth of entrants to this programme, the numbers of students in both the Access and non-Access groups are relatively small. Larger scale studies in this area would be valuable, though with the low proportions of non-traditional entry students per year, data from many cohorts would be necessary. Alternatively a cross-institutional study might provide sufficient data for conclusions with wider scope to be drawn, though such a study would necessarily include a number of differing variables to take into account (e.g. variation in entry requirements, different levels of student support, as mentioned above). We offer the findings of this study as a snapshot of a group of SLT students in the UK in the early 21st century, and as a pointer for future research.

The proportion of students who enter this programme with non-traditional academic backgrounds is four times the national average (QAA 2012) and yet is only 7.4% of the total number of students. The drive by the government and universities, in the UK and elsewhere, to recruit students from a broad range of backgrounds to work as SLTs makes the profession better prepared to serve a diversity of communities. These findings suggest that though targeted support may be beneficial for some, these individuals are professionally competent students and have the potential to be critical-thinking, reflective clinicians (Health Professions Council (HPC) 2007).