A wide range of health conditions may impact on students’ learning, assessment performance, and class attendance. These conditions include epilepsy, asthma, diabetes, kidney disorders, cystic fibrosis, cancer, hepatitis, chronic fatigue syndrome (CFS), and HIV/AIDS. While some of these conditions are lifelong, others, such as CFS, will be unpredictable and episodic.
These conditions may be related to other disabilities: students with neurological diseases may also have mobility and/or vision impairment; students with epilepsy may have damage to the part of the brain which affects speech. Some conditions will diminish balance and coordination, or cause severe headaches, backache, joint pains, blurred vision, weakness or numbness in limbs, and breathlessness triggered by stress.
Students receiving treatment for cancer may have long and debilitating periods of nausea and fatigue. Respiratory and cardiac diseases may affect mobility and impair the strength, speed, endurance, coordination and dexterity necessary for writing and manipulating equipment. Symptoms may vary in severity over quite short periods of time. Some health conditions are progressively degenerative; the course of others can be highly unpredictable.
Impact of Chronic Health Conditions
The impact of a chronic health condition on learning will vary according to the disability. Students may be affected in the following ways:
- Some conditions leave students vulnerable to a wide range of infections and viruses, and frequent absenteeism owing to hospitalisation and/or medication changes may be the first indication that teaching staff have of the existence of a medical condition.
- There may be striking inconsistencies in performance. Some students may have difficulty persisting with tasks especially when physical discomfort is an issue. There may be intolerance to extremes of heat or light, and to some chemicals.
- Some medications may result in lethargy and difficulty with concentration. This may mean that students do not participate actively in tutorial discussions. Participation may also be affected when energy levels are low and for those whose speech is affected by the disability.
- Mood swings and depression may be associated with chronic health conditions.
- Students may sometimes exhibit extreme anxiety, particularly if there is a history of unexpected ‘episodes’ in public.
- Some students will have had gaps in their educational experience as a result of these periods of being affected by the health condition.
There are some specific strategies that are useful in teaching students with chronic health conditions:
- Students who tire easily may find it difficult moving about within the constraints of lecture timetables. Absence or lateness may be a result of the distance between teaching venues, so at the end of a lecture you may need to recap any information given at the beginning.
- Some students may need to use a tape recorder or note-taker in lectures.
- Extra time is involved in processing information acquired through a tape recorder or note-taker. It is common practice in some departments to routinely tape all lectures. This is a practice which will assist a variety of students, including those who may be absent from time to time because of their health condition.
- Students may need extensions to deadlines for work involving locating and using library resources. Provide reading lists well before the start of a course so that reading can begin early.
- Social and academic isolation may be an issue for students who are unable to participate regularly in some class activities. One-to-one sessions with a tutor may help fill this gap in participation.
- Because of gaps in schooling or lengthy periods of hospitalisation, students initially may be very unsure of the level at which to pitch their work. They may set unrealistically high standards for themselves, and you therefore may need to help them focus on more realistic and achievable standards and goals. This process will be assisted if you make your expectations clear and explicit.
- Students may have frequent or unexpected absences from class. Flexible delivery of teaching material via electronic media is particularly helpful for these students. Consider taping your lectures so that students who are absent do not have to rely on other students for their learning materials.
- Students who are frequently absent will benefit from advance notice of topics to be covered and assignments to be completed. You may need to be flexible about attendance rules and deadlines.
Students with chronic health conditions may need particular adjustments to assessment tasks. Once you have a clear picture of how the disability impacts on learning you can consider alternative assessment strategies.
In considering alternative forms of assessment, equal opportunity, not a guaranteed outcome, is the objective. You are not expected to lower standards to accommodate students with disability, but rather are required to give them a reasonable opportunity to demonstrate what they have learned.
- A reader or an oral examination (either presenting answers on tape or participating in a viva voce) are alternatives to the conventional written paper. An oral examination is not an easy option for students. Give the same time for an oral examination as for a written exam, but allow extra time for the student to listen to and refine or edit responses. In your assessment, allowance should be made for the fact that spoken answers are likely to be less coherent than written answers.
- For some students the combination of written and oral examination will be most appropriate. Allow students to write answer plans or make outline notes, but then to answer the question orally. Your assessment should be based on both the notes and the spoken presentation.
- Provide extra time in examinations for students who have reduced writing speed. Some students may need rest breaks.
- Consider extensions to assignment deadlines if extensive research involving physical activity (e.g. frequent trips to the library or collection of data from dispersed locations) is required.
- Consider redistributing the weighting of assignments. For example, you might set six assignments for a semester, but inform students that only the best four marks will be counted. Students who have been unwell will thus have some choice about what and how many assignments to submit.
- Take-home examinations may be an option, particularly for students with kidney disease, cancer etc. It is important for these students to be in an environment where they can use their usual support systems.
- When a health condition enters an active phase, any assessment should be postponed. If the cut-off date for withdrawal without fail has passed, students should be counselled to seek advice from their provider’s disability adviser about their situation.