User Cases

Using Stilwell

The student

Amanda was a 1st year nursing student. Although she had some experience of working in health care she soon realised that becoming a nurse required a much broader set of abilities. She was nervous about  working with a team of different professionals and realised that she didn’t know much about their roles. She appreciated it would be helpful to learn about the roles of others before she went on placement.

Early in her course she began working with Stilwell and quickly found it gave her insights into just the areas she needed. In particular Amanda was allocated to a multidisciplinary student team for  interprofessional studies. They were given a problem based scenario to work on which involved a character from Stilwell.

Amanda said:

‘Our character was Eva Bernstein an elderly Jewish lady suffering from Alzheimer’s. We had to explore our different professional roles in caring for Eva and supporting her family. Many members of my team didn’t know anything about the disease and found this a valuable learning opportunity, especially as we saw how each profession could contribute to her care.  We found ourselves drawn into her story as it unfolded, like a soap opera. You really got to care for Eva and her husband Max, as if they were real. Stilwell made us think about a range of much wider issues and provided us with a range of links to expand our learning around the topic. It also made us think in a more joined up interprofessional way. For example the occupational therapists wanted to find out about her home and the area she lived in.  Social work students stressed the importance of her social history and how Mr. Bernstein was coping. Everything we needed to know was contained in the story and it was just so realistic. What the other professions saw as initial priorities taught me about the importance of social circumstances and thinking holistically. It also made me appreciate their roles more clearly.

The teacher

How I use Stilwell in my teaching

I make regular use of Stilwell within my modules as it is so versatile.  It can just be used on an ad-hoc basis, using a story to illustrate a topic, but it is best when I plan an activity that involves the students getting into the rich narrative of the characters and their inter-relationships. A bonus is that it works equally well in class or online.

As the content is so rich, the initial direction I give students can be simple. I can ask them to consider a desired learning outcome in relation to a particular character having done some background theoretical work.  The discussions that emerge from this can be really exciting with genuine ‘light bulb moments’ and serious  critical thinking. Stilwell facilitates students following up on work and motivates them to want to learn more. The bottom line is I don’t need to spend time creating complex case studies; instead I can spend time facilitating their learning.

For example in learning about leadership we can explore Jo Peart’s story. She is a trading standards officer but her story works across a wide range of disciplines Because the story is so immersive, the students became really interested in a range of issues such as corruption, bullying, strategic policy making and paternalistic management styles.. I was able to explore their ideas with them and then they could go back into Stilwell to consider how these discussions resonated with the authentic and complex situations Jo faced and how things came to a head.

Stilwell also promotes critical reflection on practice. As students become immersed in the characters they make links and observations that I didn’t even think of. This shows them developing a critical approach and allows me to explore more challenging and ambiguous issues.  Stilwell provides  an authentic context within which to explore difficult professional dilemmas without real patients being placed at risk

The programme leader/planner

As a programme leader I need to ensure that the quality of my programme is high and that the learning across the programme is constructively aligned with the learning outcomes of the programme.  Sometimes tutors only see their module rather than the wider programme and find it hard to develop a common thread across the whole curriculum.. As a result students only see the programme as discrete modules and fail  to consider how one module supports another.

By integrating Stillwell into a programme it is possible to create a common thread running throughout as we follow the lives of one or more families.  I made sure tutors understood that Stilwell was their resource to control and use as they wished. It would be wrong to force a curriculum into a Stilwell story (‘tail wagging the dog’). However such is the range of stories there are plenty of options. We could settle on a couple of families to follow across  the whole programme and some that could be introduced for certain modules.   A further major advantage is that all this material consists of reusable resources, which makes for a very efficient use of time and helps reduce staff workloads.

For example our advanced practice programme includes modules on consultation skills, evidence based practice, medicines and leadership.  Jean Forrest’s story links all these modules starting with consultation skills at her first presentation with minor symptoms.  Her story shows how poor consultation skills and a failure to appreciate the risks of false positives in lab testing is compounded by a lack of awareness of adverse drug reactions. As a result Jean ends up in hospital with septicaemia. The ward sister finds herself in a challenging leadership situation as issues of advocacy and poor professional practice collide with institutional medicine. At the end of this story, students could really see the progress they had made.