Physiotherapy clinical education: power interplay examined through the lens of Bourdieu

Abstract

Clinical education is pivotal to professional socialisation and mandatory registration of physiotherapy students. Traditionally, responsibility for student learning in the clinical environment resides with experienced physiotherapists in tandem with their other tasks, predominantly providing patient care. Competing stakeholder interests, however, converge on clinical educators. They are challenged to meet expectations and demands from, for example, patients, colleagues and academic staff. While crucial to the processes of clinical education, there is little known about clinical educators and their perspectives. This research, therefore, examined power interplay in clinical education in New Zealand from the perspectives of clinical educators, and contextualised by perceptions of associated stakeholders. It is located in the critical paradigm, and was underpinned by Bourdieu’s theories. Recommendations for change emerged which provide strategies for enhancing relationships to promote a more cohesive and unified approach to clinical education across organisations and the profession.

Methodology, method and analysis were informed by Bourdieu’s research procedures; specifically three levels of interaction between habitus and field were applied. Semi-structured interviews were conducted with a purposive sample of 18 clinical educators and 18 stakeholders in clinical education. Participants included academic staff, managers, representatives of the profession, and students. Emergent themes were affirmed by, and further explored, with seven of the 18 clinical educators.

Five key findings emerged. First, the framework verified and clarified power interplay in New Zealand clinical education. Second, clinical educators were identified as a distinctive and disadvantaged social class. Third, hierarchies were found, based on knowledge which valued ‘clinical’, ‘education’ and ‘research’ differently, and by association, those who imparted such knowledge. Fourth, competing value systems were symbolic of different organisation perspectives: stakeholders as service providers and consumers competed for resources. Fifth, services provided by clinical educators have become commodified, and located within the commercial world of healthcare. This was found to be contrary to the vocational origins of the physiotherapy profession, and professional obligation of physiotherapists to train the future workforce.

It is recommended that the value of clinical educators and pedagogy is reappraised by organisations and the profession. Ways of increasing the visibility of pedagogy in undergraduate curricula warrants review. Career pathways in clinical education offer another review focus. In this thesis, several strategies are proposed to reduce the dissonance in knowledge and social hierarchies including simulated learning in the classroom, collaborative research, and joint lecturer-practitioner positions. Research is warranted that investigates the preparedness of physiotherapy graduates for the New Zealand workforce. The economic consequences of students in the workplace and the patient’s voice as consumer of clinical education should be investigated by future researchers.