Learning as participation in early clinical experience: its meaning for student physiotherapists

Hargreaves, Julian P (2014) Learning as participation in early clinical experience: its meaning for student physiotherapists. Doctoral thesis (EdD), University of Sussex.

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This research explores the meaning of learning as a process of social participation in clinical practice. The study focused on six first‐year student physiotherapists during a period of early clinical experience on a work integrated learning programme. The programme was unique at the time of the study in that it placed students in clinical settings from the first week of their undergraduate experience. The research applied a case study design and qualitative data were gathered from each student via on‐line learning journals, reflection lines and pre/post experience interviews. Data were analysed, between and within cases, to develop a sense of progressive narrative through the experiences made significant by each participant over the
course of the clinical experience. An abductive logic was applied to develop a more theoretical explanation of learning as participation in clinical practice for each participant.

The study concludes that these individuals adopted an agentic approach and recognised the benefit to their learning of proactively seeking opportunities to get involved in practice. Interaction with a range of co‐participants was valued, for a variety of reasons. Students were more willing to discuss their own deficits and ask questions of junior clinicians. Interactions
with senior clinicians were more likely to challenge and extend the students’ practice. Interactions with non‐physiotherapy colleagues in the multidisciplinary team were valued for the different perspectives they offered. Students valued participation in situations where they
could assume greater responsibility, as long as their efforts were recognised by the clinical educator. Participants did not always see value in “routine” practice where there was little opportunity to be involved in decision making or discussion, describing their involvement as being “an extra pair of hands”.

Participants described their performance of secondary Discourses of practice in the construction of their respective identities, which I describe as productive worker, trustworthy student, engaged student and junior professional. These Discourses supported participants’
bids for recognition and progressive involvement in communities of clinical practice. However,
where the participant identity was associated too strongly with a particular Discourse the educator could restrict access to learning opportunities. Participants dis‐identified themselves from Discourses that conflicted with individual habitus and conveyed lack of care or unethical behaviour. Where power relations challenged the possibility of overt rejection, participants were strategic and excluded these Discourses from their future, rather than current repertoires.

At the start of their early clinical experience, participants expressed a desire to “learn by doing” and “learn on the job”. These cases demonstrate that even at an early stage of experience, participants were contributing to the productivity of the workplace and they felt
valued when their contributions were recognised.

These cases demonstrate that mutual relations support participation but require ongoing negotiation. Considering mutuality as a mechanism for participation in early clinical experience can support analysis of the ways in which social relations support both learning and work
objectives. Mutuality as a mechanism for participation requires the learner and educator to recognise these dual objectives. Changing conditions of practice can threaten mutuality. Where a threat occurs, it is countered by adaptive practices that continue to support mutuality
in terms of engagement, repertoire and enterprise with the community of clinical practice.

Item Type: Thesis (Doctoral)
Schools and Departments: School of Education and Social Work > Education
Subjects: L Education > LB Theory and practice of education > LB2300 Higher education > LB2371 Graduate education
R Medicine > RM Therapeutics. Pharmacology > RM0695 Physical medicine. Physical therapy Including massage, exercise, occupational therapy, hydrotherapy, phototherapy, radiotherapy, thermotherapy, electrotherapy
Depositing User: Library Cataloguing
Date Deposited: 31 Jul 2014 09:43
Last Modified: 24 Sep 2015 14:53
URI: http://srodev.sussex.ac.uk/id/eprint/49396

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