Physiotherapy student practice education: Students’ perspectives through Cultural-Historical Activity Theory

Abstract

Physiotherapy student practice education, the focus of this thesis, is a highly valued, yet scarcely researched component of pre-registration physiotherapy education. Moreover, the student voice is largely absent from existing research. In this study, 14 physiotherapy students’ perspectives of practice education were gained through email communications (n=13) and face-to-face interviews (n=12). To provide an in-depth and provocative view, physiotherapy student practice education was analysed as a type of activity system, employing concepts borrowed from cultural-historical activity theory (CHAT). Interacting activity systems, objects, players, rules, norms, divisions of labour, mediating artefacts, intra- and inter-systemic contradictions were explored and identified. The findings show that assessment skewed students’ object motives. Practice educators were positioned as powerful gatekeeper/assessor gift-holders. Physiotherapy students enacted ‘learning practice’ norms, such as extensive reading, and adopted the position of practice educator-pleaser. Students sometimes refrained from speaking when they wanted to, for example, to challenge unprofessional staff behaviour. Students were reluctant to show themselves as learners, feeling instead that they needed to present themselves as knowledgeable, able practitioners. However, students did not easily recognise themselves as able contributors to practice. For students, knowledge for practice was focussed on patient assessment and treatment, but the level, depth and volume of knowledge required was perceived differently across distinctive practice areas. Intra- and inter-systemic contradictions, such as the skewing of student object motives towards assessment, and away from whole-patient-centred care, are highlighted. The study findings therefore have implications for patient care as well as for the object of physiotherapy student practice education, student learning and assessment and workplace learning. A cross-profession review of the object of physiotherapy student practice education, to include the voice of service users, students, practice educators, HEIs and service providers, is recommended. A review of physiotherapy student practice-placement assessment, which seemed to be at the core of PSPE dynamics and conditions, is recommended, to take account of the extent to which assessment can influence students’ PSPE object motives, PE/student dynamics and student/patient interactions. Developmental Work Research is proposed as a way forward for future research in this area.