Who determines clinical placement capacity? Understanding the historical, social, and political context using Foucault's critical discourse analysis.

Abstract

Securing sufficient placement opportunities for healthcare students has been an internationally well-documented, long-standing, challenge. Creating placement opportunities is vital to addressing workforce shortages to meet healthcare needs. Previous studies have primarily focused on investigating different clinical placement models, lacking focus on the perspectives of those in leadership. The aim of this study was to understand the broader influence of power within organisational decision making for occupational therapy clinical placements. Foucauldian critical discourse analysis was employed to explore the placement problem from the context within which it is situated. Data collection included: interviews and focus groups with occupational therapy education leaders, and the creation of an archive of text. Foucault discourse analysis included extracting data from transcripts; analysing statements and extracting data from archive documents that support, or contradict, participant discursive statements. The three dominant discourses identified were: student education is an opportunity for personal gain; student education is an expectation; student education is beyond capacity. This research demonstrates the complex interplay of historical, social, and political forces that shape organisational decisions around student placements in the Australian health system. National and state-level policies have the potential to drive systemic change and foster a culture that values and invests in student clinical education. Attention to the top-down drivers that empower organisations with facilitatory structures and incentives, cannot be overlooked when securing the future of clinical education and workforce development.