Construction of the client in physiotherapy student's practical learning sessions: a discourse analytic study

In recent years, there has been a tendency to stress the active role and equal partnership of clients in social and healthcare. Moreover, research in the role of clients has attracted growing interest. Clinical education has been seen as an excellent arena for learning the distinctiveness of the interaction between the client and the professional physiotherapist by giving students the chance to participate in actual healthcare encounters. This study focuses on examining the construction of various client roles through interactions between participants in practical learning sessions that physiotherapy students took part in. These sessions were real professional physiotherapy encounters. Qualitative discourse analysis was applied to 12 videotaped practical learning sessions and four constructions of the client were identified. These interpretative repertoires were named according to the client's role in the interaction as ‘receiver’, ‘executer’, ‘participator’ and ‘fellow’. The identified repertoires represented the multi-dimensionality and contradictory construction of the client during sessions where two professionals differing in knowledge and skills worked together. Although the professional appeared to play a dominant role in constructing the client role, the client's eagerness to participate was also significant. Extrapolating from the study, we suggest that in aiming to enhance student understanding and practice of patient-centred physiotherapy, clinical educators should be aware of the interactional practices through which the participation of the client can be supported.