Making practice education visible: Challenging assumptions about the patient's place in placement environments

Background/aims: Reviews of high-profile scandals in healthcare challenge health professionals to put the patient first in everything they do, including in the education of students. This paper focusses on learning in placement settings and, adopting a social perspective of learning, questions whether the rhetoric of patient-centred professional education is visible in the learning activities that students enact. Methods: Informed by interaction and workplace studies, this study comprised an ethnomethodologically-informed ethnographic observation of physiotherapy student placement education in two hospital-based settings. The study followed six final-year students for two full days each as they undertook their everyday placement activities with their 28 educators and their patient workload. Using a novel notation system combining field notes and proxemics sketches, this study makes the minutiae of naturally-occurring, student-present interactions visible. Findings: The results suggest that physiotherapy placement education interactions, which the educator, the student and the patient coproduce unquestioningly, frame patients as person-absent audiovisual aids to learning. Conclusions: This paper illustrates the use of a new method to develop evidence-informed discussions about the rhetoric vs. the reality of patient-centred care in health-care education interactions. Studying interaction practices throws light onto previously unnoticed and unquestioned habits and norms in professional practice.