JCPSLP Vol 23 No 3

Creative clinical education

Exploring perceptions of involving tãngata whaiora in the education of health care professionals in New Zealand Anton Spelman, Nadia Mantell, Shinhee Song, Philippa Friary, and Bianca Jackson

Patient involvement in clinical education promotes the learning of client-centred practice. This study explored how tãngata whaiora (persons seeking wellness) are involved in the entry-to-practice education of health care professionals in New Zealand (NZ). Barriers and facilitators to active patient involvement in clinical education were explored. This study was designed by two post-graduate students, two clinical educators and a tãngata whaiora. Twenty educators from NZ health care programs completed an online survey. Three focus groups were conducted for tãngata whaiora, clinical educators and mixed. Themes were identified that expanded on survey responses.Content analysis of survey responses suggest the role of tãngata whaiora is mostly passive. Tãngata whaiora are minimally involved in curriculum design and governance. Focus groups participants all recognised challenges in partnering more, yet were willing to discuss new approaches to clinical education. With appropriate support, the shift from passive to active tãngata whaiora involvement in clinical education is possible. For patient voices to be heard in clinical education, a framework that can truly reflect a relationship-based approach is required. T he active involvement of patients in entry-to- practice clinical education has become less radical and more widely accepted in both research and educational spheres (Spencer et al., 2019). The dynamic and shifting role of service users in the modern health care system is appropriately reflected in the Mãori term tãngata whaiora (“tan-ga-ta fie-or-ra”) . This term highlights the autonomy and independence of individuals seeking well- being in health care and its use is consistent with the NZ government cross-agency commitment to the use of te reo Mãori (Mãori language) in public services (Ministry of Health, 2000).

Partnership between clinical educators and tãngata whaiora 1 is increasingly seen as essential in producing qualified health professionals that are truly client-centred in their practice (Dijk et al., 2020). Existing understandings differ as to what patients’ roles are within curricula, whether this be a passive, bedside learning role or an active patient-as-teacher role (Rowland et al., 2019). The involvement of patients is on a continuum, ranging from full partnership with institutions of education and involvement in the development of curriculum to being solely tokenistic in nature (Towle & Godolphin, 2011). This continuum or Ladder of Involvement from Canada highlights the diversity of patient involvement in clinical education and contrasts the degree to which patients are actively involved in learning encounters with elements of time, autonomy, planning and institutional commitment (Gordon et al., 2020). Benefits to tãngata whaiora have been widely reported (Gordon et al., 2020; Regan de Bere & Nunn, 2016). These benefits include satisfaction from helping others, feeling more informed about the health care system and one’s personal health (Spencer et al., 2019). Also, tãngata whaiora develop empowerment and ownership over one’s own illness narrative (Scott et al., 2012; Towle et al., 2010). Moreover, patients experience increased self-esteem and confidence through the process of supporting student education (Scott et al., 2012). Students recognise the expertise and resourcefulness of patients, develop empathy and recognise cultural diversity and lifestyle factors (Spencer et al., 2019). The incorporation of “patients as teachers” can be challenging as it questions traditional hierarchical and cultural power dynamics which place the health professional as the expert (Sharma, 2018; Towle & Godolphin, 2011). Patients can feel unqualified to be involved as teachers and educators might discover new understandings of their roles with patients and students (Friary et al., 2018). The majority of existing studies are from the UK, Canada, and USA, with these countries making substantial commitments to patient involvement in clinical education (Regan de Bere & Nunn, 2016). In Oceania, organisations such as Speech Pathology Australia (n.d.) and the Australian Medical Council have committed to reciprocal learning between health professionals and patients (Dijk et al., 2020). However, little is written about the role of patients in entry-to-practice education in Oceania and more specifically within NZ. The aim of this study is to explore the ways in which tãngata whaiora voices and experiences are

KEYWORDS CLINICAL EDUCATION PATIENT INVOLVEMENT CO-DESIGN ALLIED HEALTH THIS ARTICLE HAS BEEN PEER- REVIEWED

Anton Spelman (top), Nadia Mantell (centre) and Shinhee Song

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JCPSLP Volume 23, Number 3 2021

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