JCPSLP Vol 23 No 3

the three meetings, initial themes were identified by student researcher and reviewed by the team to reach a consensus on the name, description and relevance of each theme. Quotes presented here exemplify the findings and are from the notes taken in the groups, not verbatim transcriptions. Results Survey Respondents were 20 clinical educators representing 11 different medical and allied health professions teaching courses including medicine, midwifery, nursing, health science, clinical psychology, audiology, and physiotherapy. A majority had more than 10 years ( n = 17) experience teaching within health care professional programs at tertiary level. Participants were involved in teaching both undergraduate and post-graduate level courses located in cities with universities in NZ, the majority being located in Auckland ( n = 8), Waikato ( n = 3) and Wellington ( n = 2). How do students meet tãngata whaiora? Multiple responses were allowed. Largely, students met tãngata whaiora in a passive role ( n = 34), through clinical placement ( n = 18) and simulated exercises and scenarios ( n = 5). Active roles taken included guest lecturing ( n = 11), tutorials and workshops ( n = 9), clinical assessors during clinical placement ( n = 6) and as research partners ( n = 5). Students also met tãngata whaiora in mentorship roles ( n = 4) and at institution social events ( n = 5). Two respondents said tãngata whaiora shared their experiences with students by “providing their stories” and “video interviewing them and asking questions posed by the students”. Seven responses indicated that tãngata whaiora do not participate in active or direct teaching: tãngata whaiora operated in a passive role as “participants in research projects”, or “purely as a client”. Overall, responses indicate limited involvement. How are tãngata whaiora involved in the design, development and delivery of curriculum? Eight respondents indicated that tãngata whaiora had no involvement in the design and development of health care curriculum. Others involved patients to varying extent at a micro level such as consulting about a particular subject, “we engaged with tãngata whaiora for specific information on the condition that they were living with”. Four respondents indicated patients were members of an advisory group. Are there any barriers to working alongside tãngata whaiora? Funding and access were most commonly reported as the biggest barriers to tãngata whaiora participation: “getting enough clients to meetings”, “access to clinics” and “ability to provide an appropriate koha [offering]”. Time was also a barrier: “time to organise, time to include them [tãngata whaiora] in the curriculum”. Three respondents identified a lack of adequate systems and processes being in place: “processes around consent” and “knowing who to approach to ask sensitive information about either clients or students that may arise”. Three respondents identified institutional barriers “stigma” and “staff attitudes” such as tãngata whaiora having “lack of academic insight” and “only personal experiences, lacking a bigger overview”. The roles of tãngata whaiora in an ideal world Of 12 responses, five spoke about the potential role being “inclusive and immersive”, “integrated”, “active and engaged” and tãngata whaiora being seen as “colleagues

used in the clinical education of health professionals in NZ and to explore the perspectives of clinical educators in NZ and implications for the health care curriculum, evaluation, and governance. Method Design Co-design is an approach that involves research in partnership with stakeholders (Bate & Robert, 2007; Goodyear-Smith et al., 2015). In this manner, end-users and those impacted by research are involved from the outset, in design and implementation of the research. As such, the team consisted of students (NM, SS), tãngata whaiora (AS, in addition to a wider stakeholder group) and two clinical educators (PF, BJ). Both NM and AS identify as Mãori. Reflexive journaling was completed throughout. The initial phase of this project involved an online survey, followed by three focus groups, which are reported here. Ethics approval was granted by University of Auckland ref 022760. Survey procedure Survey invitations were sent to clinical directors of 60 health professional programs at tertiary level in NZ. The programs identified included medicine, nursing, and a wide range of allied health programs. The survey link was also made available via the social media pages of the researchers. Survey questions focused on the ways in which tãngata whaiora are involved in the design, development and implementation of curriculum, how they meet students, and barriers to patient involvement in clinical education (available from the author). The online survey in Qualtrics was open for six weeks with one reminder sent. A pilot survey was trialled with three teaching colleagues from the faculty to ensure clarity of questions. Survey analysis Quantitative questions were constructed with predetermined responses, based on theorising from prior review of the extant literature. Responses were tallied for each possible response and bar graphs were produced for analysis and interpretation. Qualitative questions were used to gain narrative data. Content analysis was used to determine the main responses to specific questions. Initial analysis of the data was completed independently, then discussed among the research group until consensus was reached. Focus groups procedure Email invitations were sent to clinical directors of health programs in one university in Auckland. Email invites were also sent to all clients on the research registry of the same university clinic. Three face-to-face focus groups were held: one for tãngata whaiora, one for clinical educator, and a combined group of tãngata whaiora and clinical educators. During the open discussions among the focus group, SS and PF gathered data by note-taking in the room. Each focus group was 90 minutes long and led by AS. A summary of each group, recognising the key concepts discussed, was sent to participants immediately after the researchers debriefed together. The third group built on earlier groups, by first summarising the prior discussions and then considering ways forward together. Focus groups analysis Data from focus groups was analysed using inductive thematic analysis (Braun & Clarke, 2014). Using notes from

Philippa Friary (top) and Bianca Jackson

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JCPSLP Volume 23, Number 3 2021

Journal of Clinical Practice in Speech-Language Pathology