JCPSLP Vol 23 No 3

to more patient involvement, similar to the extant literature (Gutteridge & Dobbins, 2010; Sharma, 2018). Themes from the focus groups supported and expanded on survey responses. In an ideal world, tãngata whaiora would be integrated into clinical courses and students would be immersed in the patient experience across a course, not just as a one-off. Patients would be supported to understand the academic perspective and the student journey through a particular course. Time for developing a program, and support from colleagues and the institution were seen as barriers to this occurring. Time constraints from the institution resulted in frustration and stress for all concerned. Major institutional barriers are documented extensively in the extant literature (Towle & Godolphin, 2011). To change this, developing relationships should be a professional and institutional priority (Regan de Bere & Nunn, 2016). The tãngata whaiora involved in the focus groups reported limited involvement in the direction of their own health care and some wanted a more active role. Initial discussions focused on their own negative health care experiences and the changes that are needed in the curriculum of health care students to address these negative experiences, in particular, how to build authentic relationships, cultural competency and empathy. The focus groups patients clearly stated that they are not content experts but they are experts in their own experience and they valued being seen as individuals within a health care professional/tãngata whaiora relationship. In order for tãngata whaiora to fully adopt a more active role their own health care, relevant information and knowledge regarding their own health must be conveyed sufficiently through competent communication (Dijk et al., 2020). Communication must consider the cultural communication style of the patient as well as the accurate content of the information being provided. This equips them with knowledge to provide relevant feedback to students, as well as to confidently make decisions regarding their own health. Clinical educators likewise expressed that patients needed competent communication to successfully communicate with students about their performance. Tãngata whaiora expressed disappointment in the lack of empathy and rapport with health care professionals and students. Such barriers to developing rapport made working with clinical educators and students less meaningful. Clinical educators in the focus groups were protective of their students, indicating that when students are early in their practice, and are nervous, they are more focused on their own performance and less able to be empathetic. Patient involvement over time is shown to develop student empathy (Gordon et al., 2020). An overt focus on establishing collaborative relationships between students and patients within the clinical curriculum could enable them all to feel more comfortable. leading to a better outcome for both parties. It was evident that understanding the culture of active tãngata whaiora involvement in clinical education was a challenge for all. From the clinical educators’ perspective, it was difficult to orchestrate a shift to a more tãngata whaiora involved practice when they could not envision how it can be accomplished without sacrificing other programmatic requirements. Clinical educators recognised it would be beneficial for students, but felt sceptical and hesitant. Active involvement of tãngata whaiora in clinical education curriculum was not a pre-existing vision but perceived as idealistic. Tãngata whaiora demonstrated

some initial difficulty in solidifying the newly introduced concept of active tãngata whaiora or tãngata whaiora-led programs, which meant identifying potential challenges and opportunities was not easy. Patient involvement is shown to develop empathy, communication skills and patient-centred skills in students (Gordon et al., 2020). It is disappointing that despite ten years of evidence, we are still not seeing educational practices and curricula in NZ reflecting what has been widely accepted knowledge and best practice. Findings here are consistent with a colonising approach to clinical education (Sharma, 2018), and true partnership will involve a deliberate, reflexive effort on the part of clinical educators and their institutions. While this study highlights how patients continue to play a mostly passive role in clinical education in NZ, we are assured that there is interest in moving into such a space in the future. Clearly some survey respondents and group participants are hopeful of a move towards a partnership-based approach to education. We assert that a model or approach to working together is required based on partnership between tãngata whaiora and tertiary health care programs to guide the future of this work. Limitations We felt “tãngata whaiora” was an inclusive term describing a person who is actively seeking health (Ministry of Health, 2000). Yet, some survey questions may have been interpreted as relating only to Mãori consumers of health services as opposed to all service users. In future, we hope the general development of health professionals and educators in key aspects of Mãori worldview will have expanded to a more common understanding of such terminology. It is possible that there are some good practices happening in NZ, but we were not able to identify them, suggesting an alternative recruitment process should be considered in future. While a low number of clinical educators were involved in this project, this ratio between tãngata whaiora and clinical educator could be viewed positively from an equity lens to ensure we capture the voice of tãngata whaiora. Recommendations We propose a patient involvement framework be created that guides clinical education programs to work with tãngata whaiora to design, develop and deliver quality curricula to health care professional students in NZ. This framework should be built on the premise of partnership, with the voices and experiences of tãngata whaiora at the centre. Further to this, a definition of the roles and spaces of each party, being tãngata whaiora and educational institutions, is required in order to define and understand where responsibilities lie and to make expectations clear. This may involve deconstructing narratives which exist around who holds power in this relationship. Partnership is understood as a relational construct which requires those involved to work mutually. It is reciprocal. The process is less prescriptive and therefore less predictable than other frameworks or approaches. It is our hope that this approach, once further developed, will become the norm, defining the way we train and educate future health care professionals in NZ. Conclusion The results of this study highlight the current passive role tãngata whaiora have in the education and development of

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JCPSLP Volume 23, Number 3 2021

Journal of Clinical Practice in Speech-Language Pathology