Criticality

In the light of trying to understand factors contributing to, what I would argue as being, the almost static position of disabled students in healthcare education, during the analysis, I approached participants’ accounts critically to focus on the (re)production of dominance and the exercise of social power by institutions and groups that can result in social inequality (van Dijk 1993). This led me to think about pedagogical interactions being influenced by embedded notions of ‘client as disabled’ and ‘therapist as non-disabled’, this being unconsciously believed and practiced because of habit and culture.

Within the NHS and HEIs there are pre-existing hierarchies and structures; the processes and discourses associated with these will influence people’s conceptions and experience. Critical disability theory, which has emancipation as ‘its cornerstone’, views society as basically unjust and disabled people as undervalued and discriminated against, so revealing a need to expose the power dynamics involved in these types of hierarchical social

relations (Meekosha and Shuttleworth 2009). Arguably, in relation to this study, there are important elements that lead to a pattern of situated physiotherapy professional practices with regard to disabled students. Societal practices concerning disability that continue to be structured around an able-bodied framework (Meekosha, Shuttleworth and Soldatic 2013), the medicalised context of the NHS, often reductive biomedical physiotherapy practice (Eisenberg 2012, Nicholls and Gibson 2010) plus the relatively powerless position of the student (Baird, Bracken and Grierson 2016, van der Zwet, de la Croix, de Jonge et al

76 2014) with or without disability. Individuals often inhabit relatively different positions which may be unequal; this inequality is socially constructed within specific historical conditions.

Extensive literature relates to students in HE studying vocational programmes and some focuses on disabled students generally. Little attention has been given, however, to the ways in which being immersed in a biomedical healthcare educational setting might influence the behaviour of, and relationships between, medical educators and their disabled students in the clinical environment. The situation is universally regarded, however, as one of difficulty, anxiety and stress for both educators and students (Adams and Brown 2006; Carey 2012; Opie and Taylor 2008; Ryan and Struhs 2007).

5.2.1 Absence

Absence is a concept in which everything is in part defined by what is not; arguably information and policy will be skewed by this absence. Along with other marginalized groups the voices of disabled people are absent in much of the research that relates to them, and yet they are crucially involved (Alderson 2013). Recognising this and

understanding disability as a diverse social construct and set of beliefs and behaviours, opens up possibilities for exploration. It is important to acknowledge the significance of disability in expanding the boundaries in critical sociological thought that continue to be structured around an able-bodied framework (Meekosha et al 2013).

5.2.2 Emancipatory?

While not emancipatory in the sense of including disabled people within the research itself (an absence that is noted) it is intended that this work may ‘disrupt’ some of thinking of practitioners in clinical settings in relation to working with disabled students. It may enable them to begin to be differently informed and provide possibilities to think in other ways in relation to their practice. If a better understanding of the social processes of disability knowledge can be articulated this could lead to critical reflection on the application of theory to practice aimed at emancipatory courses of action (Gable 2013). This could change or inform physiotherapy professional practice.

Considering the educators

Another notion of emancipation that can be deployed here is that of the position of

practice educators themselves. As noted they are embedded within pre-existing hierarchies and structures which may effect their conceptions, experience and ‘ways of being’. As

77 discussed in section 2.4.3 they must also contend with wide ranging pressures and could be perceived as entrapped within the interrelations, organisational behaviour and power structures of the NHS. It may be the case that problematisation of consequent taken for granted assumptions (here, relating to disability/disabled students) could pose them as a challenge to consider, allowing new viewpoints and ideas for possible action to emerge. This process might enable recognition of the existence of these issues, encouraging educators and disabled students to enter into dialogue about these assumptions and ways of being.

5.2.3 Using ideas from Bourdieu as a lens

Bourdieu was interested in ways in which society is reproduced and how dominant groups maintain their positions. He examined the intricate interrelations between agency,

structure and culture in many of his works exploring how “subjective and objective

structural and cultural resources, processes and institutions maintain individuals and groups in competitive and self-perpetuating hierarchies of domination and oppression” (Bryne 2014,121). His work has been deployed in disability theory to move beyond the reductive conceptions of the medical and social models of disability to consider how the concept of habitus might offer a way “of bringing an analysis of the body to bear upon an

understanding of the social inequalities which are core to the lives of disabled people” (Edwards and Imrie 2003,241).

The following section briefly introduces the elements of Bourdieu’s (1977) social theory of practice and explores how these ideas might be useful in viewing, understanding and challenging the world of educators and their relationships with disabled students in the placement setting. These ideas proved of value in coming to understand participants’ accounts regarding the broader contexts of their professional practice.