Physiotherapy students’ conceptualisations of clinical communication: A call to revisit communication in physiotherapy education

Article accepted

This article has been accepted for publication. Peer reviews and author responses are available at the end of the article.


Background: Communication is fundamental in collaborative physiotherapy practice. Students develop understandings of what constitutes ‘good’ communication through the formal, informal and hidden curricula. Understanding how students understand communication and how this is influenced by the curricula can help educators consider how best to enhance communication knowledge and skills. Aim: This study explored how physiotherapy students conceptualised clinical communication. Methods: This study was underpinned by a social constructionist epistemology. Data consisted of fifteen assignments, completed by students as part of their coursework. Assignments were analysed using the Listening Guide which prompted attention to how the different ways students understood communication and how these understandings were constructed. Results: Communication was understood as uni-dimensional. It was presented as an act done to the patient by the physiotherapist, with little attention to the patient’s communication and involvement in the interaction. Through communication, physiotherapists demonstrated and reinforced their expertise while simultaneously positioning the patient as the recipient of care and knowledge. Conclusion: Understandings of communication reflect broader constructions of physiotherapy and the role of the physiotherapist. These also reflect tensions in the curricula. Enhancing communication in student education requires all parties to understand, value and critically reflect on how communication is constructed and enacted.


General comments:

An interesting article which created curiosity from the start on. Currently an important topic in both the clinical as the educational field. The article emphasizes on contemporary perspectives, opinions, paradigms and also dilemmas occurring in clinical communication and the training of clinical communication. As such the article will be of assistance for existing and developing University physiotherapy programs.

Still I have some suggestions which might be helpful. Hope these suggestions might be of help to enhance the readability of your article.


Clear and good understandable.


The introduction provides a logical structure through the different elements and connecting arguments. The arguments and statements are placed in context and supported by sources. Within the text it seems a prevalence towards a direction of preferred interprofessional communication is tangible, though this stays implicit. It might be useful, to consider of a preferred position is taken and as such to be more open and explicit about your position. This will help the reader, by understanding the lens through which this article is written.

The last paragraph briefly states the purpose and goal. This might be elaborated by placing the exploration more into context as is described above and in the below chapters. Specific it might be of importance to state how the concept of learning is used within this study. Especially cause “learn” is explicitly stated in your title. Also, the connection to the specific course discussed below might be important as a relation between the “learned” and “taught” is drawn. The following text reads as a summary and feels a bit odd in this place. Furthermore, the stated findings, arguments and suggestions are difficult to connect at this point. The context, audit trail and findings are not presented yet, which makes it hard to follow the described conclusion.

Methodology and methods


Helpful to start by stating the paradigm and approach of your methodology, it sets the lens for the reader. Also, an interesting and appropriate methodology in relation with the explored question. As the “Voice Centred Relational Methodology” is not a commonly used methodology, it might be useful for the reader to provide more explanation. Especially the concerning choices you made within this study. This will help readers to follow your progress trail.

Research context:

The described context is mostly stating a specific course and its content. It would be interesting to highlight why this context helps to explore what students learn, or being taught, about communicating in general, in contrast to and to distinguish between what have they gained from this specific course.

In the introduction a sophisticated view on interpersonal communication was given. It might be interesting to describe in an even sophisticated manner what educational approach was used and in which educational paradigm the described course was constructed.

Recruitment and participants:

The recruitment process is clear and clearly described. It might be of interest to provide more background information about the participants and the physiotherapy program they follow.


Within this paragraph the reflection was selected as data input for the study. It might be interesting to elaborate your choice and argumentation for this product. Even so, it might be interesting to elaborate if an ambiguity might exist between an open reflective account of one’s own believes versus a reflective account biased by assessment criteria. Perhaps an appendix might be added with a course description and assessment criteria


The findings are clear and well written. The findings are underpinned with quotes and the line of thought, logic and consistency are easy to follow.


The discussion creates a sophisticated context for the findings. A link between teaching, learning and pedagogy is established. Some interesting questions are raised within the discussion which will help progress and deepening the topic of communication in health and physiotherapy.

I want to thank you very much for sharing this interesting article. Looking forward to seeing more in the future.

General comments: It was a great pleasure to review this article. I find the article both very useful for educators, as well as for practitioners as it touches upon the link between learning in university setting and clinical practice. Furthermore, the article includes updated references and a solid argumentation enhancing the quality of the article. Below I will outline a few suggestions to improve the clarity of the article and make specific concepts more understandable to a general physiotherapy population.


Generally, well-written abstract.


The introduction covers the main literature on the topic of communication in physiotherapy practice, including practitioner-centred vs transactional approaches. It reviews articles within the context of physiotherapy curricula and identifies a lack of studies describing how physiotherapy students understand communication.

However, I would have liked to see a more detailed argument regarding the advantages and disadvantages of different approaches to investigate students’ conceptualisation of communication skills with regards to students’ ‘actual communication skills’.  What do we know about the process of learning in order to benefit from “reflecting about communication skills” to enhance communication skills?

Methodology and methods

Methodology: The article describes clearly the ontological and epistemological assumptions underlying this qualitative study. Being unfamiliar with the “Voice-centred relational methodology” and “Listening guide”, I would have liked to get more information regarding this approach. This information could be in included in a table highlighting the main ideas, or in an Appendix.

Research context: Could you explain more about the “tools for reflecting on communication” (p.4)? These tools seem relevant and closely linked to the objective of this study and would help the reader understand the context better.

Recruitment and participants: As I am not aware of the higher education system in New Zealand, I would appreciate an overview of the student population. What is the students’ age range, educational history, gender proportion, etc?


The findings are clearly explained and illustrated with quotes. I only have a minor comment regarding the presentation.

Presentation of quotes: I was not quite sure about how to understand the numbering: does #02 mean that this is coming from the second assignment? There is a number in brackets in the document, but it is unclear what the [1] means – this needs to be clarified. Personally, I find it easier to follow the argument if quotes are presented separately (as done with #6 and #01 on page 7).


The discussion puts the results in the context of the current literature. One point that might require more attention is related to the tension between formal, informal and hidden curricula: how could we enhance critical reflexivity within a school of physiotherapy? Do you have any suggestions?

Thank you very much for this very interesting article. I look forward to seeing more discussion on these topics in the future.

Communication is one of the core competency in most health professions education therefore this article is relevant.



  • The literature around interpersonal / transactional communication is extensively covered however it would be useful to explore or reference clinical communication as this widely covered in other discipline. Defining it , highlighting differences ( if there is) with transactional communication taught in this particular curriculum
  • Rephrasing of first line/sentence of last paragraph (page 420)
  • Inclusion of background of content of communication, teaching strategies & assessment would assist to understand and follow purpose of study (more detail than in research context)


  • Include brief description of social- constructionist
  • Research Context: – detail of how communication is taught from first to final year


  • It appears that the purpose or requirement of the assignments included a wide range of elements other than communication. This definitely impacts on the analysis of the data, the quality of the data as well as the relevancy of using this assignments as data-source.
  • There appears to be disjuncture between the research question/aim & the data-source
  • In addition, the learning outcome of the communication course is not aligned with the requirements of the assignment


  • It would be valuable to explore the students’ clinical experience/exposure to patients or clients and how this impacts or affect their perception of communication and role of physiotherapist


  • The link between the findings and discussions is not clear
  • It is challenging to follow clear issues highlighted in findings
  • It is long, new issues and literature included without linking to introduction or findings.

General comments

  • I would suggest that fewer issues to be included, ‘streamline’ issues
  • Focus only on communication and communication strategies, exclude national codes of rights, complexities of practices, etc





Amendments made to this article following review

We have made a number of revisions in response to reviewer feedback:
1. Changing the title to better reflect the focus of the paper
2. Addressing the role of reflection in learning, and the benefits and challenges of using reflection as a form of data
3. Providing more information about the methodology
4. Providing more information about the research context, including the specific learning outcome being assessed (Appendix 1)

Conflict of interest statement

No conflicts of interest to declare.

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