Capital Sharing and Socialization in an Interprofessional Student-Led Clinic: A Bordieuan Analysis

Capital Sharing and Socialization in an Interprofessional Student-Led Clinic: A Bordieuan Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Capital Sharing and Socialization in an Interprofessional Student-Led Clinic: A Bordieuan Analysis Chris Roberts, Priya Khanna, Annette Burgess This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3262907/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Feb, 2024 Read the published version in BMC Medical Education → Version 1 posted 10 You are reading this latest preprint version Abstract Background Interprofessional student-led clinics provide valuable settings for authentic clinical experiences and collaborative patient care. However, there is a lack of theoretically informed research to optimize the factors impacting the sustainability of these clinics. This study aimed to address this gap by exploring the dynamic relationships between students and patients in a co-creating student-led clinic for individuals living with Parkinson's Disease, using Bourdieu's theoretical framework. Methods The teaching focussed clinic was established in 2018 to emulate a clinical service. Semi-structured focus groups with participants (20 students from 5 disciplines and 11 patients) were conducted to gather in-depth insights into their clinic experience. A thematic analysis was guided by Bourdieu’s concepts of field, habitus, capital, and power. Results Our findings suggests that the student-led clinic emerged as a complex field intersecting with a patient support group, an aged care facility, and university-based healthcare disciplines. We developed three broad themes: Fostering students’ disposition to interprofessional care, Capitalizing on collaboration and empowerment and Culture of mutual capital exchange. Students and patients developed specific dispositions which enriched their habitus, by focused on meeting shared patient well-being goals. As participants engaged in interprofessional collaborative practice, they brought different forms of capital to the clinic. Social and cultural capital was exchanged among students, fostering trust and respect for disciplinary expertise and professional boundaries. Students gained cultural capital, acquiring interprofessional knowledge about and with patients. In a culture of mutual trust, patients felt empowered through their symbolic capital, investing in students' learning and recognizing the importance of their own well-being goals within the collaborative setting. Conclusion The findings highlight the collective symbolic power of the interprofessional student-led clinic, where the recognition and exchange of valued forms of capital among participants fostered student learning and enriched the habitus of both students and patients. Valuing and sharing different forms of capital other than economic, such as social and cultural capital, contributed to optimizing the participants' clinic experience. These insights can inform the development and sustainability of interprofessional student-led clinics, emphasizing the importance of mutual trust, respect, and shared goals between students and patients, and educators. student-led clinic student -delivered patient outcomes interprofessional education medical education social capital cultural capital interprofessional practice Figures Figure 1 Figure 2 INTRODUCTION Student-led health clinics have emerged as valuable interprofessional activities that offer unique opportunities for students, patients and educators. These clinics provide an authentic experience of collaborative patient care, allowing participants to contribute their diverse levels of knowledge, skills and behaviours [1] [2] [3] [4]. Despite the increasing recognition of the importance of Interprofessional Education (IPE) globally [5, 6] and a growing literature regarding the benefits of IPE [7], implementing educationally impactful but resource-intensive activities remains a challenge [8] [9]. Whilst the existing research has identified the opportunities and barriers for sustaining student-led clinics in various contexts, further theoretical understanding is needed about the underlying mechanisms that sustain conditions for interprofessional and collaborative practice to flourish [10]. This issue is of critical concern because the implementation and sustainability of IPE heavily depend on educational and practice settings that are predominantly uniprofessional, with medicine often dominating the prevailing culture and structures of training [11]. In order to facilitate change, IPE educators need to find ways of co-creating student-led clinics in complex healthcare and educational settings. An opportunity to explore these issues arose when a student led clinic was established as a collaboration between healthcare faculties within a research intensive university, an aged care facility within a secondary health care provider, and a patient support group. Implementing and sustaining student-run clinics is influenced by several factors including economic, political, social-cultural, physical, and technological. Funding for student-led clinics is complex and influenced by various enablers including healthcare funding models, faculty volunteerism, strong partnerships with community organizations and stakeholders and well-developed business plan outlining goals and financial projections. [12] [13] Conversely, barriers include lack of funding availability and limited experience in fundraising and financial management, preferences to work within one’s own disciplines, logistical issues such as timetabling and space allocation, availability of trained facilitators or supervisors, lack of operational structure for delivering IPE activities, legal and insurance concerns around student clinical decision making, and patient recruitment and management. [14]. [15] [16]. In response to these challenges, student led clinics can vary from simulating authentic clinical practice, to service provision for underserved communities with funding often associated with the later [17, 18] [16]. Given the complexity of setting up a student clinic there needs to be a reframing of economic and resources arguments to put real value on what student clinics can bring educationally for students and enhancing health outcomes for patients. In this paper, we adopt a social theory lens to explore the mechanisms of interprofessional student learning when students and staff co-created an student-led clinic in partnership with people living with Parkinson’s Disease, a complex chronic neurological impairment. Research framework: Introducing Bourdieu’s field, habitus, and the forms of capital In understanding the dynamics of IPE in the educational and healthcare system, social theories that explore the relationship between structure and human agency are gaining prominence [19] [20]. Within the realm of IPE, student learning and patient experiences have been conceptualised as social activities within multiple communities of practice. [21] [22] Formal networking and collaboration opportunities for IPE during university can support students by promoting agency and maximising learning experiences within specific communities of teaching practice. [23],[24] including student led clinics. [3] [4] [25] Bourdieu's work stands out as a grand theory that addresses the interplay between practice structures and human agency, a key concern in social research. [26] [27]. Bourdieu’s theory of practice examines the opportunities and constraints in overcoming cultural domination and developing reflexivity, thus holding promise for understanding and optimising the conditions for change in IPE. [28] Bourdieu's framework revolves around three core concepts: Field, Habitus and Capital and their relationship with Power. Field refers to a social domain (e.g., family, school, sport, healthcare) with distinct roles, relationships, and practices that individuals become socialized into. Each specific field is distinguished by its objective relations, its agents and institutions and the specific logic of practice or “rules of the game”. [29] Fields coexist and overlap at various levels, with smaller fields nested within larger ones. Within a field, individuals vie for position, seek control over capital invested in the field, and may attempt to alter the rules. Habitus encompasses the durable and transposable dispositions of agents (individuals, groups of actors or institutions) within a social setting. [30] It comprises competencies, expectations, biases, and insecurities that develop and shape their aspirations and practices. Habitus sets the boundaries of agency and influences future choices and actions. Habitus is enriched with the capital which individuals acquire as they are socialised in various domains such family life, leisure, formal education, and work. [30] [31] Capital and Power: In addition to economic capital, Bourdieu (1997) describes three other forms of capital: social, cultural, and symbolic. Social capital encompasses shared norms, values, trust, networks, and social relations that facilitate cooperation and collective action. ” [32] It is influenced by an individuals’ social network, and the power within those networks. [31] Cultural capital is what one knows and what one has, for example possessing the ‘right’ kind of knowledge [33] Symbolic capital is acquired automatically upon entering a field and refers to the amount of prestige or honour derived from other forms of capital. Symbolic capital involves a good faith economy where capital exchange is based on mutual trust. [29] Symbolic power makes people see and believe in a certain vision of the world and directs them to act accordingly. Relationships between individuals depend upon the accumulation of symbolic power allowing an individual to impose their world view on others. [34] Bourdieu’s theoretical frameworks in IPE settings Bourdieu’s theoretical lens has been applied in both uniprofessional e.g. medicine [35] [36] [37], and interprofessional settings [38] [39] [40] to understand the conditions for changing the dominating cultures and complex relationships between field, habitus, and capital. Within the field of medicine, the dominant culture has traditionally emphasized technical clinical competence (cultural capital) over caring, which can negatively impact the habitus of medical students [35]. Conversely, in allied health, the relationships and interactions students experienced during IPE activities, was a major influence on enriching students’ habitus. [38] Bourdieu’s theory of social space (a mapping of individuals positions in the field) has been used in the context of how the ‘nurses’ station” on hospital wards promotes communication and teamwork for the provision of safe and quality patient care. [41] This paper aims to explore the mechanisms of interprofessional student learning within an IPE student clinic through the lens of Bourdieu's social theory. By analyzing the relationships between field, habitus, and capital and power, we seek to uncover the underlying factors that contribute to the co-creation and sustainability of an authentic interprofessional collaborative care environment. This research has the potential to deepen our understanding of how social inequalities manifest in clinical interactions and how addressing these inequalities can enhance patient-centered care in student clinics. Study Aim and Research Questions The research questions guiding this qualitative study were as follows: 1. In what ways do students’ dispositions to the clinic influence collaborative working? 2. How did patients express and influence their habitus and capital in the student led clinic? 3. What were the nature and forms of capital that were brought, exchanged and taken away by the students and the patients from the clinic? METHODS Setting and Participants The study took place within a student-led interprofessional clinic for people living with Parkinson’s disease. This has been described in detail elsewhere, [42] where 32 senior students and thirteen patients took part throughout 2018. In summary, the student clinic involved five health care disciplines (medicine, pharmacy, occupational therapy, physiotherapy, and speech pathology) collaborating with a patient support group and an aged care facility in local teaching hospital to provide a simulated clinic. It had been designed to emulate an existing multidisciplinary service clinic for people living with Parkinson’s disease, where patients had family doctors and access to relevant neurological services. In uniprofessional pairs, students rotated through four ‘stations’, spending 30min with each volunteer patient, taking a history and performing an examination. Their goal was to produce a collaborative management plan based around three personal well-being goals provided by the patient. The detail of the structure of the clinic is given in Table 1. Insert table 1 about here Data collection To explore our research questions, qualitative data were collected from three of the five clinics that ran in 2018. A total of 20 students (6 male, 13 female) who attended one of the clinics participated in the student focus groups. The students represented various disciplines, including medical (9), physiotherapy (5), pharmacy (2), speech (3), and occupational therapy (1). The student focus group discussions were semi-structured with questions exploring the student experience of the clinics including shared decision making, working in a team, disciplinary differences, leadership, and patient safety. In addition, there were 11 patients (5 female, 6 male) living with Parkinson's disease who took part in the patient focus groups. All were taking anti-Parkinson's medication and had regular consultations with a neurologist and access to a general practitioner ( family physician). Among them, two had mild early symptoms of Parkinson's within the last 18 months, eight had moderate symptoms, and one patient had severe symptoms and relied on a wheelchair for mobility. Additionally, all of the patients were fluent in English. Patient interviews covered benefits and insights received on their health goals, communication with the student team, and suggestions for improving the clinic experience. Data analysis Focus group data were transcribed verbatim. In our secondary analysis we independently read and analysed all the data to identify recurrent themes and subthemes, and negotiated alternative interpretations. A thematic analysis [43] enabled interpretation of student and patient accounts of their encounters in the clinic. We began by considering the social spaces in which the student and patients were working and their relationships within them, based on previous work. [22] [24]. At this point we realised the utility of the Bordieuan lens as a set of `thinking tools' namely field, habitus, and capital to illuminate our understanding of the social world of the clinic. [44] [31] Consistent with a Bordieuan approach, we augmented our focus group data analysis with reading of the student patient management plans undertaken on the structured clinic record, and brief field notes from the interprofessional student debriefings after each clinic. Following further discussions, a coding framework was jointly developed (CR, PK and AB) and was used by one author (CR) to code the entire dataset. Data was then rearranged from the Bordieuan perspective to facilitate comprehensive interpretation. We claimed sufficient information power [45] given our focused aim (i.e. clinic participants’ views and experiences of the clinic), the richness of the dialogue in the focus groups and our use of Bordieuan theory during data analysis. Ethics Statement. This study was approved by the University’s Human Research Ethics Committee (Approval No: 2018/209). Written consent for participation was obtained from all participants to enable us to include their data from this study. Team reflexivity Discussions of the quality of research between the authors encouraged reflexivity about the methodological implications of particular decisions made during the course of the project. [46] In immersing ourselves in the data we reflected on our own fields of practice, habitus and capital to acknowledge the ways these could affect our interpretation of the data. [47] Our different perspectives and insights on the data as an academic general practitioner and two educational researchers ultimately helped to support a more rigorous interpretation. Mindful of people first language in disability research, we acknowledge that in our setting healthcare recipients appear to prefer the term ‘patient.’ [48] Though we use that term in this paper, we recognise some readers will prefer one of client, consumer, survivor or service-user. RESULTS Our data illuminated the student clinic as a field of practice, where intersecting fields included a patient support group, an aged care clinical practice within a teaching hospital, and supervised interprofessional teaching practices. We considered the positions and dispositions and habitus of our study participants within the field of the clinic, and report the various forms and amounts of capital that were brought, enriched and exchanged by the students and patient partners. To answer our research questions we developed three broad themes from our data: Fostering Students’ disposition to interprofessional care, Capitalizing on collaboration and empowerment and Culture of mutual capital exchange. We provide extracts of the participant voices to support the interpretation. Fostering Students’ disposition to interprofessional care Students adjusted to their positions and relationships in the context of their role in the field of the clinic. They varied in the way they internalized their relationships and expectations for working in the clinic. Some students had prior experience of being in an interprofessional team on simulated patient cases in the earlier years of their degree. They thus brought differing amounts of social and cultural capital, but their disposition to practice interprofessionally was changed through their practice (actions) in the clinic. In first year we got together – but we didn’t have a real patient. It was a pseudo scenario and then we had to come up with a plan and a video. .. at uni… nothing like this. I find this a lot more beneficial to actually see the patient, then you can come back and discuss the issues. It was a completely different experience in clinic when you are in that chair, seeing that patient and then leave that room and discuss with your colleagues as to how to best manage. (student) Students recognised the central position of the patient as partners in influencing their own disposition to interprofessional care. Students demonstrated a number of strategies to engage with their peers in a context of mutual trust around a common goal of influencing the outcomes of patient care. …for me, what I’ve learnt today is not – not just from a medication point of view, but it’s to be able to talk to all the other health care professionals and then that’s how we provide it better – the best care for the patient that is to combined all the aspects and then to – that’s an overall picture and then, just, try to improve that for the patient. (student) The structuring of interprofessional practice is realised across multiple fields e.g. clinical placements in hospital or community settings, assessment practices, supervisory practices, and practices of patient care. Balancing the need of patients and the limits of what they can do in the clinic predisposed students to sharing their social ( who they know) and cultural capital ( knowledge and competence) with their peers. For example a physio student said: It really just shows how connected everyone is. I know that you deal with medicines and doctors and we deal more with the mobility and gait and all that stuff, but doing this you see, we’ve seen this impairment, they see a medication that affects that impairment and stuff, so, it’s really obvious how much everything ties into each other. (student) The interactions among students in the clinic reflect a diverse range of dispositions, particularly their shared commitment to patient-centered collaborative care. This collective habitus, which can be seen as the "presence of the past in the present"[ 49 ] signifies the ongoing journey towards collaborative practice from being a novice towards being an expert. That is, the development of the students’ habitus is a gradual process influenced by their prior socialisation into both inter- and unidisciplinary ways of working. It is shaped by the accumulation of various forms of capital arising from their prior experiences and socialization into healthcare and interprofessional settings. [ 30 ] Within the field of the clinic, student’s habitus encompasses their cultural capital including the depth of their disciplinary knowledge, competencies, and interprofessional behaviours. It is shaped by the accumulation of various forms of capital arising from their prior experiences and socialization in healthcare and interprofessional settings. Moreover, students’ habitus is influenced by their positions (roles) in the clinic, their dispositions to engage and exchange capital, and their preferences in becoming both uni- and interprofessional practitioners. However, it was evident that some students were at different stages of this journey as they internalized their relationships with peers and patients, influenced by their own expectations. Capitalizing on Collaboration and Empowerment Patients in the field of student-led clinic were critical contributors of capital. Patients invested significantly in the clinic by physically attending, sharing their stories and goals, and exposing themselves to examination. They felt that participating in the clinic was a worthwhile investment because they gained new understandings of their own well-being. One patient noting “….that’s how they help us. So we are benefiting by this trial”. Some patients felt that they made a unique contribution to student learning. This can be seen as the symbolic capital they brought to the clinic allowing the students to see different stages of a disease, share goals for well-being and gain rich insights into the patients’ real world experience, including how they accessed their health and social care related networks. “they see symptoms which are not in the textbook. We could have symptoms which are completely different….. I think they would be more aware and because they’re seeing such a – a different diversity of Parkinson’s” (Patient participant) The patients appreciated the interprofessional team approach in the student-led clinic and contrasted this with their experiences of multidisciplinary care outside the student clinic. They felt a sense of investment in the student clinic, knowing that students from different disciplines communicated with each other to provide patient centred care plans, which might ultimately improve future healthcare practice. It was more of a struggle to get their own health care team to talk to each other “About having a team approach, you’re dealing with things like Parkinson’s. I mean I’ve got a good GP and a good specialist, but they don’t really talk to each other very often….and they all talk about how we had a team approach but the – I haven’t seen too many teams really.” (Patient participant) This can be seen as the dominance of the medical model, and suggests that there is little shared social capital in service models of interprofessional care. Patients felt that interacting with the students inspired them to stay active. They felt empowered by the collaborative practice of the students around personal patient goals, and this is recognisable as their social (who they know) and cultural capital (knowledge and competence). Another aspect that occurred to me are the benefits of talking to these young people today - I get really, really cranky if – when we’re at our group, and we’re sitting next to somebody who is sitting there, and their carer’s sitting here, and [fellow patient partner] goes to get his coffee – and they’re giving it to him. I say, “Put it down. Let him or her get up themselves.” Because we don’t (want to be ) be killed with kindness. We want our independence as long as we can have it - - - - and the only way we’re going to get it, is us looking after ourselves…. and not taking shortcuts. (Patient participant) Interestingly, the symbolic power of the university expressed as mode of cultural/social domination, in not permitting students to release their care plans to the patients, constrained patient engagement with the clinic. Patients explained that they wanted a conversation with the students or to read their recommendations, with input from the academic clinicians. "I would love to be part of the (student ) team to see the results, so I think the only negative I can think of is not being able to be part of the outcome." (Patient participant) In summary, in the student-led clinic, patients contributed significant symbolic capital through their investment in time, self-exposure, and willingness to participate in examinations. They bring cultural capital to the clinic by providing real-world insights into their health experiences and social capital in sharing how they access health and social care networks. Patients feel empowered by the interprofessional collaboration in the clinic and contrast it with their experiences of multidisciplinary care outside the student-led setting. However, in this setting, patient engagement with the clinic is constrained by the university's restriction on students sharing care plans with patients. Patients express a desire for conversation and access to the students' recommendations, which limits their involvement in the outcomes. Culture of Mutual Capital Exchange Students reflected on their cultural capital i.e. what they know, and how they can apply and exchange this knowledge in the field in which they found themselves. In this case, a pharmacy student is able to reflect on the coming together of various roles and relationships within the clinic where various forms of "capital" such as prestige or resources are at stake. These resources were available for exchange with patients by also with their peers. .. as a pharmacy student, it was definitely really helpful in seeing and interviewing a Parkinson’s patient and seeing the full picture and how complex things can get. A lot of the medications in particular, there was a lot of polypharmacy, there was a lot of side effects that overlapped, and it really helps you to see how complex the bigger picture is when you’re actually speaking to a real Parkinson’s patient. (student ) The pharmacy student suggests a conflict between different forms of cultural capital, such as the pharmacist's disciplinary expertise and the patient's priorities. An empirical application of guidelines by the pharmacist to medication management, an area of healthcare professional expertise, conflicts with the patient’s sense of being and what is important. More over the guidelines conflict with the priorities produced by the other disciplines. Such conflicts in practice were then taken to the student interprofessional team meeting and reflexively negotiated to arrive at a consensus for future action. Within the structure of the clinic, a physiotherapy student recognised the exchange of cultural capital by their pharmacy and medical peers when explaining the medications in the student team meeting. The physiotherapy students’ position in the clinic and disposition to learn from their peers allowed them to achieve something not covered in their own curriculum, but necessary for patient care. Taken together this is an example of the influence of sharing capital on habitus and enriching the clinic as a field. I really appreciate the fact that you actually broke it down and actually said, this is for this, and, you know, this is to help them to reduce, you know, all that stuff. It was really good to actually find out more information about medications. I think that’s something that physios in general should know what to do. (student) Some students were concerned that they lacked sufficient capital at the beginning of the clinic, for example cultural, the depth of disciplinary knowledge of their peers from other disciplines. They wanted faculty to further increase its investment of capital, rather than relying on their own agency to engage with both their peers and the patient partners for their learning. One student wanted more instruction and to be provided with “a set of standardised questions “ to ask each patient. Another student felt that only certain types of capital had value, for example competence (cultural). Some felt they had no expert knowledge in medication, an important component of the management of Parkinson and therefore worried they couldn’t meaningfully participate. …. when we read patient charts just to find out what medications they’re on and what to help, our educator, obviously they’ve been working in hospitals for a long time, so they know what each one does, but I don’t., I, kind of, sat there going, I don’t know what that is, and don’t know what that does but okay….if I see that next time on someone else’s chart then I’ll know, good. They’ve taken it. It’s good. I’m good to go treating them, but I wouldn’t know what it does, if that makes sense. (student) Yet, they recognised the rich capital on display from the clinical educators, and that they too would have to invest in this area to increase their own social and cultural capital. Medical students also valued the social capital that they exchanged with their interprofessional peers in the clinic. Interestingly, they were surprised at the value of the cultural capital they gained in working with the patient partners. …the last time I ever studied neurology was back in second year… so it’s just good to see, actual Parkinson patients. I saw one for the first time in a while, took a history and exam. Like … seeing the clinical signs was a bonus working with multidisciplinary team and seeing what each team does differently, and you know learning from one another. (student) All the students needed to develop a common currency, a shared language and narratives with which to exchange their capital. As an example, the use of disciplinary specific abbreviations was constraining patient care and student learning. Feedback to their peers promoted the use of a common language in describing the patients’ problems in the management plans, and avoiding acronyms. and most of the medications were quite similar anyway so that made more sense. So it was it’s like reading a report with a bunch of abbreviations though, that maybe you’ve never used before but it’s very common for someone else. (student) Patients were able to assess what kind of knowledge and skills ( cultural capital) the students brought to the clinic when acting in their uni-professional role. Yet recognising that some disciplines needed more interprofessional knowledge (cultural capital) at this point in their learning trajectory. I had a couple of the physio and a couple of the pharmacy. The medical students, I did ask a couple of questions, but I think it’s a little bit too early in their learning curve to answer it directly and responsibly, because everybody’s symptoms, as we all know with Parkinson’s is totally different. We’re not all the same, and I think that’s where it becomes a really big issue for some people. (patient participant) Patients actively engaged with students, providing valuable insights, experiences, and perspectives related to their Parkinson’s. By sharing their knowledge, challenges, and reflecting on student recommendations, patients contribute to the social and cultural capital of the students, fostering a collaborative and enriching learning environment whilst enriching their own knowledge. "These different clinicians [from various disciplines], they ask pertinent questions of us, things that perhaps, you might forget about, and then you sort of think to yourself, 'Oh yes. That’s sort of important, and that’s happened to me.'" (patient participant) As students were rapidly socialised into the field of the clinic, they recognised the complexity of the intersection of layers within the field. Students arrived at the clinic with a varying but often rich sense of the social and cultural capital they bring, and what they are willing to share. They may not know the other students, but they know what (inter) disciplinary roles they are expected to achieve. Students recognised the rich symbolic capital invested in the authentic portrayal of the clinic offering exchange with patients. Students valued the patients’ symbolic capital and their willingness to entrust their stories, their health and social care problems to the students. Thus, there was mutual recognition of an exchange of capital, patients recognising the capital the student bring. Like-wise, the patients showed their committed to student learning by sharing their cultural capital with the students (see Fig. 1 ). Our data, however, did not support use of symbolic power by the students to influence the other students to their own disciplinary worldview. A summary of the ways in which the collective capital of participants intersects with their habitus within the field of the student clinic are illustrated in Fig. 1 . Insert Fig 1 about here DISCUSSION Summary of key findings The study applied Bourdieu's theory of practice to understand the mechanisms that underpin the co-creation of a interprofessional student-led clinic. Overall, the study provides insights into the interplay between field, habitus, and capital in the context of a student-led clinic, emphasizing the significance of patient empowerment, student socialization, and the exchange of social and cultural capital for developing interprofessional practice in an atmosphere of mutual trust. The habitus plays a crucial role in shaping students' dispositions and guiding their responses to the clinic's constraints and enablers of interprofessional working. It fosters trust and readiness for interprofessional practice among students. Patients, on the other hand, feel empowered in recognizing the importance of their well-being goals and their symbolic power in influencing student learning. The findings highlight the importance of recognizing and valuing the various forms of capital brought by students and patients, as well as the equal relationship between them within the clinics as a field of practice. The shared culture of mutual entrustment between students and patients influences students’ learning experiences and enriches their habitus. Students are socialized into the field of interprofessional practice in the clinic, using their cultural capital to access to other forms of capital from patients, peers, and supervisors. Caring for the patient is a common goal, and students learn to build their capital through partnership and collaboration. The strength, trust, and value of the interactions between participants within the clinic contribute to the overall quality of social capital that is generated within that environment. The combined resources, experiences, and knowledge of the participants (both students and patients) come together and interact with their ingrained dispositions, behaviours, and ways of thinking (habitus) within the context of the student clinic. Students and patient partners arrive with, invest in, and share capital, leading to the development of new dispositions which further enrich habitus. The most valuable capital in the clinic's field is the symbolic capital brought and shared by the patients, contributing to a culture of mutual trust and an aspiration to improve patient outcomes. The symbolic power of the clinic was defined by the equal relationship between those who traditionally exercise power (the clinical academics and the students) and those who undergo it (the patients), in the field of the clinic. [ 50 ] Comparison with existing theory and literature Our findings reflect the underlying principles of the dynamic interplay between field, habitus and capital in providing interprofessional healthcare. [ 47 ] Although our findings partially align with the work of Bonello et al [ 47 ] in taking a Bordieuan lens IPE, our empirical study extends this work by illustrating a multiplicity of influences in the reproduction of a complex IPE activity, the student led clinic. In our study there was no evidence of symbolic power struggles between the students, as predicted by other scholars reporting medical domination [ 47 ] [ 35 , 51 ] IPE in clinical settings might be expected to create role conflicts in terms of certain disciplines such as medical students struggling to see the benefit of the IPE experience. [ 52 ] Though we expected some students to feel they had more cultural, social or symbolic capital, we did not find any conflicts as they acknowledged their professional boundaries, and respected the mutual goal of patient care. Rather the struggle we observed was to learn and work with each other to provide health care centred around patients’ needs [ 53 ] which they saw as expertise-based than profession-based . Our data supports the concept of habitus serving as a framework to understand how the structure and functioning of the clinic shape students' long-lasting tendencies, attitudes, and abilities to engage in interprofessional practices. Their habitus, guides them in their creative responses to the constraints and enablers of being and becoming interprofessional. [ 54 ] By emulating authentic interprofessional practice around the needs of the patient, students negotiated with the multiple voices of peers, patients and supervisors in the field of the clinic through their habitus. The students’ habitus became a ‘practice-unifying and practice-generating principle’ [ 49 ] This development within habitus was influential in students trusting and becoming ready for interprofessional practice. The habitus partially resonates with the notion of the interprofessional identity evolving from a uniprofessional identity. [ 55 ] The patients’ sense of their symbolic power arose from sharing their goals for well-being and recognising the mindfulness of the interprofessional team in trying to achieve them. Additionally, in being realistic about what can be done to help them achieve their well-being goals. This emphasizes the importance of social connections between students and patients, creating a source of influence that leads to the accumulation of shared symbolic value, which encompasses cultural and social aspects. [ 31 ] Power seemed to be culturally and symbolically created and constantly re-enacted through this interplay of relationships in the field of the clinic. Trust was an important component of students’ and patients’ willingness to share their cultural capital.[ 29 ] The central role of the patients appeared de-centering and seemed to disrupt the often reported power relations between students; often imagining medical students in the ascendant. [ 46 , 56 ] [ 57 ] [ 8 ] [ 58 ] Patients didn’t particularly privilege the capital of one discipline. For these reasons, we believe that we did not see the issues of power and conflict found in other interprofessional initiatives related to symbolic barriers of strong medical dominance and lack of collaboration at all levels. [ 47 ] Sharing of cultural capital with others gives a sense of collective identity and of collective capital, an important practice -generating principle. Individual’s practices or actions are the consequences of their cultural capital and habitus interacting within the context of a given field. [ 59 ] Being able to convey professional knowledge regarding the situation of a patient and consider the professional views of others is essential to interprofessional work, as a means to providing the best patient outcomes [ 60 ] [ 53 ]. Trust in interprofessional learning group members is thought to transfer to generalised trust of other professional groups in the workplace, and the advantages of working interprofessionally accumulates. [ 61 ] Our findings support the notion that to sustain interprofessional student led clinics, IPL the leaders must persuade a diverse range of stakeholders, not only those who would be engaged as learners, supervisors, and administrators but those with the power to provide resources.[ 8 ] We would argue the patient voice needs to be considered as partners. Methodological Strengths and challenges The strength of this study is its contribution to and extension of the existing literature in three ways. First, it provides insights into the experiences of two key stakeholder groups, prospective healthcare practitioners and patients living with a chronic disability on the perceived value of a co-created student-led clinic. Second, it offers a theoretical framework that goes beyond economic considerations and emphasizes the importance of alternative forms of capital in promoting interprofessional collaborative practice. Third, it replaces the idea of a power struggle between medicine and the other healthcare disciplines causing a lack of collaboration to one of cooperation between patients and the student team around patient well-being goals. In terms of the challenges, we did not employ the range of Bordieuan methodologies for example looking at our field in relationship to other fields; in particular the recognized fields of power in the university and the health care providers. We do not have the data from the multiple clinicians and educators consulted in setting up the clinic. Despite the limitations of our sample, being within one institution, and amongst students and patients who volunteered and may have had more positive dispositions to engage with IPE, we still believe the findings will be valuable to researchers wishing to develop their own clinics or reflect on their own established practices. Implications for Educational Practice Our findings suggest ways of optimising IPE student and patient experiences through investment in and exchange of differing forms of capital to create a sustainable field of interprofessional practice. Whilst this does not underplay the need for financial capital, our findings provide insights into understanding the cultural shifts required to promote collaborative practice. Interprofessional curricular initiatives which attempt to promote social learning in the workplace amongst health professional students can be seen as unifying in the field of practice. Our findings suggest that there is collective power of various forms of ‘capital’ in shaping interprofessional practice. In order for student clinics to thrive in sustainable fashion, considerable investment is required from faculties, patient partners, service provider organisations and the student body, in the form of investing and exchanging social and cultural capital within an atmosphere of mutual trust. At some point these needed to be turned into economic capital as part of a robust health-provider university partnership. Educators must create alternative sources of capital, through fostering collaborative alliances between the university, the service providers, patient representation and the student body. Logic models may provide a useful evaluation process [ 62 ] A framework for conceptualising the logic of Interprofessional Practice in a student led clinic though the Bourdieuan concepts of field, habitus and capital is given in Fig. 2 Insert Fig. 2 about here Implications for further research Given the methodological insights and constraints associated with this study, further research is advised employing sociological methodologies such as ethnography from the outset of studies to further elucidate the struggles in setting up IPE clinics and their impacts on patient outcomes and student professional development. We encourage researchers to explore the impacts of different types of Interprofessional student led clinics e.g., vaccination clinics, pre-diabetic care, or rehabilitation clinics. Further research could also consider the adaptability of the current findings in other settings in both resource rich and resource challenged countries. By reframing the research question, a Bordieuan approach may help to explain how various entities within the university faculty leadership groups, the health care professional education disciplines, leadership groups from within healthcare providers and patients’ representation could exercise their powers and generate mechanisms to make student-led interprofessional clinics flourish. Conclusion In conclusion, this study highlights the co-creation of interprofessional collaborative practice in a student-led clinic through the lens of Bourdieu's framework. The findings emphasize the significance of recognizing and valuing the various forms of capital brought by students and patients, as well as the equal relationship between them. The role of habitus in shaping students' dispositions and guiding their responses within the clinic's field is also underscored. The study provides valuable insights for educators and researchers, urging them to invest in collaborative alliances and explore alternative forms of capital other than financial to promote sustainable interprofessional practice Declarations Acknowledgements We wish to thank Dr Cesar Uy, the clinician in charge of the aged care facility that hosted the clinic, to Richard Babb, Chair of the local Parkinson’s support group, members of the Parkinson’s support group for their wisdom. The local health authority discipline leaders, university discipline academic leaders, and to Drs Carl Schneider and Rebecca Moles for facilitating students in the clinic. Funding None Availability of Data and Materials Datasets supporting the conclusions of this article are included within the article. The datasets generated and analysed during the current study are not publicly available due to confidentiality agreements approved by the Human Research Ethics Committee but are available from the corresponding author on reasonable request. Authors’ contributions CR was the principal academic supervisor of the clinic. CR and AB designed the study. AB secured ethics approval and undertook the focus group interviews. CR PK and AB were involved in theorising, analysing and interpreting study data. CR and AB wrote the first draft and with PK revised various iterations of the paper. All authors give their final approval for this version to be published. Ethical approval and consent to participate All research method were carried out in accordance with relevant guidelines and regulations. The University of Sydney Human Research Ethics Committee (Approval No: 2018/209) approved the research. Informed written consent for participation was obtained from participants to enable us to include their data from this study. All participants were reassured that data were strictly de-identified to protect participant privacy. Consent for publication Not applicable Competing interests All authors have a conflict to declare. CR is a Senior Editorial Board member and PK and AB are editorial board members of BMC Medical Education Author Details Chris Roberts The University of Sheffield, School of Medicine and Population Health, Faculty of Health, The University of Sheffield, S10 2RX, UK Priya Khanna The University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Education Office, The University of Sydney, NSW, 2006, Australia Annette Burgess The University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Education Office, The University of Sydney, NSW, 2006, Australia References Briggs L, Fronek P: Student Experiences and Perceptions of Participation in Student-Led Health Clinics: A Systematic Review . Journal of Social Work Education 2020, 56 (2):238-259. Schutte T, Tichelaar J, Dekker RS, van Agtmael MA, de Vries TP, Richir MC: Learning in student‐run clinics: A systematic review . Medical education 2015, 49 (3):249-263. Hopkins S, Bacon R, Flynn A: Student outcomes for interprofessional education in student led clinics: A rapid review . Journal of Interprofessional Care 2022, 36 (2):234-244. Broman P, Tokolahi E, Wilson OWA, Haggie M, Andersen P, Brownie S: Patient Outcomes from Student-Run Health Services: An Integrative Review . Journal of Multidisciplinary Healthcare 2022, 15 :641-665. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garcia P, Ke Y, Kelley P: Health professionals for a new century: transforming education to strengthen health systems in an interdependent world . The lancet 2010, 376 (9756):1923-1958. Organization WH: Framework for action on interprofessional education and collaborative practice . In . : World Health Organization; 2010. Reeves S, Fletcher S, Barr H, Birch I, Boet S, Davies N, McFadyen A, Rivera J, Kitto S: A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39 . Med Teach 2016, 38 (7):656-668. Whyte S, Paradis E, Cartmill C, Kuper A, Boon H, Hart C, Razack S, Pipher M, Whitehead CR: Misalignments of purpose and power in an early Canadian interprofessional education initiative . Advances in Health Sciences Education 2017, 22 (5):1123-1149. Clay MC, Garr D, Greer A, Lewis R, Blue A, Evans C: An update on the status of interprofessional education and interprofessional prevention education in US academic health centers . Journal of Interprofessional Education & Practice 2018, 10 :61-66. Hean S, Hammick M, Miers M, Barr H, Hind M, Craddock D, Borthwick A, O'Halloran C: Evolving theory in interprofessional education: Conclusion report res-451-26-0360 , vol. null; 2009. Freeth D, Savin-Baden M, Thistlethwaite J: Interprofessional education . Understanding medical education 2010:53-68. McAndrew R, Kaskutas V: A logic model for planning, implementing, and evaluating a student-run free clinic . Journal of Student-Run Clinics 2020, 6 (1). Parihar A, Devanathan N, Sepulveda MN, Sevilla-Martir JF: Financial Impact of the Indiana University Student-Run Free Clinic . J Community Health 2023:1-4. Lawlis TR, Anson J, Greenfield D: Barriers and enablers that influence sustainable interprofessional education: a literature review . Journal of interprofessional care 2014, 28 (4):305-310. Jorm C, Roberts C: Using Complexity Theory to Guide Medical School Evaluations . Academic Medicine 2018, 93 (3):399-405. Kent F, Drysdale P, Martin N, Keating JL: The Mixed-Discipline Aged-Care Student Clinic: An Authentic Interprofessional Learning Initiative . Journal of Allied Health 2014, 43 (1):51-56. Sheu L, O’Brien B, O’Sullivan PS, Kwong A, Lai CJ: Systems-based practice learning opportunities in student-run clinics: a qualitative analysis of student experiences . Academic Medicine 2013, 88 (6):831-836. Sheu LC, Zheng P, Coelho AD, Lin LD, O’sullivan PS, O’brien BC, Albert YY, Lai CJ: Learning through service: student perceptions on volunteering at interprofessional hepatitis B student-run clinics . Journal of Cancer Education 2011, 26 (2):228-233. Varpio L, Aschenbrener C, Bates J: Tackling wicked problems: how theories of agency can provide new insights . Medical Education 2017, 51 (4):353-365. Thistlethwaite J: Interprofessional education: a review of context, learning and the research agenda . Med Educ 2012, 46 (1):58-70. Wenger E: Communities of practice and social learning systems . Organization 2000, 7 (2):225-246. Roberts C, Daly M, Held F, Lyle D: Social learning in a longitudinal integrated clinical placement . Advances in Health Sciences Education 2017, 22 (4):1011-1029. Burgess A, Kalman E, Haq I, Leaver A, Roberts C, Bleasel J: Interprofessional team-based learning (TBL): how do students engage? BMC Medical Education 2020, 20 (1):118. Held FP, Roberts C, Daly M, Brunero C: Learning relationships in community-based service-learning: a social network analysis . BMC Medical Education 2019, 19 (1):113. Hamilton V, Baird K, Fenwick J: Nurturing autonomy in student midwives within a student led antenatal clinic . Women and Birth 2020, 33 (5):448-454. Bhaskar R, Danermark B, Price L: Interdisciplinarity and Wellbeing: A Critical Realist General Theory of Interdisciplinarity : Routledge; 2017. Archer MS, Archer MS: Being human: The problem of agency : Cambridge University Press; 2000. Burawoy M: Making sense of Bourdieu: from demolition to recuperation and critique . Catalyst 2018, 2 (1):51-87. Bourdieu P: The logic of practice : Stanford university press; 1990. Bourdieu P: Outline of a Theory of Practice , vol. 16: Cambridge university press; 1977. Bourdieu P, Wacquant LJ: An invitation to reflexive sociology : University of Chicago press; 1992. Bhandari H, Yasunobu K: What is social capital? A comprehensive review of the concept . Asian Journal of Social Science 2009, 37 (3):480-510. Bourdieu P, Richardson JG: Handbook of Theory and Research for the Sociology of Education , vol. null; 1986. Bourdieu P: Language and symbolic power : Harvard University Press; 1991. Brosnan C: Making sense of differences between medical schools through Bourdieu’s concept of ‘field’ . Medical Education 2010, 44 (7):645-652. Hu WC, Thistlethwaite JE, Weller J, Gallego G, Monteith J, McColl GJ: ‘It was serendipity’: a qualitative study of academic careers in medical education . Medical Education 2015, 49 (11):1124-1136. Olsson C, Kalén S, Ponzer S: Sociological analysis of the medical field: using Bourdieu to understand the processes preceding medical doctors’ specialty choice and the influence of perceived status and other forms of symbolic capital on their choices . Advances in Health Sciences Education 2019:1-15. Almås SH: Interprofessional education: an analysis of the introduction of a common core in curricula for selected health professions : The University of Bergen; 2007. Paton M, Kuper A, Paradis E, Feilchenfeld Z, Whitehead CR: Tackling the void: the importance of addressing absences in the field of health professions education research . Advances in Health Sciences Education 2020. Hawick L, Kitto S, Cleland J: Contact is not enough: a qualitative study of how space and place impact on interprofessional education . Journal of Interprofessional Care 2021, 35 (5):710-717. Gum LF, Prideaux D, Sweet L, Greenhill J: From the nurses' station to the health team hub: how can design promote interprofessional collaboration? Journal of interprofessional care 2012, 26 (1):21-27. Burgess A, Roberts C: Interprofessional student-led clinics: the volunteer patient experience . BMC Med Educ 2022, 22 (1):1-6. Braun V, Clarke V, Terry G: Thematic Analysis . Qualitative Research in Clinical and Health Psychology 2014:95. Grenfell* M, James D: Change in the field—chang ing the field: Bourdieu and the methodological practice of educational research . British Journal of Sociology of Education 2004, 25 (4):507-523. Malterud K, Siersma VD, Guassora AD: Sample size in qualitative interview studies: guided by information power . Qualitative health research 2016, 26 (13):1753-1760. El-Awaisi A, Awaisu A, Jaam M, Saffouh El Hajj M, Verjee MA: Does the delivery of interprofessional education have an effect on stereotypical views of healthcare students in Qatar? Journal of Interprofessional Care 2020, 34 (1):44-49. Bonello M, Wright J, Morris J, Sadlo G: Bourdieu and interprofessional education: what’s the relevance? Studies in Continuing Education 2018, 40 (1):1-16. Costa DSJ, Mercieca-Bebber R, Tesson S, Seidler Z, Lopez A-L: Patient, client, consumer, survivor or other alternatives? A scoping review of preferred terms for labelling individuals who access healthcare across settings . BMJ Open 2019, 9 (3):e025166. Bourdieu P: Pascalian Meditations (R. Nice Transaltions) . In . : Stanford University Press, Standford; 2000. Bourdieu P: Symbolic power . Critique of anthropology 1979, 4 (13-14):77-85. Brosnan C: Pierre Bourdieu and the theory of medical education: Thinking ‘relationally’about medical students and medical curricula . In: Handbook of the sociology of medical education. edn.: Routledge; 2009: 65-82. Hudson JN, Lethbridge A, Vella S, Caputi P: Decline in medical students’ attitudes to interprofessional learning and patient‐centredness . Medical education 2016, 50 (5):550-559. Dubbin LA, Chang JS, Shim JK: Cultural health capital and the interactional dynamics of patient-centered care . Social Science & Medicine 2013, 93 :113-120. Wacquant L: A concise genealogy and anatomy of habitus . The Sociological Review 2016, 64 (1):64-72. Thistlethwaite J, Kumar K, Roberts C: Becoming interprofessional: professional identity formation in the health professions . In: Teaching medical professionalism: Supporting the development of a professional identity. edn.: Cambridge University Press; 2016: 140-154. Roberts C, Howe A, Winterburn S, Fox N: Not so easy as it sounds: a qualitative study of a shared learning project between medical and nursing undergraduate students . Medical Teacher 2000, 22 (4):386-391. Hean S, Clark JM, Adams K, Humphris D: Will opposites attract? Similarities and differences in students' perceptions of the stereotype profiles of other health and social care professional groups . Journal of interprofessional care 2006, 20 (2):162-181. Kuper A, Whitehead C: The paradox of interprofessional education: IPE as a mechanism of maintaining physician power? In . : Taylor & Francis; 2012. Edgerton JD, Roberts LW: Cultural capital or habitus? Bourdieu and beyond in the explanation of enduring educational inequality . Theory and Research in Education 2014, 12 (2):193-220. Hammick M, Anderson E: Sustaining interprofessional education in professional award programmes . Interprofessional education: Making it happen 2009:202-226. Hean S, Cowley S, Forbes A, Griffiths P, Maben J: The M–C–M′ cycle and social capital . Social Science & Medicine 2003, 56 (5):1061-1072. McAndrew R, Ellis J: An evaluation of the multiple mini-interview as a selection tool for dental students . Br Dent J 2012, 212 (7):331-335. Table Table 1 Interprofessional student led clinic for people living with Parkinson’s disease Overview There was no specific funding for the clinic. The program was delivered from 8.30am – 1:00pm, five times throughout the year. At each clinic, three or four real patients, six to eight students, and at least one clinical educator and one educator were in attendance. Booking for the clinic were organised by the university clinical school staff. Clinic participants: Students: Eight final year students from medicine, pharmacy and allied health (physiotherapy, occupational therapy, speech pathology) in any one clinic Patients: The “patients as partners “, volunteers from community groups for people living with Parkinson’s disease and their carers and families. They were asked to identify three areas which they hoped the clinic would focus on, for example increasing exercise, or fall prevention. Educators: At each session, there was at least two clinical educators, who ran an initial orientation session (and provided supervision (pharmacy and medicine) with an aged care consultant in whose unit the clinic ran,, on standby. Clinic schedule and record keeping Students were provided with a 30 minute orientation led by a clinical educator, and given the Parkinson’s Disease Clinic General Assessment Form to guide the patient assessment. Then in pairs matched with their own discipline, students rotated through four ‘stations’, spending 30 minutes with each patient. Each time students met with a patient, the patient notes were passed to the next pair of students. Students then organised a interprofessional team meeting lasting 30 minutes, and then presented to the academic educator(s) (30 minutes) who gave feedback. Together, students were required to produce an integrated patient management plan to present to the supervisor academic. In this clinic the patient did not hear the management plans as the patient partners had other activities to attend. Additional Declarations Competing interest reported. All authors have a conflict to declare. CR is a Senior Editorial Board member and PK and AB are editorial board members of BMC Medical Education Cite Share Download PDF Status: Published Journal Publication published 19 Feb, 2024 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 15 Nov, 2023 Reviews received at journal 05 Nov, 2023 Reviewers agreed at journal 03 Nov, 2023 Reviews received at journal 18 Sep, 2023 Reviewers agreed at journal 15 Sep, 2023 Reviewers invited by journal 15 Sep, 2023 Editor assigned by journal 08 Sep, 2023 Editor invited by journal 07 Sep, 2023 Submission checks completed at journal 07 Sep, 2023 First submitted to journal 14 Aug, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3262907","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":231577794,"identity":"32f6f72e-0c11-4d21-b97c-c97c437f9536","order_by":0,"name":"Chris Roberts","email":"data:image/png;base64,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","orcid":"","institution":"The University of Sheffield, The University of Sheffield","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Chris","middleName":"","lastName":"Roberts","suffix":""},{"id":231577795,"identity":"fb705eeb-b586-4890-a9e7-73547911e1ab","order_by":1,"name":"Priya Khanna","email":"","orcid":"","institution":"The University of Sydney, The University of Sydney","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Priya","middleName":"","lastName":"Khanna","suffix":""},{"id":231577796,"identity":"e599241f-69fa-488f-bb87-321973a371ad","order_by":2,"name":"Annette Burgess","email":"","orcid":"","institution":"The University of Sydney, The University of Sydney","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Annette","middleName":"","lastName":"Burgess","suffix":""}],"badges":[],"createdAt":"2023-08-14 13:44:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3262907/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3262907/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-024-05117-7","type":"published","date":"2024-02-19T15:01:14+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":43007874,"identity":"1743d82b-69d9-4aa0-b716-2f092b19e1a4","added_by":"auto","created_at":"2023-09-12 14:15:09","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":47957,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCo-created Field of Student-led IPE Clinic and Practice of IPE as a function of Habitus and Shared Capital\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3262907/v1/50fb3308a93157a86d11a876.jpg"},{"id":43007875,"identity":"4d5893ce-33b6-4c9d-9559-1119cc21cb0b","added_by":"auto","created_at":"2023-09-12 14:15:09","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":84727,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA framework for conceptualising the logic of Interprofessional Practice in a student led clinic though the Bordieuan concepts of field, habitus and capital.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3262907/v1/18c1e0384b28bd94b4e2d456.jpg"},{"id":51648299,"identity":"c9af452d-7e86-47a4-a97b-c5eed5a4a2c3","added_by":"auto","created_at":"2024-02-26 15:12:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1636509,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3262907/v1/35f2f981-5e26-40e8-8966-9a50b52a92b4.pdf"}],"financialInterests":"Competing interest reported. All authors have a conflict to declare. CR is a Senior Editorial Board member and PK and AB are editorial board members of BMC Medical Education","formattedTitle":"\u003cp\u003eCapital Sharing and Socialization in an Interprofessional Student-Led Clinic: A Bordieuan Analysis\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eStudent-led health clinics have emerged as valuable interprofessional activities that offer unique \u0026nbsp;opportunities for students, patients and educators. These clinics provide an authentic experience of collaborative patient care, allowing participants to contribute their diverse levels of knowledge, skills and behaviours [1] [2] [3] [4]. Despite the increasing recognition of the importance of Interprofessional Education (IPE) globally [5, 6] and a growing literature regarding the benefits of IPE [7], implementing educationally impactful but resource-intensive activities remains a challenge [8] [9]. Whilst the existing research has identified the opportunities and barriers for sustaining student-led clinics in various contexts, further \u0026nbsp;theoretical understanding is needed about the underlying mechanisms that sustain conditions for interprofessional and collaborative practice to flourish [10].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis issue is of critical concern because the implementation and sustainability of IPE heavily depend \u0026nbsp;on educational and practice settings that are predominantly uniprofessional, with medicine often dominating the prevailing culture and structures of training [11]. \u0026nbsp;In order to facilitate change, IPE educators need to find ways of co-creating \u0026nbsp;student-led clinics in complex healthcare and educational settings. An opportunity to explore these issues arose when a student led clinic was established as a collaboration between healthcare \u0026nbsp;faculties within a research intensive university, \u0026nbsp;an aged care facility within a secondary health care provider, and a \u0026nbsp; patient support group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eImplementing and sustaining \u0026nbsp; student-run clinics is influenced by several factors including \u0026nbsp;economic, political, social-cultural, physical, and technological. Funding for student-led clinics is complex and influenced by various enablers including healthcare funding models, faculty volunteerism, strong partnerships with community organizations and stakeholders and well-developed business plan outlining goals and financial projections. [12] [13] Conversely, barriers include lack of funding availability and limited experience in fundraising and financial management, preferences to work within one\u0026rsquo;s own disciplines, logistical issues such as timetabling and space allocation, availability of trained facilitators or supervisors, lack of operational structure for delivering IPE activities, legal and insurance concerns around student clinical decision making, and patient recruitment and management. [14]. [15] [16]. In response to these challenges, student led clinics can vary from simulating authentic clinical practice, to service provision for underserved communities with funding often associated with the later [17, 18] [16]. \u0026nbsp; Given the complexity of setting up \u0026nbsp;a student clinic there needs to be a reframing \u0026nbsp;of \u0026nbsp;economic and resources arguments to put real value \u0026nbsp;on what student clinics can bring educationally for students and enhancing health outcomes for patients. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this paper, we adopt a social theory lens to explore the mechanisms of interprofessional student learning when students and staff co-created an student-led clinic in partnership with people living with Parkinson\u0026rsquo;s Disease, a complex chronic neurological impairment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch framework: Introducing Bourdieu\u0026rsquo;s field, habitus, and the forms of capital\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn understanding the dynamics of IPE in the educational and healthcare system, social theories that explore the relationship between structure and human agency are gaining prominence [19] [20]. Within the realm of IPE, student learning and patient experiences have been conceptualised as social activities within multiple communities of practice. [21] [22] Formal networking and collaboration opportunities for IPE during university can support students by promoting agency and maximising learning experiences within specific communities of teaching practice. [23],[24] including student led clinics. [3] [4] [25] \u0026nbsp;Bourdieu\u0026apos;s work stands out as a grand theory that addresses the interplay between practice structures and human agency, a key concern in social research. [26] [27]. Bourdieu\u0026rsquo;s theory of practice examines the opportunities and constraints in overcoming cultural domination and developing reflexivity, \u0026nbsp;thus holding \u0026nbsp; promise for understanding and optimising the conditions for change in IPE. [28] \u0026nbsp;Bourdieu\u0026apos;s framework revolves around three core concepts: Field, Habitus and Capital and their relationship with Power.\u003c/p\u003e\n\u003cp\u003eField refers to a social domain (e.g., family, school, sport, healthcare) with distinct roles, relationships, and practices that individuals become socialized into. Each specific field is distinguished by its objective relations, its agents and institutions and the specific logic of practice or \u0026ldquo;rules of the game\u0026rdquo;. [29] Fields coexist and overlap at various levels, with smaller fields nested within larger ones. Within a field, individuals vie for position, seek control over capital invested in the field, and may attempt to alter the \u0026nbsp;rules. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHabitus encompasses the durable and transposable dispositions of agents (individuals, groups of actors or institutions) within a social setting. [30] It comprises competencies, expectations, biases, and insecurities that develop and shape their aspirations and practices. Habitus sets the boundaries of agency and influences future choices and actions. Habitus is enriched with the capital which individuals acquire as they are socialised in various domains such family life, leisure, formal education, and work. [30] \u0026nbsp;[31]\u003c/p\u003e\n\u003cp\u003eCapital and Power: In addition to economic capital, Bourdieu (1997) describes three other forms of capital: social, cultural, and symbolic. \u0026nbsp;Social capital encompasses shared norms, values, trust, networks, and social relations that facilitate cooperation and collective action.\u003cem\u003e\u0026rdquo;\u003c/em\u003e [32] It is influenced by an individuals\u0026rsquo; social network, and the power within those networks. [31] Cultural capital is what one knows and what one has, for example possessing the \u0026lsquo;right\u0026rsquo; kind of knowledge [33] Symbolic capital is acquired automatically upon entering a field and refers to the amount of prestige or honour derived from other forms of capital. Symbolic capital involves a good faith economy where capital exchange is based on mutual trust. [29] Symbolic power makes people see and believe in a certain vision of the world and directs them to act accordingly. Relationships between individuals depend upon the accumulation of symbolic power allowing an individual to impose their world view on others. [34]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBourdieu\u0026rsquo;s theoretical\u003c/strong\u003e \u003cstrong\u003eframeworks in IPE settings\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBourdieu\u0026rsquo;s \u0026nbsp;theoretical lens has been applied \u0026nbsp;in both uniprofessional \u0026nbsp;e.g. medicine [35] [36] [37], and \u0026nbsp;interprofessional settings [38] [39] [40] to understand the conditions for changing the dominating cultures and complex relationships between field, habitus, and capital. Within the field of medicine, the dominant culture has traditionally emphasized technical clinical competence (cultural capital) over caring, which can negatively impact the habitus of medical students [35]. \u0026nbsp; Conversely, in allied health, the relationships and interactions students experienced during IPE activities, was a major influence on enriching students\u0026rsquo; habitus. [38] Bourdieu\u0026rsquo;s theory of social space (a mapping of individuals positions in the field) has been used in the context of how the \u0026lsquo;nurses\u0026rsquo; station\u0026rdquo; on hospital wards promotes communication and teamwork for the provision of safe and quality patient care. [41]\u003c/p\u003e\n\u003cp\u003eThis paper aims to explore the mechanisms of interprofessional student learning within an IPE student clinic through the lens of Bourdieu\u0026apos;s social theory. By analyzing the relationships between field, habitus, and capital and power, we seek to uncover the underlying factors that contribute to the co-creation and sustainability of an authentic interprofessional collaborative care environment. This research has the potential to deepen our understanding of how social inequalities manifest in clinical interactions and how addressing these inequalities can enhance patient-centered care in student clinics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Aim and Research Questions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research questions guiding this qualitative study were as follows:\u003c/p\u003e\n\u003cp\u003e1. In what ways do\u0026nbsp;students\u0026rsquo; dispositions to the clinic influence collaborative working?\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2. How did patients express and influence their habitus and capital in the student led clinic?\u003c/p\u003e\n\u003cp\u003e3. What were the nature and forms of capital that were brought, \u0026nbsp;exchanged \u0026nbsp; and taken away by the students and the patients from the clinic?\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eSetting and Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study took place within a student-led interprofessional clinic\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003efor people living with Parkinson\u0026rsquo;s disease. \u0026nbsp;This has been described in detail elsewhere, [42] \u0026nbsp;where 32 senior students and thirteen patients took part throughout 2018. In summary, the student clinic involved five health care disciplines (medicine, pharmacy, occupational therapy, physiotherapy, and speech pathology) collaborating with a patient support group and an aged care facility in \u0026nbsp;local \u0026nbsp;teaching hospital to provide a simulated clinic. \u0026nbsp;It had been designed to emulate an existing multidisciplinary service clinic for people living with Parkinson\u0026rsquo;s disease, where patients had family doctors and access to relevant neurological services. In uniprofessional pairs, students rotated through four \u0026lsquo;stations\u0026rsquo;, spending 30min with each volunteer patient, taking a history and performing an examination. Their goal was to \u0026nbsp;produce a collaborative management plan based around three personal well-being goals provided by the \u0026nbsp;patient. \u0026nbsp;The detail of the structure of the clinic is given in Table 1. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInsert table 1 about here\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo explore our research questions, qualitative data were collected from three of the five clinics that ran in 2018.\u003cem\u003e\u0026nbsp;\u003c/em\u003eA total of 20 students (6 male, 13 female) who attended one of the clinics participated in the student focus groups. The students represented various disciplines, including medical (9), physiotherapy (5), pharmacy (2), speech (3), and occupational therapy (1). The student focus group discussions were semi-structured with questions exploring the student experience of the clinics \u0026nbsp;including shared decision making, working in a team, disciplinary differences, leadership, and patient safety.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition, there were 11 patients (5 female, 6 male) living with Parkinson\u0026apos;s disease who took part in the patient focus groups. All were taking anti-Parkinson\u0026apos;s medication and had regular consultations with a neurologist and access to a general practitioner ( family physician). Among them, two had mild early symptoms of Parkinson\u0026apos;s within the last 18 months, eight had moderate symptoms, and one patient had severe symptoms and relied on a wheelchair for mobility. Additionally, all of the patients were fluent in English. Patient interviews covered benefits and insights received on their health goals, communication with the student team, and suggestions for improving the clinic experience.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFocus group data were transcribed verbatim. In our secondary analysis we independently read and analysed all the data to identify recurrent themes and subthemes, and negotiated alternative interpretations. A thematic analysis [43] enabled interpretation of student and patient accounts of their encounters in the clinic. We began by considering the social spaces in which the student and patients were working and their relationships within them, based on previous work. [22] [24]. \u0026nbsp;At this point we realised the utility of the Bordieuan lens as a set of `thinking tools\u0026apos; \u0026nbsp;namely field, habitus, and capital to illuminate our understanding of the social world of the clinic. [44] [31] Consistent with a Bordieuan approach, we augmented our focus group data analysis with reading of the student patient management plans undertaken on the structured clinic record, and brief field notes from the interprofessional student debriefings after each clinic. Following further discussions, a coding framework was jointly developed (CR, PK and AB) and was used by one author (CR) to code the entire dataset. Data was then rearranged from the Bordieuan perspective to facilitate comprehensive interpretation. We claimed sufficient information power [45] given our focused aim (i.e. clinic participants\u0026rsquo; views and experiences of the clinic), the richness of the dialogue in the focus groups and our use of Bordieuan theory during data analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the University\u0026rsquo;s Human Research Ethics Committee (Approval No: 2018/209). Written consent for participation was obtained from all participants to enable us to include their data from this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTeam reflexivity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDiscussions of the quality of research between the authors encouraged reflexivity about the methodological implications of particular decisions made during the course of the project. [46] In immersing ourselves in the data we reflected on our own fields of practice, habitus and capital to acknowledge the ways these could affect our interpretation of the data. [47] Our different perspectives and insights on the data as an academic general practitioner and two educational researchers ultimately helped to support a more rigorous interpretation. Mindful of people first language in disability research, we acknowledge that in our setting healthcare recipients appear to prefer the term \u0026lsquo;patient.\u0026rsquo; [48] Though we use that term in this paper, we recognise some readers will prefer one of client, consumer, survivor or service-user.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e Our data illuminated the student clinic as a field of practice, where intersecting fields included a patient support group, an aged care clinical practice within a teaching hospital, and supervised interprofessional teaching practices. We considered the positions and dispositions and habitus of our study participants within the field of the clinic, and report the various forms and amounts of capital that were brought, enriched and exchanged by the students and patient partners.\u003c/p\u003e \u003cp\u003eTo answer our research questions we developed three broad themes from our data: Fostering Students\u0026rsquo; disposition to interprofessional care, Capitalizing on collaboration and empowerment and Culture of mutual capital exchange. We provide extracts of the participant voices to support the interpretation.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFostering Students\u0026rsquo; disposition to interprofessional care\u003c/h2\u003e \u003cp\u003eStudents adjusted to their positions and relationships in the context of their role in the field of the clinic. They varied in the way they internalized their relationships and expectations for working in the clinic. Some students had prior experience of being in an interprofessional team on simulated patient cases in the earlier years of their degree. They thus brought differing amounts of social and cultural capital, but their disposition to practice interprofessionally was changed through their practice (actions) in the clinic.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eIn first year we got together \u0026ndash; but we didn\u0026rsquo;t have a real patient. It was a pseudo scenario and then we had to come up with a plan and a video. .. at uni\u0026hellip; nothing like this. I find this a lot more beneficial to actually see the patient, then you can come back and discuss the issues. It was a completely different experience in clinic when you are in that chair, seeing that patient and then leave that room and discuss with your colleagues as to how to best manage.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e(student)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Students recognised the central position of the patient as partners in influencing their own disposition to interprofessional care. Students demonstrated a number of strategies to engage with their peers in a context of mutual trust around a common goal of influencing the outcomes of patient care.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026hellip;for me, what I\u0026rsquo;ve learnt today is not \u0026ndash; not just from a medication point of view, but it\u0026rsquo;s to be able to talk to all the other health care professionals and then that\u0026rsquo;s how we provide it better \u0026ndash; the best care for the patient that is to combined all the aspects and then to \u0026ndash; that\u0026rsquo;s an overall picture and then, just, try to improve that for the patient.\u003c/em\u003e (student)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe structuring of interprofessional practice is realised across multiple fields e.g. clinical placements in hospital or community settings, assessment practices, supervisory practices, and practices of patient care. Balancing the need of patients and the limits of what they can do in the clinic predisposed students to sharing their social ( who they know) and cultural capital ( knowledge and competence) with their peers. For example a physio student said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eIt really just shows how connected everyone is. I know that you deal with medicines and doctors and we deal more with the mobility and gait and all that stuff, but doing this you see, we\u0026rsquo;ve seen this impairment, they see a medication that affects that impairment and stuff, so, it\u0026rsquo;s really obvious how much everything ties into each other.\u003c/em\u003e (student)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e The interactions among students in the clinic reflect a diverse range of dispositions, particularly their shared commitment to patient-centered collaborative care. This collective habitus, which can be seen as the \"presence of the past in the present\"[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] signifies the ongoing journey towards collaborative practice from being a novice towards being an expert. That is, the development of the students\u0026rsquo; habitus is a gradual process influenced by their prior socialisation into both inter- and unidisciplinary ways of working. It is shaped by the accumulation of various forms of capital arising from their prior experiences and socialization into healthcare and interprofessional settings. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] Within the field of the clinic, student\u0026rsquo;s habitus encompasses their cultural capital including the depth of their disciplinary knowledge, competencies, and interprofessional behaviours. It is shaped by the accumulation of various forms of capital arising from their prior experiences and socialization in healthcare and interprofessional settings. Moreover, students\u0026rsquo; habitus is influenced by their positions (roles) in the clinic, their dispositions to engage and exchange capital, and their preferences in becoming both uni- and interprofessional practitioners. However, it was evident that some students were at different stages of this journey as they internalized their relationships with peers and patients, influenced by their own expectations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCapitalizing on Collaboration and Empowerment\u003c/h2\u003e \u003cp\u003ePatients in the field of student-led clinic were critical contributors of capital. Patients invested significantly in the clinic by physically attending, sharing their stories and goals, and exposing themselves to examination. They felt that participating in the clinic was a worthwhile investment because they gained new understandings of their own well-being. One patient noting \u003cem\u003e\u0026ldquo;\u0026hellip;.that\u0026rsquo;s how they help us. So we are benefiting by this trial\u0026rdquo;.\u003c/em\u003e Some patients felt that they made a unique contribution to student learning. This can be seen as the symbolic capital they brought to the clinic allowing the students to see different stages of a disease, share goals for well-being and gain rich insights into the patients\u0026rsquo; real world experience, including how they accessed their health and social care related networks.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;they see symptoms which are not in the textbook. We could have symptoms which are completely different\u0026hellip;.. I think they would be more aware and because they\u0026rsquo;re seeing such a \u0026ndash; a different diversity of Parkinson\u0026rsquo;s\u0026rdquo;\u003c/em\u003e (Patient participant)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe patients appreciated the interprofessional team approach in the student-led clinic and contrasted this with their experiences of multidisciplinary care outside the student clinic. They felt a sense of investment in the student clinic, knowing that students from different disciplines communicated with each other to provide patient centred care plans, which might ultimately improve future healthcare practice. It was more of a struggle to get their own health care team to talk to each other\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;About having a team approach, you\u0026rsquo;re dealing with things like Parkinson\u0026rsquo;s. I mean I\u0026rsquo;ve got a good GP and a good specialist, but they don\u0026rsquo;t really talk to each other very often\u0026hellip;.and they all talk about how we had a team approach but the \u0026ndash; I haven\u0026rsquo;t seen too many teams really.\u0026rdquo;\u003c/em\u003e (Patient participant)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis can be seen as the dominance of the medical model, and suggests that there is little shared social capital in service models of interprofessional care. Patients felt that interacting with the students inspired them to stay active. They felt empowered by the collaborative practice of the students around personal patient goals, and this is recognisable as their social (who they know) and cultural capital (knowledge and competence).\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eAnother aspect that occurred to me are the benefits of talking to these young people today - I get really, really cranky if \u0026ndash; when we\u0026rsquo;re at our group, and we\u0026rsquo;re sitting next to somebody who is sitting there, and their carer\u0026rsquo;s sitting here, and [fellow patient partner] goes to get his coffee \u0026ndash; and they\u0026rsquo;re giving it to him. I say, \u0026ldquo;Put it down. Let him or her get up themselves.\u0026rdquo; Because we don\u0026rsquo;t (want to be ) be killed with kindness. We want our independence as long as we can have it - - - - and the only way we\u0026rsquo;re going to get it, is us looking after ourselves\u0026hellip;. and not taking shortcuts.\u003c/em\u003e (Patient participant)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eInterestingly, the symbolic power of the university expressed as mode of cultural/social domination, in not permitting students to release their care plans to the patients, constrained patient engagement with the clinic. Patients explained that they wanted a conversation with the students or to read their recommendations, with input from the academic clinicians.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"I would love to be part of the (student ) team to see the results, so I think the only negative I can think of is not being able to be part of the outcome.\"\u003c/em\u003e (Patient participant)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn summary, in the student-led clinic, patients contributed significant symbolic capital through their investment in time, self-exposure, and willingness to participate in examinations. They bring cultural capital to the clinic by providing real-world insights into their health experiences and social capital in sharing how they access health and social care networks. Patients feel empowered by the interprofessional collaboration in the clinic and contrast it with their experiences of multidisciplinary care outside the student-led setting. However, in this setting, patient engagement with the clinic is constrained by the university's restriction on students sharing care plans with patients. Patients express a desire for conversation and access to the students' recommendations, which limits their involvement in the outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eCulture of Mutual Capital Exchange\u003c/h2\u003e \u003cp\u003eStudents reflected on their cultural capital i.e. what they know, and how they can apply and exchange this knowledge in the field in which they found themselves. In this case, a pharmacy student is able to reflect on the coming together of various roles and relationships within the clinic where various forms of \"capital\" such as prestige or resources are at stake. These resources were available for exchange with patients by also with their peers.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e..\u003cem\u003eas a pharmacy student, it was definitely really helpful in seeing and interviewing a Parkinson\u0026rsquo;s patient and seeing the full picture and how complex things can get. A lot of the medications in particular, there was a lot of polypharmacy, there was a lot of side effects that overlapped, and it really helps you to see how complex the bigger picture is when you\u0026rsquo;re actually speaking to a real Parkinson\u0026rsquo;s patient.\u003c/em\u003e (student )\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe pharmacy student suggests a conflict between different forms of cultural capital, such as the pharmacist's disciplinary expertise and the patient's priorities. An empirical application of guidelines by the pharmacist to medication management, an area of healthcare professional expertise, conflicts with the patient\u0026rsquo;s sense of being and what is important. More over the guidelines conflict with the priorities produced by the other disciplines. Such conflicts in practice were then taken to the student interprofessional team meeting and reflexively negotiated to arrive at a consensus for future action.\u003c/p\u003e \u003cp\u003eWithin the structure of the clinic, a physiotherapy student recognised the exchange of cultural capital by their pharmacy and medical peers when explaining the medications in the student team meeting. The physiotherapy students\u0026rsquo; position in the clinic and disposition to learn from their peers allowed them to achieve something not covered in their own curriculum, but necessary for patient care. Taken together this is an example of the influence of sharing capital on habitus and enriching the clinic as a field.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI really appreciate the fact that you actually broke it down and actually said, this is for this, and, you know, this is to help them to reduce, you know, all that stuff. It was really good to actually find out more information about medications. I think that\u0026rsquo;s something that physios in general should know what to do.\u003c/em\u003e (student)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome students were concerned that they lacked sufficient capital at the beginning of the clinic, for example cultural, the depth of disciplinary knowledge of their peers from other disciplines. They wanted faculty to further increase its investment of capital, rather than relying on their own agency to engage with both their peers and the patient partners for their learning. One student wanted more instruction and to be provided with \u003cem\u003e\u0026ldquo;a set of standardised questions\u003c/em\u003e\u0026ldquo; to ask each patient. Another student felt that only certain types of capital had value, for example competence (cultural). Some felt they had no expert knowledge in medication, an important component of the management of Parkinson and therefore worried they couldn\u0026rsquo;t meaningfully participate.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026hellip;. when we read patient charts just to find out what medications they\u0026rsquo;re on and what to help, our educator, obviously they\u0026rsquo;ve been working in hospitals for a long time, so they know what each one does, but I don\u0026rsquo;t., I, kind of, sat there going, I don\u0026rsquo;t know what that is, and don\u0026rsquo;t know what that does but okay\u0026hellip;.if I see that next time on someone else\u0026rsquo;s chart then I\u0026rsquo;ll know, good. They\u0026rsquo;ve taken it. It\u0026rsquo;s good. I\u0026rsquo;m good to go treating them, but I wouldn\u0026rsquo;t know what it does, if that makes sense.\u003c/em\u003e (student)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eYet, they recognised the rich capital on display from the clinical educators, and that they too would have to invest in this area to increase their own social and cultural capital. Medical students also valued the social capital that they exchanged with their interprofessional peers in the clinic. Interestingly, they were surprised at the value of the cultural capital they gained in working with the patient partners.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026hellip;the last time I ever studied neurology was back in second year\u0026hellip; so it\u0026rsquo;s just good to see, actual Parkinson patients. I saw one for the first time in a while, took a history and exam. Like \u0026hellip; seeing the clinical signs was a bonus working with multidisciplinary team and seeing what each team does differently, and you know learning from one another.\u003c/em\u003e (student)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAll the students needed to develop a common currency, a shared language and narratives with which to exchange their capital. As an example, the use of disciplinary specific abbreviations was constraining patient care and student learning. Feedback to their peers promoted the use of a common language in describing the patients\u0026rsquo; problems in the management plans, and avoiding acronyms.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eand most of the medications were quite similar anyway so that made more sense. So it was it\u0026rsquo;s like reading a report with a bunch of abbreviations though, that maybe you\u0026rsquo;ve never used before but it\u0026rsquo;s very common for someone else.\u003c/em\u003e (student)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ePatients were able to assess what kind of knowledge and skills ( cultural capital) the students brought to the clinic when acting in their uni-professional role. Yet recognising that some disciplines needed more interprofessional knowledge (cultural capital) at this point in their learning trajectory.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI had a couple of the physio and a couple of the pharmacy. The medical students, I did ask a couple of questions, but I think it\u0026rsquo;s a little bit too early in their learning curve to answer it directly and responsibly, because everybody\u0026rsquo;s symptoms, as we all know with Parkinson\u0026rsquo;s is totally different. We\u0026rsquo;re not all the same, and I think that\u0026rsquo;s where it becomes a really big issue for some people.\u003c/em\u003e (patient participant)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ePatients actively engaged with students, providing valuable insights, experiences, and perspectives related to their Parkinson\u0026rsquo;s. By sharing their knowledge, challenges, and reflecting on student recommendations, patients contribute to the social and cultural capital of the students, fostering a collaborative and enriching learning environment whilst enriching their own knowledge.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"These different clinicians [from various disciplines], they ask pertinent questions of us, things that perhaps, you might forget about, and then you sort of think to yourself, 'Oh yes. That\u0026rsquo;s sort of important, and that\u0026rsquo;s happened to me.'\" (patient participant)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAs students were rapidly socialised into the field of the clinic, they recognised the complexity of the intersection of layers within the field. Students arrived at the clinic with a varying but often rich sense of the social and cultural capital they bring, and what they are willing to share. They may not know the other students, but they know what (inter) disciplinary roles they are expected to achieve. Students recognised the rich symbolic capital invested in the authentic portrayal of the clinic offering exchange with patients. Students valued the patients\u0026rsquo; symbolic capital and their willingness to entrust their stories, their health and social care problems to the students. Thus, there was mutual recognition of an exchange of capital, patients recognising the capital the student bring. Like-wise, the patients showed their committed to student learning by sharing their cultural capital with the students (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Our data, however, did not support use of symbolic power by the students to influence the other students to their own disciplinary worldview.\u003c/p\u003e \u003cp\u003eA summary of the ways in which the collective capital of participants intersects with their habitus within the field of the student clinic are illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e\u003cp\u003e\u003cstrong\u003eInsert Fig 1 about here\u003c/strong\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003eSummary of key findings\u003c/h2\u003e\n \u003cp\u003eThe study applied Bourdieu\u0026apos;s theory of practice to understand the mechanisms that underpin the co-creation of a interprofessional student-led clinic. Overall, the study provides insights into the interplay between field, habitus, and capital in the context of a student-led clinic, emphasizing the significance of patient empowerment, student socialization, and the exchange of social and cultural capital for developing interprofessional practice in an atmosphere of mutual trust.\u003c/p\u003e\n \u003cp\u003eThe habitus plays a crucial role in shaping students\u0026apos; dispositions and guiding their responses to the clinic\u0026apos;s constraints and enablers of interprofessional working. It fosters trust and readiness for interprofessional practice among students. Patients, on the other hand, feel empowered in recognizing the importance of their well-being goals and their symbolic power in influencing student learning.\u003c/p\u003e\n \u003cp\u003eThe findings highlight the importance of recognizing and valuing the various forms of capital brought by students and patients, as well as the equal relationship between them within the clinics as a field of practice. The shared culture of mutual entrustment between students and patients influences students\u0026rsquo; learning experiences and enriches their habitus.\u003c/p\u003e\n \u003cp\u003eStudents are socialized into the field of interprofessional practice in the clinic, using their cultural capital to access to other forms of capital from patients, peers, and supervisors. Caring for the patient is a common goal, and students learn to build their capital through partnership and collaboration. The strength, trust, and value of the interactions between participants within the clinic contribute to the overall quality of social capital that is generated within that environment.\u003c/p\u003e\n \u003cp\u003eThe combined resources, experiences, and knowledge of the participants (both students and patients) come together and interact with their ingrained dispositions, behaviours, and ways of thinking (habitus) within the context of the student clinic. Students and patient partners arrive with, invest in, and share capital, leading to the development of new dispositions which further enrich habitus. The most valuable capital in the clinic\u0026apos;s field is the symbolic capital brought and shared by the patients, contributing to a culture of mutual trust and an aspiration to improve patient outcomes. The symbolic power of the clinic was defined by the equal relationship between those who traditionally exercise power (the clinical academics and the students) and those who undergo it (the patients), in the field of the clinic. [\u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003eComparison with existing theory and literature\u003c/h2\u003e\n \u003cp\u003eOur findings reflect the underlying principles of the dynamic interplay between field, habitus and capital in providing interprofessional healthcare. [\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e] Although our findings partially align with the work of Bonello et al [\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e] in taking a Bordieuan lens IPE, our empirical study extends this work by illustrating a multiplicity of influences in the reproduction of a complex IPE activity, the student led clinic. In our study there was no evidence of symbolic power struggles between the students, as predicted by other scholars reporting medical domination [\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e] [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e] IPE in clinical settings might be expected to create role conflicts in terms of certain disciplines such as medical students struggling to see the benefit of the IPE experience. [\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e] Though we expected some students to feel they had more cultural, social or symbolic capital, we did not find any conflicts as they acknowledged their professional boundaries, and respected the mutual goal of patient care. Rather the struggle we observed was to learn and work with each other to provide health care centred around patients\u0026rsquo; needs [\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e] which they saw as expertise-based than profession-based .\u003c/p\u003e\n \u003cp\u003eOur data supports the concept of habitus serving as a framework to understand how the structure and functioning of the clinic shape students\u0026apos; long-lasting tendencies, attitudes, and abilities to engage in interprofessional practices. Their habitus, guides them in their creative responses to the constraints and enablers of being and becoming interprofessional. [\u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e] By emulating authentic interprofessional practice around the needs of the patient, students negotiated with the multiple voices of peers, patients and supervisors in the field of the clinic through their habitus. The students\u0026rsquo; habitus became a \u0026lsquo;practice-unifying and practice-generating principle\u0026rsquo; [\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e] This development within habitus was influential in students trusting and becoming ready for interprofessional practice. The habitus partially resonates with the notion of the interprofessional identity evolving from a uniprofessional identity. [\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/p\u003e\n \u003cp\u003eThe patients\u0026rsquo; sense of their symbolic power arose from sharing their goals for well-being and recognising the mindfulness of the interprofessional team in trying to achieve them. Additionally, in being realistic about what can be done to help them achieve their well-being goals. This emphasizes the importance of social connections between students and patients, creating a source of influence that leads to the accumulation of shared symbolic value, which encompasses cultural and social aspects. [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e] Power seemed to be culturally and symbolically created and constantly re-enacted through this interplay of relationships in the field of the clinic. Trust was an important component of students\u0026rsquo; and patients\u0026rsquo; willingness to share their cultural capital.[\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e] The central role of the patients appeared de-centering and seemed to disrupt the often reported power relations between students; often imagining medical students in the ascendant. [\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e] [\u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e] [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e] [\u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e] Patients didn\u0026rsquo;t particularly privilege the capital of one discipline. For these reasons, we believe that we did not see the issues of power and conflict found in other interprofessional initiatives related to symbolic barriers of strong medical dominance and lack of collaboration at all levels. [\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e] Sharing of cultural capital with others gives a sense of collective identity and of collective capital, an important practice -generating principle. Individual\u0026rsquo;s practices or actions are the consequences of their cultural capital and habitus interacting within the context of a given field. [\u003cspan class=\"CitationRef\"\u003e59\u003c/span\u003e] Being able to convey professional knowledge regarding the situation of a patient and consider the professional views of others is essential to interprofessional work, as a means to providing the best patient outcomes [\u003cspan class=\"CitationRef\"\u003e60\u003c/span\u003e] [\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e]. Trust in interprofessional learning group members is thought to transfer to generalised trust of other professional groups in the workplace, and the advantages of working interprofessionally accumulates. [\u003cspan class=\"CitationRef\"\u003e61\u003c/span\u003e] Our findings support the notion that to sustain interprofessional student led clinics, IPL the leaders must persuade a diverse range of stakeholders, not only those who would be engaged as learners, supervisors, and administrators but those with the power to provide resources.[\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e] We would argue the patient voice needs to be considered as partners.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eMethodological Strengths and challenges\u003c/h2\u003e\n \u003cp\u003eThe strength of this study is its contribution to and extension of the existing literature in three ways. First, it provides insights into the experiences of two key stakeholder groups, prospective healthcare practitioners and patients living with a chronic disability on the perceived value of a co-created student-led clinic. Second, it offers a theoretical framework that goes beyond economic considerations and emphasizes the importance of alternative forms of capital in promoting interprofessional collaborative practice. Third, it replaces the idea of a power struggle between medicine and the other healthcare disciplines causing a lack of collaboration to one of cooperation between patients and the student team around patient well-being goals.\u003c/p\u003e\n \u003cp\u003eIn terms of the challenges, we did not employ the range of Bordieuan methodologies for example looking at our field in relationship to other fields; in particular the recognized fields of power in the university and the health care providers. We do not have the data from the multiple clinicians and educators consulted in setting up the clinic. Despite the limitations of our sample, being within one institution, and amongst students and patients who volunteered and may have had more positive dispositions to engage with IPE, we still believe the findings will be valuable to researchers wishing to develop their own clinics or reflect on their own established practices.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003eImplications for Educational Practice\u003c/h2\u003e\n \u003cp\u003eOur findings suggest ways of optimising IPE student and patient experiences through investment in and exchange of differing forms of capital to create a sustainable field of interprofessional practice. Whilst this does not underplay the need for financial capital, our findings provide insights into understanding the cultural shifts required to promote collaborative practice. Interprofessional curricular initiatives which attempt to promote social learning in the workplace amongst health professional students can be seen as unifying in the field of practice. Our findings suggest that there is collective power of various forms of \u0026lsquo;capital\u0026rsquo; in shaping interprofessional practice. In order for student clinics to thrive in sustainable fashion, considerable investment is required from faculties, patient partners, service provider organisations and the student body, in the form of investing and exchanging social and cultural capital within an atmosphere of mutual trust. At some point these needed to be turned into economic capital as part of a robust health-provider university partnership. Educators must create alternative sources of capital, through fostering collaborative alliances between the university, the service providers, patient representation and the student body. Logic models may provide a useful evaluation process [\u003cspan class=\"CitationRef\"\u003e62\u003c/span\u003e] A framework for conceptualising the logic of Interprofessional Practice in a student led clinic though the Bourdieuan concepts of field, habitus and capital is given in Fig.\u0026nbsp;2\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003cp\u003e\u003cstrong\u003eInsert Fig. 2 about here\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\n \u003ch2\u003eImplications for further research\u003c/h2\u003e\n \u003cp\u003eGiven the methodological insights and constraints associated with this study, further research is advised employing sociological methodologies such as ethnography from the outset of studies to further elucidate the struggles in setting up IPE clinics and their impacts on patient outcomes and student professional development. We encourage researchers to explore the impacts of different types of Interprofessional student led clinics e.g., vaccination clinics, pre-diabetic care, or rehabilitation clinics. Further research could also consider the adaptability of the current findings in other settings in both resource rich and resource challenged countries. By reframing the research question, a Bordieuan approach may help to explain how various entities within the university faculty leadership groups, the health care professional education disciplines, leadership groups from within healthcare providers and patients\u0026rsquo; representation could exercise their powers and generate mechanisms to make student-led interprofessional clinics flourish.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study highlights the co-creation of interprofessional collaborative practice in a student-led clinic through the lens of Bourdieu\u0026apos;s framework. The findings emphasize the significance of recognizing and valuing the various forms of capital brought by students and patients, as well as the equal relationship between them. The role of habitus in shaping students\u0026apos; dispositions and guiding their responses within the clinic\u0026apos;s field is also underscored. The study provides valuable insights for educators and researchers, urging them to invest in collaborative alliances and explore alternative forms of capital other than financial to promote sustainable interprofessional practice\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe wish to thank Dr Cesar Uy, the clinician in charge of the aged care facility that hosted the clinic, to Richard Babb, Chair of the local Parkinson\u0026rsquo;s support group, members of the Parkinson\u0026rsquo;s support group for their wisdom. The local health authority discipline leaders, university discipline academic leaders, and to Drs Carl Schneider and Rebecca Moles for facilitating students in the clinic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDatasets supporting the conclusions of this article are included within the article. The datasets generated and analysed during the current study are not publicly available due to confidentiality agreements approved by the Human Research Ethics Committee but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; \u0026nbsp;contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCR was the principal academic supervisor of the clinic. CR and AB designed the study. AB secured ethics approval and undertook the focus group interviews. CR PK and AB were involved in theorising, analysing and interpreting study data. CR and AB wrote the first draft and with PK revised various iterations of the paper. All authors give their final approval for this version to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll research method were carried out in accordance with relevant guidelines and regulations. The University of Sydney Human Research Ethics Committee (Approval No: 2018/209) approved the research. Informed written consent for participation was obtained from participants to enable us to include their data from this study. All participants were reassured that data were strictly de-identified to protect participant privacy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have a conflict to declare. CR is a Senior Editorial Board member and PK and AB are editorial board members of BMC Medical \u0026nbsp;Education\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChris Roberts\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe University of Sheffield, School of Medicine and Population Health, Faculty of Health, The University of Sheffield, S10 2RX, UK\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePriya Khanna\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Education Office, The University of Sydney, NSW, 2006, Australia\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnnette Burgess\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Education Office, The University of Sydney, NSW, 2006, Australia\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBriggs L, Fronek P: \u003cstrong\u003eStudent Experiences and Perceptions of Participation in Student-Led Health Clinics: A Systematic Review\u003c/strong\u003e. \u003cem\u003eJournal of Social Work Education \u003c/em\u003e2020, \u003cstrong\u003e56\u003c/strong\u003e(2):238-259.\u003c/li\u003e\n\u003cli\u003eSchutte T, Tichelaar J, Dekker RS, van Agtmael MA, de Vries TP, Richir MC: \u003cstrong\u003eLearning in student‐run clinics: A systematic review\u003c/strong\u003e. \u003cem\u003eMedical education \u003c/em\u003e2015, \u003cstrong\u003e49\u003c/strong\u003e(3):249-263.\u003c/li\u003e\n\u003cli\u003eHopkins S, Bacon R, Flynn A: \u003cstrong\u003eStudent outcomes for interprofessional education in student led clinics: A rapid review\u003c/strong\u003e. \u003cem\u003eJournal of Interprofessional Care \u003c/em\u003e2022, \u003cstrong\u003e36\u003c/strong\u003e(2):234-244.\u003c/li\u003e\n\u003cli\u003eBroman P, Tokolahi E, Wilson OWA, Haggie M, Andersen P, Brownie S: \u003cstrong\u003ePatient Outcomes from Student-Run Health Services: An Integrative Review\u003c/strong\u003e. \u003cem\u003eJournal of Multidisciplinary Healthcare \u003c/em\u003e2022, \u003cstrong\u003e15\u003c/strong\u003e:641-665.\u003c/li\u003e\n\u003cli\u003eFrenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garcia P, Ke Y, Kelley P: \u003cstrong\u003eHealth professionals for a new century: transforming education to strengthen health systems in an interdependent world\u003c/strong\u003e. \u003cem\u003eThe lancet \u003c/em\u003e2010, \u003cstrong\u003e376\u003c/strong\u003e(9756):1923-1958.\u003c/li\u003e\n\u003cli\u003eOrganization WH: \u003cstrong\u003eFramework for action on interprofessional education and collaborative practice\u003c/strong\u003e. In\u003cem\u003e.\u003c/em\u003e: World Health Organization; 2010.\u003c/li\u003e\n\u003cli\u003eReeves S, Fletcher S, Barr H, Birch I, Boet S, Davies N, McFadyen A, Rivera J, Kitto S: \u003cstrong\u003eA BEME systematic review of the effects of interprofessional education: BEME Guide No. 39\u003c/strong\u003e. \u003cem\u003eMed Teach \u003c/em\u003e2016, \u003cstrong\u003e38\u003c/strong\u003e(7):656-668.\u003c/li\u003e\n\u003cli\u003eWhyte S, Paradis E, Cartmill C, Kuper A, Boon H, Hart C, Razack S, Pipher M, Whitehead CR: \u003cstrong\u003eMisalignments of purpose and power in an early Canadian interprofessional education initiative\u003c/strong\u003e. \u003cem\u003eAdvances in Health Sciences Education \u003c/em\u003e2017, \u003cstrong\u003e22\u003c/strong\u003e(5):1123-1149.\u003c/li\u003e\n\u003cli\u003eClay MC, Garr D, Greer A, Lewis R, Blue A, Evans C: \u003cstrong\u003eAn update on the status of interprofessional education and interprofessional prevention education in US academic health centers\u003c/strong\u003e. \u003cem\u003eJournal of Interprofessional Education \u0026amp; Practice \u003c/em\u003e2018, \u003cstrong\u003e10\u003c/strong\u003e:61-66.\u003c/li\u003e\n\u003cli\u003eHean S, Hammick M, Miers M, Barr H, Hind M, Craddock D, Borthwick A, O\u0026apos;Halloran C: \u003cstrong\u003eEvolving theory in interprofessional education: Conclusion report res-451-26-0360\u003c/strong\u003e, vol. null; 2009.\u003c/li\u003e\n\u003cli\u003eFreeth D, Savin-Baden M, Thistlethwaite J: \u003cstrong\u003eInterprofessional education\u003c/strong\u003e. \u003cem\u003eUnderstanding medical education \u003c/em\u003e2010:53-68.\u003c/li\u003e\n\u003cli\u003eMcAndrew R, Kaskutas V: \u003cstrong\u003eA logic model for planning, implementing, and evaluating a student-run free clinic\u003c/strong\u003e. \u003cem\u003eJournal of Student-Run Clinics \u003c/em\u003e2020, \u003cstrong\u003e6\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eParihar A, Devanathan N, Sepulveda MN, Sevilla-Martir JF: \u003cstrong\u003eFinancial Impact of the Indiana University Student-Run Free Clinic\u003c/strong\u003e. \u003cem\u003eJ Community Health \u003c/em\u003e2023:1-4.\u003c/li\u003e\n\u003cli\u003eLawlis TR, Anson J, Greenfield D: \u003cstrong\u003eBarriers and enablers that influence sustainable interprofessional education: a literature review\u003c/strong\u003e. \u003cem\u003eJournal of interprofessional care \u003c/em\u003e2014, \u003cstrong\u003e28\u003c/strong\u003e(4):305-310.\u003c/li\u003e\n\u003cli\u003eJorm C, Roberts C: \u003cstrong\u003eUsing Complexity Theory to Guide Medical School Evaluations\u003c/strong\u003e. \u003cem\u003eAcademic Medicine \u003c/em\u003e2018, \u003cstrong\u003e93\u003c/strong\u003e(3):399-405.\u003c/li\u003e\n\u003cli\u003eKent F, Drysdale P, Martin N, Keating JL: \u003cstrong\u003eThe Mixed-Discipline Aged-Care Student Clinic: An Authentic Interprofessional Learning Initiative\u003c/strong\u003e. \u003cem\u003eJournal of Allied Health \u003c/em\u003e2014, \u003cstrong\u003e43\u003c/strong\u003e(1):51-56.\u003c/li\u003e\n\u003cli\u003eSheu L, O\u0026rsquo;Brien B, O\u0026rsquo;Sullivan PS, Kwong A, Lai CJ: \u003cstrong\u003eSystems-based practice learning opportunities in student-run clinics: a qualitative analysis of student experiences\u003c/strong\u003e. \u003cem\u003eAcademic Medicine \u003c/em\u003e2013, \u003cstrong\u003e88\u003c/strong\u003e(6):831-836.\u003c/li\u003e\n\u003cli\u003eSheu LC, Zheng P, Coelho AD, Lin LD, O\u0026rsquo;sullivan PS, O\u0026rsquo;brien BC, Albert YY, Lai CJ: \u003cstrong\u003eLearning through service: student perceptions on volunteering at interprofessional hepatitis B student-run clinics\u003c/strong\u003e. \u003cem\u003eJournal of Cancer Education \u003c/em\u003e2011, \u003cstrong\u003e26\u003c/strong\u003e(2):228-233.\u003c/li\u003e\n\u003cli\u003eVarpio L, Aschenbrener C, Bates J: \u003cstrong\u003eTackling wicked problems: how theories of agency can provide new insights\u003c/strong\u003e. \u003cem\u003eMedical Education \u003c/em\u003e2017, \u003cstrong\u003e51\u003c/strong\u003e(4):353-365.\u003c/li\u003e\n\u003cli\u003eThistlethwaite J: \u003cstrong\u003eInterprofessional education: a review of context, learning and the research agenda\u003c/strong\u003e. \u003cem\u003eMed Educ \u003c/em\u003e2012, \u003cstrong\u003e46\u003c/strong\u003e(1):58-70.\u003c/li\u003e\n\u003cli\u003eWenger E: \u003cstrong\u003eCommunities of practice and social learning systems\u003c/strong\u003e. \u003cem\u003eOrganization \u003c/em\u003e2000, \u003cstrong\u003e7\u003c/strong\u003e(2):225-246.\u003c/li\u003e\n\u003cli\u003eRoberts C, Daly M, Held F, Lyle D: \u003cstrong\u003eSocial learning in a longitudinal integrated clinical placement\u003c/strong\u003e. \u003cem\u003eAdvances in Health Sciences Education \u003c/em\u003e2017, \u003cstrong\u003e22\u003c/strong\u003e(4):1011-1029.\u003c/li\u003e\n\u003cli\u003eBurgess A, Kalman E, Haq I, Leaver A, Roberts C, Bleasel J: \u003cstrong\u003eInterprofessional team-based learning (TBL): how do students engage?\u003c/strong\u003e \u003cem\u003eBMC Medical Education \u003c/em\u003e2020, \u003cstrong\u003e20\u003c/strong\u003e(1):118.\u003c/li\u003e\n\u003cli\u003eHeld FP, Roberts C, Daly M, Brunero C: \u003cstrong\u003eLearning relationships in community-based service-learning: a social network analysis\u003c/strong\u003e. \u003cem\u003eBMC Medical Education \u003c/em\u003e2019, \u003cstrong\u003e19\u003c/strong\u003e(1):113.\u003c/li\u003e\n\u003cli\u003eHamilton V, Baird K, Fenwick J: \u003cstrong\u003eNurturing autonomy in student midwives within a student led antenatal clinic\u003c/strong\u003e. \u003cem\u003eWomen and Birth \u003c/em\u003e2020, \u003cstrong\u003e33\u003c/strong\u003e(5):448-454.\u003c/li\u003e\n\u003cli\u003eBhaskar R, Danermark B, Price L: \u003cstrong\u003eInterdisciplinarity and Wellbeing: A Critical Realist General Theory of Interdisciplinarity\u003c/strong\u003e: Routledge; 2017.\u003c/li\u003e\n\u003cli\u003eArcher MS, Archer MS: \u003cstrong\u003eBeing human: The problem of agency\u003c/strong\u003e: Cambridge University Press; 2000.\u003c/li\u003e\n\u003cli\u003eBurawoy M: \u003cstrong\u003eMaking sense of Bourdieu: from demolition to recuperation and critique\u003c/strong\u003e. \u003cem\u003eCatalyst \u003c/em\u003e2018, \u003cstrong\u003e2\u003c/strong\u003e(1):51-87.\u003c/li\u003e\n\u003cli\u003eBourdieu P: \u003cstrong\u003eThe logic of practice\u003c/strong\u003e: Stanford university press; 1990.\u003c/li\u003e\n\u003cli\u003eBourdieu P: \u003cstrong\u003eOutline of a Theory of Practice\u003c/strong\u003e, vol. 16: Cambridge university press; 1977.\u003c/li\u003e\n\u003cli\u003eBourdieu P, Wacquant LJ: \u003cstrong\u003eAn invitation to reflexive sociology\u003c/strong\u003e: University of Chicago press; 1992.\u003c/li\u003e\n\u003cli\u003eBhandari H, Yasunobu K: \u003cstrong\u003eWhat is social capital? A comprehensive review of the concept\u003c/strong\u003e. \u003cem\u003eAsian Journal of Social Science \u003c/em\u003e2009, \u003cstrong\u003e37\u003c/strong\u003e(3):480-510.\u003c/li\u003e\n\u003cli\u003eBourdieu P, Richardson JG: \u003cstrong\u003eHandbook of Theory and Research for the Sociology of Education\u003c/strong\u003e, vol. null; 1986.\u003c/li\u003e\n\u003cli\u003eBourdieu P: \u003cstrong\u003eLanguage and symbolic power\u003c/strong\u003e: Harvard University Press; 1991.\u003c/li\u003e\n\u003cli\u003eBrosnan C: \u003cstrong\u003eMaking sense of differences between medical schools through Bourdieu\u0026rsquo;s concept of \u0026lsquo;field\u0026rsquo;\u003c/strong\u003e. \u003cem\u003eMedical Education \u003c/em\u003e2010, \u003cstrong\u003e44\u003c/strong\u003e(7):645-652.\u003c/li\u003e\n\u003cli\u003eHu WC, Thistlethwaite JE, Weller J, Gallego G, Monteith J, McColl GJ: \u003cstrong\u003e\u0026lsquo;It was serendipity\u0026rsquo;: a qualitative study of academic careers in medical education\u003c/strong\u003e. \u003cem\u003eMedical Education \u003c/em\u003e2015, \u003cstrong\u003e49\u003c/strong\u003e(11):1124-1136.\u003c/li\u003e\n\u003cli\u003eOlsson C, Kal\u0026eacute;n S, Ponzer S: \u003cstrong\u003eSociological analysis of the medical field: using Bourdieu to understand the processes preceding medical doctors\u0026rsquo; specialty choice and the influence of perceived status and other forms of symbolic capital on their choices\u003c/strong\u003e. \u003cem\u003eAdvances in Health Sciences Education \u003c/em\u003e2019:1-15.\u003c/li\u003e\n\u003cli\u003eAlm\u0026aring;s SH: \u003cstrong\u003eInterprofessional education: an analysis of the introduction of a common core in curricula for selected health professions\u003c/strong\u003e: The University of Bergen; 2007.\u003c/li\u003e\n\u003cli\u003ePaton M, Kuper A, Paradis E, Feilchenfeld Z, Whitehead CR: \u003cstrong\u003eTackling the void: the importance of addressing absences in the field of health professions education research\u003c/strong\u003e. \u003cem\u003eAdvances in Health Sciences Education \u003c/em\u003e2020.\u003c/li\u003e\n\u003cli\u003eHawick L, Kitto S, Cleland J: \u003cstrong\u003eContact is not enough: a qualitative study of how space and place impact on interprofessional education\u003c/strong\u003e. \u003cem\u003eJournal of Interprofessional Care \u003c/em\u003e2021, \u003cstrong\u003e35\u003c/strong\u003e(5):710-717.\u003c/li\u003e\n\u003cli\u003eGum LF, Prideaux D, Sweet L, Greenhill J: \u003cstrong\u003eFrom the nurses\u0026apos; station to the health team hub: how can design promote interprofessional collaboration?\u003c/strong\u003e \u003cem\u003eJournal of interprofessional care \u003c/em\u003e2012, \u003cstrong\u003e26\u003c/strong\u003e(1):21-27.\u003c/li\u003e\n\u003cli\u003eBurgess A, Roberts C: \u003cstrong\u003eInterprofessional student-led clinics: the volunteer patient experience\u003c/strong\u003e. \u003cem\u003eBMC Med Educ \u003c/em\u003e2022, \u003cstrong\u003e22\u003c/strong\u003e(1):1-6.\u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V, Terry G: \u003cstrong\u003eThematic Analysis\u003c/strong\u003e. \u003cem\u003eQualitative Research in Clinical and Health Psychology \u003c/em\u003e2014:95.\u003c/li\u003e\n\u003cli\u003eGrenfell* M, James D: \u003cstrong\u003eChange in the field\u0026mdash;chang ing the field: Bourdieu and the methodological practice of educational research\u003c/strong\u003e. \u003cem\u003eBritish Journal of Sociology of Education \u003c/em\u003e2004, \u003cstrong\u003e25\u003c/strong\u003e(4):507-523.\u003c/li\u003e\n\u003cli\u003eMalterud K, Siersma VD, Guassora AD: \u003cstrong\u003eSample size in qualitative interview studies: guided by information power\u003c/strong\u003e. \u003cem\u003eQualitative health research \u003c/em\u003e2016, \u003cstrong\u003e26\u003c/strong\u003e(13):1753-1760.\u003c/li\u003e\n\u003cli\u003eEl-Awaisi A, Awaisu A, Jaam M, Saffouh El Hajj M, Verjee MA: \u003cstrong\u003eDoes the delivery of interprofessional education have an effect on stereotypical views of healthcare students in Qatar?\u003c/strong\u003e \u003cem\u003eJournal of Interprofessional Care \u003c/em\u003e2020, \u003cstrong\u003e34\u003c/strong\u003e(1):44-49.\u003c/li\u003e\n\u003cli\u003eBonello M, Wright J, Morris J, Sadlo G: \u003cstrong\u003eBourdieu and interprofessional education: what\u0026rsquo;s the relevance?\u003c/strong\u003e \u003cem\u003eStudies in Continuing Education \u003c/em\u003e2018, \u003cstrong\u003e40\u003c/strong\u003e(1):1-16.\u003c/li\u003e\n\u003cli\u003eCosta DSJ, Mercieca-Bebber R, Tesson S, Seidler Z, Lopez A-L: \u003cstrong\u003ePatient, client, consumer, survivor or other alternatives? A scoping review of preferred terms for labelling individuals who access healthcare across settings\u003c/strong\u003e. \u003cem\u003eBMJ Open \u003c/em\u003e2019, \u003cstrong\u003e9\u003c/strong\u003e(3):e025166.\u003c/li\u003e\n\u003cli\u003eBourdieu P: \u003cstrong\u003ePascalian Meditations (R. Nice Transaltions)\u003c/strong\u003e. In\u003cem\u003e.\u003c/em\u003e: Stanford University Press, Standford; 2000.\u003c/li\u003e\n\u003cli\u003eBourdieu P: \u003cstrong\u003eSymbolic power\u003c/strong\u003e. \u003cem\u003eCritique of anthropology \u003c/em\u003e1979, \u003cstrong\u003e4\u003c/strong\u003e(13-14):77-85.\u003c/li\u003e\n\u003cli\u003eBrosnan C: \u003cstrong\u003ePierre Bourdieu and the theory of medical education: Thinking \u0026lsquo;relationally\u0026rsquo;about medical students and medical curricula\u003c/strong\u003e. In: \u003cem\u003eHandbook of the sociology of medical education.\u003c/em\u003e edn.: Routledge; 2009: 65-82.\u003c/li\u003e\n\u003cli\u003eHudson JN, Lethbridge A, Vella S, Caputi P: \u003cstrong\u003eDecline in medical students\u0026rsquo; attitudes to interprofessional learning and patient‐centredness\u003c/strong\u003e. \u003cem\u003eMedical education \u003c/em\u003e2016, \u003cstrong\u003e50\u003c/strong\u003e(5):550-559.\u003c/li\u003e\n\u003cli\u003eDubbin LA, Chang JS, Shim JK: \u003cstrong\u003eCultural health capital and the interactional dynamics of patient-centered care\u003c/strong\u003e. \u003cem\u003eSocial Science \u0026amp; Medicine \u003c/em\u003e2013, \u003cstrong\u003e93\u003c/strong\u003e:113-120.\u003c/li\u003e\n\u003cli\u003eWacquant L: \u003cstrong\u003eA concise genealogy and anatomy of habitus\u003c/strong\u003e. \u003cem\u003eThe Sociological Review \u003c/em\u003e2016, \u003cstrong\u003e64\u003c/strong\u003e(1):64-72.\u003c/li\u003e\n\u003cli\u003eThistlethwaite J, Kumar K, Roberts C: \u003cstrong\u003eBecoming interprofessional: professional identity formation in the health professions\u003c/strong\u003e. In: \u003cem\u003eTeaching medical professionalism: Supporting the development of a professional identity.\u003c/em\u003e edn.: Cambridge University Press; 2016: 140-154.\u003c/li\u003e\n\u003cli\u003eRoberts C, Howe A, Winterburn S, Fox N: \u003cstrong\u003eNot so easy as it sounds: a qualitative study of a shared learning project between medical and nursing undergraduate students\u003c/strong\u003e. \u003cem\u003eMedical Teacher \u003c/em\u003e2000, \u003cstrong\u003e22\u003c/strong\u003e(4):386-391.\u003c/li\u003e\n\u003cli\u003eHean S, Clark JM, Adams K, Humphris D: \u003cstrong\u003eWill opposites attract? Similarities and differences in students\u0026apos; perceptions of the stereotype profiles of other health and social care professional groups\u003c/strong\u003e. \u003cem\u003eJournal of interprofessional care \u003c/em\u003e2006, \u003cstrong\u003e20\u003c/strong\u003e(2):162-181.\u003c/li\u003e\n\u003cli\u003eKuper A, Whitehead C: \u003cstrong\u003eThe paradox of interprofessional education: IPE as a mechanism of maintaining physician power?\u003c/strong\u003e In\u003cem\u003e.\u003c/em\u003e: Taylor \u0026amp; Francis; 2012.\u003c/li\u003e\n\u003cli\u003eEdgerton JD, Roberts LW: \u003cstrong\u003eCultural capital or habitus? Bourdieu and beyond in the explanation of enduring educational inequality\u003c/strong\u003e. \u003cem\u003eTheory and Research in Education \u003c/em\u003e2014, \u003cstrong\u003e12\u003c/strong\u003e(2):193-220.\u003c/li\u003e\n\u003cli\u003eHammick M, Anderson E: \u003cstrong\u003eSustaining interprofessional education in professional award programmes\u003c/strong\u003e. \u003cem\u003eInterprofessional education: Making it happen \u003c/em\u003e2009:202-226.\u003c/li\u003e\n\u003cli\u003eHean S, Cowley S, Forbes A, Griffiths P, Maben J: \u003cstrong\u003eThe M\u0026ndash;C\u0026ndash;M\u0026prime; cycle and social capital\u003c/strong\u003e. \u003cem\u003eSocial Science \u0026amp; Medicine \u003c/em\u003e2003, \u003cstrong\u003e56\u003c/strong\u003e(5):1061-1072.\u003c/li\u003e\n\u003cli\u003eMcAndrew R, Ellis J: \u003cstrong\u003eAn evaluation of the multiple mini-interview as a selection tool for dental students\u003c/strong\u003e. \u003cem\u003eBr Dent J \u003c/em\u003e2012, \u003cstrong\u003e212\u003c/strong\u003e(7):331-335.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 1 Interprofessional \u0026nbsp; student led clinic for people living with Parkinson\u0026rsquo;s disease\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eOverview\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eThere was no specific funding for the clinic. The program was delivered from 8.30am \u0026ndash; 1:00pm, five times throughout the year. At each clinic, three or four real patients, six to eight students, and at least one clinical educator and one educator were in attendance. Booking for the clinic were organised by the university clinical school staff.\u003c/p\u003e\n \u003cp\u003e\u003cu\u003eClinic participants:\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eStudents:\u003c/em\u003e Eight final year students from medicine, pharmacy and allied health (physiotherapy, occupational therapy, speech pathology) in any one clinic\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePatients:\u003c/em\u003e The \u0026ldquo;patients as partners \u0026ldquo;, volunteers from community groups for people living with Parkinson\u0026rsquo;s disease and their carers and families. They were asked to identify three areas which they hoped the clinic would focus on, for example increasing exercise, or fall prevention.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eEducators:\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eAt each session, there was at least two clinical educators, who ran an initial orientation session \u0026nbsp;(and provided supervision (pharmacy and medicine) with an aged care consultant in whose unit the clinic ran,, on standby.\u003c/p\u003e\n \u003cp\u003e\u003cu\u003eClinic schedule and record keeping\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eStudents were provided with a 30 minute orientation led by a clinical educator, and given the Parkinson\u0026rsquo;s Disease Clinic General Assessment Form to guide the patient assessment. \u0026nbsp;Then in pairs \u0026nbsp;matched with their own discipline, students rotated through four \u0026lsquo;stations\u0026rsquo;, spending 30 minutes with each patient. Each time students met with a patient, the patient notes were passed to the next pair of students. \u0026nbsp; \u0026nbsp; Students then organised a interprofessional team meeting lasting 30 minutes, and then presented to the academic educator(s) (30 minutes) who gave feedback. \u0026nbsp;Together, students were required to produce an integrated patient management plan to present to the supervisor academic. In this clinic the patient did not hear the management plans as the patient partners had other activities to attend.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"student-led clinic, student -delivered, patient outcomes, interprofessional education, medical education, social capital cultural capital, interprofessional practice","lastPublishedDoi":"10.21203/rs.3.rs-3262907/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3262907/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInterprofessional student-led clinics provide valuable settings for authentic clinical experiences and collaborative patient care. \u0026nbsp;However, there is a lack of theoretically informed research to optimize the factors impacting the sustainability of these clinics. This study aimed to address this gap by exploring the dynamic relationships between students and patients in a co-creating \u0026nbsp;student-led clinic for individuals living with Parkinson's Disease, using Bourdieu's theoretical framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe \u0026nbsp;teaching focussed clinic was established in 2018 to emulate a clinical service. Semi-structured focus groups with participants (20 students from 5 disciplines and 11 patients) were conducted to gather in-depth insights into their clinic experience. A thematic analysis was guided by Bourdieu’s concepts of field, habitus, capital, and power.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur findings suggests that the student-led clinic emerged as a complex field intersecting with a patient support group, an aged care facility, and university-based healthcare disciplines. We developed three broad themes: Fostering students’ disposition to interprofessional care, Capitalizing on collaboration and empowerment\u003cem\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/em\u003eand Culture of mutual capital exchange. Students and patients developed specific dispositions which enriched their habitus, by focused on meeting shared patient well-being goals. As participants engaged in interprofessional collaborative practice, they brought different forms of capital to the clinic. Social and cultural capital was exchanged among students, fostering trust and respect for disciplinary expertise and professional boundaries. Students gained cultural capital, acquiring interprofessional knowledge about and with patients. In a culture of mutual trust, patients felt empowered through their symbolic capital, investing in students' learning and recognizing the importance of their own well-being goals within the collaborative setting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings highlight the collective symbolic power of the interprofessional student-led clinic, where the recognition and exchange of valued forms of capital among participants fostered student learning and enriched the habitus of both students and patients. Valuing and sharing different forms of capital other than economic, such as social and cultural capital, contributed to optimizing the participants' clinic experience. These insights can inform the development and sustainability of interprofessional student-led clinics, emphasizing the importance of mutual trust, respect, and shared goals between students and patients, and educators.\u003c/p\u003e","manuscriptTitle":"Capital Sharing and Socialization in an Interprofessional Student-Led Clinic: A Bordieuan Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-09-12 14:15:04","doi":"10.21203/rs.3.rs-3262907/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2023-11-16T03:07:21+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-11-05T18:03:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"a8cf2a09-d96d-4fff-92a4-96edbbcdb925","date":"2023-11-03T09:16:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-09-18T19:09:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"d87f0db9-733d-4cac-b593-c41cf5a4a879","date":"2023-09-15T14:33:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-09-15T14:30:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-09-08T14:07:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-09-07T14:22:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-09-07T14:21:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2023-08-14T13:37:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d3c5bed-a764-470a-aa55-fc290c5de63b","owner":[],"postedDate":"September 12th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-02-26T15:04:51+00:00","versionOfRecord":{"articleIdentity":"rs-3262907","link":"https://doi.org/10.1186/s12909-024-05117-7","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2024-02-19 15:01:14","publishedOnDateReadable":"February 19th, 2024"},"versionCreatedAt":"2023-09-12 14:15:04","video":"","vorDoi":"10.1186/s12909-024-05117-7","vorDoiUrl":"https://doi.org/10.1186/s12909-024-05117-7","workflowStages":[]},"version":"v1","identity":"rs-3262907","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3262907","identity":"rs-3262907","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}