Learning through service user involvement in allied health education: A qualitative investigation of the student experience

Learning through service user involvement in allied health education: A qualitative investigation of the student experience | 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 Learning through service user involvement in allied health education: A qualitative investigation of the student experience Sarah Dillon, Pauline Boland, Alexandra Cremona, Mary Fitzpatrick This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7129987/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The value of service user involvement (SUI) is gaining recognition within healthcare education. As stakeholders in the education process, exploring the student experience with SUI is critical to ensuring effective andragogical practices. Within this, an appreciation of both what and how students learn is needed to underpin the wider adoption of SUI across healthcare education. A qualitative research design was employed to explore allied health students’ experiences with and learning from SUI, and its alignment with relevant learning theories. Semi-structured interviews with eleven students generated five themes. Students reported variable satisfaction and differing levels of SUI in their education, noting ethical and logistical concerns with its adoption. Despite these reservations, students emphasised that SUI prompted key learning in the enhancement of empathy and consideration of a holistic, patient-centred approach to practice. Storytelling was identified as an effective andragogical tool, with SUI recognised as a memorable and impactful learning strategy. When service users contributed in a classroom setting, students reported perceived changes in power dynamics, facilitating interaction and knowledge construction. Learning was characterised as patient-centred, experiential and transformative, with students describing shifts in attitudes and practice resulting from their engagement with service users. By exploring the student experience, through relevant learning theories, this research offers a deeper understanding of how students engage with and derive meaning from SUI in education. Students acknowledged the unique capabilities of SUI in learning, and its capacity to foster patient-centred practice, a critical insight which lends support to service users' formal and sustained involvement in healthcare education. Service user involvement healthcare education student learning allied health Figures Figure 1 Introduction Service users are increasingly recognised as “experts by experience”, with a growing shift towards their inclusion in healthcare education (Jobling & Sayuri, 2023; Scammell et al., 2016). Among the catalysts of this approach is the potential for service user involvement (SUI) to promote a patient-centred healthcare system, which prioritises their needs and is responsive to their experiences as end-users (Mead & Bower, 2000). Where traditionally, students have learned within faculty-directed curricula, informed by clinical and academic expertise, it is now recognised that service users add unique insights of their lived experience within the health system (Bennett-Weston et al., 2024). Creating a collaborative relationship between healthcare professionals and service users at the early stages of their professional development sets the foundations for future practice, centring the service user voice in shared decision-making and the broader continuum of care. The involvement of service users as active partners in healthcare education has been found to deliver benefits across multiple stakeholders (Gordon et al., 2020; Hill et al., 2014; Scammell et al., 2016). Academic institutions and educators gain from having patient-informed curricula. This enhances their social accountability and ensures that graduates can deliver services sensitive to the evolving demands of real-world practice (Sorensen et al., 2019). For service users, their participation builds respectful relationships with students and the wider healthcare community (Cullen et al., 2022). Moreover, their experiences are platformed, empowering them to take an active role in their care, with service users describing fulfilment derived through their contributions (Dijk et al., 2020; Muir & Laxton, 2012). From a student perspective, SUI, as part of their studies, has been suggested to increase empathy (Kuti & Houghton, 2019; Switaj et al., 2019) and improve clinical skills (Bideau et al., 2006). To date, SUI has primarily been explored within the areas of medical education (Gordon et al., 2020), nursing (Alberti et al., 2023; Scammell et al., 2016) and social work (Adamson et al., 2022). Integration of service users within allied health disciplines has received less attention (Soon et al., 2020), despite similarly high levels of patient contact for such students and policies calling on the integration of service users into their education (CORU, 2009; HCPC, 2025). Including students in conversations regarding the involvement of service users in their education is important in ensuring a student-centred approach to teaching and learning (Gover et al., 2019; Lea et al., 2003). Many research studies examine discrete experiences of SUI related to a single or modular interaction (Jha et al., 2015; Jobling & Sayuri, 2023), with less focus placed on their experiences of SUI at a programmatic or institutional level. Gaining this broader perspective may offer a more authentic view of its usefulness and limitations from the student perspective. Furthermore, examining the theoretical underpinnings of student learning in relation to SUI has received little attention (Gordon et al., 2020). Understanding the potential theoretical basis of SUI in healthcare supports educators in embedding it appropriately within curricula. Moreover, knowledge of how learning is achieved could further legitimise this teaching approach, justifying the institutional commitment to SUI in healthcare education, which will likely require substantial investment (Bennett-Weston et al., 2024). Therefore, further work needs to be done to more comprehensively explore both what and how allied health students learn from SUI in their professional education. The manifestation of SUI in educational settings has been varied. Contributions of service users encapsulate many roles, including those of teachers, assessors, curriculum developers, and selection committee members (Dijk et al., 2020). Numerous frameworks have been applied to SUI in healthcare education, such as Arnstein’s Model of Citizen Participation (Arnstein, 1969) and Tew’s Ladder of Involvement (Tew et al., 2004). Among the most frequently cited is the Spectrum of Involvement, proposed by Towle and colleagues (2010). This framework describes six distinct levels, each representing an increasing degree of involvement of service users. This engagement ranges from minimal participation of service users to true partnership. Whilst this model, and similar, have existed for over 15 years, translation of these frameworks into practice is generally thought to be poorly described (Gordon et al., 2020) and inconsistent, sometimes driven by isolated faculty members rather than a coordinated effort (Towle et al., 2016). Although service users have long contributed passively to healthcare education as subjects in case-based learning (McLean, 2016), their active participation as co-educators and involvement at a sustained curricular level has been far less widely adopted (Gordon et al., 2020). This is primarily attributed to issues associated with the sustainable implementation of SUI, including a lack of institutional support, resource-intensiveness, and unclear guidelines regarding service user training (Dijk et al., 2020; Jha et al., 2009). Despite the acknowledged challenges, in recent years, comprehensive embedding of SUI in healthcare education has gained traction as an andragogical strategy, largely due to its potential to enhance healthcare delivery. However, sparsity in the literature exists in the context of the student perspective of SUI. Specifically, the experience of allied health students and the theory underpinning their learning in relation to SUI is under-researched. To address these gaps, the present study investigates how allied health students experience SUI within the context of their professional education. The central research question guiding this investigation is: What are the experiences of allied health students with SUI? Specifically, this study seeks to explore the following objectives: Determine the current involvement and desired extent of involvement of service users in allied health education from the student perspective. Explore the perceived challenges and benefits of SUI in student learning. Examine the key learnings of students in relation to SUI in education and identify underlying learning theories. Methods Study Design A qualitative study design was employed, using semi-structured interviews to explore the experience and opinions of allied health students regarding SUI in education. The study was grounded in a constructivist framework, acknowledging the subjective nature of experience, the contextual influences shaping it, and the co-construction of meaning between the researcher and participant (Byrne, 2021). Semi-structured interviews were selected for their open-ended and flexible nature, promoting in-depth sharing of opinions and experiences (Adeoye‐Olatunde & Olenik, 2021). A pre-determined interview schedule (Online Resource A) was designed, informed by previous research and the aims and objectives of the study. The interview schedule was pilot tested for comprehension, comprehensiveness, and clarity with one student and was revised by the research team (SD, PB, MF). Questions explored the experiences of students with SUI in education, including their satisfaction, their desired level of involvement, and the effect on their learning and practice. Service users were defined as “experts by experience” of living with a health condition and/or engaging with healthcare services, either in a personal or caring capacity. SUI within academic, community, and practice education settings was considered relevant. Towle’s Spectrum of Involvement (Towle et al., 2010) was used to describe the level of SUI experienced by students. As per this framework, Level 1 indicates passive involvement of service users as the subjects of case scenarios. Level 2 involves their participation in clinical education settings where they act as patients for students to practice their clinical skills. At Level 3, service users contribute to a faculty-guided curriculum, for example, as guest lecturers. Level 4 includes service users as co-educators involved in teaching and evaluating students, with Level 5 additionally including them at a curricular planning level. The final level represents the highest participation, embodying Level 5 plus additional institutional-mandated sustained involvement. The Consolidated Criteria for Reporting Qualitative Research Qualitative Checklist (COREQ) (Tong et al., 2007) was used to aid transparency of reporting (Online Resource B). Clinical trial number: not applicable. Study Setting This study was conducted in an allied health tertiary education setting, within a publicly funded university in the Midwest of Ireland. Within the university are four faculties, with the School of Allied Health lying within the Faculty of Education and Health Sciences. The School houses several pre- and post-registration professional programmes: Human Nutrition and Dietetics (MSc), Occupational Therapy (MSc), Physiotherapy (BSc and MSc), and Speech and Language Therapy (MSc). Each programme is regulated by CORU (Home - Coru), the Irish Healthcare Regulator, in addition to societies that oversee the profession's scope of practice. All programmes incorporate service users to varying degrees, though none implement sustained SUI at a curricular level. Sample Selection and Recruitment A convenience sample of students was recruited via the University’s internal online learning platform. Word-of-mouth and snowball sampling were additionally implemented. Participants were considered eligible if they met the following criteria: (i) ≥18 years of age (ii) were a current student in an undergraduate or postgraduate professional qualification allied health higher education programme (iii) were enrolled in year 2 (final year) of a professional MSc or year 3 onwards of a BSc programme. Participant selection was confined to the latter stages of programmes to ensure that students had sufficient exposure to educational content and delivery methods. Data Collection Ethical approval was granted from the University of Limerick Education and Health Sciences Ethics Committee (2025_01_01_EHS). Prior to data collection, informed consent was obtained from all participants, and they were made aware of the purposes of the study. Interviews were conducted by two researchers (SD and AC), using a pre-determined interview schedule (Online Resource A), and took place online. Field notes were taken during data collection (Byrne, 2021). Interviews were initially transcribed verbatim using Microsoft Teams and later verified for accuracy using audio recordings. Given the debate surrounding the concept of data saturation, particularly the questionable nature of true saturation due to the inherent subjectivity of thematic analysis, the final sample size was reached based on the primary researcher's (SD) determination of data adequacy. This was gauged through considering the richness and complexity of data in relation to the research question (Braun & Clarke, 2019b). Data Analysis Data was analysed in line with Braun and Clarke’s (2023) reflexive thematic analysis by one author (SD). To achieve familiarisation and contextual understanding of the data, recordings and transcripts were reviewed. Interviews were then coded using NVivo (Version 15), and themes were generated (Braun & Clarke, 2019a; Braun & Clarke, 2023). Field notes and reflective diaries were examined as part of the analysis process (Byrne, 2021). It is acknowledged that deductive and inductive approaches to analysis are not mutually exclusive within qualitative research (Braun & Clarke, 2019a). This research primarily adopted an inductive approach, generating themes from the interview data. However, deductive reasoning was used in the latter stages of the write-up by mapping findings to established theories, deepening the theoretical understanding of the learning experienced by students. Research Team Positionality and Reflexivity The principal investigator, SD (BSc, PhD), is a Lecturer in Physiotherapy and course director of a professional postgraduate programme, with four years' experience in teaching healthcare professionals. This work formed part of her Master of Arts Degree in Teaching, Learning, and Scholarship, focusing on SUI, a subject she has been engaged with for the past three years. AC (BSc, MSc, PhD) is a lecturer in Human Nutrition and Dietetics with 7 years of clinical education experience and has previously completed an MSc in Health Professions Education. She had no prior experience in SUI research. Both researchers had previous experience in conducting qualitative interviews. It was acknowledged that, as teaching staff, the relationship between the student and interviewers may have affected the data collected. To lessen potential power dynamics, participants were matched with interviewers with whom they had no prior teaching or personal relationships. Moreover, students were encouraged by interviewers to speak openly and honestly, with assurances given that their identifiable views would remain anonymous. The remaining two authors, PB (BSc, MA, PhD) and MF (BBS Grad Dip in Education, MA, PhD), are academics within the areas of Occupational Therapy and Teaching and Learning, respectively. Both authors have qualifications in andragogy and contributed their insights into the overall design, implementation, analysis, and interpretation of the study. All researchers are white females. As a lecturer within the allied health sciences and a physiotherapist herself, SD recognised that her experience in both delivering and receiving healthcare education and her engagement with educational research influenced this research. Although both interviewers’ roles as educators may have improved their ability to probe meaningfully during interviews, it was recognised that their experiences could give rise to assumptions. SD acknowledged her part in constructing the meaning of information through the lens of its relevance to the research question and her own interpretation of the narratives (Byrne, 2021). To critically examine her influence on the data interpretation and enhance the trustworthiness of data, she participated in one reflective discussion with a co-author (PB) and kept a reflective diary throughout the analysis process (Olmos-Vega et al., 2022). Member-checking was employed as per McKim (2023) to enhance the validity of data by circulating the drafted results to participants, though no students suggested changes. Results Of the approximately 140 students eligible for participation, a total of 11 students across the four allied health disciplines participated. Demographic details of students are presented in Table 1. Interviews averaged 24 minutes in duration (from 18 to 35 minutes). Students described their experience of SUI, ranging from service users as the subject of case studies or prerecorded videos (Level 1), to participation as co-educators in a module (Level 4) (Towle et al., 2010). Table 1 Demographic details of participants. Student ID Programme of study, Year SUI in educational encounter Highest level of SUI described as per Towle et al. (2010) Age (years) Gender Highest level of education attained 1 MSc OT, Year 2 Subject of case scenarios Patient on placement Guest lecturer 3 31 F BSc 2 MSc SLT, Year 2 Subject of case scenarios Patient on placement Guest lecturer Co-educator 4 28 F BSc 3 MSc OT, Year 2 Subject of case scenarios Guest lecturer Patient on placement 3 46 F BSc 4 MSc SLT, Year 2 Subject of case scenarios Patient on placement Guest lecturer Co-educators 4 29 F BSc 5 MSc SLT, Year 2 Subject of case scenarios Patient on placement Guest lecturer Co-educators 3 25 F BSc 6 MSc PT, Year 2 Subject of case scenarios Patient on placement Guest lecturer 3 31 M BEd 7 BSC PT, Year 3 Subject of case scenarios Patient on placement Guest lecturer 3 21 F 2 nd Level 8 MSc PT, Year 2 Subject of paper/electronic scenarios Patient on placement Guest lecturer 3 24 F BSc 9 BSC PT, Year 3 Subject of case scenarios Patient on placement Guest lecturer 3 21 M 2 nd Level 10 BSc PT, Year 3 Subject of case scenarios Patient on placement Guest lecturer 3 21 M 2 nd Level 11 MSc HnD, Year 2 Subject of case scenarios/videos Patient on placement 2 26 F BSc Abbreviations: SUI- Service User Involvement, MSc- Master of Science, OT- Occupational Therapy, F- Female, M- Male, BSc- Bachelor of Science, SLT- Speech and Language Therapy, PT- Physiotherapy, BEd- Bachelor of Education, HnD- Human Nutrition and Dietetics. In the thematic analysis of interviews, five themes were generated: (1) Diverse journeys with SUI; (2) Enhanced SUI- A challenging road; (3) SUI prompts transformative learning; (4) The power of SUI in the classroom; (5) Making it stick- SUI and impactful learning. These have been discussed below. The coding tree is available in Figure 1. Theme 1: Diverse journeys with SUI Students described varying experiences of SUI in allied health education. Some students described it as satisfactory and enjoyable, with an acceptable blend of educator-delivered information and service user input across their programmes. Student 2, a Speech and Language Therapy student, reported positively on the extent of SUI, “I think it's a really good amount. I think it's a good balance”. However, this satisfaction varied, even between students of the same programme and year, who would have been exposed to identical involvement. For example, Student 4, also a Speech and Language Therapy student, expressed a desire for maximising service users' input, stating , “The more exposure, the better, probably.” Diverse experiences were noted in terms of the level of involvement of service users. Some students recounted numerous instances of service users as guest lecturers or as co-trainers. Generally, dissatisfaction was expressed when students described limited or tertiary involvement, comprising service users as subjects of case scenarios, pre-recorded video materials, or as patients within the practice education environment. Student 11 illustrated her perception of the limited SUI in her programme: “So I do think that could definitely be improved upon… The service user kind of experience was always relayed through a third party, like, during lectures you would hear from a clinical specialist about how their patients were getting on, or the lived experience would translate that way, whereas the only time we've had direct contact with the service user would be on placement.” Some students indicated that the scope of SUI should be confined to guest lectures. They indicated that this was the maximum level of integration that they could envisage, “I kind of think, like, in terms of college, they're involved as much as, well, everywhere they're involved. I can't see anywhere else, beyond giving guest lectures and coming in and talking” (Student 7). Students who had experienced service users in the capacity of co-educators recalled positive experiences, classifying these encounters as “a really good experience” (Student 2) and “enriching” (Participant 5) for them as students. Students also indicated the need for more diversity of experiences to be introduced, from people of differing ages, and in varying roles, such as parents or carers. It was discussed that doing so may create a more equitable learning environment, given that practice education opportunities are not identical. “That would have been nice. If we could have had, like, maybe a child and a parent come in or something like that. Just so something is uniform, because on placement, everyone's having such different experiences. Yes, we've done the same course, but we have all had different things- like we could go to the same location, but the practice educator is different, and their way of doing it is different, so you know that would be something. It doesn't seem as standard if everyone's doing different things.” (Student 1) Theme 2: Enhanced SUI- A Challenging Road Students identified several logistical and ethical complexities associated with greater SUI in allied health education. Logistical challenges The desire for an increased level of SUI was always met with a qualification of the logistical obstacles associated with its implementation. Time was noted as a limiting factor by many students, particularly those enrolled in professional MSc programmes. Student 5 shared, “So being in an accelerated program, we wouldn't have more time, resources to do more of that.” Lack of accessibility of learning spaces and unclear reimbursement protocols were also mentioned by students as barriers to implementation. Students considered involving service users at a curricular level to be a useful approach, with suggestions of forming a panel of service users to oversee and advise on programmatic developments met with widespread positivity. However, some difficulties were flagged with this, particularly in ensuring diverse representation of service users. Student 2 expressed concerns, saying, “It's gonna be really difficult to cover all the sides because, again, I can only speak to SLT, but there's countless difficulties that a person might experience. Like, what about the paediatric population?”. Moreover, students felt that SUI may not be appropriate in every area of healthcare education, with hesitance concerning assessment tasks. Students cited that service users may lack regulatory and andragogical knowledge, possibly creating ambiguity in assessment delivery and design. Student 11 shared her concerns regarding the professional implications of adopting service users at the assessment level: “They (graduates) have to evidence, you know, how does your proficiency map to this assignment? I can't see an integration there because it's so fundamental to getting our registration with CORU.” Students showed concern for service users' misunderstanding of the scope and realities of practice, and its potential to translate into inappropriate or unfair assessment practices: “We have to bear in mind that the service users don't know everything and don't have sight of everything, like I said. They glorify health professionals. They have high stakes for it. So, the expectations are high and sometimes may expect miracles. You know, and that is a tough standard to follow.” (Student 5) Most students indicated that the academic role of overseeing should not be overlooked and should provide the foundation for SUI. Ethical Challenges Students also outlined ethical issues associated with SUI. Amongst the most common was the possible burden on the service user. Some students noted that service users might not feel comfortable sharing their private medical experience, citing data protection issues with their involvement: “If it's a sensitive condition or, you know, if it is something that someone does feel is a sensitive condition. You know people have different levels of privacy and different levels of kind of boundaries, and you know, say you have a condition that you don't openly talk about, and you've been asked to do this. You know, there could be stress about, you know, ‘are they going to recognise me on the street?’” (Student 11) Other students remarked on the potential vulnerability of service users and stressed that educators would “need to be very mindful of the burden that that would put on them” (Student 3). Students cited that issues with coercion to participate and factors such as poor mental health may make their involvement inappropriate. Student 1 expressed their thoughts regarding the ethical complexities of involving service users in education: “If it's someone with mental health issues, it might not be appropriate… I'm thinking ethics. Like, is that right? Do you know what I mean? And someone could say, yeah, I'll come in. But like, is that kind of not taking advantage? Is it ethical?” Theme 3: SUI prompts transformative learning This theme encapsulates the shift in perceptions and behaviours of students through their interaction with service users in allied health programmes. Developing the empathetic and holistic clinician The ability of SUI to nurture a sense of empathy within students was highlighted by most participants. Students noted that interactions stimulated a redirection of priorities, encouraging focus on the needs of the service user, rather than their needs as students. Student 5 remarked that this was a key learning, “It is the client who's important here and not you.” Students described their respect for the service user's knowledge, with the lived experience of service users forming the basis of seeing the service user as a person-first. Student 9 expressed the value of SUI, “I think it's beneficial for people in the class because then they don't see that person as an ‘other’. They see that person as a person, not the disability.” The manifestation of empathy in practice was documented in various ways. Students described increased personal sensitivity towards patient issues, prompting changes in their communication and actions within the practice education environment. Student 6 stated that the experience of a guest speaker allowed him to reframe interactions and reconsider his role, adopting a more empathetic approach: “Only for I probably heard that story and realised what they've gone through… I kind of had a prior sense of empathy and understanding for them in the bed. Whereas, I think before that placement, if I had not listened to that story or hadn’t had that experience, I think I would have went in there with my clipboard with my initial neuro assessment and, you know, these people are only after waking up in a critical care unit where they're asking them very difficult questions. And I think as a student out on placement, I probably would have been, kind of you just, you know, ‘I'm here to learn. I need to get through this assessment. I need him to answer X, Y and Z for me.’ Whereas, from having the service user experience, we had more of an understanding, more empathy, I suppose, with the person in the bed.” Students described developing an appreciation of the holistic aspects of a person- the integration of mental, emotional, and physical elements, as well as the “real-world context” ( Student 4). Student 9 remarked that SUI prompted a shift towards “taking all aspects of a patient into consideration and not just focusing on their condition”. One student (Student 3) remarked that simply seeing a service user navigating a university setting was important in demonstrating the challenges that service users experience, which students may have to consider in practice , “That day, that one lady with the brain injury, she recorded her lecture because her speech wasn't amazing and (because) of fatigue and everything else. So that was a nice insight into how you manage all of that.” Professional preparedness Students reported feeling more confident in their future professional practice following interactions with service users as co-educators or guest lecturers. They noted that this was especially influential in the earlier stages of learning, in which it provided context for future clinical scenarios they would face. Additionally, some students described that SUI could facilitate interactions with populations that they may not meet or had not met in a placement setting, bolstering their sense of preparedness before entering these areas of practice. Student 11 explained how SUI could provide a frame of reference, promoting preparedness: “You'd feel more comfortable going in, you know, especially in some settings, like this is my first time experiencing them and I think ‘oh, I remember that video from Jane or whoever, Michael or something, you know, and or when, you know, Peter came in to speak to us.’ I think it could really help ground everything that we're doing and make you feel more at ease.” Although students had not yet graduated to become independent practitioners, many imagined, and some provided illustrative examples of changes in their practice resulting from SUI. All changes described were positive; some students described that SUI developed their clinical skills, whilst others described the development of softer communication skills. Students explained that SUI prompted them to talk to patients “properly” (Student 5), amid a busy clinical environment, which does not always lend itself to this practice. Student 9 reflected on how they might apply their learning: “People tell you what they like and what's worked for them and what doesn't work for them, and it gives you a good opportunity to learn how to properly interact and engage with different people and what works and what doesn't work.” Theme 4: The power of SUI in the classroom This theme speaks to the effectiveness of SUI, specifically within classroom-based sessions, both as guest speakers and co-educators. Students noted that involving service users in the university classroom environment enhanced comfort and increased the approachability of asking questions and exploring experiences, which was not seen to be available within a clinical setting. Student 2 remarked, “I suppose it’s kind of nice that you know when someone’s in a classroom, you can kind of learn from them a little bit and ask questions, where maybe you can’t as much when you’re on placement.” Students highlighted that, within the classroom, their role as learners was clear, in contrast to the professional identity expected within a practice education setting. Student 1 explained the distinction in roles, “But on placement, you're more of an OT (occupational therapist) than a student or like a training OT. Whereas in the classroom, you're definitely a student.” Students described the safety of the classroom as important in facilitating discussion. Among the features that contributed to this comfort was the oversight provided by the academic staff in guiding sessions, creating a low-stakes environment. This was expressed by Student 5 , “But what's better than gaining the experience while having the security and protection of being surveilled, you know?” Students described that SUI within the classroom, often following years of interaction with a health system, rather than in a clinical setting during one isolated interaction, allowed service users time to process personal experiences and provide honest and authentic accounts. Students felt that this could aid them in understanding service users better: “I find it helpful. Hearing her (the service user’s) opinion of several OTs that aren't in the room. She can give feedback on it, rather than it being in the moment. Like, obviously, these interactions she's had are over now, so she's had time to process and form how they made her feel, whereas in the moment, maybe she wouldn't have spoken up.” (Student 1) Theme 5: Making it stick- SUI and impactful learning SUI was commonly referred to as “impactful” (Student 6) or similar, with multiple students remarking on the memorable nature of SUI. This was especially common in the context of guest lectures in which service users shared their personal experiences. SUI was often cited as the highlight or strongest section of programmes. Student 4 highlighted the effectiveness of this mechanism of learning: “Because I think lecture notes can get very repetitive, and this does not really have much impact. But when you're hearing someone's actual story, it’s way more emotional, even. Or, it kind of just sticks out to you. It's just way more impactful, and you can just, like, I can remember those instances way more than thinking back on actual lectures.” Students felt that SUI interactions were engaging and effectively captured their attention. They noted that SUI sessions encouraged them to “really listen” (Student 6). Moreover, it was suggested that SUI within guest lectures prompted greater class engagement than traditional lectures, inducing an interactive learning experience. Student 10 described how SUI encouraged students to actively contribute: “When these people (service users) came in, they were generally asked quite a lot of questions in comparison to- normally at the end of lectures there would be maximum of one or two questions. You know, there nearly would be, definitely more than seven or eight asked (during SUI sessions) that would nearly go on for another 25 minutes, half an hour.” Students signalled that they often felt that SUI was inspirational. Service users drawing on their experience with the healthcare system prompted students to see the value of their profession, motivating them to learn. Student 2 noted the mutual empowerment derived from SUI: “I think it's both empowering for us, seeing that what we do matters, because it achieves those kind of results, and it's also empowering for them (service users) that they can engage with students and prepare the future generation of clinicians. ‘Look, I am living experience of your guys's work.’” Students noted that SUI added value to their education that could not be replicated by other factors/stakeholders. The insights related to service users' nuanced and unique experiences with the healthcare system were acknowledged. Student 6 described the distinctive knowledge generated from SUI, “Because, sometimes they (service users) pick up on things that maybe us as healthcare professionals might not pick up on from each other, but they might give us a different level of understanding.” Students deferred to academics to provide the knowledge of various conditions, best practice evidence, and theoretical underpinning, but they expressed that service users were uniquely positioned to share their lived experience, rather than educators or advocates “reading off from what they have heard” (Student 8). The service user's story was considered the focal point of learning by many, with Student 6 stating, “I think the patient's story as an education tool, I think it is very powerful.” Discussion This qualitative study explored the student experiences of SUI in allied health education. The five themes generated from these interviews identified the nature of what students learned, their desires for and perceived challenges of SUI in education, and the mechanisms of learning employed. This study presents new insights relating learning stimulated by SUI to theoretical underpinnings. Notably, the student experience of SUI in the allied health context closely mirrored what has been found in other healthcare education settings. Extent of and satisfaction with SUI There was a notable variation in both the extent of SUI and the level of satisfaction reported by students, despite this study being situated within a single allied health education school. This has been echoed in previous research, which has described fragmented efforts across higher-level settings (Towle et al., 2016). A recent review of the literature suggests that engagement and true partnership lack guidelines for adoption (Gordon et al., 2020), which may impede progress in the area. Service user encounters described by students in our study related to levels 1 to 4 of Towle’s framework (2010), similar to what has been found across research in nursing (Alberti et al., 2023; Scammell et al., 2016) and medical education (Gordon et al., 2020). Student satisfaction with SUI was similarly varied, with some students finding it sufficient and others indicating a strong desire for greater involvement. Generally, when it was implemented within an allied health setting, SUI was seen as a positive factor by students, echoing previous research (Morgan & Jones, 2009). Although service user input in curricular development was positively received by students, there was hesitance to adopt SUI at every level described within Towle and colleagues' Framework (2010). Specifically, students questioned the place of SUI in assessment, preferring to defer to the academics to oversee this aspect. The complexity of integrating service users into assessment has been highlighted previously (Haycock-Stuart et al., 2016; Stacey et al., 2012), with caution advised regarding its practicality. The perceived lack of knowledge of service users with regard to regulatory processes was considerably concerning for students, perhaps necessitating service user training if their integration into assessments is to be widely implemented, a recommendation made by other authors previously (Jha et al., 2009). Transparent communication with students about how and why service users are involved in their education may enhance students’ acceptance of this approach. The “what” and “how” of learning from SUI A transformative learning experience Many of the learning experiences recounted by students align with the concept of Transformative Learning described previously (Mezirow, 2009). Underscoring this theory is the belief that learning encounters challenge viewpoints, assumptions, and expectations, fostering adult learning. Students expressed the view that educational interactions involving service users were instrumental in promoting a more comprehensive understanding of them as people, rather than defining service users solely by their presenting health complaint. Instances of critical self-reflection were described, characteristic of transformative learning. Among the notable shifts acknowledged by students was their increased empathy, reflecting findings of previous research (Bennett-Weston et al., 2024; Gordon et al., 2020; Howick et al., 2024). Empathy, often defined as “feeling as others” (Hein & Singer, 2008, p. 157) is recognised as an important professional characteristic, particularly given the association between increased empathy of health professionals and patient satisfaction (Batbaatar et al., 2017), and positive outcomes (Howick et al., 2018). This is particularly relevant to the healthcare sector, in light of previous research indicating the potential for progressive decline in student empathy throughout their education (Howick et al., 2023). Embedding service user interactions could serve to address this (Howick et al., 2024). SUI in allied health education was, in many cases, accompanied by corresponding changes in practice. Many of the learning experiences relayed align with Kolb’s Experiential Learning Cycle (Kolb, 1975). Students shared concrete accounts of SUI, often citing interactions in guest lectures as pivotal moments of reflection. These interactions prompted students to reimagine their professional practice, engaging with abstract conceptualisation of key changes they would make. Some students described applying their learning to practice education settings, illustrating behaviour adaptations, for example, through the adoption of more holistic management approaches. Other ways students demonstrated learning included through improved communication and practical skills, as has been found in other literature (Arenson et al., 2015; Bideau et al., 2006). These findings add credence to the suggestion that SUI can create meaningful changes in professional practice (Bennett-Weston et al., 2024). However, how this translates to satisfaction with care and patient outcomes requires further investigation. Some students described that their prioritisation of the patient voice prompted a shift in focus from their own academic goals as students to placing greater value on the goals and perspectives of service users. This has the potential to have far-reaching effects. Research in the social care education setting suggests that recognition of service users as experts in their own care persists beyond the confines of the student role, with sustained deference for the patient experience continuing into independent professional practice (Hughes, 2017). Patient-centred learning The person-first approach, which appeared to develop in response to SUI, also falls under the scope of “patient-centred learning” (Bleakley & Bligh, 2008). Inclusive within the concept of patient-centredness (Mead & Bower, 2000) is adopting a “patient-as-person” and biopsychosocial approach. Students described this through their acknowledgement of the service user experience and their appreciation for the rich context of psychological and physical factors contributing to it. Previous research has also framed SUI in education within this model (Towle & Godolphin, 2013). This approach encapsulates the shift from the primary relationship in learning existing between educators and students, with service users playing a supportive role, to the educators supporting the primary relationship that lies between students and service users (Bleakley & Bligh, 2008). It has been suggested that this transfers the focus from students simply mirroring what is shown to them by educators, to students co-producing novel and “innovative” knowledge with service users. This is reflected in our study, with students describing that SUI created unique information and provided context that could not be gained from other sources. Students noted that the inputs of service users facilitated more nuanced and real-world interpretations of theoretical learnings, as students and service users collaborated to “construct” knowledge to inform future practice (Vygotsky, 1978). In many instances, this was realised through the integration of student conceptual knowledge with authentic accounts of service users' experiences. Storytelling as a learning tool Students particularly valued hearing the service user story, which often detailed their personal experiences within the healthcare system and the interaction of their illness with their daily lives. The distinct capabilities of service users as “experts by experience” has been previously explored (Horgan et al., 2018). Many students drew on examples of service users as guest speakers, commonly citing this learning as memorable. Storytelling has been suggested to aid learning in healthcare education due to its ability to resonate with listeners and prompt reflection (Gray, 2013). Students foster a connection to a topic by allowing them to identify features relating to their own experience and knowledge (Lordly, 2007; Schwartz & Abbott, 2007). Whilst this is a valuable addition to healthcare programmes, storytelling gives rise to the potential for tokenism (Voronka & Grant, 2021). It has been argued that it may prompt students to centre individual experience of service users rather than prompting the criticism of the systemic issues they are subject to. This was apparent in our findings, with students raising issues concerning the diversity of service user input. Moreover, service users may feel pressured to fulfil certain palatable narratives, for example, “tragedy to triumph” stories (Voronka & Grant, 2021). Therefore, caution with its integration is advised. Educators and institutions may need to consider integrating service users from diverse backgrounds in a multimodal way, such as within assessments or as co-educators, rather than solely through single instances of storytelling. Embedding service users in such a manner may further platform the importance of service users in education and legitimise their involvement. The unique affordances of SUI in the classroom Students considered the classroom to be superior to the clinical environment in providing a comfortable and accessible setting for learning and interaction with service users. It is possible that this environment encouraged psychological safety (Clark, 2020; Edmondson et al., 2016), which has been suggested to play an essential role in ensuring positive and productive learning experiences for healthcare students (Edmonson, 1999). High-stakes healthcare settings can discourage learning (Edmonson et al., 2016) whereas the familiar learning environment of the classroom seemingly created a sense of security, reducing anxiety associated with risk-taking. Importantly, students highlighted their comfort/ease in asking questions and learning collaboratively, a finding mirrored elsewhere (Edmonson et al., 2016). Similarly, it was emphasised that the classroom environment may have encouraged service users to share openly and honestly, fostering contributor safety, increasing the potential for authenticity and collaborative learning (Clark, 2020). Students acknowledged that adopting the role of the learner within service user encounters the classroom encouraged learning, a finding echoed in other research (Henriksen & Ringsted, 2014). This has been theorised to be related to nuanced changes in power dynamics. The clear distinction in roles established in the classroom - students as learners and service users as educators- encouraged students to ask questions that they may have considered inappropriate within the clinical setting. Strengths and limitations This research presents novel insights into the role of SUI in student learning. To our knowledge, this is the first study to explore this topic within an Irish allied health context, finding that students largely report that SUI facilitates learning and provides unique advantages that cannot be obtained from traditional educator-student learning interactions. Strengths of this study lie in the mapping of learning theories to the study findings, indicating that transformative, experiential, and patient-centred learning underlies many of the instances of SUI recounted. Notwithstanding the strengths identified, several limitations also exist. Firstly, although efforts were made to enhance transparency by providing the context surrounding this study and the descriptive details of participants, the generalisability to other educational settings is unclear. Secondly, while students indicated that some learnings transferred to practice education settings, it was not within the remit of this research to explore the applied learning that participants may have demonstrated after graduating as independent clinicians. Moreover, although students perceived that SUI led to changes in patient care, the effects of this on patient care were not evaluated. Finally, although efforts were made during recruitment to publicise the need for diverse views, it is possible that those choosing to participate represented a sample of students who had strong opinions about SUI in education. Implications and Future Directions This research prompts several recommendations for both practice and research. Ensuring that approaches to teaching are evidence-based is imperative in facilitating effective learning (Davies, 2009). Therefore, a strong research base is needed to inform SUI in education. Whilst this study investigated the experiences of students currently enrolled in education programmes, it is recommended that future studies follow students beyond graduation to assess the long-term impact of SUI in healthcare education. This could include the assessment of both the translation of learning into practice and the value for the healthcare organisation and service users themselves. Using a mixed-method research approach, involving focus groups or interviews, and scales (Tobbell et al., 2018) may provide both quantitative and qualitative information to support these initiatives. Integrating models of training evaluation in the research design may also be useful in achieving this aim (Kirkpatrick & Kirkpatrick, 2016). For academic institutions and educators, this research offers evidence to support the belief that allied health students derive value from SUI in education. Moreover, theories were identified by which students learn, lending credibility to SUI as an effective learning strategy. Therefore, formal and sustained embedding of service users within curricula of healthcare programmes is a key recommendation of this research. This study may be used to guide the co-creation of course content, as it informs how best to integrate SUI in the curriculum and undercovers core competencies students gain, such as empathy and enhanced communication. Additional consideration may be necessary to ensure clarity for students regarding the involvement of service users in components such as assessment, an aspect highlighted as concerning for students. In addressing this, it may be useful to adopt a co-design approach, which includes the voices of multiple stakeholders, such as students, academics, and service users. This may take the form of an open forum or World Café (Brown & Isaacs, 2005) to establish a roadmap of “optimum involvement” of service users within this educational setting. It is important to acknowledge that the above suggestions for practice and research will likely demand investment and significant commitment at an institutional level. Universities may need to consider allocating funds, as they would for academic posts, to ensure sustainable and non-tokenistic involvement of service users. Conclusion As stakeholders in the education process, consideration of the student perspective is important in curricular development. This study investigated the student experience of SUI in allied health education, adding novel insights, particularly regarding the theoretical underpinnings of student learning. Similar to what has been found in other contexts, students described varying levels of SUI in their programmes, mainly relating to lower-level, non-curricular involvement. Largely, students reported positive experiences with SUI, with some desiring greater degrees of integration. Among the challenges acknowledged by students regarding SUI were ethical issues of service user burden and logistical concerns in relation to the scope of service user knowledge. Students evidenced that SUI enhanced their learning, highlighting the distinct benefit derived from these interactions. Knowledge was collaboratively constructed between service users and students to serve the mutual purpose of improving healthcare delivery. Significant value was placed on the personal experience of service users, with storytelling emerging as a powerful educational tool. The key reported learnings related to the enhancement of empathy and the adoption of a holistic approach to practice, aligning with experiential and patient-centred learning theories. Students outlined the transformative nature of these experiences to shift attitudes and develop skills, and in many cases, students intended to, or had already, applied learning to professional practice. Whilst challenging, embedding SUI in healthcare education presents substantial opportunities for enriching student learning and fostering a patient-centred approach from the outset. Declarations Author Contributions Conceptualisation: Sarah Dillon, Pauline Boland, Mary Fitzpatrick; Methodology: Sarah Dillon, Pauline Boland, Mary Fitzpatrick; Formal analysis and investigation: Sarah Dillon, Pauline Boland, Mary Fitzpatrick, Alexandra Cremona; Writing - original draft preparation: Sarah Dillon; Writing - review and editing: Sarah Dillon, Pauline Boland, Mary Fitzpatrick, Alexandra Cremona. Funding Details No funding was received to assist with the preparation of this manuscript. Disclosure Statement All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Compliance with Ethical Standards Conflicts of Interest The authors have no competing interests to declare that are relevant to the content of this article. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the University of Limerick Education and Health Sciences Ethics Committee (2025_01_01_EHS). Consent to Participate Informed consent was obtained from all individual participants included in the study. Acknowledgements The authors extend their sincere gratitude to the participants for generously sharing their experiences. References Adamson, K., Goulden, A., Logan, J., & Hammond, J. (2022). Service user involvement in social work education: a scoping review. Social Work Education , 43 (2), 374-392. https://doi.org/10.1080/02615479.2022.2097213 Adeoye‐Olatunde, O. A., & Olenik, N. L. (2021). Research and scholarly methods: Semi‐structured interviews. Journal of the American College of Clinical Pharmacy , 4 (10), 1358-1367. https://doi.org/10.1002/jac5.1441 Alberti, S., Ferri, P., Ghirotto, L., Bonetti, L., Rovesti, S., Vannini, V., Jackson, M., Rossi, F., & Caleffi, D. (2023). The patient involvement in nursing education: A mixed-methods systematic review. Nurse Education Today , 128 , 105875. https://doi.org/10.1016/j.nedt.2023.105875 Arenson, C., Umland, E., Collins, L., Kern, S. B., Hewston, L. A., Jerpbak, C., Antony, R., Rose, M., & Lyons, K. (2015). The health mentors program: three years experience with longitudinal, patient-centered interprofessional education. J Interprof Care , 29 (2), 138-143. https://doi.org/10.3109/13561820.2014.944257 Arnstein, S. R. (1969). A Ladder Of Citizen Participation. Journal of the American Institute of Planners , 35 (4), 216-224. https://doi.org/10.1080/01944366908977225 Batbaatar, E., Dorjdagva, J., Luvsannyam, A., Savino, M. M., & Amenta, P. (2017). Determinants of patient satisfaction: a systematic review. Perspectives in Public Health , 137 (2), 89-101. https://doi.org/10.1177/1757913916634136 Bennett-Weston, A., Bostock, J., & Howick, J. (2024). The case for patient involvement in medical curriculum development. BMJ , 386 , e080641. https://doi.org/10.1136/bmj-2024-080641 Bideau, M., Guerne, P. A., Bianchi, M. P., & Huber, P. (2006). Benefits of a programme taking advantage of patient-instructors to teach and assess musculoskeletal skills in medical students. Annals of the Rheumatic Diseases , 65 (12), 1626-1630. https://doi.org/10.1136/ard.2004.031153 Bleakley, A., & Bligh, J. (2008). Students learning from patients: let's get real in medical education. Advances in Health Science Education , 13 (1), 89-107. https://doi.org/10.1007/s10459-006-9028-0 Braun, V., & Clarke, V. (2019a). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health , 11 (4), 589-597. https://doi.org/10.1080/2159676x.2019.1628806 Braun, V., & Clarke, V. (2019b). To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qualitative Research in Sport, Exercise and Health , 13 (2), 201-216. https://doi.org/10.1080/2159676x.2019.1704846 Braun, V., & Clarke, V. (2023). Toward good practice in thematic analysis: Avoiding common problems and be(com)ing a knowing researcher. Internation Journal of Transgender Health , 24 (1), 1-6. https://doi.org/10.1080/26895269.2022.2129597 Brown, J., & Isaacs, D. (2005). The World Cafe: Shaping our futures through conversations that matter. Berrett-Koehler Publishers. Byrne, D. (2021). A worked example of Braun and Clarke’s approach to reflexive thematic analysis. Quality & Quantity , 56 (3), 1391-1412. https://doi.org/10.1007/s11135-021-01182-y Clark, T. (2020). The 4 stages of psychological safety: Defining the path to inclusion and innovation . Berrett-Koehler Publishers. CORU. (2009). Framework for Public & Service User Involvement in Health and Social Care Regulation in Ireland . Ireland Cullen, M., Cadogan, C., George, S., Murphy, S., Freeney, S., Fitzpatrick, R., & Strawbridge, J. (2022). Key stakeholders' views, experiences and expectations of patient and public involvement in healthcare professions' education: a qualitative study. BMC Medical Education , 22 (1), 305. https://doi.org/10.1186/s12909-022-03373-z Davies, P. (2009). Approaches to evidence-based teaching. Medical Teacher , 22 (1), 14-21. https://doi.org/10.1080/01421590078751 Dijk, S. W., Duijzer, E. J., & Wienold, M. (2020). Role of active patient involvement in undergraduate medical education: a systematic review. BMJ Open , 10 (7), e037217. https://doi.org/10.1136/bmjopen-2020-037217 Edmondson, A. C., Higgins, M., Singer, S., & Weiner, J. (2016). Understanding Psychological Safety in Health Care and Education Organizations: A Comparative Perspective. Research in Human Development , 13 (1), 65-83. https://doi.org/10.1080/15427609.2016.1141280 Edmonson, A. (1999). Psychological Safety and Learning Behavior i. Administrative Science Quarterly . https://doi.org/10.2307/2666999 Edmonson, A., Higgins, M., Singer, S., & Weiner, J. (2016). Understanding Psychological Safety in Health Care and Education Organizations: A Comparative Perspective. Research in Human Development . https://doi.org/10.1080/15427609.2016.1141280 Gordon, Gupta, S., Thornton, D., Reid, M., Mallen, E., & Melling, A. (2020). Patient/service user involvement in medical education: A best evidence medical education (BEME) systematic review: BEME Guide No. 58. Medical Teacher , 42 (1), 4-16. https://doi.org/10.1080/0142159X.2019.1652731 Gover, A., Loukkola, T., & Peterbauer, H. (2019). Student-centred learning: approaches to quality assurance. Gray, J. B. (2013). The power of storytelling: Using narrative in the healthcare context. Journal of Communication in Healthcare , 2 (3), 258-273. https://doi.org/10.1179/cih.2009.2.3.258 Haycock-Stuart, E., Donaghy, E., & Darbyshire, C. (2016). Involving users and carers in the assessment of preregistration nursing students' clinical nursing practice: a strategy for patient empowerment and quality improvement? Journal of Clinical Nursing , 25 (13-14), 2052-2065. https://doi.org/10.1111/jocn.13279 HCPC. (2025). Service User and Carer Involvement . Retrieved 29 March 2025 from https://www.hcpc-uk.org/education/resources/education-standards/service-user-and-carer-involvement/#:~:text=We%20use%20the%20term%20’service,family%20member%2C%20partner%20or%20friend. Hein, G., & Singer, T. (2008). I feel how you feel but not always: The empathic brain and its modulation. Current Opinion in Neurobiology , 18 , 153-158. https://doi.org/ 10.1016/j.conb.2008.07.012 . Henriksen, A. H., & Ringsted, C. (2014). Medical students' learning from patient-led teaching: experiential versus biomedical knowledge. Advances in Health Science Education , 19 (1), 7-17. https://doi.org/10.1007/s10459-013-9454-8 Hill, G., Thompson, G., Willis, S., & Hodgson, D. (2014). Embracing service user involvement in radiotherapy education: A discussion paper. Radiography , 20 (1), 82-86. https://doi.org/10.1016/j.radi.2013.08.007 Horgan, A., Manning, F., Bocking, J., Happell, B., Lahti, M., Doody, R., Griffin, M., Bradley, S. K., Russell, S., Bjornsson, E., O'Donovan, M., MacGabhann, L., Savage, E., Pulli, J., Goodwin, J., van der Vaart, K. J., O'Sullivan, H., Dorrity, C., Ellila, H.,…Biering, P. (2018). 'To be treated as a human': Using co-production to explore experts by experience involvement in mental health nursing education - The COMMUNE project. International Journal of Mental Health Nursing , 27 (4), 1282-1291. https://doi.org/10.1111/inm.12435 Howick, J., Dudko, M., Feng, S. N., Ahmed, A. A., Alluri, N., Nockels, K., Winter, R., & Holland, R. (2023). Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies. BMC Medical Education , 23 (1), 270. https://doi.org/10.1186/s12909-023-04165-9 Howick, J., Moscrop, A., Mebius, A., Fanshawe, T. R., Lewith, G., Bishop, F. L., Mistiaen, P., Roberts, N. W., Dieninyte, E., Hu, X. Y., Aveyard, P., & Onakpoya, I. J. (2018). Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. Journal of the Royal Society of Medicine , 111 (7), 240-252. https://doi.org/10.1177/0141076818769477 Howick, J., Slavin, D., Carr, S., Miall, F., Ohri, C., Ennion, S., & Gay, S. (2024). Towards an empathic hidden curriculum in medical school: A roadmap. Journal of Evaluation in Clinical Practice , 30 (4), 525-532. https://doi.org/10.1111/jep.13966 Hughes, M. (2017). What difference does it make? Findings of an impact study of service user and carer involvement on social work students’ subsequent practice. Social Work Education , 36 (2), 203-216. https://doi.org/10.1080/02615479.2016.1274725 Jha, V., Buckley, H., Gabe, R., Kanaan, M., Lawton, R., Melville, C., Quinton, N., Symons, J., Thompson, Z., Watt, I., & Wright, J. (2015). Patients as teachers: a randomised controlled trial on the use of personal stories of harm to raise awareness of patient safety for doctors in training. BMJ Qual Saf , 24 (1), 21-30. https://doi.org/10.1136/bmjqs-2014-002987 Jha, V., Quinton, N. D., Bekker, H. L., & Roberts, T. E. (2009). Strategies and interventions for the involvement of real patients in medical education: a systematic review. Medical Education , 43 (1), 10-20. https://doi.org/10.1111/j.1365-2923.2008.03244.x Jobling, H., & Sayuri, S. (2023). The Impact of Service User Involvement in Health and Social Care Education: A Scoping Review. Practice , 36 (3), 193-211. https://doi.org/10.1080/09503153.2023.2248414 Kirkpatrick, J. D., & Kirkpatrick, W. K. (2016). Kirkpatrick's four levels of training evaluation . Association for Talent Development. Kolb, D. A. a. F. R. (1975). Towards an applied theory of experiential learning. Theories of Group Process, Kuti, B., & Houghton, T. (2019). Service user involvement in teaching and learning: student nurse perspectives. Journal of Research in Nursing , 24 (3-4), 183-194. https://doi.org/10.1177/1744987119837594 Lea, S. J., Stephenson, D., & Troy, J. (2003). Higher Education Students' Attitudes to Student-centred Learning: Beyond 'educational bulimia'? Studies in Higher Education , 28 (3), 321-334. https://doi.org/10.1080/03075070309293 Lordly, D. (2007). Once upon a time.... Storytelling to enhance teaching and learning. Canadian Journal of Dietetic Practice and Research. Revue Canadienne de la Pratique et de la Recherche en Dietetique , 68 (1), 30-35. https://doi.org/10.3148/68.1.2007.30 McKim, C. (2023). Meaningful Member-Checking: A Structured Approach to Member Checking. American Journal of Qualitative Research , 7 , 41-52. https://doi.org/10.29333/ajqr/12973 McLean, S. F. (2016). Case-Based Learning and its Application in Medical and Health-Care Fields: A Review of Worldwide Literature. J Med Educ Curric Dev , 3 . https://doi.org/10.4137/JMECD.S20377 Mead, N., & Bower, P. (2000). Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med , 51 (7), 1087-1110. https://doi.org/10.1016/s0277-95368 Mezirow, J. (2009). Transformative learning theory . Jossey-Bass-Wiley. Morgan, A., & Jones, D. (2009). Perceptions of service user and carer involvement in healthcare education and impact on students' knowledge and practice: a literature review. Medical Teacher , 31 (2), 82-95. https://doi.org/10.1080/01421590802526946 Muir, D., & Laxton, J. C. (2012). Experts by experience; the views of service user educators providing feedback on medical students' work based assessments. Nurse Education Today , 32 (2), 146-150. https://doi.org/10.1016/j.nedt.2011.08.015 Olmos-Vega, F. M., Stalmeijer, R. E., Varpio, L., & Kahlke, R. (2022). A practical guide to reflexivity in qualitative research: AMEE Guide No. 149. Medical Teacher , 1-11. https://doi.org/10.1080/0142159X.2022.2057287 Scammell, J., Heaslip, V., & Crowley, E. (2016). Service user involvement in preregistration general nurse education: a systematic review. Journal of Clinical Nursing , 25 (1-2), 53-69. https://doi.org/10.1111/jocn.13068 Schwartz, M., & Abbott, A. (2007). Storytelling: a clinical application for undergraduate nursing students. Nurse Education in Practice , 7 (3), 181-186. https://doi.org/10.1016/j.nepr.2006.06.005 Soon, Y. E., Murray, C. M., Aguilar, A., & Boshoff, K. (2020). Consumer involvement in university education programs in the nursing, midwifery, and allied health professions: a systematic scoping review. International Journal of Nursing Studies , 109 , 103619. https://doi.org/10.1016/j.ijnurstu.2020.103619 Sorensen, J., Norredam, M., Suurmond, J., Carter-Pokras, O., Garcia-Ramirez, M., & Krasnik, A. (2019). Need for ensuring cultural competence in medical programmes of European universities. BMC Medical Education , 19 (1), 21. https://doi.org/10.1186/s12909-018-1449-y Stacey, G., Stickley, T., & Rush, B. (2012). Service user involvement in the assessment of student nurses: a note of caution. Nurse Education Today , 32 (5), 482-484. https://doi.org/10.1016/j.nedt.2011.12.001 Switaj, P., Grygiel, P., Krzyzanowska-Zbucka, J., Sonik, J., Chrostek, A., Jaholkowski, P., Wciorka, J., & Anczewska, M. (2019). The evaluation of the impact of anti-stigma training led by "experts by experience" on participants' attitudes towards persons with mental illness. Psychiatria Polska , 53 (6), 1219-1236. https://doi.org/10.12740/PP/109818 Tew, J., Gell, C., & Foster, S. (2004). Learning from experience. Higher Education . Tobbell, J., Boduszek, D., Kola-Palmer, S., Vaughan, J., & Hargreaves, J. (2018). Evaluating service user pedagogy in UK higher education: Validating the Huddersfield Service User Pedagogy Scale. Nurse Education Today , 63 , 81-86. https://doi.org/10.1016/j.nedt.2018.01.014 Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care , 19 (6), 349-357. https://doi.org/10.1093/intqhc/mzm042 Towle, A., Bainbridge, L., Godolphin, W., Katz, A., Kline, C., Lown, B., Madularu, I., Solomon, P., & Thistlethwaite, J. (2010). Active patient involvement in the education of health professionals. Medical Education , 44 (1), 64-74. https://doi.org/10.1111/j.1365-2923.2009.03530.x Towle, A., Farrell, C. J., Gaines, M. E., Godolphin, W., John, G., Kline, C., Lown, B., Morris, P., Symons, J., & Thistlethwaite, J. (2016). The patient’s voice in health and social care professional education: The Vancouver Statement. International Journal of Health Governance , 21 , 18-25. https://doi.org/0.1108/IJHG-01-2016-0003 Towle, A., & Godolphin, W. (2013). Patients as educators: interprofessional learning for patient-centred care. Medical Teacher , 35 (3), 219-225. https://doi.org/10.3109/0142159X.2012.737966 Voronka, J., & Grant, J. (2021). Service user storytelling in social work education: goals, constraints, strategies, and risks. Social Work Education , 41 (5), 977-992. https://doi.org/10.1080/02615479.2021.1908251 Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. 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14:24:45","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":187411,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7129987/v1/f6642af40901ffe068c407fd.html"},{"id":92874018,"identity":"810bb4b8-05fa-4f14-b75a-abfe940a6e77","added_by":"auto","created_at":"2025-10-06 14:24:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":156458,"visible":true,"origin":"","legend":"\u003cp\u003eThe coding tree of the interview analysis. Abbreviations: SUI- service user involvement.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7129987/v1/f57c95d0aff30a2e5c31fbf3.png"},{"id":94474479,"identity":"7552cf70-9ed4-4cda-8a33-04f40e0a061b","added_by":"auto","created_at":"2025-10-27 15:49:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1133600,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7129987/v1/a1fc061e-4a7f-4ce1-b695-fb2a1faa5efc.pdf"},{"id":92874017,"identity":"5fe1910d-d259-4a1a-9d53-d5b1b4b74c0c","added_by":"auto","created_at":"2025-10-06 14:24:45","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":15695,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineResourceA.docx","url":"https://assets-eu.researchsquare.com/files/rs-7129987/v1/ffb86b86214ffdfce96e9707.docx"},{"id":92875038,"identity":"4bc23277-3d30-479f-b6c5-edf7175a4485","added_by":"auto","created_at":"2025-10-06 14:32:45","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20130,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineResourceB.docx","url":"https://assets-eu.researchsquare.com/files/rs-7129987/v1/255d139babefad44d392e801.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Learning through service user involvement in allied health education: A qualitative investigation of the student experience","fulltext":[{"header":"Introduction","content":"\u003cp\u003eService users are increasingly recognised as \u0026ldquo;experts by experience\u0026rdquo;, with a growing shift towards their inclusion in healthcare education (Jobling \u0026amp; Sayuri, 2023; Scammell et al., 2016). Among the catalysts of this approach is the potential for service user involvement (SUI) to promote a patient-centred healthcare system, which prioritises their needs and is responsive to their experiences as end-users (Mead \u0026amp; Bower, 2000). Where traditionally, students have learned within faculty-directed curricula, informed by clinical and academic expertise, it is now recognised that service users add unique insights of their lived experience within the health system (Bennett-Weston et al., 2024). Creating a collaborative relationship between healthcare professionals and service users at the early stages of their professional development sets the foundations for future practice, centring the service user voice in shared decision-making and the broader continuum of care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe involvement of service users as active partners in healthcare education has been found to deliver benefits across multiple stakeholders (Gordon et al., 2020; Hill et al., 2014; Scammell et al., 2016). \u0026nbsp;Academic institutions and educators gain from having patient-informed curricula. This enhances their social accountability and ensures that graduates can deliver services sensitive to the evolving demands of real-world practice (Sorensen et al., 2019). For service users, their participation builds respectful relationships with students and the wider healthcare community (Cullen et al., 2022). Moreover, their experiences are platformed, empowering them to take an active role in their care, with service users describing fulfilment derived through their contributions (Dijk et al., 2020; Muir \u0026amp; Laxton, 2012). \u0026nbsp;From a student perspective, SUI, as part of their studies, has been suggested to increase empathy (Kuti \u0026amp; Houghton, 2019; Switaj et al., 2019) and improve clinical skills (Bideau et al., 2006). To date, SUI has primarily been explored within the areas of medical education (Gordon et al., 2020), nursing (Alberti et al., 2023; Scammell et al., 2016) and social work (Adamson et al., 2022). Integration of service users within allied health disciplines has received less attention (Soon et al., 2020), despite similarly high levels of patient contact for such students and policies calling on the integration of service users into their education (CORU, 2009; HCPC, 2025).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIncluding students in conversations regarding the involvement of service users in their education is important in ensuring a student-centred approach to teaching and learning (Gover et al., 2019; Lea et al., 2003). Many research studies examine discrete experiences of SUI related to a single or modular interaction (Jha et al., 2015; Jobling \u0026amp; Sayuri, 2023), with less focus placed on their experiences of SUI at a programmatic or institutional level. Gaining this broader perspective may offer a more authentic view of its usefulness and limitations from the student perspective. Furthermore, examining the theoretical underpinnings of student learning in relation to SUI has received little attention (Gordon et al., 2020). Understanding the potential theoretical basis of SUI in healthcare supports educators in embedding it appropriately within curricula. Moreover, knowledge of how learning is achieved could further legitimise this teaching approach, justifying the institutional commitment to SUI in healthcare education, which will likely require substantial investment (Bennett-Weston et al., 2024). Therefore, further work needs to be done to more comprehensively explore both \u003cem\u003ewhat\u0026nbsp;\u003c/em\u003eand \u003cem\u003ehow\u0026nbsp;\u003c/em\u003eallied health\u003cem\u003e\u0026nbsp;\u003c/em\u003estudents learn from SUI in their professional education.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe manifestation of SUI in educational settings has been varied. Contributions of service users encapsulate many roles, including those of teachers, assessors, curriculum developers, and selection committee members (Dijk et al., 2020). Numerous frameworks have been applied to SUI in healthcare education, such as Arnstein\u0026rsquo;s Model of Citizen Participation (Arnstein, 1969) and Tew\u0026rsquo;s Ladder of Involvement (Tew et al., 2004). Among the most frequently cited is the Spectrum of Involvement, proposed by Towle and colleagues (2010). This framework describes six distinct levels, each representing an increasing degree of involvement of service users. This engagement ranges from minimal participation of service users to true partnership. Whilst this model, and similar, have existed for over 15 years, translation of these frameworks into practice is generally thought to be poorly described (Gordon et al., 2020) and inconsistent, sometimes driven by isolated faculty members rather than a coordinated effort (Towle et al., 2016). Although service users have long contributed passively to healthcare education as subjects in case-based learning (McLean, 2016), their active participation as co-educators and involvement at a sustained curricular level has been far less widely adopted (Gordon et al., 2020). This is primarily attributed to issues associated with the sustainable implementation of SUI, including a lack of institutional support, resource-intensiveness, and unclear guidelines regarding service user training (Dijk et al., 2020; Jha et al., 2009).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite the acknowledged challenges, in recent years, comprehensive embedding of SUI in healthcare education has gained traction as an andragogical strategy, largely due to its potential to enhance healthcare delivery. However, sparsity in the literature exists in the context of the student perspective of SUI. Specifically, the experience of allied health students and the theory underpinning their learning in relation to SUI is under-researched. To address these gaps, the present study investigates how allied health students experience SUI within the context of their professional education. The central research question guiding this investigation is: What are the experiences of allied health students with SUI? Specifically, this study seeks to explore the following objectives:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eDetermine the current involvement and desired extent of involvement of service users in allied health education from the student perspective.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eExplore the perceived challenges and benefits of SUI in student learning.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eExamine the key learnings of students in relation to SUI in education and identify underlying learning theories.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Methods","content":"\u003ch2\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eA qualitative study design was employed, using semi-structured interviews to explore the experience and opinions of allied health students regarding SUI in education. The study was grounded in a constructivist framework, acknowledging the subjective nature of experience, the contextual influences shaping it, and the co-construction of meaning between the researcher and participant (Byrne, 2021). Semi-structured interviews were selected for their open-ended and flexible nature, promoting in-depth sharing of opinions and experiences (Adeoye‐Olatunde \u0026amp; Olenik, 2021). A pre-determined interview schedule (Online Resource A) was designed, informed by previous research and the aims and objectives of the study. The interview schedule was pilot tested for comprehension, comprehensiveness, and clarity with one student and was revised by the research team (SD, PB, MF). Questions explored the experiences of students with SUI in education, including their satisfaction, their desired level of involvement, and the effect on their learning and practice. Service users were defined as \u0026ldquo;experts by experience\u0026rdquo; of living with a health condition and/or engaging with healthcare services, either in a personal or caring capacity. SUI within academic, community, and practice education settings was considered relevant. Towle\u0026rsquo;s Spectrum of Involvement (Towle et al., 2010) was used to describe the level of SUI experienced by students. As per this framework, Level 1 indicates passive involvement of service users as the subjects of case scenarios. Level 2 involves their participation in clinical education settings where they act as patients for students to practice their clinical skills. At Level 3, service users contribute to a faculty-guided curriculum, for example, as guest lecturers. Level 4 includes service users as co-educators involved in teaching and evaluating students, with Level 5 additionally including them at a curricular planning level. The final level represents the highest participation, embodying Level 5 plus additional institutional-mandated sustained involvement. The Consolidated Criteria for Reporting Qualitative Research Qualitative Checklist (COREQ) (Tong et al., 2007) was used to aid transparency of reporting (Online Resource B). Clinical trial number: not applicable.\u003c/p\u003e\n\u003ch2 id=\"_Toc195711279\"\u003e\u003cstrong\u003eStudy Setting\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study was conducted in an allied health tertiary education setting, within a publicly funded university in the Midwest of Ireland. Within the university are four faculties, with the School of Allied Health lying within the Faculty of Education and Health Sciences. The School houses several pre- and post-registration professional programmes: Human Nutrition and Dietetics (MSc), Occupational Therapy (MSc), Physiotherapy (BSc and MSc), and Speech and Language Therapy (MSc). Each programme is regulated by CORU (Home - Coru), the Irish Healthcare Regulator, in addition to societies that oversee the profession\u0026apos;s scope of practice. All programmes incorporate service users to varying degrees, though none implement sustained SUI at a curricular level. \u003c/p\u003e\n\u003ch2 id=\"_Toc195711280\"\u003e\u003cstrong\u003eSample Selection and Recruitment\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eA convenience sample of students was recruited via the University\u0026rsquo;s internal online learning platform. Word-of-mouth and snowball sampling were additionally implemented. Participants were considered eligible if they met the following criteria: (i) \u0026ge;18 years of age (ii) were a current student in an undergraduate or postgraduate professional qualification allied health higher education programme (iii) were enrolled in year 2 (final year) of a professional MSc or year 3 onwards of a BSc programme. Participant selection was confined to the latter stages of programmes to ensure that students had sufficient exposure to educational content and delivery methods. \u003c/p\u003e\n\u003ch2 id=\"_Toc195711281\"\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eEthical approval was granted from the University of Limerick Education and Health Sciences Ethics Committee (2025_01_01_EHS). Prior to data collection, informed consent was obtained from all participants, and they were made aware of the purposes of the study. Interviews were conducted by two researchers (SD and AC), using a pre-determined interview schedule (Online Resource A), and took place online. Field notes were taken during data collection (Byrne, 2021). Interviews were initially transcribed verbatim using Microsoft Teams and later verified for accuracy using audio recordings. Given the debate surrounding the concept of data saturation, particularly the questionable nature of \u003cem\u003etrue \u003c/em\u003esaturation due to the inherent subjectivity of thematic analysis, the final sample size was reached based on the primary researcher\u0026apos;s (SD) determination of data adequacy. This was gauged through considering the richness and complexity of data in relation to the research question (Braun \u0026amp; Clarke, 2019b). \u003c/p\u003e\n\u003ch2 id=\"_Toc195711282\"\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eData was analysed in line with Braun and Clarke\u0026rsquo;s (2023) reflexive thematic analysis by one author (SD). To achieve familiarisation and contextual understanding of the data, recordings and transcripts were reviewed. Interviews were then coded using NVivo (Version 15), and themes were generated (Braun \u0026amp; Clarke, 2019a; Braun \u0026amp; Clarke, 2023). Field notes and reflective diaries were examined as part of the analysis process (Byrne, 2021). It is acknowledged that deductive and inductive approaches to\u003cem\u003e \u003c/em\u003eanalysis are not mutually exclusive within qualitative research (Braun \u0026amp; Clarke, 2019a). This research primarily adopted an inductive approach, generating themes from the interview data. However, deductive reasoning was used in the latter stages of the write-up by mapping findings to established theories, deepening the theoretical understanding of the learning experienced by students. \u003c/p\u003e\n\u003ch2 id=\"_Toc195711283\"\u003e\u003cstrong\u003eResearch Team Positionality and Reflexivity\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe principal investigator, SD (BSc, PhD), is a Lecturer in Physiotherapy and course director of a professional postgraduate programme, with four years\u0026apos; experience in teaching healthcare professionals. This work formed part of her Master of Arts Degree in Teaching, Learning, and Scholarship, focusing on SUI, a subject she has been engaged with for the past three years. AC (BSc, MSc, PhD) is a lecturer in Human Nutrition and Dietetics with 7 years of clinical education experience and has previously completed an MSc in Health Professions Education. She had no prior experience in SUI research. Both researchers had previous experience in conducting qualitative interviews. It was acknowledged that, as teaching staff, the relationship between the student and interviewers may have affected the data collected. To lessen potential power dynamics, participants were matched with interviewers with whom they had no prior teaching or personal relationships. Moreover, students were encouraged by interviewers to speak openly and honestly, with assurances given that their identifiable views would remain anonymous. The remaining two authors, PB (BSc, MA, PhD) and MF (BBS Grad Dip in Education, MA, PhD), are academics within the areas of Occupational Therapy and Teaching and Learning, respectively. Both authors have qualifications in andragogy and contributed their insights into the overall design, implementation, analysis, and interpretation of the study. All researchers are white females. \u003c/p\u003e\n\u003cp\u003eAs a lecturer within the allied health sciences and a physiotherapist herself, SD recognised that her experience in both delivering and receiving healthcare education and her engagement with educational research influenced this research. Although both interviewers\u0026rsquo; roles as educators may have improved their ability to probe meaningfully during interviews, it was recognised that their experiences could give rise to assumptions. SD acknowledged her part in constructing the meaning of information through the lens of its relevance to the research question and her own interpretation of the narratives (Byrne, 2021). To critically examine her influence on the data interpretation and enhance the trustworthiness of data, she participated in one reflective discussion with a co-author (PB) and kept a reflective diary throughout the analysis process (Olmos-Vega et al., 2022). Member-checking was employed as per McKim (2023) to enhance the validity of data by circulating the drafted results to participants, though no students suggested changes. \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the approximately 140 students eligible for participation, a total of 11 students across the four allied health disciplines participated. Demographic details of students are presented in Table 1. Interviews averaged 24 minutes in duration (from 18 to 35 minutes). Students described their experience of SUI, ranging from service users as the subject of case studies or prerecorded videos (Level 1), to participation as co-educators in a module (Level 4) (Towle et al., 2010).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1 Demographic details of participants.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudent ID\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProgramme of study,\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSUI in educational encounter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest level of SUI described\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eas per Towle et al. (2010)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest level of education attained\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMSc OT,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYear 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubject of case scenarios\u003c/p\u003e\n \u003cp\u003ePatient\u0026nbsp;on placement\u003c/p\u003e\n \u003cp\u003eGuest lecturer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBSc\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMSc SLT,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYear 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubject of case scenarios\u003c/p\u003e\n \u003cp\u003ePatient\u0026nbsp;on placement\u003c/p\u003e\n \u003cp\u003eGuest lecturer\u003c/p\u003e\n \u003cp\u003eCo-educator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBSc\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMSc OT,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYear 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubject of case scenarios\u003c/p\u003e\n \u003cp\u003eGuest lecturer\u003c/p\u003e\n \u003cp\u003ePatient\u0026nbsp;on placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBSc\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMSc SLT,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYear 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubject of case scenarios\u003c/p\u003e\n \u003cp\u003ePatient\u0026nbsp;on placement\u003c/p\u003e\n \u003cp\u003eGuest lecturer\u003c/p\u003e\n \u003cp\u003eCo-educators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBSc\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMSc SLT,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYear 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubject of case scenarios\u003c/p\u003e\n \u003cp\u003ePatient\u0026nbsp;on placement\u003c/p\u003e\n \u003cp\u003eGuest lecturer\u003c/p\u003e\n \u003cp\u003eCo-educators\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBSc\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMSc PT,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYear 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubject of case scenarios\u003c/p\u003e\n \u003cp\u003ePatient\u0026nbsp;on placement\u003c/p\u003e\n \u003cp\u003eGuest lecturer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBEd\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBSC PT,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYear 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubject of case scenarios\u003c/p\u003e\n \u003cp\u003ePatient\u0026nbsp;on placement\u003c/p\u003e\n \u003cp\u003eGuest lecturer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003csup\u003end\u003c/sup\u003e Level\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMSc PT,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYear 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubject of paper/electronic scenarios\u003c/p\u003e\n \u003cp\u003ePatient\u0026nbsp;on placement\u003c/p\u003e\n \u003cp\u003eGuest lecturer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBSc\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBSC PT,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYear 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubject of case scenarios\u003c/p\u003e\n \u003cp\u003ePatient\u0026nbsp;on placement\u003c/p\u003e\n \u003cp\u003eGuest lecturer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003csup\u003end\u003c/sup\u003e Level\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBSc PT,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYear 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubject of case scenarios\u003c/p\u003e\n \u003cp\u003ePatient\u0026nbsp;on placement\u003c/p\u003e\n \u003cp\u003eGuest lecturer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003csup\u003end\u003c/sup\u003e Level\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMSc HnD,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eYear 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSubject of case scenarios/videos\u003c/p\u003e\n \u003cp\u003ePatient\u0026nbsp;on placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBSc\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: SUI- Service User Involvement, MSc- Master of Science, OT- Occupational Therapy, F- Female, M- Male, BSc- Bachelor of Science, SLT- Speech and Language Therapy, PT- Physiotherapy, BEd- Bachelor of Education, HnD- Human Nutrition and Dietetics.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the thematic analysis of interviews, five themes were generated: (1) Diverse journeys with SUI; (2) Enhanced SUI- A challenging road; (3) SUI prompts transformative learning; (4) The power of SUI in the classroom; (5) Making it stick- SUI and impactful learning. These have been discussed below. The coding tree is available in Figure 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: Diverse journeys with SUI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents described varying experiences of SUI in allied health education. Some students described it as satisfactory and enjoyable, with an acceptable blend of educator-delivered information and service user input across their programmes. Student 2, a Speech and Language Therapy student, reported positively on the extent of SUI, \u003cem\u003e“I think it's a really good amount. I think it's a good balance”.\u0026nbsp;\u003c/em\u003eHowever, this satisfaction varied, even between students of the same programme and year, who would have been exposed to identical involvement. For example, Student 4, also a Speech and Language Therapy student, expressed a desire for maximising service users' input, stating\u003cem\u003e, “The more exposure, the better, probably.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDiverse experiences were noted in terms of the level of involvement of service users. Some students recounted numerous instances of service users as guest lecturers or as co-trainers. Generally, dissatisfaction was expressed when students described limited or tertiary involvement, comprising service users as subjects of case scenarios, pre-recorded video materials, or as patients within the practice education environment. Student 11 illustrated her perception of the limited SUI in her programme: \u003cem\u003e“So I do think that could definitely be improved upon… The service user kind of experience was always relayed through a third party, like, during lectures you would hear from a clinical specialist about how their patients were getting on, or the lived experience would translate that way, whereas the only time we've had direct contact with the service user would be on placement.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSome students indicated that the scope of SUI should be confined to guest lectures. They indicated that this was the maximum level of integration that they could envisage, \u003cem\u003e“I kind of think, like, in terms of college, they're involved as much as, well, everywhere they're involved. I can't see anywhere else, beyond giving guest lectures and coming in and talking”\u003c/em\u003e (Student 7). Students who had experienced service users in the capacity of co-educators recalled positive experiences, classifying these encounters as \u003cem\u003e“a really good experience”\u003c/em\u003e (Student 2) and \u003cem\u003e“enriching”\u003c/em\u003e (Participant 5) for them as students. Students also indicated the need for more diversity of experiences to be introduced, from people of differing ages, and in varying roles, such as parents or carers. It was discussed that doing so may create a more equitable learning environment, given that practice education opportunities are not identical.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“That would have been nice. If we could have had, like, maybe a child and a parent come in or something like that. Just so something is uniform, because on placement, everyone's having such different experiences. Yes, we've done the same course, but we have all had different things- like we could go to the same location, but the practice educator is different, and their way of doing it is different, so you know that would be something. It doesn't seem as standard if everyone's doing different things.” (Student 1)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2: Enhanced SUI- A Challenging Road\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents identified several logistical and ethical complexities associated with greater SUI in allied health education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eLogistical challenges\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe desire for an increased level of SUI was always met with a qualification of the logistical obstacles associated with its implementation. Time was noted as a limiting factor by many students, particularly those enrolled in professional MSc programmes. Student 5 shared, \u003cem\u003e“So being in an accelerated program, we wouldn't have more time, resources to do more of that.”\u003c/em\u003e Lack of accessibility of learning spaces and unclear reimbursement protocols were also mentioned by students as barriers to implementation.\u003c/p\u003e\n\u003cp\u003eStudents considered involving service users at a curricular level to be a useful approach, with suggestions of forming a panel of service users to oversee and advise on programmatic developments met with widespread positivity. However, some difficulties were flagged with this, particularly in ensuring diverse representation of service users. Student 2 expressed concerns, saying, \u003cem\u003e“It's gonna be really difficult to cover all the sides because, again, I can only speak to SLT, but there's countless difficulties that a person might experience. Like, what about the paediatric population?”.\u003c/em\u003e Moreover, students felt that SUI may not be appropriate in every area of healthcare education, with hesitance concerning assessment tasks. Students cited that service users may lack regulatory and andragogical knowledge, possibly creating ambiguity in assessment delivery and design. Student 11 shared her concerns regarding the professional implications of adopting service users at the assessment level: \u003cem\u003e“They (graduates) have to evidence, you know, how does your proficiency map to this assignment? I can't see an integration there because it's so fundamental to getting our registration with CORU.”\u0026nbsp;\u003c/em\u003eStudents showed concern for service users' misunderstanding of the scope and realities of practice, and its potential to translate into inappropriate or unfair assessment practices:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“We have to bear in mind that the service users don't know everything and don't have sight of everything, like I said. They glorify health professionals. They have high stakes for it. So, the expectations are high and sometimes may expect miracles. You know, and that is a tough standard to follow.”\u003c/em\u003e (Student 5)\u003c/p\u003e\n\u003cp\u003eMost students indicated that the academic role of overseeing should not be overlooked and should provide the foundation for SUI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical Challenges\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents also outlined ethical issues associated with SUI. Amongst the most common was the possible burden on the service user. Some students noted that service users might not feel comfortable sharing their private medical experience, citing data protection issues with their involvement:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“If it's a sensitive condition or, you know, if it is something that someone does feel is a sensitive condition. You know people have different levels of privacy and different levels of kind of boundaries, and you know, say you have a condition that you don't openly talk about, and you've been asked to do this. You know, there could be stress about, you know, ‘are they going to recognise me on the street?’”\u0026nbsp;\u003c/em\u003e(Student 11)\u003c/p\u003e\n\u003cp\u003eOther students remarked on the potential vulnerability of service users and stressed that educators would \u003cem\u003e“need to be very mindful of the burden that that would put on them”\u0026nbsp;\u003c/em\u003e(Student 3). Students cited that issues with coercion to participate and factors such as poor mental health may make their involvement inappropriate. Student 1 expressed their thoughts regarding the ethical complexities of involving service users in education:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“If it's someone with mental health issues, it might not be appropriate… I'm thinking ethics. Like, is that right? Do you know what I mean? And someone could say, yeah, I'll come in. But like, is that kind of not taking advantage? Is it ethical?”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3: SUI prompts transformative learning\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme encapsulates the shift in perceptions and behaviours of students through their interaction with service users in allied health programmes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDeveloping the empathetic and holistic clinician\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ability of SUI to nurture a sense of empathy within students was highlighted by most participants. Students noted that interactions stimulated a redirection of priorities, encouraging focus on the needs of the service user, rather than their needs as students. Student 5 remarked that this was a key learning, \u003cem\u003e“It is the client who's important here and not you.”\u003c/em\u003e Students described their respect for the service user's knowledge, with the lived experience of service users forming the basis of seeing the service user as a person-first. Student 9 expressed the value of SUI, \u003cem\u003e“I think it's beneficial for people in the class because then they don't see that person as an ‘other’. They see that person as a person, not the disability.”\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe manifestation of empathy in practice was documented in various ways. Students described increased personal sensitivity towards patient issues, prompting changes in their communication and actions within the practice education environment. Student 6 stated that the experience of a guest speaker allowed him to reframe interactions and reconsider his role, adopting a more empathetic approach:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Only for I probably heard that story and realised what they've gone through… I kind of had a prior sense of empathy and understanding for them in the bed. Whereas, I think before that placement, if I had not listened to that story or hadn’t had that experience, I think I would have went in there with my clipboard with my initial neuro assessment and, you know, these people are only after waking up in a critical care unit where they're asking them very difficult questions. \u0026nbsp;And I think as a student out on placement, I probably would have been, kind of you just, you know, ‘I'm here to learn. I need to get through this assessment. I need him to answer X, Y and Z for me.’ Whereas, from having the service user experience, we had more of an understanding, more empathy, I suppose, with the person in the bed.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStudents described developing an appreciation of the holistic aspects of a person- the integration of mental, emotional, and physical elements, as well as the \u003cem\u003e“real-world context” (\u003c/em\u003eStudent 4). Student 9 remarked that SUI prompted a shift towards \u003cem\u003e“taking all aspects of a patient into consideration and not just focusing on their condition”.\u0026nbsp;\u003c/em\u003eOne student (Student 3) remarked that simply seeing a service user navigating a university setting was important in demonstrating the challenges that service users experience, which students may have to consider in practice\u003cem\u003e, “That day, that one lady with the brain injury, she recorded her lecture because her speech wasn't amazing and (because) of fatigue and everything else. So that was a nice insight into how you manage all of that.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eProfessional preparedness\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents reported feeling more confident in their future professional practice following interactions with service users as co-educators or guest lecturers. They noted that this was especially influential in the earlier stages of learning, in which it provided context for future clinical scenarios they would face. Additionally, some students described that SUI could facilitate interactions with populations that they may not meet or had not met in a placement setting, bolstering their sense of preparedness before entering these areas of practice. Student 11 explained how SUI could provide a frame of reference, promoting preparedness:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“You'd feel more comfortable going in, you know, especially in some settings, like this is my first time experiencing them and I think ‘oh, I remember that video from Jane or whoever, Michael or something, you know, and or when, you know, Peter came in to speak to us.’ I think it could really help ground everything that we're doing and make you feel more at ease.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAlthough students had not yet graduated to become independent practitioners, many imagined, and some provided illustrative examples of changes in their practice resulting from SUI. All changes described were positive; some students described that SUI developed their clinical skills, whilst others described the development of softer communication skills. Students explained that SUI prompted them to talk to patients \u003cem\u003e“properly”\u0026nbsp;\u003c/em\u003e(Student 5), amid a busy clinical environment, which does not always lend itself to this practice. \u003cem\u003e\u0026nbsp;\u003c/em\u003eStudent 9 reflected on how they might apply their learning:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“People tell you what they like and what's worked for them and what doesn't work for them, and it gives you a good opportunity to learn how to properly interact and engage with different people and what works and what doesn't work.”\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 4: The power of SUI in the classroom\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis theme speaks to the effectiveness of SUI, specifically within classroom-based sessions, both as guest speakers and co-educators. Students noted that involving service users in the university classroom environment enhanced comfort and increased the approachability of asking questions and exploring experiences, which was not seen to be available within a clinical setting. Student 2 remarked, \u003cem\u003e“I suppose it’s kind of nice that you know when someone’s in a classroom, you can kind of learn from them a little bit and ask questions, where maybe you can’t as much when you’re on placement.”\u003c/em\u003e Students highlighted that, within the classroom, their role as learners was clear, in contrast to the professional identity expected within a practice education setting. Student 1 explained the distinction in roles, \u003cem\u003e“But on placement, you're more of an OT (occupational therapist) than a student or like a training OT. Whereas in the classroom, you're definitely a student.”\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStudents described the safety of the classroom as important in facilitating discussion. Among the features that contributed to this comfort was the oversight provided by the academic staff in guiding sessions, creating a low-stakes environment. This was expressed by Student 5\u003cem\u003e, “But what's better than gaining the experience while having the security and protection of being surveilled, you know?”\u0026nbsp;\u003c/em\u003e Students described that SUI within the classroom, often following years of interaction with a health system, rather than in a clinical setting during one isolated interaction, allowed service users time to process personal experiences and provide honest and authentic accounts. Students felt that this could aid them in understanding service users better:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“I find it helpful. Hearing her (the service user’s) opinion of several OTs that aren't in the room. She can give feedback on it, rather than it being in the moment. Like, obviously, these interactions she's had are over now, so she's had time to process and form how they made her feel, whereas in the moment, maybe she wouldn't have spoken up.”\u003c/em\u003e (Student 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 5: Making it stick- SUI and impactful learning\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSUI was commonly referred to as \u003cem\u003e“impactful”\u003c/em\u003e (Student 6) or similar, with multiple students remarking on the memorable nature of SUI. This was especially common in the context of guest lectures in which service users shared their personal experiences. SUI was often cited as the highlight or strongest section of programmes. Student 4 highlighted the effectiveness of this mechanism of learning:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Because I think lecture notes can get very repetitive, and this does not really have much impact. But when you're hearing someone's actual story, it’s way more emotional, even. Or, it kind of just sticks out to you. It's just way more impactful, and you can just, like, I can remember those instances way more than thinking back on actual lectures.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStudents felt that SUI interactions were engaging and effectively captured their attention. They noted that SUI sessions encouraged them to \u003cem\u003e“really listen”\u0026nbsp;\u003c/em\u003e(Student 6). Moreover, it was suggested that SUI within guest lectures prompted greater class engagement than traditional lectures, inducing an interactive learning experience. Student 10 described how SUI encouraged students to actively contribute:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“When these people (service users) came in, they were generally asked quite a lot of questions in comparison to- normally at the end of lectures there would be maximum of one or two questions. You know, there nearly would be, definitely more than seven or eight asked (during SUI sessions) that would nearly go on for another 25 minutes, half an hour.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStudents signalled that they often felt that SUI was inspirational. Service users drawing on their experience with the healthcare system prompted students to see the value of their profession, motivating them to learn. Student 2 noted the mutual empowerment derived from SUI:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“I think it's both empowering for us, seeing that what we do matters, because it achieves those kind of results, and it's also empowering for them (service users) that they can engage with students and prepare the future generation of clinicians. ‘Look, I am living experience of your guys's work.’”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStudents noted that SUI added value to their education that could not be replicated by other factors/stakeholders. The insights related to service users' nuanced and unique experiences with the healthcare system were acknowledged. Student 6 described the distinctive knowledge generated from SUI, \u003cem\u003e“Because, sometimes they (service users) pick up on things that maybe us as healthcare professionals might not pick up on from each other, but they might give us a different level of understanding.”\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStudents deferred to academics to provide the knowledge of various conditions, best practice evidence, and theoretical underpinning, but they expressed that service users were uniquely positioned to share their lived experience, rather than educators or advocates \u003cem\u003e“reading off from what they have heard”\u0026nbsp;\u003c/em\u003e(Student 8). The service user's story was considered the focal point of learning by many, with Student 6 stating, \u003cem\u003e“I think the patient's story as an education tool, I think it is very powerful.”\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis qualitative study explored the student experiences of SUI in allied health education. The five themes generated from these interviews identified the nature of what students learned, their desires for and perceived challenges of SUI in education, and the mechanisms of learning employed. This study presents new insights relating learning stimulated by SUI to theoretical underpinnings. Notably, the student experience of SUI in the allied health context closely mirrored what has been found in other healthcare education settings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExtent of and satisfaction with SUI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was a notable variation in both the extent of SUI and the level of satisfaction reported by students, despite this study being situated within a single allied health education school. This has been echoed in previous research, which has described fragmented efforts across higher-level settings (Towle et al., 2016). \u0026nbsp;A recent review of the literature suggests that engagement and true partnership lack guidelines for adoption (Gordon et al., 2020), which may impede progress in the area. Service user encounters described by students in our study related to levels 1 to 4 of Towle\u0026rsquo;s framework (2010), similar to what has been found across research in nursing (Alberti et al., 2023; Scammell et al., 2016) and medical education (Gordon et al., 2020). Student satisfaction with SUI was similarly varied, with some students finding it sufficient and others indicating a strong desire for greater involvement. Generally, when it was implemented within an allied health setting, SUI was seen as a positive factor by students, echoing previous research (Morgan \u0026amp; Jones, 2009). Although service user input in curricular development was positively received by students, there was hesitance to adopt SUI at every level described within Towle and colleagues\u0026apos; Framework (2010). Specifically, students questioned the place of SUI in assessment, preferring to defer to the academics to oversee this aspect. The complexity of integrating service users into assessment has been highlighted previously (Haycock-Stuart et al., 2016; Stacey et al., 2012), with caution advised regarding its practicality. The perceived lack of knowledge of service users with regard to regulatory processes was considerably concerning for students, perhaps necessitating service user training if their integration into assessments is to be widely implemented, a recommendation made by other authors previously (Jha et al., 2009). Transparent communication with students about how and why service users are involved in their education may enhance students\u0026rsquo; acceptance of this approach.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe \u0026ldquo;what\u0026rdquo; and \u0026ldquo;how\u0026rdquo; of learning from SUI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eA transformative learning experience\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany of the learning experiences recounted by students align with the concept of Transformative Learning described previously (Mezirow, 2009). Underscoring this theory is the belief that learning encounters challenge viewpoints, assumptions, and expectations, fostering adult learning. Students expressed the view that educational interactions involving service users were instrumental in promoting a more comprehensive understanding of them as people, rather than defining service users solely by their presenting health complaint. Instances of critical self-reflection were described, characteristic of transformative learning. Among the notable shifts acknowledged by students was their increased empathy, reflecting findings of previous research (Bennett-Weston et al., 2024; Gordon et al., 2020; Howick et al., 2024). Empathy, often defined as \u0026ldquo;feeling as others\u0026rdquo; (Hein \u0026amp; Singer, 2008, p. 157) is recognised as an important professional characteristic, particularly given the association between increased empathy of health professionals and patient satisfaction (Batbaatar et al., 2017), and positive outcomes (Howick et al., 2018). This is particularly relevant to the healthcare sector, in light of previous research indicating the potential for progressive decline in student empathy throughout their education (Howick et al., 2023). Embedding service user interactions could serve to address this (Howick et al., 2024).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSUI in allied health education was, in many cases, accompanied by corresponding changes in practice. Many of the learning experiences relayed align with Kolb\u0026rsquo;s Experiential Learning Cycle (Kolb, 1975). Students shared concrete accounts of SUI, often citing interactions in guest lectures as pivotal moments of reflection. These interactions prompted students to reimagine their professional practice, engaging with abstract conceptualisation of key changes they would make. Some students described applying their learning to practice education settings, illustrating behaviour adaptations, for example, through the adoption of more holistic management approaches. Other ways students demonstrated learning included through improved communication and practical skills, as has been found in other literature (Arenson et al., 2015; Bideau et al., 2006). These findings add credence to the suggestion that SUI can create meaningful changes in professional practice (Bennett-Weston et al., 2024). However, how this translates to satisfaction with care and patient outcomes requires further investigation. Some students described that their prioritisation of the patient voice prompted a shift in focus from their own academic goals as students to placing greater value on the goals and perspectives of service users. This has the potential to have far-reaching effects. Research in the social care education setting suggests that recognition of service users as experts in their own care persists beyond the confines of the student role, with sustained deference for the patient experience continuing into independent professional practice (Hughes, 2017).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePatient-centred learning\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe person-first approach, which appeared to develop in response to SUI, also falls under the scope of \u0026ldquo;patient-centred learning\u0026rdquo; (Bleakley \u0026amp; Bligh, 2008). Inclusive within the concept of patient-centredness (Mead \u0026amp; Bower, 2000) is adopting a \u0026ldquo;patient-as-person\u0026rdquo; and biopsychosocial approach. Students described this through their acknowledgement of the service user experience and their appreciation for the rich context of psychological and physical factors contributing to it. Previous research has also framed SUI in education within this model (Towle \u0026amp; Godolphin, 2013). This approach encapsulates the shift from the primary relationship in learning existing between educators and students, with service users playing a supportive role, to the educators supporting the primary relationship that lies between students and service users (Bleakley \u0026amp; Bligh, 2008). It has been suggested that this transfers the focus from students simply mirroring what is shown to them by educators, to students co-producing novel and \u0026ldquo;innovative\u0026rdquo; knowledge with service users. This is reflected in our study, with students describing that SUI created unique information and provided context that could not be gained from other sources. Students noted that the inputs of service users facilitated more nuanced and real-world interpretations of theoretical learnings, as students and service users collaborated to \u0026ldquo;construct\u0026rdquo; knowledge to inform future practice (Vygotsky, 1978). In many instances, this was realised through the integration of student conceptual knowledge with authentic accounts of service users\u0026apos; experiences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStorytelling as a learning tool\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents particularly valued hearing the service user story, which often detailed their personal experiences within the healthcare system and the interaction of their illness with their daily lives. The distinct capabilities of service users as \u0026ldquo;experts by experience\u0026rdquo; has been previously explored (Horgan et al., 2018). Many students drew on examples of service users as guest speakers, commonly citing this learning as memorable. Storytelling has been suggested to aid learning in healthcare education due to its ability to resonate with listeners and prompt reflection (Gray, 2013). Students foster a connection to a topic by allowing them to identify features relating to their own experience and knowledge \u0026nbsp; (Lordly, 2007; Schwartz \u0026amp; Abbott, 2007). \u0026nbsp;Whilst this is a valuable addition to healthcare programmes, storytelling gives rise to the potential for tokenism (Voronka \u0026amp; Grant, 2021). It has been argued that it may prompt students to centre individual experience of service users rather than prompting the criticism of the systemic issues they are subject to. This was apparent in our findings, with students raising issues concerning the diversity of service user input. Moreover, service users may feel pressured to fulfil certain palatable narratives, for example, \u0026ldquo;tragedy to triumph\u0026rdquo; stories (Voronka \u0026amp; Grant, 2021). Therefore, caution with its integration is advised. Educators and institutions may need to consider integrating service users from diverse backgrounds in a multimodal way, such as within assessments or as co-educators, rather than solely through single instances of storytelling. Embedding service users in such a manner may further platform the importance of service users in education and legitimise their involvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eThe unique affordances of SUI in the classroom\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents considered the classroom to be superior to the clinical environment in providing a comfortable and accessible setting for learning and interaction with service users. It is possible that this environment encouraged psychological safety (Clark, 2020; Edmondson et al., 2016), which has been suggested to play an essential role in ensuring positive and productive learning experiences for healthcare students (Edmonson, 1999). High-stakes healthcare settings can discourage learning (Edmonson et al., 2016) whereas the familiar learning environment of the classroom seemingly created a sense of security, reducing anxiety associated with risk-taking. Importantly, students highlighted their comfort/ease in asking questions and learning collaboratively, a finding mirrored elsewhere (Edmonson et al., 2016). Similarly, it was emphasised that the classroom environment may have encouraged service users to share openly and honestly, fostering contributor safety, increasing the potential for authenticity and collaborative learning (Clark, 2020). Students acknowledged that adopting the role of the learner within service user encounters the classroom encouraged learning, a finding echoed in other research (Henriksen \u0026amp; Ringsted, 2014). \u0026nbsp;This has been theorised to be related to nuanced changes in power dynamics. The clear distinction in roles established in the classroom - students as learners and service users as educators- encouraged students to ask questions that they may have considered inappropriate within the clinical setting.\u003c/p\u003e\n\u003ch2 id=\"_Toc195711286\"\u003e\u003cstrong\u003eStrengths and limitations\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis research presents novel insights into the role of SUI in student learning. To our knowledge, this is the first study to explore this topic within an Irish allied health context, finding that students largely report that SUI facilitates learning and provides unique advantages that cannot be obtained from traditional educator-student learning interactions. Strengths of this study lie in the mapping of learning theories to the study findings, indicating that transformative, experiential, and patient-centred learning underlies many of the instances of SUI recounted.\u003c/p\u003e\n\u003cp\u003eNotwithstanding the strengths identified, several limitations also exist. Firstly, although efforts were made to enhance transparency by providing the context surrounding this study and the descriptive details of participants, the generalisability to other educational settings is unclear. Secondly, while students indicated that some learnings transferred to practice education settings, it was not within the remit of this research to explore the applied learning that participants may have demonstrated after graduating as independent clinicians. Moreover, although students perceived that SUI led to changes in patient care, the effects of this on patient care were not evaluated. Finally, although efforts were made during recruitment to publicise the need for diverse views, it is possible that those choosing to participate represented a sample of students who had strong opinions about SUI in education.\u003c/p\u003e\n\u003ch2 id=\"_Toc195711287\"\u003e\u003cstrong\u003eImplications and Future Directions\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis research prompts several recommendations for both practice and research. Ensuring that approaches to teaching are evidence-based is imperative in facilitating effective learning (Davies, 2009). Therefore, a strong research base is needed to inform SUI in education. Whilst this study investigated the experiences of students currently enrolled in education programmes, it is recommended that future studies follow students beyond graduation to assess the long-term impact of SUI in healthcare education. This could include the assessment of both the translation of learning into practice and the value for the healthcare organisation and service users themselves. Using a mixed-method research approach, involving focus groups or interviews, and scales (Tobbell et al., 2018) may provide both quantitative and qualitative information to support these initiatives. \u0026nbsp;Integrating models of training evaluation in the research design may also be useful in achieving this aim (Kirkpatrick \u0026amp; Kirkpatrick, 2016).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor academic institutions and educators, this research offers evidence to support the belief that allied health students derive value from SUI in education. Moreover, theories were identified by which students learn, lending credibility to SUI as an effective learning strategy. Therefore, formal and sustained embedding of service users within curricula of healthcare programmes is a key recommendation of this research. This study may be used to guide the co-creation of course content, as it informs how best to integrate SUI in the curriculum and undercovers core competencies students gain, such as empathy and enhanced communication. Additional consideration may be necessary to ensure clarity for students regarding the involvement of service users in components such as assessment, an aspect highlighted as concerning for students. In addressing this, it may be useful to adopt a co-design approach, which includes the voices of multiple stakeholders, such as students, academics, and service users. \u0026nbsp;This may take the form of an open forum or World Caf\u0026eacute; (Brown \u0026amp; Isaacs, 2005) to establish a roadmap of \u0026ldquo;optimum involvement\u0026rdquo; of service users within this educational setting. It is important to acknowledge that the above suggestions for practice and research will likely demand investment and significant commitment at an institutional level. Universities may need to consider allocating funds, as they would for academic posts, to ensure sustainable and non-tokenistic involvement of service users.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAs stakeholders in the education process, consideration of the student perspective is important in curricular development. This study investigated the student experience of SUI in allied health education, adding novel insights, particularly regarding the theoretical underpinnings of student learning. Similar to what has been found in other contexts, students described varying levels of SUI in their programmes, mainly relating to lower-level, non-curricular involvement. Largely, students reported positive experiences with SUI, with some desiring greater degrees of integration. Among the challenges acknowledged by students regarding SUI were ethical issues of service user burden and logistical concerns in relation to the scope of service user knowledge. Students evidenced that SUI enhanced their learning, highlighting the distinct benefit derived from these interactions. Knowledge was collaboratively constructed between service users and students to serve the mutual purpose of improving healthcare delivery. Significant value was placed on the personal experience of service users, with storytelling emerging as a powerful educational tool. The key reported learnings related to the enhancement of empathy and the adoption of a holistic approach to practice, aligning with experiential and patient-centred learning theories. Students outlined the transformative nature of these experiences to shift attitudes and develop skills, and in many cases, students intended to, or had already, applied learning to professional practice. Whilst challenging, embedding SUI in healthcare education presents substantial opportunities for enriching student learning and fostering a patient-centred approach from the outset.\u0026nbsp;\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003eAuthor Contributions\u003c/p\u003e\n\u003cp\u003eConceptualisation: Sarah Dillon, Pauline Boland, Mary Fitzpatrick; Methodology: Sarah Dillon, Pauline Boland, Mary Fitzpatrick; Formal analysis and investigation: Sarah Dillon, Pauline Boland, Mary Fitzpatrick, Alexandra Cremona; Writing - original draft preparation: Sarah Dillon; Writing - review and editing: Sarah Dillon, Pauline Boland, Mary Fitzpatrick, Alexandra Cremona.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding Details\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo funding was received to assist with the preparation of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc195711274\"\u003eDisclosure Statement\u003c/p\u003e\n\u003cp\u003eAll authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the University of Limerick Education and Health Sciences Ethics Committee (2025_01_01_EHS).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp id=\"_Toc195711275\"\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors extend their sincere gratitude to the participants for generously sharing their experiences. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdamson, K., Goulden, A., Logan, J., \u0026amp; Hammond, J. (2022). Service user involvement in social work education: a scoping review. \u003cem\u003eSocial Work Education\u003c/em\u003e,\u003cem\u003e 43\u003c/em\u003e(2), 374-392. https://doi.org/10.1080/02615479.2022.2097213 \u003c/li\u003e\n\u003cli\u003eAdeoye‐Olatunde, O. A., \u0026amp; Olenik, N. L. (2021). Research and scholarly methods: Semi‐structured interviews. \u003cem\u003eJournal of the American College of Clinical Pharmacy\u003c/em\u003e,\u003cem\u003e 4\u003c/em\u003e(10), 1358-1367. https://doi.org/10.1002/jac5.1441 \u003c/li\u003e\n\u003cli\u003eAlberti, S., Ferri, P., Ghirotto, L., Bonetti, L., Rovesti, S., Vannini, V., Jackson, M., Rossi, F., \u0026amp; Caleffi, D. (2023). The patient involvement in nursing education: A mixed-methods systematic review. \u003cem\u003eNurse Education Today\u003c/em\u003e,\u003cem\u003e 128\u003c/em\u003e, 105875. https://doi.org/10.1016/j.nedt.2023.105875 \u003c/li\u003e\n\u003cli\u003eArenson, C., Umland, E., Collins, L., Kern, S. B., Hewston, L. A., Jerpbak, C., Antony, R., Rose, M., \u0026amp; Lyons, K. (2015). The health mentors program: three years experience with longitudinal, patient-centered interprofessional education. \u003cem\u003eJ Interprof Care\u003c/em\u003e,\u003cem\u003e 29\u003c/em\u003e(2), 138-143. https://doi.org/10.3109/13561820.2014.944257 \u003c/li\u003e\n\u003cli\u003eArnstein, S. R. (1969). A Ladder Of Citizen Participation. \u003cem\u003eJournal of the American Institute of Planners\u003c/em\u003e,\u003cem\u003e 35\u003c/em\u003e(4), 216-224. https://doi.org/10.1080/01944366908977225 \u003c/li\u003e\n\u003cli\u003eBatbaatar, E., Dorjdagva, J., Luvsannyam, A., Savino, M. M., \u0026amp; Amenta, P. (2017). Determinants of patient satisfaction: a systematic review. \u003cem\u003ePerspectives in Public Health\u003c/em\u003e,\u003cem\u003e 137\u003c/em\u003e(2), 89-101. https://doi.org/10.1177/1757913916634136 \u003c/li\u003e\n\u003cli\u003eBennett-Weston, A., Bostock, J., \u0026amp; Howick, J. (2024). The case for patient involvement in medical curriculum development. \u003cem\u003eBMJ\u003c/em\u003e,\u003cem\u003e 386\u003c/em\u003e, e080641. https://doi.org/10.1136/bmj-2024-080641 \u003c/li\u003e\n\u003cli\u003eBideau, M., Guerne, P. A., Bianchi, M. P., \u0026amp; Huber, P. (2006). Benefits of a programme taking advantage of patient-instructors to teach and assess musculoskeletal skills in medical students. \u003cem\u003eAnnals of the Rheumatic Diseases\u003c/em\u003e,\u003cem\u003e 65\u003c/em\u003e(12), 1626-1630. https://doi.org/10.1136/ard.2004.031153 \u003c/li\u003e\n\u003cli\u003eBleakley, A., \u0026amp; Bligh, J. (2008). Students learning from patients: let\u0026apos;s get real in medical education. \u003cem\u003eAdvances in Health Science Education\u003c/em\u003e,\u003cem\u003e 13\u003c/em\u003e(1), 89-107. https://doi.org/10.1007/s10459-006-9028-0 \u003c/li\u003e\n\u003cli\u003eBraun, V., \u0026amp; Clarke, V. (2019a). Reflecting on reflexive thematic analysis. \u003cem\u003eQualitative Research in Sport, Exercise and Health\u003c/em\u003e,\u003cem\u003e 11\u003c/em\u003e(4), 589-597. https://doi.org/10.1080/2159676x.2019.1628806 \u003c/li\u003e\n\u003cli\u003eBraun, V., \u0026amp; Clarke, V. (2019b). To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. \u003cem\u003eQualitative Research in Sport, Exercise and Health\u003c/em\u003e,\u003cem\u003e 13\u003c/em\u003e(2), 201-216. https://doi.org/10.1080/2159676x.2019.1704846 \u003c/li\u003e\n\u003cli\u003eBraun, V., \u0026amp; Clarke, V. (2023). Toward good practice in thematic analysis: Avoiding common problems and be(com)ing a knowing researcher. \u003cem\u003eInternation Journal of Transgender Health\u003c/em\u003e,\u003cem\u003e 24\u003c/em\u003e(1), 1-6. https://doi.org/10.1080/26895269.2022.2129597 \u003c/li\u003e\n\u003cli\u003eBrown, J., \u0026amp; Isaacs, D. (2005). \u003cem\u003eThe World Cafe: Shaping our futures through conversations that matter.\u003c/em\u003e Berrett-Koehler Publishers. \u003c/li\u003e\n\u003cli\u003eByrne, D. (2021). A worked example of Braun and Clarke\u0026rsquo;s approach to reflexive thematic analysis. \u003cem\u003eQuality \u0026amp; Quantity\u003c/em\u003e,\u003cem\u003e 56\u003c/em\u003e(3), 1391-1412. https://doi.org/10.1007/s11135-021-01182-y \u003c/li\u003e\n\u003cli\u003eClark, T. (2020). \u003cem\u003eThe 4 stages of psychological safety: Defining the path to inclusion and innovation\u003c/em\u003e. Berrett-Koehler Publishers. \u003c/li\u003e\n\u003cli\u003eCORU. (2009). \u003cem\u003eFramework for Public \u0026amp; Service User Involvement in Health and Social Care Regulation in Ireland\u003c/em\u003e. Ireland\u003c/li\u003e\n\u003cli\u003eCullen, M., Cadogan, C., George, S., Murphy, S., Freeney, S., Fitzpatrick, R., \u0026amp; Strawbridge, J. (2022). Key stakeholders\u0026apos; views, experiences and expectations of patient and public involvement in healthcare professions\u0026apos; education: a qualitative study. \u003cem\u003eBMC Medical Education\u003c/em\u003e,\u003cem\u003e 22\u003c/em\u003e(1), 305. https://doi.org/10.1186/s12909-022-03373-z \u003c/li\u003e\n\u003cli\u003eDavies, P. (2009). Approaches to evidence-based teaching. \u003cem\u003eMedical Teacher\u003c/em\u003e,\u003cem\u003e 22\u003c/em\u003e(1), 14-21. https://doi.org/10.1080/01421590078751 \u003c/li\u003e\n\u003cli\u003eDijk, S. W., Duijzer, E. J., \u0026amp; Wienold, M. (2020). Role of active patient involvement in undergraduate medical education: a systematic review. \u003cem\u003eBMJ Open\u003c/em\u003e,\u003cem\u003e 10\u003c/em\u003e(7), e037217. https://doi.org/10.1136/bmjopen-2020-037217 \u003c/li\u003e\n\u003cli\u003eEdmondson, A. C., Higgins, M., Singer, S., \u0026amp; Weiner, J. (2016). Understanding Psychological Safety in Health Care and Education Organizations: A Comparative Perspective. \u003cem\u003eResearch in Human Development\u003c/em\u003e,\u003cem\u003e 13\u003c/em\u003e(1), 65-83. https://doi.org/10.1080/15427609.2016.1141280 \u003c/li\u003e\n\u003cli\u003eEdmonson, A. (1999). Psychological Safety and Learning Behavior i. \u003cem\u003eAdministrative Science Quarterly\u003c/em\u003e. https://doi.org/10.2307/2666999 \u003c/li\u003e\n\u003cli\u003eEdmonson, A., Higgins, M., Singer, S., \u0026amp; Weiner, J. (2016). Understanding Psychological Safety in Health Care and Education Organizations: A Comparative Perspective. \u003cem\u003eResearch in Human Development\u003c/em\u003e. https://doi.org/10.1080/15427609.2016.1141280 \u003c/li\u003e\n\u003cli\u003eGordon, Gupta, S., Thornton, D., Reid, M., Mallen, E., \u0026amp; Melling, A. (2020). Patient/service user involvement in medical education: A best evidence medical education (BEME) systematic review: BEME Guide No. 58. \u003cem\u003eMedical Teacher\u003c/em\u003e,\u003cem\u003e 42\u003c/em\u003e(1), 4-16. https://doi.org/10.1080/0142159X.2019.1652731 \u003c/li\u003e\n\u003cli\u003eGover, A., Loukkola, T., \u0026amp; Peterbauer, H. (2019). \u003cem\u003eStudent-centred learning: approaches to quality assurance.\u003c/em\u003e \u003c/li\u003e\n\u003cli\u003eGray, J. B. (2013). The power of storytelling: Using narrative in the healthcare context. \u003cem\u003eJournal of Communication in Healthcare\u003c/em\u003e,\u003cem\u003e 2\u003c/em\u003e(3), 258-273. https://doi.org/10.1179/cih.2009.2.3.258 \u003c/li\u003e\n\u003cli\u003eHaycock-Stuart, E., Donaghy, E., \u0026amp; Darbyshire, C. (2016). Involving users and carers in the assessment of preregistration nursing students\u0026apos; clinical nursing practice: a strategy for patient empowerment and quality improvement? \u003cem\u003eJournal of Clinical Nursing\u003c/em\u003e,\u003cem\u003e 25\u003c/em\u003e(13-14), 2052-2065. https://doi.org/10.1111/jocn.13279 \u003c/li\u003e\n\u003cli\u003eHCPC. (2025). \u003cem\u003eService User and Carer Involvement\u003c/em\u003e. Retrieved 29 March 2025 from https://www.hcpc-uk.org/education/resources/education-standards/service-user-and-carer-involvement/#:~:text=We%20use%20the%20term%20\u0026rsquo;service,family%20member%2C%20partner%20or%20friend. \u003c/li\u003e\n\u003cli\u003eHein, G., \u0026amp; Singer, T. (2008). I feel how you feel but not always: The empathic brain and its modulation. \u003cem\u003eCurrent Opinion in Neurobiology\u003c/em\u003e,\u003cem\u003e 18\u003c/em\u003e, 153-158. https://doi.org/\u003cstrong\u003e10.1016/j.conb.2008.07.012\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e \u003c/li\u003e\n\u003cli\u003eHenriksen, A. H., \u0026amp; Ringsted, C. (2014). Medical students\u0026apos; learning from patient-led teaching: experiential versus biomedical knowledge. \u003cem\u003eAdvances in Health Science Education\u003c/em\u003e,\u003cem\u003e 19\u003c/em\u003e(1), 7-17. https://doi.org/10.1007/s10459-013-9454-8 \u003c/li\u003e\n\u003cli\u003eHill, G., Thompson, G., Willis, S., \u0026amp; Hodgson, D. (2014). Embracing service user involvement in radiotherapy education: A discussion paper. \u003cem\u003eRadiography\u003c/em\u003e,\u003cem\u003e 20\u003c/em\u003e(1), 82-86. https://doi.org/10.1016/j.radi.2013.08.007 \u003c/li\u003e\n\u003cli\u003eHorgan, A., Manning, F., Bocking, J., Happell, B., Lahti, M., Doody, R., Griffin, M., Bradley, S. K., Russell, S., Bjornsson, E., O\u0026apos;Donovan, M., MacGabhann, L., Savage, E., Pulli, J., Goodwin, J., van der Vaart, K. J., O\u0026apos;Sullivan, H., Dorrity, C., Ellila, H.,\u0026hellip;Biering, P. (2018). \u0026apos;To be treated as a human\u0026apos;: Using co-production to explore experts by experience involvement in mental health nursing education - The COMMUNE project. \u003cem\u003eInternational Journal of Mental Health Nursing\u003c/em\u003e,\u003cem\u003e 27\u003c/em\u003e(4), 1282-1291. https://doi.org/10.1111/inm.12435 \u003c/li\u003e\n\u003cli\u003eHowick, J., Dudko, M., Feng, S. N., Ahmed, A. A., Alluri, N., Nockels, K., Winter, R., \u0026amp; Holland, R. (2023). Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies. \u003cem\u003eBMC Medical Education\u003c/em\u003e,\u003cem\u003e 23\u003c/em\u003e(1), 270. https://doi.org/10.1186/s12909-023-04165-9 \u003c/li\u003e\n\u003cli\u003eHowick, J., Moscrop, A., Mebius, A., Fanshawe, T. R., Lewith, G., Bishop, F. L., Mistiaen, P., Roberts, N. W., Dieninyte, E., Hu, X. Y., Aveyard, P., \u0026amp; Onakpoya, I. J. (2018). Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. \u003cem\u003eJournal of the Royal Society of Medicine\u003c/em\u003e,\u003cem\u003e 111\u003c/em\u003e(7), 240-252. https://doi.org/10.1177/0141076818769477 \u003c/li\u003e\n\u003cli\u003eHowick, J., Slavin, D., Carr, S., Miall, F., Ohri, C., Ennion, S., \u0026amp; Gay, S. (2024). Towards an empathic hidden curriculum in medical school: A roadmap. \u003cem\u003eJournal of Evaluation in Clinical Practice\u003c/em\u003e,\u003cem\u003e 30\u003c/em\u003e(4), 525-532. https://doi.org/10.1111/jep.13966 \u003c/li\u003e\n\u003cli\u003eHughes, M. (2017). What difference does it make? Findings of an impact study of service user and carer involvement on social work students\u0026rsquo; subsequent practice. \u003cem\u003eSocial Work Education\u003c/em\u003e,\u003cem\u003e 36\u003c/em\u003e(2), 203-216. https://doi.org/10.1080/02615479.2016.1274725 \u003c/li\u003e\n\u003cli\u003eJha, V., Buckley, H., Gabe, R., Kanaan, M., Lawton, R., Melville, C., Quinton, N., Symons, J., Thompson, Z., Watt, I., \u0026amp; Wright, J. (2015). Patients as teachers: a randomised controlled trial on the use of personal stories of harm to raise awareness of patient safety for doctors in training. \u003cem\u003eBMJ Qual Saf\u003c/em\u003e,\u003cem\u003e 24\u003c/em\u003e(1), 21-30. https://doi.org/10.1136/bmjqs-2014-002987 \u003c/li\u003e\n\u003cli\u003eJha, V., Quinton, N. D., Bekker, H. L., \u0026amp; Roberts, T. E. (2009). Strategies and interventions for the involvement of real patients in medical education: a systematic review. \u003cem\u003eMedical Education\u003c/em\u003e,\u003cem\u003e 43\u003c/em\u003e(1), 10-20. https://doi.org/10.1111/j.1365-2923.2008.03244.x \u003c/li\u003e\n\u003cli\u003eJobling, H., \u0026amp; Sayuri, S. (2023). The Impact of Service User Involvement in Health and Social Care Education: A Scoping Review. \u003cem\u003ePractice\u003c/em\u003e,\u003cem\u003e 36\u003c/em\u003e(3), 193-211. https://doi.org/10.1080/09503153.2023.2248414 \u003c/li\u003e\n\u003cli\u003eKirkpatrick, J. D., \u0026amp; Kirkpatrick, W. K. (2016). \u003cem\u003eKirkpatrick\u0026apos;s four levels of training evaluation\u003c/em\u003e. Association for Talent Development. \u003c/li\u003e\n\u003cli\u003eKolb, D. A. a. F. R. (1975). Towards an applied theory of experiential learning. Theories of Group Process, \u003c/li\u003e\n\u003cli\u003eKuti, B., \u0026amp; Houghton, T. (2019). Service user involvement in teaching and learning: student nurse perspectives. \u003cem\u003eJournal of Research in Nursing\u003c/em\u003e,\u003cem\u003e 24\u003c/em\u003e(3-4), 183-194. https://doi.org/10.1177/1744987119837594 \u003c/li\u003e\n\u003cli\u003eLea, S. J., Stephenson, D., \u0026amp; Troy, J. (2003). Higher Education Students\u0026apos; Attitudes to Student-centred Learning: Beyond \u0026apos;educational bulimia\u0026apos;? \u003cem\u003eStudies in Higher Education\u003c/em\u003e,\u003cem\u003e 28\u003c/em\u003e(3), 321-334. https://doi.org/10.1080/03075070309293 \u003c/li\u003e\n\u003cli\u003eLordly, D. (2007). Once upon a time.... Storytelling to enhance teaching and learning. \u003cem\u003eCanadian Journal of Dietetic Practice and Research. Revue Canadienne de la Pratique et de la Recherche en Dietetique\u003c/em\u003e,\u003cem\u003e 68\u003c/em\u003e(1), 30-35. https://doi.org/10.3148/68.1.2007.30 \u003c/li\u003e\n\u003cli\u003eMcKim, C. (2023). Meaningful Member-Checking: A Structured Approach to Member Checking. \u003cem\u003eAmerican Journal of Qualitative Research\u003c/em\u003e,\u003cem\u003e 7\u003c/em\u003e, 41-52. https://doi.org/10.29333/ajqr/12973 \u003c/li\u003e\n\u003cli\u003eMcLean, S. F. (2016). Case-Based Learning and its Application in Medical and Health-Care Fields: A Review of Worldwide Literature. \u003cem\u003eJ Med Educ Curric Dev\u003c/em\u003e,\u003cem\u003e 3\u003c/em\u003e. https://doi.org/10.4137/JMECD.S20377 \u003c/li\u003e\n\u003cli\u003eMead, N., \u0026amp; Bower, P. (2000). Patient-centredness: a conceptual framework and review of the empirical literature. \u003cem\u003eSoc Sci Med\u003c/em\u003e,\u003cem\u003e 51\u003c/em\u003e(7), 1087-1110. https://doi.org/10.1016/s0277-95368 \u003c/li\u003e\n\u003cli\u003eMezirow, J. (2009). \u003cem\u003eTransformative learning theory\u003c/em\u003e. Jossey-Bass-Wiley. \u003c/li\u003e\n\u003cli\u003eMorgan, A., \u0026amp; Jones, D. (2009). Perceptions of service user and carer involvement in healthcare education and impact on students\u0026apos; knowledge and practice: a literature review. \u003cem\u003eMedical Teacher\u003c/em\u003e,\u003cem\u003e 31\u003c/em\u003e(2), 82-95. https://doi.org/10.1080/01421590802526946 \u003c/li\u003e\n\u003cli\u003eMuir, D., \u0026amp; Laxton, J. C. (2012). Experts by experience; the views of service user educators providing feedback on medical students\u0026apos; work based assessments. \u003cem\u003eNurse Education Today\u003c/em\u003e,\u003cem\u003e 32\u003c/em\u003e(2), 146-150. https://doi.org/10.1016/j.nedt.2011.08.015 \u003c/li\u003e\n\u003cli\u003eOlmos-Vega, F. M., Stalmeijer, R. E., Varpio, L., \u0026amp; Kahlke, R. (2022). A practical guide to reflexivity in qualitative research: AMEE Guide No. 149. \u003cem\u003eMedical Teacher\u003c/em\u003e, 1-11. https://doi.org/10.1080/0142159X.2022.2057287 \u003c/li\u003e\n\u003cli\u003eScammell, J., Heaslip, V., \u0026amp; Crowley, E. (2016). Service user involvement in preregistration general nurse education: a systematic review. \u003cem\u003eJournal of Clinical Nursing\u003c/em\u003e,\u003cem\u003e 25\u003c/em\u003e(1-2), 53-69. https://doi.org/10.1111/jocn.13068 \u003c/li\u003e\n\u003cli\u003eSchwartz, M., \u0026amp; Abbott, A. (2007). Storytelling: a clinical application for undergraduate nursing students. \u003cem\u003eNurse Education in Practice\u003c/em\u003e,\u003cem\u003e 7\u003c/em\u003e(3), 181-186. https://doi.org/10.1016/j.nepr.2006.06.005 \u003c/li\u003e\n\u003cli\u003eSoon, Y. E., Murray, C. M., Aguilar, A., \u0026amp; Boshoff, K. (2020). Consumer involvement in university education programs in the nursing, midwifery, and allied health professions: a systematic scoping review. \u003cem\u003eInternational Journal of Nursing Studies\u003c/em\u003e,\u003cem\u003e 109\u003c/em\u003e, 103619. https://doi.org/10.1016/j.ijnurstu.2020.103619 \u003c/li\u003e\n\u003cli\u003eSorensen, J., Norredam, M., Suurmond, J., Carter-Pokras, O., Garcia-Ramirez, M., \u0026amp; Krasnik, A. (2019). Need for ensuring cultural competence in medical programmes of European universities. \u003cem\u003eBMC Medical Education\u003c/em\u003e,\u003cem\u003e 19\u003c/em\u003e(1), 21. https://doi.org/10.1186/s12909-018-1449-y \u003c/li\u003e\n\u003cli\u003eStacey, G., Stickley, T., \u0026amp; Rush, B. (2012). Service user involvement in the assessment of student nurses: a note of caution. \u003cem\u003eNurse Education Today\u003c/em\u003e,\u003cem\u003e 32\u003c/em\u003e(5), 482-484. https://doi.org/10.1016/j.nedt.2011.12.001 \u003c/li\u003e\n\u003cli\u003eSwitaj, P., Grygiel, P., Krzyzanowska-Zbucka, J., Sonik, J., Chrostek, A., Jaholkowski, P., Wciorka, J., \u0026amp; Anczewska, M. (2019). The evaluation of the impact of anti-stigma training led by \u0026quot;experts by experience\u0026quot; on participants\u0026apos; attitudes towards persons with mental illness. \u003cem\u003ePsychiatria Polska\u003c/em\u003e,\u003cem\u003e 53\u003c/em\u003e(6), 1219-1236. https://doi.org/10.12740/PP/109818 \u003c/li\u003e\n\u003cli\u003eTew, J., Gell, C., \u0026amp; Foster, S. (2004). Learning from experience. \u003cem\u003eHigher Education\u003c/em\u003e. \u003c/li\u003e\n\u003cli\u003eTobbell, J., Boduszek, D., Kola-Palmer, S., Vaughan, J., \u0026amp; Hargreaves, J. (2018). Evaluating service user pedagogy in UK higher education: Validating the Huddersfield Service User Pedagogy Scale. \u003cem\u003eNurse Education Today\u003c/em\u003e,\u003cem\u003e 63\u003c/em\u003e, 81-86. https://doi.org/10.1016/j.nedt.2018.01.014 \u003c/li\u003e\n\u003cli\u003eTong, A., Sainsbury, P., \u0026amp; Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. \u003cem\u003eInternational Journal for Quality in Health Care\u003c/em\u003e,\u003cem\u003e 19\u003c/em\u003e(6), 349-357. https://doi.org/10.1093/intqhc/mzm042 \u003c/li\u003e\n\u003cli\u003eTowle, A., Bainbridge, L., Godolphin, W., Katz, A., Kline, C., Lown, B., Madularu, I., Solomon, P., \u0026amp; Thistlethwaite, J. (2010). Active patient involvement in the education of health professionals. \u003cem\u003eMedical Education\u003c/em\u003e,\u003cem\u003e 44\u003c/em\u003e(1), 64-74. https://doi.org/10.1111/j.1365-2923.2009.03530.x \u003c/li\u003e\n\u003cli\u003eTowle, A., Farrell, C. J., Gaines, M. E., Godolphin, W., John, G., Kline, C., Lown, B., Morris, P., Symons, J., \u0026amp; Thistlethwaite, J. (2016). The patient\u0026rsquo;s voice in health and social care professional education: The Vancouver Statement. \u003cem\u003eInternational Journal of Health Governance\u003c/em\u003e,\u003cem\u003e 21\u003c/em\u003e, 18-25. https://doi.org/0.1108/IJHG-01-2016-0003 \u003c/li\u003e\n\u003cli\u003eTowle, A., \u0026amp; Godolphin, W. (2013). Patients as educators: interprofessional learning for patient-centred care. \u003cem\u003eMedical Teacher\u003c/em\u003e,\u003cem\u003e 35\u003c/em\u003e(3), 219-225. https://doi.org/10.3109/0142159X.2012.737966 \u003c/li\u003e\n\u003cli\u003eVoronka, J., \u0026amp; Grant, J. (2021). Service user storytelling in social work education: goals, constraints, strategies, and risks. \u003cem\u003eSocial Work Education\u003c/em\u003e,\u003cem\u003e 41\u003c/em\u003e(5), 977-992. https://doi.org/10.1080/02615479.2021.1908251 \u003c/li\u003e\n\u003cli\u003eVygotsky, L. S. (1978). \u003cem\u003eMind in society: The development of higher psychological processes.\u003c/em\u003e Harvard University Press. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Service user involvement, healthcare education, student learning, allied health","lastPublishedDoi":"10.21203/rs.3.rs-7129987/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7129987/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe value of service user involvement (SUI) is gaining recognition within healthcare education. As stakeholders in the education process, exploring the student experience with SUI is critical to ensuring effective andragogical practices. Within this, an appreciation of both \u003cem\u003ewhat\u003c/em\u003e and \u003cem\u003ehow\u003c/em\u003e students learn is needed to underpin the wider adoption of SUI across healthcare education. A qualitative research design was employed to explore allied health students\u0026rsquo; experiences with and learning from SUI, and its alignment with relevant learning theories. Semi-structured interviews with eleven students generated five themes. Students reported variable satisfaction and differing levels of SUI in their education, noting ethical and logistical concerns with its adoption. Despite these reservations, students emphasised that SUI prompted key learning in the enhancement of empathy and consideration of a holistic, patient-centred approach to practice. Storytelling was identified as an effective andragogical tool, with SUI recognised as a memorable and impactful learning strategy. When service users contributed in a classroom setting, students reported perceived changes in power dynamics, facilitating interaction and knowledge construction. Learning was characterised as patient-centred, experiential and transformative, with students describing shifts in attitudes and practice resulting from their engagement with service users. By exploring the student experience, through relevant learning theories, this research offers a deeper understanding of how students engage with and derive meaning from SUI in education. Students acknowledged the unique capabilities of SUI in learning, and its capacity to foster patient-centred practice, a critical insight which lends support to service users' formal and sustained involvement in healthcare education.\u003c/p\u003e","manuscriptTitle":"Learning through service user involvement in allied health education: A qualitative investigation of the student experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-06 14:24:40","doi":"10.21203/rs.3.rs-7129987/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b1f4ace1-64a9-4664-a541-6f0b504bba92","owner":[],"postedDate":"October 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T14:34:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-06 14:24:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7129987","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7129987","identity":"rs-7129987","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}