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