A review of standardized patients in clinical education: Implications for speech-language pathology programs

Audiology Students' Clinical Communication During Simulated Peer Role Play Consultations: An Exploratory Study

PURPOSE

The objectives of this study were to describe the clinical communication practices of student audiologists during case history taking and feedback giving using simulated peer role play consultations and to explore whether clinical communication skills outcomes can be achieved through simulated peer role play.

METHOD

An exploratory, qualitative research design was used for this pilot study. A total of four simulated peer role play consultations were video-recorded, comprising two adult diagnostic audiology case scenarios. Eight online interviews were conducted with the student participants following the simulated audiological consultation. Analysis of the video-recorded sessions incorporated an interactional sociolinguistic focus, and interviews were analyzed using inductive thematic analysis.

RESULTS

Findings from the video analysis and interviews were triangulated, with a specific focus on establishing commonalities in terms of communication skills of student clinicians, reflections of their own skills, and the simulated peer patient's reflections on the student clinician's skills. Although variation was noted in terms of case history taking skills, feedback giving was similar among all student clinicians. These communication practices are consistent with findings from related literature on consultations with real patients. Student clinicians reflected on feedback giving as more challenging than case history taking, with room for improvement suggested by the simulated peer patients.

CONCLUSIONS

Our findings highlight key questions regarding the use of peer simulation in facilitating the development of communication skills for audiological consultations among student audiologists. We discuss some considerations for using this approach to clinical training more effectively.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25492804.

Standardized patients' experience of participating in medical students' education: a qualitative content analysis

BACKGROUND

Standardized patients are considered a significant educational method in medical sciences and have been successfully employed for many years. This study was conducted with the aim of explaining the experience of standardized patients participating in the education of medical student.

METHOD

A qualitative content analysis approach was used. This study was conducted at Standardized Patient Center, Tehran University of Medical Sciences, Tehran, Iran, May to February 2022. Fifteen standard patients were selected through purposive sampling with maximum variation. Semi-structured, in-depth, face-to-face interviews were conducted with standard patients. The average duration of the interviews was 60 to 90 min. Data were transcribed and analyzed using the Graneheim and Lundman approach.

RESULTS

A passport for the future and duality of feelings were the two main themes identified in this study with six subthemes. One of the main themes was passport for the future with subthemes creative, participation in educating future generation, reflection and another theme was duality of feeling with subthemes feeling of value, guilty conscience, and fear of judgment by others.

CONCLUSION

The participants expressed having mixed feelings about their role as standard patients. They felt conflicted because they were compensated for their participation, which made them worry about being judged by others and feel guilty about taking the fee. Therefore, it is recommended to conduct further studies in this area.

Student Perceptions of Simulation to Enhance Clinical Readiness for Assessment and Management of Adults With Voice Disorders

BACKGROUND

Simulation is a safe, supported, and accessible learning method for students to gain skills and experience, especially in difficult to access range of practice areas such as voice.

OBJECTIVE

The study aimed to explore change in students' perceptions of knowledge, confidence, anxiety, and clinical readiness for assessment and management of an adult with a voice disorder after participation in simulation-based learning activities.

METHODS

Participants (N = 113) were students enrolled in a mandatory course dedicated to the voice and voice disorders. Students completed 32 hours of academic coursework which included lectures and tutorials and two 30-minute simulation-based learning activities with a standardized patient playing the role of an adult with a voice disorder. The impact of the simulation-based learning activities on student perceptions of their knowledge, confidence, anxiety, and clinical readiness for work within the area of voice were surveyed at three time points: (1) pre lectures, (2) post lectures but pre simulation, and (3) post simulation. Change across time was analyzed using repeated measures analysis of variance with post hoc Bonferroni adjustment.

RESULTS

All students perceived significant (P ≤ 0.001) positive changes in knowledge and confidence across time points for all activities, except for writing an assessment report. Anxiety related to the management of a client with a voice disorder fluctuated significantly (P ≤ 0.001) throughout the program. Overall, the majority (>90%) of students agreed or strongly agreed that the simulation-based learning activities were useful and helped them to develop clinical skills, apply content taught in lectures, and gain confidence and interest in voice.

CONCLUSION

This study supports incorporation of simulation-based learning as part of students' clinical preparation for the assessment and management of voice disorders.

Evaluation of a pilot to introduce simulated learning activities to support speech and language therapy students' clinical development

BACKGROUND

Speech and language therapy (SLT) education must meet the needs of the future workforce, training enough students who are competent practitioners able to meet the workforce demands. Increasing student numbers and the impact on placement providers mean students must be equipped for learning on placement. Simulation is a way of supporting students to develop their clinical skills and decision-making in a safe, supportive environment.

AIMS

To explore the perspectives of SLT students who were introduced to simulation during their undergraduate degree at a UK university as part of a pilot study. The aim of the pilot was to listen to the students' voices to begin to understand their lived experiences of simulation and to gather views on how simulation can support their clinical learning.

METHODS & PROCEDURES

Focus groups and semi-structured interviews were carried out with second-year BSc SLT students in semester 2 following the simulated learning activities and clinical placement. Qualitative data were gathered and thematic analysis was applied to the data to identify the barriers and enablers to students' clinical learning in simulation.

OUTCOMES & RESULTS

A total of 11 students responded out of a cohort of 38. Three key themes were identified from the analysis: individual learning needs, facilitator skill and programme-level organization.

CONCLUSIONS & IMPLICATIONS

Student experience of simulation was positive. One of the key elements students found to support their clinical skills was the importance of the safe space; support for learning instead of correction led them to engage in active learning. Key barriers to simulation related to having sufficient prior knowledge, the skills of the facilitator, group size and the wider learning landscape of the programme. In response to this pilot, there are plans to continue developing this model of simulation and embed simulation across the programme, led by a sound pedagogical approach with clear preparation and planning and building the necessary infrastructure. Other SLT programmes and practice educators developing simulation as part of their programmes or placement may wish to consider some of these findings to support the use of simulation in their workplace.

WHAT THIS PAPER ADDS

What is already known on this subject Simulation as a teaching methodology is widely used in medicine and nursing programmes. It is now used in various allied health professions and in some SLT programmes. There is evidence to suggest simulation increases student confidence and clinical skills without increasing the capacity on those offering clinical placements in practice. What is already known on this subject This study offers a practical example of introducing simulation in an established undergraduate programme for SLT students. It explains the background to this innovative way of teaching clinical skills and explains why this approach could be beneficial for the future speech and language therapist. What are the clinical implications of this work? This study gives practical examples of how simulation can work to facilitate student clinical learning and knowledge. It may offer ideas to those working in clinical practice to organize placements differently or add simulation elements to improve the student experience. Other educational establishments and placement educators may find the recommendations helpful in developing their own simulation approach.

Identifying Clinical Behaviors Using the Motor Learning Classification Framework: A Pilot Study

CONTEXT

Although differences in clinical interactions with patients between students and experienced clinicians are well described, differences in therapeutic training behaviors have not been explored, especially in relation to motor learning principles.

AIMS

This pilot study compared clinical behaviors between speech language pathology (SLP) students and experienced SLPs in a voice therapy task, using prepractice variables in the Motor Learning Classification Framework (MLCF).

METHODS

Using a quasi-experimental design, five final-year undergraduate SLP students and four experienced SLPs with a voice therapy caseload taught a standardized patient to produce a vocal siren. Two trained raters categorized the clinicians' behaviors using the MLCF.

RESULTS

High intrarater reliability (91.9%, 92.3%) and interrater reliability (89.6%, 82.1%) were shown across both raters. Both clinician groups used the same percentage of behaviors classified as verbal information but differed in the subtypes of these behaviors. Experienced clinicians used behaviors categorized as problem-solving and only experienced clinicians used repeated behavior sequences that included perceptual training. Both groups used significantly more talking behaviors than doing behaviors.

CONCLUSIONS

The MLCF can be reliably used to identify prepractice behaviors during client interactions in voice therapy. Students and experienced clinicians showed similarities in behaviors, but experienced clinicians used more problem solving and perceptual training behaviors than students. These differences have implications for student training. The greater use of talking behaviors than doing behaviors warrants further investigation into whether this impacts the subsequent quality of practice engaged by the client and ultimately treatment effectiveness.

Watch vs do: A randomized crossover design evaluating modified simulated patients and video learning for novice speech-language therapy students

BACKGROUND

Simulated learning activities are an effective tool for reducing speech-language therapy (SLT) students' anxiety and improving their confidence for clinical placements. Such activities include interacting with patients who are actors, clinical educators or peers and are known to decrease anxiety and increase confidence in SLT students. Screen-simulated patients using video are another alternative, which has not yet been fully evaluated in the education of SLT students.

AIMS

To compare the effectiveness of (1) modified simulated patient and (2) video simulated learning for increasing self-reported (a) confidence and (b) preparedness and (c) decreasing self-reported anxiety.

METHODS & PROCEDURES

This study used a randomized crossover design with 127 first-year graduate-entry master's SLT student participants. Students participated in two activities related to a clinical interaction with a paediatric client's carer: (1) a 1-hr modified simulated patient experience with clinical staff as the simulated patient; and (2) a video-learning task, with two videos of a clinician-carer interaction and an accompanying worksheet. Students were randomly allocated to a group of four students and the groups randomly allocated to receive modified simulated patient or video-learning first. Students were not blinded to the activities. The students completed a 19-item questionnaire at three time points: before either activity, after the first activity and after the second activity, to evaluate their self-reported confidence, clinical preparedness and anxiety.

OUTCOMES & RESULTS

A total of 62 students completed modified simulated patient first and 63 completed video-learning first. After either single activity the students had significantly increased confidence and preparedness scores, while only the modified simulated patient significantly reduced student anxiety scores. As a second activity, modified simulated patient resulted in further significant improvements in confidence, preparedness and anxiety; however, adding video learning as a second activity resulted in no significant benefit.

CONCLUSIONS & IMPLICATIONS

This study demonstrates the effectiveness of two low-resource clinical-learning activities for novice SLT students that can be applied in a range of settings. Of the two activities, modified simulated patient had greater effectiveness, as it was the only activity to decrease anxiety. An investigation of the pedagogical principles within the activities revealed that modified simulated patient activity had more opportunities for peer learning, supervisor feedback and verbal reflection in comparison with video learning that may explain the increased benefits.

WHAT THIS PAPER ADDS

What is already known on the subject Simulated learning activities are an effective teaching tool for SLT students, increasing confidence and decreasing anxiety in preparation for placement. Simulated patients require more resources than video simulation. Both simulated patients and video simulation provide a safe learning environment, where students can learn without risk to clients. What this paper adds to existing knowledge This study is among the first to investigate a modified version of simulated patients; our modification involves a clinical educator performing the role of both the simulated patient and simulation facilitator. It is the first to evaluate simulation via video learning for SLT students. The paper demonstrates the effectiveness of these two activities, and the slight advantage of modified simulated patient, for increasing novice students' confidence and preparedness and decreasing their anxiety about clinic. It also unpacks the pedagogical principles used in each activity to explain the reasons that modified simulated patient had greater effectiveness. What are the potential or actual clinical implications of this work? The two educational activities required no specialist equipment and can be applied in a range of pre-clinical and clinical settings by university staff and/or community clinical educators. Increasing confidence and preparedness, and decreasing anxiety will help ensure that student learning on scarce clinical placements is maximized.

Improving Clinical Competence Through Simulated Training in Evidence-Based Practice for Stuttering: A Pilot Study

PURPOSE

The purpose of this pilot study was to determine the effectiveness and acceptability of an initial module (1.1; active listening skills) of the Simulated Training in Evidence-Based Practice for Stuttering (STEPS) program, a theory-driven, multimodule, content and learning platform designed to advance knowledge and skills in working with culturally and linguistically diverse persons who stutter of all ages.

METHOD

Fifteen preservice speech-language pathologists (SLPs) were randomly assigned to complete either the STEPS 1.1 module or a control module. In both conditions, all participants engaged in pre- and post-clinical interviews with a standardized patient portraying a parent of a child who stutters. Prior to participation, all participants provided self-ratings on the Jefferson Scale of Physician Empathy-Health Profession Student. Post participation, trained observers rated all participants' active listening behaviors using the Active Listening Observation Scale-Modified. Post participation, the STEPS 1.1 participants also completed an intervention acceptability questionnaire.

RESULTS

No differences between groups were found in self-perceived clinical empathy prior to participation. Participants who completed the STEPS 1.1 condition utilized paraphrasing and client-directed eye gaze significantly more frequently at posttest than at pretest and significantly more than the control group at posttest. Quantitative and qualitative responses from the participants who completed STEPS 1.1 indicated high acceptability of its content, structure, duration, and perceived impact.

CONCLUSION

Preliminary data from the present pilot study support use of the STEPS 1.1 module to improve preservice SLPs' use of skills that have been shown to predict perceived clinical empathy and increase assessment and treatment effectiveness.

E-learning communication skills training for physiotherapy students: A two phased sequential mixed methods study

OBJECTIVE

Test whether a single e-learning session can improve empathy and communication across pre-registration and postgraduate physiotherapy students.

METHODS

Design: Two-phase sequential mixed methods study. Phase 1: Pilot randomised control trial. Phase 2: Qualitative study using interpretive phenomenological analysis.

SAMPLING

A purposive sample for both phases.

OUTCOME MEASURES

Phase 1: At baseline, post and 6-week follow up. Demographics.

PRIMARY OUTCOME

Inter-personal Reactivity Index (IRI). Phase 2: Demographics and interview schedule.

INTERVENTION

An e-learning (E) narrative intervention group or active control condition.

ANALYSIS

Phase 1: Descriptive statistics and confidence intervals. Mann-Whitney U test to compare across group change. Phase 2: Thematic analysis.

RESULTS

Thirty-nine participants took part in the mixed methods study (Phase 1 n = 25; Phase 2 n = 14). Phase 1: No significant differences between groups were identified. Potentially importance changes across time were found for the intervention group and control group. Phase 2 results identified 5 themes and 12 sub-themes.

CONCLUSION

The e-learning groups identified an increase in the perceived ability to handle distressing communication. Other important findings from the e-learning are discussed. Further research is warranted. Practical Implications Novel e-learning intervention may have an important role in curriculum development and clinical practice to promote therapeutic communication.

PRACTICAL IMPLICATIONS

Novel e-learning intervention may have an important role in curriculum development and clinical practice to promote therapeutic communication.

The experience of speech-language therapists and audiologists when delivering bad news: A qualitative analysis

BACKGROUND

As part of their professional responsibilities, speech-language therapists and audiologists are required to deliver bad news.

AIMS

The aim of this qualitative study is to describe and characterize the subjective experience of speech-language therapists and audiologists when delivering bad news to clients or their family members.

METHODS & PROCEDURES

A group of 156 speech-language therapists and audiologists replied in writing to an open question asking them to describe a clinical encounter in which they delivered bad news. The texts that were generated in response to this question served as a data base. Qualitative content analysis was used to analyse data and generate themes.

OUTCOMES & RESULTS

Thematic analysis of participants' texts revealed the challenges inherent to the delivery of bad news. Four main themes emerged from text analysis: difficulty in phrasing the news; the deliverer's emotional experience; the receiver's reaction; and being alone or in companion with another healthcare provider during the delivery of the bad news.

CONCLUSIONS & IMPLICATIONS

Speech-language therapists and audiologists experience difficulties similar to those experienced by other healthcare professionals when delivering bad news. Nevertheless, speech-language therapists and audiologists seem to perceive the delivery of bad news situation in a broader sense than the conventional definition given to this term in the medical arena. What this paper adds What is already known on the subject The task of delivering bad news is stressful to healthcare professionals. Most of the literature on the topic pertains to physicians. Little is known regarding the delivery of bad news in speech-language therapy and audiology. What this paper adds to existing knowledge This study highlights the challenges that speech-language therapists and audiologists encounter when delivering bad news. Furthermore, it illuminates the implicit perceptions of these professionals regarding what is considered 'bad news'. What are the potential or actual clinical implications of this work? The emotional challenges associated with the delivery of bad news underscore the importance of support and training regarding the delivery of bad news. It is especially important to prepare for a client's difficult questions, and to prefer a collaborative approach to the delivery of bad news.

The Effects of an Online Training on Preservice Speech-Language Pathologists' Use of Family-Centered Skills

Purpose Despite the recognition that family-centered services are best practice in augmentative and alternative communication services, many speech-language pathologists (SLPs) are lacking in their acquisition and implementation of family-centered skills. The purpose of this study was to evaluate the effects of online instruction in a family-centered, relational skills strategy on preservice SLPs use of family-centered skills. Method A switching replications design was used to evaluate the effects of an online training on the use of family-centered behaviors by 15 preservice SLPs who were randomly assigned to two groups. The online training taught the students a four-step relational skills strategy (summarized by the acronym LAFF): (a) Listen, empathize, and communicate respect; (b) Ask questions; (c) Focus on the issues; and (d) Find a first step. Participants were videotaped during interactions with simulated parents before and after the training. Results After an average of 61 min of instruction via the online module, all of the preservice SLPs significantly improved their demonstration of relational skills. Additionally, one parent of a child who used augmentative and alternative communication viewed the video recordings and chose 14 of the 15 postinstruction role plays as more family-centered. Conclusion The findings from this study provide support for the use of an online environment to teach preservice SLPs family-centered relational skills. In order to prepare future SLPs and ensure the delivery of family-centered services, future research is necessary, including investigations to determine whether other family-centered skills can be effectively taught through an online environment. Supplemental Material https://doi.org/10.23641/asha.12462344.

A simulation-based learning experience in augmentative and alternative communication using telepractice: speech pathology students' confidence and perceptions

BACKGROUND

Simulation, as an activity in speech-language pathology training, can increase opportunities for students to gain required skills and competencies. One area that has received little attention in the simulation literature, yet is a growing area of clinical practice, is alternative and augmentative communication (AAC). Also growing, is the use of telepractice to deliver services. This exploratory study investigated graduate entry speech-language pathology student perceptions of a simulation learning experience working with an adult with complex communication needs via telepractice.

METHODS

First year Master of Speech Pathology students completed a 1-day simulation using a videoconferencing delivery platform with an actor portraying an adult client with motor neurone disease requiring AAC. Quantitative and qualitative survey measures were completed pre- and post-simulation to explore students' confidence, perceived impact on clinical performance, and perceived extent of learning, specifically, their interest, competence, and tension. Further, students' perceptions about the telepractice system useability were explored. Fifty-two responses were received and analysed using descriptive statistics and content analysis.

RESULTS

Post-simulation, students reported increased confidence and perceived positive impacts on their confidence and clinical skills across communication, assessment, and management domains. They felt better prepared to manage a client with a progressive neurological condition and to make AAC recommendations. For telepractice delivery, technology limitations were identified as impacting its use, including infrastructure (e.g., weak internet connection). In addition, some students reported feeling disconnected from the client.

CONCLUSION

This study supports the use of simulation in AAC through telepractice as a means of supporting Masters-level speech pathology student learning in this area of practice.

Student perceptions of two simulated learning environments in paediatric audiology

Objective: To determine audiology student perceptions of two simulated learning environments (SLE) in paediatric audiology.Design: A one-shot case study design.Study sample: Fifteen audiology students who completed questionnaires after participating in two SLEs, one simulating auditory brainstem response (ABR) assessments of neonates in a hospital ward and one simulating visually reinforced orientation audiometry (VROA) assessments of young children in an audiology clinic.Results: The students responded positively to 11/11 areas of audiometric testing and client interaction in both SLEs, to 7/7 aspects of their interactions with the mannequins in both SLEs, and to 8/8 aspects of their interactions with fellow students playing the role of parent in the ABR SLE and 7/8 of these aspects in the VROA SLE. The students reported low levels of anxiety towards both SLEs but rated the ABR SLE more highly than the VROA SLE in areas of preparedness, effectiveness, realism, pre-SLE training, reinforcement of lecture content, and overall usefulness.Conclusions: The participating students responded positively to almost all aspects of both SLEs. Further research is warranted using research designs capable of determining if these SLEs directly improve student abilities as they transition from academic settings to clinical placements in paediatric audiology.

Teaching Medical Students Skills for Effective Communication With Patients Who Have Communication Disorders

Purpose Patients with communication impairments including speech, language, cognition, or hearing disorders face many barriers to communication in health care settings. These patients report loss of autonomy in health care decision making, are at increased risk for medical errors, and are less satisfied with health care than patients without communication disorders. Although medical students receive training in effective patient-provider communication, most of this training assumes patients have intact communication abilities. Medical students and other health care providers are often unprepared to meet the communication needs of patients with communication disorders in health care encounters. The purpose of this study was to assess the impact of a curriculum for training medical students to communicate effectively with patients who have a range of communication disorders. Method Twenty-six 2nd-year medical students volunteered for assessments before and after a required workshop in a class. This workshop included instruction about different types of communication disorders and communication strategies, followed by practice with standardized patients portraying different communication disorders. Outcome measures included a knowledge test, ratings of self-efficacy, and evaluation of students' skills when interviewing standardized patients portraying aphasia and dysarthria. Results Medical students demonstrated significant improvements in knowledge, self-efficacy, and use of recommended communication techniques. Conclusions The curriculum appeared effective in changing medical students' knowledge and skills for working with patients with communication disorders. Equipping medical students to meet the needs of patients with communication disorders is 1 key element for improving the quality of health care for this patient population.

Preparing Physiotherapy Students for Clinical Placement: Student Perceptions of Low-Cost Peer Simulation. A Mixed-Methods Study

INTRODUCTION

Simulation is increasingly used in health care education, yet the organizational and financial costs can be prohibitive. This study aimed to investigate whether peer simulation is perceived by third-year undergraduate physiotherapy students as valuable for clinical placement preparation.

METHODS

Third-year undergraduate physiotherapy students participated in a 9-week peer simulation program, using each other as patients, and were invited to complete two surveys evaluating perceptions of the program. The program consisted of weekly patient interactions during which students were required to assess and treat a "patient" under strict simulation guidelines and in accordance with stated learning objectives. Items rated included self-perceived skills, confidence, time management, and clinical placement readiness and included collection of qualitative responses. Surveys were released at commencement and completion of the simulation program.

RESULTS

Of 79 third-year students, 63% completed survey 1 and 66% completed survey 2. Students had high expectations of the program and these were consistently met. Peer simulation rated highly for all items, including identifying knowledge and skill deficits, and improving confidence, clinical reasoning, time management, and communication. Simulation was considered safe, supportive, engaging, and valuable for clinical placement preparation. Students identified some lack of authenticity when working with peers.

CONCLUSIONS

Peer simulation was perceived by students as valuable in preparing them for clinical placement, despite a perceived lack of realism. These findings support the use of peer simulation as an alternative to the use of more formalized standardized patients in an undergraduate physiotherapy program. Further investigation is required to establish a detailed cost analysis of the program and to determine the amount of realism required to optimize the benefits of this promising educational strategy.

Comparison of paired and single clinical placement models: a time-use analysis

BACKGROUND

To meet rising clinical placement demand caused by increasing health student numbers, the use of paired (two students) rather than single (one student) placement models has been proposed. There is, however, limited research available to inform placement providers about the relative effects of both models on healthcare services, including patient- and non-patient-related activities and patient occasions of service.

AIMS

To investigate a key clinical question: Does clinical educator (supervisor) and student time use differ during paired placements compared with single placements? Also to examine the satisfaction levels of clinical educators (CEs) and students with paired and single clinical placement models.

METHODS & PROCEDURES

Queensland Health speech and language therapists (N = 44) and speech and language therapy students (N = 32) involved in paired or single clinical placements were recruited for this study. CEs and students completed time-use surveys for 3 days after the midpoint of placements; CEs also completed surveys for 3 matched days during a non-placement period 3 weeks or more following placements for comparative purposes. CEs and students additionally completed a satisfaction survey at the end of placements. Paired and single CE and student groups were compared for differences in their time-use and satisfaction levels using non-parametric statistics.

OUTCOMES & RESULTS

The placement model did not impact on occasions of service provided by CEs (p = 0.931) or students (p = 0.776). It also had no effect on the percentage of time CEs or students engaged in patient-related activities (p = 0.577; 0.291) and non-patient-related activities (p = 0.559; 0.177). On clinical placement days, CEs spent a median 10 minutes longer at work regardless of whether or not it was a paired or single placement, compared with non-placement days (p = 0.107). CEs and students who had been involved in a paired placement reported the same high levels of placement satisfaction (various measures) as those who had been involved in a single placement.

CONCLUSIONS & IMPLICATIONS

The paired-placement model has the potential to increase student placement offers without negatively impacting on clinical service provision including occasions of service, patient or non-patient-related activities, or overall CE time spent at work.

Delivering Bad News: Attitudes, Feelings, and Practice Characteristics Among Speech-Language Pathologists

PURPOSE

The purpose of this study was to examine the attitudes, feelings, and practice characteristics of speech-language pathologists (SLPs) in Israel regarding the subject of delivering bad news.

METHOD

One hundred and seventy-three Israeli SLPs answered an online survey. Respondents represented SLPs in Israel in all stages of vocational experience, with varying academic degrees, from a variety of employment settings. The survey addressed emotions involved in the process of delivering bad news, training on this subject, and background information of the respondents. Frequency distributions of the responses of the participants were determined, and Pearson correlations were computed to determine the relation between years of occupational experience and the following variables: frequency of delivering bad news, opinions regarding training, and emotions experienced during the process of bad news delivery.

RESULTS

Our survey showed that bad news delivery is a task that most participants are confronted with from the very beginning of their careers. Participants regarded training in the subject of delivering bad news as important but, at the same time, reported receiving relatively little training on this subject. In addition, our survey showed that negative emotions are involved in the process of delivering bad news.

CONCLUSIONS

Training SLPs on specific techniques is required for successfully delivering bad news. The emotional burden associated with breaking bad news in the field of speech-language pathology should be noticed and addressed.

Improving medical students' knowledge and skill in communicating with people with acquired communication disorders

PURPOSE

To explore the effects of an interactive workshop on medical students' knowledge and skill in communicating with people with acquired communication disorders.

METHOD

Sixty-nine medical students received a lecture on acquired communication disorders. Thirty-six of these students also participated in a workshop where they practised using supportive strategies in interaction with a simulated patient with aphasia. All students completed a questionnaire exploring attitudes, confidence in knowledge and ability to suggest suitable supportive strategies pre- and post-lecture/workshop and 15 students were video recorded when interacting with a simulated patient pre- and post-workshop.

RESULT

The results show no change in attitude in either student group, but both groups rated their confidence in knowledge as higher post-lecture/workshop. The students' ability to suggest supportive strategies post training was significantly higher only in the workshop group. Comparing post training results regarding knowledge and ability to suggest supportive strategies between the groups, higher ratings were found for the workshop group. The analysis of video recordings indicated that the students also used new supportive strategies and used strategies more frequently after the workshop.

CONCLUSION

An interactive workshop can improve medical students' knowledge and skills in communicating with people with acquired communication disorders.

The Use of Simulation in Physician Assistant Programs: A National Survey

PURPOSE

The purpose of this study was to develop a national-level description of the current use of simulation activities in physician assistant (PA) education and to assess the degree to which the use of simulation varies by PA program size and institutional type.

METHODS

An electronic survey on medical simulation was sent to 177 PA program directors or to a designated simulation activities coordinator, using the directory on the Physician Assistant Education Association website. The survey addressed program characteristics, types of simulation modalities in use, and frequency of use of those modalities in PA training. The specific content areas addressed were error disclosure, medical knowledge, patient care, and psychomotor skills.

RESULTS

The survey was emailed 3 times from early April to mid-May 2014, with a follow-up call to nonrespondents in August 2014. Of the 177 PA programs contacted, 63 completed the survey, for a response rate of 35.6%. Results indicate widespread use of simulation by survey respondents, especially in teaching, assessment of medical knowledge, and clinical skills, with somewhat lower levels of use in content areas such as error disclosure, delivery of bad news, and team training.

CONCLUSIONS

Although barriers exist to its use in training health care professionals, simulation has become an important tool for training PAs in a variety of medical and interpersonal skills. It is also clear that simulation is an important tool for conducting interprofessional training. More research is needed to identify optimal approaches to the use of simulation in health care professions training.

Assessing the Believability of Standardized Patients Trained to Portray Communication Disorders

PURPOSE

The purpose of this study was to evaluate the believability of standardized patients portraying individuals with communication disorders as part of a larger study in which standardized patients help train medical and allied health students about communication disorders.

METHOD

Two women portrayed persons with aphasia, and 2 men depicted persons with dysarthria associated with Parkinson's disease. Two stakeholder groups rated believability. Speech-language pathologists rated believability of videos online. Persons with aphasia rated aphasia videos during in-person sessions with the researchers.

RESULTS

Targeted believability was 80 or higher (0-100 scale; 0 = not at all believable, 100 = very believable). For speech-language pathologist raters, average ratings met the target for the portrayals of the aphasia characteristics of word-finding problems, agrammaticism, nonverbal communication, and overall portrayal but not for auditory comprehension problems. Targets for the portrayals were met for the dysarthria characteristics of reduced speech movements, reduced loudness, reduced intonation, flat affect, and overall portrayal but not for speech rate. Ratings for different standardized patients portraying the same case were not significantly different from each other on most characteristics. Ratings from persons with aphasia were highly variable.

CONCLUSION

Standardized patients who do not have communication disorders can portray disorder characteristics in a believable manner.

Comparison of Psychophysiological Stress in Physiotherapy Students Undertaking Simulation and Hospital-Based Clinical Education

INTRODUCTION

Simulation-based clinical education often aims to replicate varying aspects of real clinical practice. It is unknown whether learners' stress levels in simulation are comparable with those in clinical practice. The current study compared acute stress markers during simulation-based clinical education with that experienced in situ in a hospital-based environment.

METHODS

Undergraduate physiotherapy students' (n = 33) acute stress responses [visual analog scales of stress and anxiety, continuous heart rate (HR), and saliva cortisol] were assessed during matched patient encounters in simulation-based laboratories using standardized patients and during hospital clinical placements with real patients. Group differences in stress variables were compared using repeated measures analysis of variance for 3 time points (before, during the patient encounter, and after) at 2 settings (simulation and hospital).

RESULTS

Visual analog scale stress and anxiety as well as HR increased significantly from baseline levels before the encounter in both settings (all P < 0.05). Stress and anxiety were significantly higher in simulation [mean (SD), 45 (22) and 44 (25) mm; P = 0.003] compared with hospital [mean (SD), 31 (21) and 26 (20) mm; P = 0.002]. The mean (SD) HR during the simulation patient encounter was 90 (16) beats per minute and was not different compared with hospital [mean (SD), 87 (15) beats per minute; P = 0.89]. Changes in salivary cortisol before and after patient encounters were not statistically different between settings [mean (SD) simulation, 1.5 (2.4) nmol/L; hospital, 2.5 (2.9) nmol/L; P = 0.70].

CONCLUSIONS

Participants' experienced stress on clinical placements, irrespective of the clinical education setting (simulation vs. hospital). This study revealed that psychological stress and anxiety were greater during simulation compared with hospital settings; however, physiological stress responses (HR and cortisol) were comparable. These results indicate that psychological stress may be heightened in simulation, and health professional educators need to consider the impact of this on learners in simulation-based clinical education. New learners in their clinical education program may benefit from a less stressful simulation environment, before a gradual increase in stress demands as they approach clinical practice.

Teaching medical students about communication in speech-language disorders: Effects of a lecture and a workshop

PURPOSE

This study aims to explore the effects of an interactive workshop involving speech-language pathology students on medical students' knowledge about communication in relation to speech-language disorders.

METHOD

Fifty-nine medical students received a lecture about speech-language disorders. Twenty-six of them also participated in a workshop on communication with patients with speech-language disorders. All students completed a 12-item questionnaire exploring knowledge and attitudes towards communication before and after the lecture or the workshop. The results from the two groups' self-ratings of confidence in knowledge were compared with expert-ratings of their ability to choose suitable communicative strategies.

RESULT

Both the lecture and the workshop increased the students' confidence in knowledge about speech-language disorders and how to support communication. Only the workshop group also displayed a statistically significant increase in expert-rated ability and changed their attitude regarding responsibility for the communication in cases of speech-language disorders. There were no statistically significant correlations between the student's own confidence ratings and the experts' ratings of ability.

CONCLUSION

Increased confidence in knowledge from learning is not always reflected in actual knowledge in how to communicate. However, an interactive workshop proved to increase medical students' expert-rated ability and attitudes related to communication in cases of speech-language disorders.

A tool for assessing case history and feedback skills in audiology students working with simulated patients

OBJECTIVE

To develop a tool for assessing audiology students taking a case history and giving feedback with simulated patients (SP).

DESIGN

Single observation, single group design.

STUDY SAMPLE

Twenty-four first-year audiology students, five simulated patients, two clinical educators, and three evaluators.

RESULTS

The Audiology Simulated Patient Interview Rating Scale (ASPIRS) was developed consisting of six items assessing specific clinical skills, non-verbal communication, verbal communication, interpersonal skills, interviewing skills, and professional practice skills. These items are applied once for taking a case history and again for giving feedback. The ASPIRS showed very high internal consistency (α = 0.91-0.97; mean inter-item r = 0.64-0.85) and fair-to-moderate agreement between evaluators (29.2-54.2% exact and 79.2-100% near agreement; κ_weighted up to 0.60). It also showed fair-to-moderate absolute agreement amongst evaluators for single evaluator scores (intraclass correlation coefficient [ICC] r = 0.35-0.59) and substantial consistency of agreement amongst evaluators for three-evaluator averaged scores (ICC r = 0.62-0.81). Factor analysis showed the ASPIRS' 12 items fell into two components, one containing all feedback items and one containing all case history items.

CONCLUSION

The ASPIRS shows promise as the first published tool for assessing audiology students taking a case history and giving feedback with an SP.

Use of Simulation With Standardized Patients in AAC Pre-Service Training: Potentiating Practical Learning

In this article, a brief overview of simulation is presented as a way to contextualize discussion of its application to pre-service clinical skill learning in augmentative and alternative communication (AAC). The emphasis of this article is on the process of standardized patient implementation rather than its product. The steps involved in preparing for, implementing, and evaluating this learning activity will be discussed, as will directions for further relevant activity and research.

Student self-reported communication skills, knowledge and confidence across standardised patient, virtual and traditional clinical learning environments

BACKGROUND

Advanced communication skills are vital for allied health professionals, yet students often have limited opportunities in which to develop them. The option of increasing clinical placement hours is unsustainable in a climate of constrained budgets, limited placement availability and increasing student numbers. Consequently, many educators are considering the potentials of alternative training methods, such as simulation. Simulations provide safe, repeatable and standardised learning environments in which students can practice a variety of clinical skills. This study investigated students' self-rated communication skill, knowledge, confidence and empathy across simulated and traditional learning environments.

METHOD

Undergraduate speech pathology students were randomly allocated to one of three communication partners with whom they engaged conversationally for up to 30 min: a patient in a nursing home (n = 21); an elderly trained patient actor (n = 22); or a virtual patient (n = 19). One week prior to, and again following the conversational interaction, participants completed measures of self-reported communication skill, knowledge and confidence (developed by the authors based on the Four Habit Coding Scheme), as well as the Jefferson Scale of Empathy - Health Professionals (student version).

RESULTS

All three groups reported significantly higher communication knowledge, skills and confidence post-placement (Median d = .58), while the degree of change did not vary as a function of group membership (Median η (2)  < .01). In addition, only students interacting with a nursing home resident reported higher empathy after the placement. Students reported that conversing with the virtual patient was more challenging than conversing with a nursing home patient or actor, and students appeared to derive the same benefit from the experience.

CONCLUSIONS

Participants self-reported higher communication skill, knowledge and confidence, though not empathy, following a brief placement in a virtual, standardised or traditional learning environment. The self-reported increases were consistent across the three placement types. It is proposed that the findings from this study provide support for the integration of more sustainable, standardised, virtual patient-based placement models into allied health training programs for the training of communication skills.

The outcome of interprofessional education: Integrating communication studies into a standardized patient experience for advanced practice nursing students

The purpose of this qualitative study was to examine the impact of standardized patient experiences (SPE) in the education of the Advanced Practice Nurse (APN). The education of the APN requires educators to make every attempt to promote competency in the areas of communication and clinical-decision making. SPE programs have been found to improve the interpersonal, problem solving, and critical thinking skills of nursing students. For this research twenty-nine APN students participated in SPEs over the course of two semesters. Fifteen student volunteers of those 29 participants were then interviewed three months after the experience. Results revealed that having an expert in the field of communication studies increased awareness of communication skills and how to improve nurse-patient encounters in the clinical setting. The interprofessional collaboration during the SPEs assisted in facilitating the application of learned communication skills into patient-centered care of the APN student.

Developing clinical skills in paediatric dysphagia management using human patient simulation (HPS)

PURPOSE

The use of simulated learning environments to develop clinical skills is gaining momentum in speech-language pathology training programs. The aim of the current study was to examine the benefits of adding Human Patient Simulation (HPS) into the university curriculum in the area of paediatric dysphagia.

METHOD

University students enrolled in a mandatory dysphagia course (n = 29) completed two, 2-hour HPS scenarios: (a) performing a clinical feeding assessment with a medically complex infant; and (b) conducting a clinical swallow examination (CSE) with a child with a tracheostomy. Scenarios covered technical and non-technical skills in paediatric dysphagia management. Surveys relating to students' perceived knowledge, skills, confidence and levels of anxiety were conducted: (a) pre-lectures; (b) post-lectures, but pre-HPS; and (c) post-HPS. A fourth survey was completed following clinical placements with real clients.

RESULT

Results demonstrate significant additive value in knowledge, skills and confidence obtained through HPS. Anxiety about working clinically reduced following HPS. Students rated simulation as very useful in preparing for clinical practice. Post-clinic, students indicated that HPS was an important component in their preparation to work as a clinician.

CONCLUSION

This trial supports the benefits of incorporating HPS as part of clinical preparation for paediatric dysphagia management.

Incorporating Standardized Colleague Simulations in a Clinical Assessment Course and Evaluating the Impact on Interprofessional Communication

OBJECTIVE

To determine the impact of incorporating standardized colleague simulations on pharmacy students' confidence and interprofessional communication skills.

DESIGN

Four simulations using standardized colleagues portraying attending physicians in inpatient and outpatient settings were integrated into a required course. Pharmacy students interacted with the standardized colleagues using the Situation, Background, Assessment, Request/Recommendation (SBAR) communication technique and were evaluated on providing recommendations while on simulated inpatient rounds and in an outpatient clinic. Additionally, changes in student attitudes and confidence toward interprofessional communication were assessed with a survey before and after the standardized colleague simulations.

ASSESSMENT

One hundred seventy-one pharmacy students participated in the simulations. Student interprofessional communication skills improved after each simulation. Student confidence with interprofessional communication in both inpatient and outpatient settings significantly improved.

CONCLUSION

Incorporation of simulations using standardized colleagues improves interprofessional communication skills and self-confidence of pharmacy students.

Simulated patients in a mental health occupational therapy course: A pilot study

Introduction

The use of simulated patients is well established in medicine and nursing. There is little research evaluating the use of simulated patients in occupational therapy education and none which focuses on mental health. This study sought to determine the acceptability and effectiveness of using simulated patients in a mental health occupational therapy course. The pilot also sought to address the challenge of providing simulation experience to a large number of students in a cost and time effective manner.

Method

Occupational therapy students participated in a simulation which involved an initial interview assessment with an actor portraying a person with a mental health diagnosis. The students worked in small groups for the simulation, rotating into the therapist role using a carousel model. Students completed a survey about their experience of the simulation.

Results

The students rated the simulation experience highly in terms of authenticity and learning outcomes. Qualitative analysis of open-ended responses produced five themes: authentic experience, developing skills, feedback and reflection, we should do more of this, and developing the experience further.

Conclusion

The pilot was effective in allowing a large number of students to engage directly with the simulated patient without negatively impacting on the experience.

Teaching Active Listening Skills to Pre-Service Speech-Language Pathologists: A First Step in Supporting Collaboration With Parents of Young Children Who Require AAC

Purpose

This study examined the effect of instruction in an active listening strategy on the communication skills of pre-service speech-language pathologists (SLPs).

Method

Twenty-three pre-service SLPs in their 2nd year of graduate study received a brief strategy instruction in active listening skills. Participants were videotaped during a simulated parent meeting before and after the strategy instruction. Simulated parent meetings addressed issues that parents of children who use augmentative and alternative communication (AAC) may face. Social validity measures were gathered from the participants and from parents of children who use AAC.

Results

Pre- and postinstruction use of the active listening strategy was scored and compared using a Wilcoxon signed-ranks test, with statistically significant results. Postinstruction scores were significantly higher than preinstruction scores, providing evidence of the effectiveness of the instruction. Furthermore, participants and parents of children who use AAC described the postinstruction interactions more positively than the preinstruction interactions, suggesting that the pre-service SLPs benefited from the instruction.

Conclusion

The current study provides evidence of the effectiveness of strategy instruction in active listening skills that may be incorporated into SLP preparation programs.

Assessment of student competency in a simulated speech-language pathology clinical placement

Clinical education programs in speech-language pathology enable the transition of students' knowledge and skills from the classroom to the workplace. Simulated clinical learning experiences provide an opportunity to address the competency development of novice students. This study reports on the validation of an assessment tool designed to evaluate speech-language pathology students' performance in a simulated clinical placement. The Assessment of Foundation Clinical Skills (AFCS) was designed to link to concepts and content of COMPASS(®): Competency Assessment in Speech Pathology, a validated assessment of performance in the workplace. It incorporates units and elements of competency relevant to the placement. The validity of the AFCS was statistically investigated using Rasch analysis. Participants were 18 clinical educators and 130 speech-language pathology students undertaking the placement. Preliminary results support the validity of the AFCS as an assessment of foundation clinical skills of students in this simulated clinical placement. All units of competency and the majority of elements were relevant and representative of these skills. The use of a visual analogue scale which included a pre-Novice level to rate students' performance on units of competency was supported. This research provides guidance for development of quality assessments of performance in simulated placements.

The performance of standardized patients in portraying clinical scenarios in speech-language therapy

BACKGROUND

Standardized patients (SPs) are frequently included in the clinical preparation of students in the health sciences. An acknowledged benefit of using SPs is the opportunity to provide a standardized method by which students can demonstrate and develop their competency. Relatively little is known, however, about the capacity of SPs to offer an accurate and standardized performance across a speech-language therapy student cohort.

AIMS

To investigate the accuracy, reproducibility (consistent performance of each SP across student interviews) and replicability (consistent performance of a number of SPs across each scenario) of SPs portraying three scenarios, each as a parent of a child presenting with a speech disorder.

METHODS & PROCEDURES

Forty-four speech-language therapy students interviewed four SPs to gain a case history. All interviews were videotaped. The accuracy of SP portrayal of key features of each scenario was scored by an expert rater and two other raters. Data were analysed to determine levels of accuracy, reproducibility and replicability, and inter-rater reliability was evaluated.

OUTCOMES & RESULTS

SPs were found to have moderate to high levels of accuracy across the three scenarios. There were no significant differences in the performances of each individual SP across interviews or between all SPs on each scenario, indicating that reproducibility and replicability were achieved. Overall inter-rater reliability between raters across all scenarios was greater than 80%.

CONCLUSIONS & IMPLICATIONS

The results would seem to indicate that SPs can present in a standardized manner within a speech-language therapy context, confirming the value of their inclusion in clinical education programmes. Suggestions for improving the training of SPs in order to maintain accuracy are highlighted.

The confidence of speech-language pathology students regarding communicating with people with aphasia

BACKGROUND

Aphasia is an acquired language disorder that can present a significant barrier to patient involvement in healthcare decisions. Speech-language pathologists (SLPs) are viewed as experts in the field of communication. However, many SLP students do not receive practical training in techniques to communicate with people with aphasia (PWA) until they encounter PWA during clinical education placements.

METHODS

This study investigated the confidence and knowledge of SLP students in communicating with PWA prior to clinical placements using a customised questionnaire. Confidence in communicating with people with aphasia was assessed using a 100-point visual analogue scale. Linear, and logistic, regressions were used to examine the association between confidence and age, as well as confidence and course type (graduate-entry masters or undergraduate), respectively. Knowledge of strategies to assist communication with PWA was examined by asking respondents to list specific strategies that could assist communication with PWA.

RESULTS

SLP students were not confident with the prospect of communicating with PWA; reporting a median 29-points (inter-quartile range 17-47) on the visual analogue confidence scale. Only, four (8.2%) of respondents rated their confidence greater than 55 (out of 100). Regression analyses indicated no relationship existed between confidence and students' age (p = 0.31, r-squared = 0.02), or confidence and course type (p = 0.22, pseudo r-squared = 0.03). Students displayed limited knowledge about communication strategies. Thematic analysis of strategies revealed four overarching themes; Physical, Verbal Communication, Visual Information and Environmental Changes. While most students identified potential use of resources (such as images and written information), fewer students identified strategies to alter their verbal communication (such as reduced speech rate).

CONCLUSIONS

SLP students who had received aphasia related theoretical coursework, but not commenced clinical placements with PWA, were not confident in their ability to communicate with PWA. Students may benefit from an educational intervention or curriculum modification to incorporate practical training in effective strategies to communicate with PWA, before they encounter PWA in clinical settings. Ensuring students have confidence and knowledge of potential communication strategies to assist communication with PWA may allow them to focus their learning experiences in more specific clinical domains, such as clinical reasoning, rather than building foundation interpersonal communication skills.

Simulated learning environments in speech-language pathology: an Australian response

The rising demand for health professionals to service the Australian population is placing pressure on traditional approaches to clinical education in the allied health professions. Existing research suggests that simulated learning environments (SLEs) have the potential to increase student placement capacity while providing quality learning experiences with comparable or superior outcomes to traditional methods. This project investigated the current use of SLEs in Australian speech-language pathology curricula, and the potential future applications of SLEs to the clinical education curricula through an extensive consultative process with stakeholders (all 10 Australian universities offering speech-language pathology programs in 2010, Speech Pathology Australia, members of the speech-language pathology profession, and current student body). Current use of SLEs in speech-language pathology education was found to be limited, with additional resources required to further develop SLEs and maintain their use within the curriculum. Perceived benefits included: students' increased clinical skills prior to workforce placement, additional exposure to specialized areas of speech-language pathology practice, inter-professional learning, and richer observational experiences for novice students. Stakeholders perceived SLEs to have considerable potential for clinical learning. A nationally endorsed recommendation for SLE development and curricula integration was prepared.

Can simulation replace part of clinical time? Two parallel randomised controlled trials

CONTEXT

Education in simulated learning environments (SLEs) has grown rapidly across health care professions, yet no substantive randomised controlled trial (RCT) has investigated whether SLEs can, in part, substitute for traditional clinical education.

METHODS

Participants were physiotherapy students (RCT 1, n = 192; RCT 2, n = 178) from six Australian universities undertaking clinical education in an ambulatory care setting with patients with musculoskeletal disorders. A simulated learning programme was developed as a replica for clinical education in musculoskeletal practice to replace 1 week of a 4-week clinical education placement. Two SLE models were designed. Model 1 provided 1 week in the SLE, followed by 3 weeks in clinical immersion; Model 2 offered training in the SLE in parallel with clinical immersion during the first 2 weeks of the 4-week placement. Two single-blind, multicentre RCTs (RCT 1, Model 1; RCT 2, Model 2) were conducted using a non-inferiority design to determine if the clinical competencies of students part-educated in SLEs would be any worse than those of students educated fully in traditional clinical immersion. The RCTs were conducted simultaneously, but independently. Within each RCT, students were stratified on academic score and randomised to either the SLE group or the control ('Traditional') group, which undertook 4 weeks of traditional clinical immersion. The primary outcome measure was a blinded assessment of student competency conducted over two clinical examinations at week 4 using the Assessment of Physiotherapy Practice (APP) tool.

RESULTS

Students' achievement of clinical competencies was no worse in the SLE groups than in the Traditional groups in either RCT (Margin [Δ] ≥ 0.4 difference on APP score; RCT 1: 95% CI - 0.07 to 0.17; RCT 2: 95% CI - 0.11 to 0.16).

CONCLUSIONS

These RCTs provide evidence that clinical education in an SLE can in part (25%) replace clinical time with real patients without compromising students' attainment of the professional competencies required to practise.

Reflections on clinical learning in novice speech-language therapy students

BACKGROUND

Reflective practice is reported to enhance clinical reasoning and therefore to maximize client outcomes. The inclusion of targeted reflective practice in academic programmes in speech-language therapy has not been consistent, although providing opportunities for speech-language therapy students to reflect during their clinical practice has been reported. Indeed, there has been limited investigation of the nature of speech-language therapy students' reflections.

AIMS

(1) To describe the breadth and depth of reflection skills of novice speech-language therapy students by utilizing structured reflective learning journals. (2) To evaluate the use of a coding system to determine its reliability and relevance in identifying reflection skills.

METHODS & PROCEDURES

Participants were 52 students in their second year of a 4-year undergraduate speech-language therapy programme. Mean participant age was 20.5 years; all students were female. Participants completed guided written reflections following three interviews with a standardized patient (an actor portraying a parent of a child with delayed speech development). Reflections were coded by two raters. Nine participants' reflections were recoded by raters A and B to establish intra-rater reliability. Inter-rater reliability between these two raters was calculated and a third rater completed coding of 20% of students' reflections to further establish inter-rater reliability.

OUTCOMES & RESULTS

Results indicated that the majority of students were categorized as 'reflectors'. All students demonstrated at least one element of reflection. Their reflective writing primarily focused on a discussion of the content of and strategies used within the interviews, and reflection on and for action. Results also indicated that the coding system used within the study was reliable in determining both the breadth and depth of student reflections.

CONCLUSIONS & IMPLICATIONS

This study found that novice speech-language therapy students can reflect on their clinical learning experiences within a structured clinical environment involving standardized patients. Only a small number of novice students were found to be critical reflectors who were able to analyse the content of clinical interviews, view the interaction from the perspective of the patient, and record changes to their own perspective which occurred as a result. The coding system was established as reliable and thus relevant for use in furthering research on reflective practice within speech-language therapy and other disciplines. Further investigation of reflective skills within other clinical environments and with additional clinical experience is recommended.

Use of simulated patients for a student learning experience on managing difficult patient behaviour in speech-language pathology contexts

A student learning experience about managing difficult patients in speech-language pathology is described. In 2006, 40 students participated in a daylong learning experience. The first part of the experience consisted of presentations and discussions of different scenarios of interpersonal difficulty. The theoretical introduction was followed by an active learning experience with simulated patients. A similar experience without the simulated patients was conducted for 45 students in 2010. Both years of students rated the experience with an overall grade and gave qualitative feedback. There was no significant difference between the overall grades given by the students in 2006 and 2010. The qualitative feedback indicated that the students valued the experience and that they felt it added to their learning and professional development. The students in 2006 also provided detailed feedback on the simulation activities. Students endorsed the experience and recommended that the learning experience be repeated for future students. However, the students in 2006 also commented that they had felt inadequately prepared for interacting with the simulated patients. A learning experience with simulated patients can add to students' learning. The inclusion of simulated patients can provide a different, but not automatically better, learning experience.