An investigation of the use of simulated patients in audiology student education

Abstract

Audiologists are health care professionals responsible for the non-medical management of hearing and hearing disorders. A review of population and health statistics in Australia indicates that increasingly more audiologists are needed to service its growing and ageing population.The task of training audiologists falls to the universities that offer audiology programs. One of the biggest limiters on this training is the diminishing numbers of clinical placement opportunities available to the audiology students as a result of clinics external to the universities withdrawing their support of student training (due mostly to commercial pressures). As a result, many university audiology programs have begun to investigate simulation as a method of preparing students for clinical placements, and in particular, simulated patients (SPs). While SPs have been used widely in medicine and allied health professional education, only two studies have been conducted on their use in audiology. While both studies showed audiology students enjoyed working with SPs, neither showed if this work results in measurable gains in student skills. To investigate the potential of using SPs to train basic audiology skills in audiology students, the present research aimed to: (1) develop a tool for assessing the clinical skills of students working with SPs; and (2) compare the effectiveness of SP training versus seminar training for improving the clinical skills of first year audiology students. To develop a tool for assessing audiology students taking a case history from and giving feedback to a simulated patient (SP), a tool from the cognate discipline of speech pathology was modified for use on audiology students. The modified tool, the Audiology Simulated Patient Interview Rating Scale (ASPIRS), was then used by three evaluators to assess 24 first-year masters of audiology students taking case histories from and providing feedback to SPs. Analysis of the tool’s results showed it to have very high internal consistency (Cronbach’s alpha values from 0.91 to 0.97) and mean inter-item correlations (0.64 to 0.85) within evaluators, lower exact (29.2% to 54.2) but higher near (79.2% to 100%) agreement percentages between pairs of evaluators, and fair to moderate absolute agreement amongst evaluators for single evaluator scores (ICC values from 0.35 to 0.59) to substantial consistency agreement amongst evaluators for three evaluator averaged scores (ICC values from 0.62 to 0.81). Factor analysis showed the 12 items of the ASPIRS fell into two components, a more dominant component addressing feedback and a less dominant component addressing case history. These results indicated the ASPIRS has promise as a tool for assessing the clinical skills of audiology students as they take a case history from and provide feedback to a standardized patient (SP). To compare seminar training versus SP training as methods for training audiology students to take case histories from and give feedback to adult patients, a randomised controlled trial with cross-over design was used to put 24 first-year audiology students through SP then seminar training (n=12) or seminar then SP training (n=12). The SP training involved one student per SP in a clinic setting with individualized feedback. The seminar training involved one academic staff member for the student group in a seminar setting with group feedback. The students were assessed taking a case history and giving feedback to an SP before the first training block, between the two training blocks, and after the final training block. A mixed model analyses of derived factors for case history and feedback showed significant (p<0.05) effects for assessment occasion (i.e., student skills improved with more training) but not for training sequence (i.e., order of training did not affect skill improvements) or training type (i.e., type of training did not affect skill improvements). Results indicated that while student skills improved with SP training there no significant benefit over seminar training in audiology students learning to take case histories from and give feedback to adult patients. Overall, the two studies in this thesis showed two main findings: 1) the ASPIRS has potential for use in the assessment of audiology students interacting with SPs, and 2) SP training provided no significant benefit over seminar training in audiology students learning to take case histories from and give feedback to adult patients. These results suggest basic simulations (in this case lower fidelity seminars rather than higher fidelity SPs) are adequate for teaching basic audiological skills (in this case taking a case history from and giving feedback to a co-operative adult client in a basic, diagnostic audiology setting) to first-year audiology students. The use of more advanced and more expensive simulations (in this case the higher fidelity SPs) in such settings may not be justified. Further investigations into the use of SPs to train audiology students should better consider how the use of SPs fits within the greater context of deliberate instructional design and how SP training might promote transfer of learning to the clinical setting.