The use of simulation-based learning in speech pathology to support students’ development of clinical skills in stuttering

Abstract

Clinical placements are an essential component of training health professional students, providing them with an opportunity to learn actively and apply their theoretical learning to practice. In the profession of speech pathology, increasing numbers of university programs and students have placed additional burden on the workplace to provide these critical clinical learning opportunities for students. In response, university programs have designed alternative learning experiences. One such example is simulation-based learning which is increasingly being used to support the development of clinical skills in a safe learning environment. Research has shown that simulation-based learning experiences can replace a proportion of clinical placement time for nursing, occupational therapy, physiotherapy, and speech pathology clinical placement students, with no impact on students’ clinical competency outcomes. To date, there has been limited research in speech pathology investigating the use of simulation-based learning focused on adult patients with communication and swallowing difficulties. Therefore, the aim of this thesis was to investigate the use of simulation-based learning in university speech pathology programs to support the development of students’ clinical skills in adult areas of practice. Four studies were conducted with speech pathology students and clinical educators.The first study in Chapter 2 aimed to investigate students’ confidence, skills, knowledge, and perceptions of simulation-based learning experiences focussing on adult areas of speech pathology practice. A pilot group of six final-year undergraduate and graduate-entry masters students engaged in a 1-day simulation-based learning experience. Results indicated a perceived improvement in clinical skills across the domains of foundation knowledge, case history, assessment, intervention, interaction, and clinical reasoning related to adult speech pathology practice. Students reported that the simulation-based learning experience was valuable and assisted in their preparation for clinical placements.Following the positive results of the pilot trial, the second study in Chapter 3 sought to explore the perspectives of 13 undergraduate third-year speech pathology students and five clinical educators after student participation in an extended 5-day simulation-based learning program focusing on adult speech pathology practice. Students attended the simulation-based learning program immediately prior to their clinical placement. Thematic network analysis of students’ and clinical educators’ perceptions of student learning within simulation revealed six organising themes; (1) simulation is different, (2) simulation offers varied learning opportunities, (3) simulation provides an opportunity to prepare students for clinical placements, (4) simulation is valued, (5) perceptions of the simulation-based learning program, and (6) skills learnt in simulation support students on placements. The organising themes highlighted students’ and clinical educators’ perceived value of simulation to assist the development of students’ clinical skills. Additionally, both participant groups perceived that simulation provided different learning opportunities and an opportunity to prepare students for clinical practice. An overarching global theme suggested that simulation offers unique learning benefits to prepare students for traditional clinical placements.The third study in Chapter 5 aimed to (1) evaluate students’ clinical skills in managing stuttering within a simulation-based learning program, (2) develop an assessment tool, the Standardised Patient Interview Rating Scale for Stuttering (SPIRS-Stuttering), and (3) conduct a preliminary investigation of its validity in measuring students’ performance. Third-year undergraduate and first-year graduate-entry masters students (n=106) participated in this study. Results revealed that students made statistically significant improvements in their stuttering management skills between two separate simulation sessions focussing on the assessment and treatment of adult stuttering as measured by the SPIRS-Stuttering tool. The tool was shown to have good content validity and variable internal consistency, however it had low levels of intra-rater reliability.The final study in Chapter 6 examined speech pathology students’ comfort, anxiety, knowledge, and confidence in stuttering management at the commencement of an academic stuttering course, and prior to and following participation in a stuttering simulation-based learning program. Participants were 96 third-year undergraduate and first-year graduate-entry masters students. Students’ perceptions were gained through a purpose-designed survey administered at three separate time points: pre-course (T1), pre-simulation (T2), and post-simulation (T3). Results revealed that students perceived improvements in their knowledge and confidence from T1 to T2. Statistically significant improvements in students’ perceived comfort levels, knowledge, and confidence were noted from T2 to T3 with a reduction in students’ perceived anxiety levels.Overall, the results of these studies support the use of simulation-based learning in speech pathology programs to develop students’ clinical skills in adult areas of practice and specifically in stuttering. These findings have direct implications for university teaching and learning practices. First, students value simulation as a contributor to their learning and self-efficacy. Second, clinical educators identified a difference in students’ clinical skill development following participation in simulation-based learning experiences prior to attending clinical placement. Third, simulation-based learning experiences can provide clinical learning opportunities such as within stuttering management when access to real-life clinical placement experiences is not possible. Finally, this program of research has produced empirically-designed simulation-based learning programs focussed on adult areas of practice and stuttering.