JCPSLP - March 2018

It is important to note the finding that most student SLPs did not have a preference for in-clinic over telehealth service delivery pre-placement, despite a lack of experience with telehealth service delivery. This finding is at odds with previous literature reporting SLP resistance in the uptake of telehealth as a service delivery model (Margaryan et al., 2011). Given that none of the student SLPs had experienced telehealth on previous placements, their lack of preference for in-clinic service delivery may be a reflection of their confidence in being supervised and supported throughout the learning process (Lam et al., 2016). Limitations and future directions Generalisability of this data is limited by the small sample size and thus the findings must be interpreted cautiously. It is recommended that future studies exploring student SLP telehealth service delivery include a larger sample size, treatment outcomes and include in-depth qualitative reports from clients. The use of pre-post self-report measures are known to have inherent limitations, namely the lack of control over the variables affecting change. Respondents are also potentially biased in their responses as they may be aware that the objective of pre-post surveys is to demonstrate positive change. This could be addressed in future studies by having clinical sessions recorded and then presented to blind assessors for behavioural observation. Such measurement of clinical behaviour could also occur before and after explicit telehealth training. Finally, such practices should also be extended to student clinical education in other practice areas of speech pathology. Conclusion With the development and expansion of eHealth, the speech pathology profession must ensure that clinical education directly exposes students to telehealth service delivery, rather than assuming that students’ in-clinic experiences or familiarity with personal technology are directly transferable to professional telehealth contexts. Creating direct learning experiences within tertiary health science courses may serve to increase student SLPs’ confidence and capacity to engage with telehealth. In turn, this will result in future graduates being proficient and willing to engage with this increasingly utilised method of service delivery. References Australian College of Rural & Remote Medicine. (2016). ACRRM Telehealth Advisory Committee Standards Framework . Brisbane: Author. Retrieved from http://www. ehealth.acrrm.org.au/sites/default/files/ATHAC%20 Telehealth%20Standards%20Framework%202016.pdf. Block, S., Onslow, M., Packman, A., Gray, B., & Dacakis, G. (2005). Treatment of chronic stuttering: Outcomes from a student training clinic. International Journal of Language & Communication Disorders , 40 (4), 455–466. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology , 3 (2), 77–101. doi:10.1191/1478088706qp063oa Bridgman, K., Onslow, M., O’Brian, S., Jones, M., & Block, S. (2016). Lidcombe Program webcam treatment for early stuttering: A randomized controlled trial. Journal of Speech, Language, and Hearing Research , 59 (5), 932–939. Bull, T. P., Dewar, A. R., Malvey, D. M., & Szalma, J. L. (2016). Considerations for the telehealth systems of tomorrow: An analysis of student perceptions of telehealth technologies. JMIR Medical Education , 2 (2), e11. doi:10.2196/mededu.5392

see the stuttering characteristics”. Student SLPs also reported that telehealth made it difficult to use physical resources as part of the session, for example stimulus materials. Contingencies were also required in the instances that communication with international clients was required. These included using the instant messenger function on Skype TM or ensuring clients had access to their email. Discussion This preliminary, small-scale exploration of student SLPs’ attitudes and experiences of telehealth service delivery on clinical placement yielded favourable outcomes supporting the use of telehealth services in tertiary education. The findings of this pilot study are similar to those of larger studies of student perspectives (e.g., Bull et al., 2016; Glinkowski et al., 2013; Lam et al., 2016), in that, by the end of their placement, the majority of students perceived telehealth to be an accessible and convenient mode of service delivery. Also consistent with previous studies was that despite telehealth being viewed positively, student SLPs still experienced technological issues and reported challenges working within the virtual space (Bull et al., 2016; Glinkowski et al., 2013) including the impersonal nature of telehealth that has been described previously (Lam et al., 2016). The most unexpected finding in this evaluation was that student SLPs reported feeling less anxious during telehealth sessions than in a traditional clinical context, despite having more experience with the latter across their previous placements. This finding most likely reflects the student SLPs’ comments that CE feedback and scaffolding during telehealth sessions was less disruptive to the flow of sessions. Consequently, this may have reduced student SLPs’ angst about being corrected by their CE in front of a client. Telehealth allowed for the student to be instructed or supported “out of view” of the client, with the CE writing notes, gesturing or whispering real-time feedback or clinical suggestions. Such real-time coaching is similar to current simulated learning experiences that allow for “built-in feedback”, immediate behaviour modification and “extra assistance” (MacBean, Theodoros, Davidson & Hill, 2013). Five of the six student SLPs strongly indicated a need for telehealth training within tertiary education models. Explicit training could be integrated at a cohort level with the inclusion of telehealth skills and guidelines embedded within course curriculum. Examples of such include the Speech Pathology Australia Position Statement on Telepractice (SPA, 2014) and the more recent Australian College of Rural and Remote Medicine Telehealth Advisory Committee Standards Framework (Australian College of Rural & Remote Medicine, 2016), which details quality aspects of synchronous video consultations. These include information about clinical, technical and contextual aspects of telehealth. On-line simulation programs may also be a beneficial teaching method (Ellis, Hercelinskyj, & McEwan, 2011; MacBean et al., 2013). Such training is likely to see an increase of SLP-led telehealth services developed, as predicted by the Speech Pathology Australia 2030 report. Consistent with existing literature (May & Erickson, 2014; Theodoros, 2011), providing knowledge, training and experience in telehealth service delivery resulted in all student SLPs within this service evaluation developing a positive attitude toward the use of telehealth and viewing it as an advantageous addition to their skill set as new graduates. Responses to Likert-scale questions indicated that student SLPs felt confident using telehealth in their future clinical practice following graduation.

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JCPSLP Volume 20, Number 1 2018

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