JCPSLP Vol 23, Issue 1 2021

student-led group-based model for assessment and management of people with chronic dysphagia living in the community. Specifically, this study aimed to evaluate the impact of the new model on clients’ satisfaction, knowledge and well-being in respect to their swallowing, as well as students’ satisfaction and knowledge, and confidence in providing dysphagia assessment. It was hypothesised that the student-led group delivery model would have high client satisfaction, and increased knowledge and well-being related to their swallowing difficulty. Moreover, it was hypothesised that students providing the service would demonstrate increased knowledge and confidence and reduced anxiety around dysphagia management as well as higher satisfaction following this learning opportunity compared to prior to participating. Methods This feasibility trial used a single group pre–post design. Ethical clearance was gained from the local health service (HREC/13/QGC/163) and written informed consent was received from all participants. Data was analysed from participants with dysphagia as well as the student participants. Participants Participants with dysphagia Participants with dysphagia were recruited from the post-acute and chronic disease SLP community caseload of Gold Coast Hospital and Health Service between 2012 and 2013. All clients recruited were known to the service and had undergone individualised initial assessment with the treating SLP prior to being reviewed in the group setting. All participants included in the study had been diagnosed with a mild or mild-moderate dysphagia through previous clinical assessment with their primary SLP prior to participating in the group. Clients included in the study were over 18 years of age, presented with a chronic illness (i.e., COPD) or neurological degenerative disease (i.e., Parkinson’s Disease) and resided within the Gold Coast catchment area. High care nursing-home residents, clients eligible for disability services, clients residing outside of the Gold Coast catchment area or requiring home visits as a result of their medical condition were all excluded from the study. New clients to the service who had not been previously assessed by the SLP and those diagnosed with a moderate, moderate-severe or severe dysphagia were also excluded from the study. Speech-language pathology student participants Student participants were recruited from Griffith University (Gold Coast campus, Queensland, Australia) Masters of Speech Pathology program. All students were in their second or third semester of their four semester (2-year) program. Eligible students were identified by the clinical placement coordinator at Griffith University. All student participants had completed their dysphagia learning components within the degree and had some exposure to adults with dysphagia via a clinical placement (including observational placement with limited hands-on experience). Students with no previous clinical placement with adults with dysphagia and had not completed the dysphagia learning units within the degree were excluded from the study. Students were able to count DAT participation as an intermediate-level placement experience.

the demands for increased SLP services in the community is the use of student-led clinics. While there is minimal literature available in the delivery of student-led clinics within a group intervention setting, there is evidence to suggest that student-led clinics offer a range of valuable and practical learning experiences for students. For example, in the area of stuttering, student-led clinics have been found to increase confidence in delivery of fluency intervention, and reduce anxiety levels while maintaining patient outcomes comparable to those of existing intervention programs (Block et al., 2005; Cardell & Hill, 2013). In interprofessional student-led clinics involving SLP students, positive perceptions around collaborating with other professions, relationship building, and increased respect for other professions have been found (Gustafsson et al., 2016). Turning to client experiences, good satisfaction with, and willingness to participate in, student-led services in private practice have been reported by Sokkar et al. (2019). Benefits to the community from student-led clinics also have emerged. In other allied health professions, supervised student-led health clinics have provided students with the opportunity to develop their practical skills by delivery of clinical services to communities with limited services available (Briggs & Fronek, 2019). Furthermore, medical student-led clinics have had clear benefits to the community by mitigating service gaps while providing students with experiential learning experiences (Bostick, 2014). In Australia, dysphagia is one of six range of practice areas in SLP, and to demonstrate entry-level competencies, as defined by Competency-based Occupational Standards (CBOS) (Speech Pathology Australia, 2011, 2017), direct clinical experiences are desirable. The capacity for student placements in Australia is becoming increasingly limited due to increased student numbers from new programs and in existing programs (Hill, 2013; Sokkar et al., 2019; SPA, 2018). As a result, adequate clinical training of students across all practice areas is becoming more challenging, and novel models of student education are required to ensure students receive the required clinical experiences to meet CBOS (2011, 2017). Local contexts The Gold Coast Hospital and Health Service is a tertiary Australian non-metropolitan health service. In 2012–2013, due to the high number of SLP clients and limited staffing to service the caseload, alternative delivery models were investigated, leading to this project. With such caseload demands came a risk of delay between completion of initial client assessments and their subsequent reviews due to limited staffing resources in the community sector. There has been consistent growth of community referrals for chronic swallowing management in the context of limited resources, which is a problem other health services also face. Given this, and the current promising evidence of group-based and student-led models in other populations, new service delivery models need to be developed and evaluated to ensure patient safety and accessibility to SLP services in a timely manner while being feasible for the service to implement and acceptable to clients. Such an evaluation would also add to the current literature in this area. Aims and hypotheses The overarching aim of the Dysphagia Afternoon Tea (DAT) project was to evaluate the feasibility and impact of a

Melissa Lawrie (top) and Elizabeth Cardell

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JCPSLP Volume 23, Number 1 2021

www.speechpathologyaustralia.org.au