JCPSLP Vol 23, Issue 1 2021

specific areas need to continue to be incorporated into other curricular activities and clinical placements for further consolidation of skills. Although these outcomes are positive, it is unknown whether improved confidence equates to improved clinical ability (Cardell & Hill, 2013). As this was not a formally assessed clinical placement, it cannot be confirmed if there was an actual improvement in clinical ability. Significant improvements in students’ reported knowledge of various areas of dysphagia were also found. Prior to participation in the group, students indicated they had “some” to “quite a bit” of knowledge about dysphagia assessment and intervention as well as knowledge of the impacts on dysphagia on the client/carer. This suggested that previous clinical experiences as well at the university academic program were likely successful in providing students with a knowledge foundation in the area of dysphagia. Participation in the group significantly increased post knowledge to “quite a bit” to “good” knowledge across all knowledge areas. Improvements in perceptions of clinical reasoning was found for students (including other allied health students) who participated in free student-led clinics (Seif et al., 2014). Furthermore, another study found medical students reported improvements in their core competencies as a direct result of participation in student- led clinics (Schutte et al., 2017). Similarly, Cardell and Hill (2013) found participation in the student-led models are valuable for further developing perceptions of competence and confidence within knowledge parameters. Results found are therefore consistent with the literature in that motivation and participation in these voluntary clinics likely result in student perceptions of increased knowledge and confidence in the delivery of SLP cares. Students reported moderate levels of anxiety interacting with adults with dysphagia prior to participation in the DAT group however these significantly decreased to “not anxious” to “only a little anxious” post group. It is known that anxiety affects the nature and quality of clinical education experiences for SLP students (Chan, 1994). The reduction in perceived anxiety levels may be attributed to the fact the group was not a formally assessed clinical placement, students worked in pairs, and the group had clear structure and expectations. Furthermore, students volunteered to participate in the DAT group and therefore had intrinsic motivation to participate in the innovative and potentially exciting learning opportunity (Schutte et al., 2017). Finally, a key driver for this study was to build capacity in clinical placements and to provide services in a growing area of speech pathology practice, that is, community dysphagia management. The positive outcomes for both clients and students suggest the DAT group holds promise as a model for increasing placements and services. Limitations and future directions The study had a number of limitations to consider. A small client sample size was obtained, with specific inclusion and exclusion criteria. As such, the sample may not be representative of the general population with dysphagia. There was an annual change in the SLP working at the community site due to health service rotations requiring re-introduction of the study and varying clinicians coordinating and facilitating each group. Although SLP’s were given consistent orientation and instructions on coordinating and running the group, this nevertheless identifies a potential variability in how the group environment

of public awareness of the role of the SLP in dysphagia. In contrast, it is possible these open-ended knowledge questions remained unfilled due to time constraints following the group when completing surveys. Responses were relatively neutral (neither agree nor disagree) when participants were asked if they preferred an individual 1:1 face-to-face assessment in comparison to the new group service delivery model. These results remained largely unchanged post-group which indicates that clients in this study did not have a strong preference for traditional service models (i.e., individual face-to-face consultations) following participation in the group intervention model. Furthermore, participants agreed that they were happy to attend further groups for swallowing assessment and management and, importantly, they were interested in meeting other people with similar conditions to them, which the group intervention strongly facilitated. In the absence of other known dysphagia assessment group intervention studies to compare our results to, these findings support the notion that implementing this novel group-based intervention model led by students is potentially acceptable to clients. Our results further support the findings of Sokkar et al. (2019) that clients were satisfied with, and willing to be treated by, students in private practice. Student-led intervention The results from the study indicated that student-led dysphagia assessment increased students’ perceptions of confidence in assessing dysphagia and knowledge in management of dysphagia. Furthermore, participation in these clinics significantly reduced students’ anxiety about working within the dysphagia context within the adult population. These findings were not unexpected as it is now well-established that students’ clinical experiences in specific practice areas positively impact on their perceptions of knowledge, skills and attitudes in those areas (Cardell & Hill, 2013). Students’ confidence levels for generic skills, including establishing rapport with clients and interacting in a professional manner with clients, showed minimal change from pre-post DAT group attendance. Notably, pre attendance revealed a mean well above the neutral 3 rating. Such responses in these areas suggest successful, cumulative development of these skills from prior clinical placements given that all students were in their second or third semester of their Master’s degree. These results are also consistent with findings in other SLP student-led clinics (Cardell & Hill, 2013). Students’ confidence relating specifically to dysphagia assessment was lower than generic skills prior to participation in the group. Within specific assessment questions (i.e., performing an oromotor assessment, performing a clinical swallowing assessment and interpreting results) most pre group ratings remained within the neutral score of 3. All areas except three averaged 4 or above post group, demonstrating that the dysphagia group intervention model provided a valuable and worthwhile opportunity for developing students’ competencies in dysphagia. Areas which did not show the same level of increase (although remaining statistically significant) were interpreting dysphagia assessment results and implementing direct and indirect dysphagia therapy techniques. This was likely due to the known need for repeated exposure to consolidate clinical reasoning (Kassirer, 2010), combined with limited opportunity for specific direct and indirect dysphagia therapy techniques depending on the clients’ needs within the DAT. These

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JCPSLP Volume 23, Number 1 2021

Journal of Clinical Practice in Speech-Language Pathology