JCPSLP Vol 23 No 3

Creative clinical education

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Creative approaches to clinical education using simulation Dr Elizabeth Bourne R ecent SLP research has explored the use of online and mixed reality simulations as an alternative to the commonly used standardised patients (e.g. Hill et al., 2021). I would like to highlight two papers using these approaches to simulation to develop student capabilities. The first paper (Towson et al., 2021) compared the effects of using mixed reality (where students interacted with avatars via a computer screen) or peer role-play simulation to develop the interprofessional interaction skills of SLP students. The study also compared these two methods with and without coaching feedback by qualified SLPs. Students interacted with an avatar or peer simulating a parent, teacher and an otolaryngologist regarding a paediatric speech and language case. The study looked at student self-efficacy (student awareness of, and confidence in, their own abilities, based on the work of Bandura [1977]), student interprofessional skills rated by a qualified SLP using the SBAR-C (Situation, Background, Assessment, Recommendation, Communication Style, see Taylor et al., 2017)), and a questionnaire examining student perceptions of the simulation experience. Using data from 80 SLP students, researchers found no significant difference in self-efficacy whether students participated in mixed reality or role-play simulations. However, students in either simulation who received coaching feedback had significantly higher scores on the SBAR-C. Students had similar perceptions of their learning experiences in either simulation. This is interesting not only given the difference in modes, but also the varied degree of training: the mixed reality was structured using highly trained facilitators, yet for role-play, peers were not given specific direction in how to act. A strength of this study is the use of multiple measures to demonstrate the effectiveness of two simulation methods in developing interprofessional skills, particularly when combined with feedback. One key limitation of this study is that a single researcher completed both coaching and rating students on the SBAR-C, although interrater reliability checks were conducted and reported. Researchers also identify a limitation being the difference in the learning experience, where some students watched their peers in the mixed reality simulation prior to their own simulation, whereas those participating in role plays had the experience from multiple viewpoints. While there are costs to either

approach, and likely more in the case of mixed reality, this study offers alternatives to “real life” placements which may be of interest not only to universities but also the wider SLP profession as they consider work readiness capabilities of graduates. The second paper (Lee et al., 2020) adapted online learning resources shown to enhance cultural empathy in nursing students (Everson et al., 2015) and piloted their use with SLP students. The study utilised a 10-minute video depicted from the viewpoint of an Australian traveller hospitalised in an unfamiliar, non-English speaking country. The simulation also involved an online debriefing tutorial which included information on health care for culturally and/ or linguistically diverse people in Australia. Researchers examined SLP student cultural empathy by comparing pre- and post- scores on the Comprehensive Empathy Scale (CES, Levett-Jones et al., 2017). This measure presents vignettes of hospital experiences of culturally and/or linguistically diverse patients followed by survey questions using rating scales. The simulation was offered to first year SLP students with resources accessed by over 65 students. Researchers present the demographic profile of 11 SLP students who completed pre- and post- surveys and report an average change of +11.3 on the CES. This was not statistically significant however and researchers calculated that a much larger sample size was needed for statistical power. Within the data, researchers highlight some interesting patterns, including two students whose score decreased post-simulation and a student whose score increased without watching the video. They suggest that factors such as personal experiences, as well as changing levels of confidence or awareness of cultural competence may have impacted results. The researchers also highlight the limitations of the CES and suggest that it may have affected students’ cultural empathy given it also presented a health care experience of a person from a culturally and/or linguistically diverse background. Certainly, this could be explored in future studies which the researchers suggest should use larger numbers of students as well as a control group. I would also suggest that longer term follow up to ascertain if short-term changes in cultural empathy measured on the CES are sustained during subsequent placements is important. However, this adapted simulation has potential particularly given the current university context of increased use of online teaching methods as well as limited academic teaching resources. Further, providing “culturally safe and responsive services” (Speech Pathology Australia, 2020, p.6) is a critical component of the SLP role and this format may have application to qualified SLPs seeking to enhance their capabilities in this area.

Elizabeth Bourne (top) and Laura Loftus

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JCPSLP Volume 23, Number 3 2021

Journal of Clinical Practice in Speech-Language Pathology