Clinical education programs are integral to tertiary courses that prepare students to practise in the health professions. Students have traditionally gained professional competencies through participation in group or individual supervision models of practice within university or workplace clinics. Increasing numbers of university programs in speech pathology and changing requirements for workforce practice have necessitated consideration of alternative placement structures. Simulation, in particular the use of standardised patients, has been used within medicine and nursing education programs for some decades and has gained momentum in other health sciences. Standardised patients (SPs) are actors who are trained to portray a role within a clinical situation to enable students to apply their clinical skills and meet designated learning objectives. To date, there has been limited research investigating the use of SPs within speech pathology contexts. Therefore, the overarching aim of this research was to explore the use of SPs within a clinical education program for speech pathology students.
A series of five studies was conducted. Participants in this research were undergraduate and graduate entry master students, clinical educators, and SPs participating in a simulated clinic module designed to support the clinical learning of novice speech pathology students. Learning objectives for this module specifically focussed on the development of foundation clinical skills such as communication, interaction with clients, interviewing skills, and utilising current theoretical knowledge to support clinical practice. Students participated in interviews with an SP who portrayed a parent of a child with presenting speech delay. The module also included clinical workshops which focussed on discussion of the above foundation skills in addition to practical paediatric speech data analysis and intervention planning.
The first study aimed to investigate the accuracy, reproducibility and replicability of the SPs in portraying their role. Forty four undergraduate students interviewed one of four SPs to obtain a case history. The accuracy of SP portrayal of key features of three scenarios was scored by an expert rater and two other raters. Results suggested that SPs can achieve a moderate to high level of accuracy and that they can be reproducible and replicable in their portrayal of clinical scenarios.
The second and third studies investigated the validity of two tools designed for student evaluation: (1) to assess students’ competency in an interview with an SP (the Standardised Patient Rating Scale; SPaRS); and (2) to assess students’ learning in all components of the simulated clinic module at the midway point of the module and at its conclusion (the Assessment of Foundation Clinical Skills; AFCS). Participants in these studies were second year undergraduate students (N=76 for study 2 and N=130 for study 3). Results of these studies indicated that both tools were valid for assessing competency in the module and that, with appropriate modification, they may be applicable to the assessment of competency in other clinical environments and with different student groups.
The fourth study evaluated students’ perceptions of changes in their levels of anxiety and confidence for working with ‘real clients’ following the simulated clinic module. Participants in this study were 131 undergraduate and 44 graduate entry masters students who completed the module. The undergraduate group reported a significant decrease in anxiety following the module, with results from the masters group indicating a trend towards reduction in anxiety. Both groups reported a significant increase in confidence in a range of clinical skills. Results of this study provided evidence of students’ perception that the use of SPs adds value to their clinical learning experiences.
The final study examined the nature of students’ reflections on their clinical learning following their interviews with SPs within the module. The reflections of 52 undergraduate students were coded to determine the depth and breadth of their responses to structured reflective questions. In addition, the reliability of the coding system was evaluated. Results indicated that the majority of students reflected on an aspect of the interview but rarely at a critical level. Their reflections focussed primarily on interview content and the strategies used within the interviews, in addition to reflection on and for action. The coding system used for this study was found to be reliable.
Overall, the results of these studies support the use of SPs in clinical education programs for speech pathology students. In particular, these results have determined that an SP program can provide novice students with opportunities to develop foundation clinical competencies. This finding is significant given the current imperative to investigate alternative options for preparing students for professional practice. Further research is recommended to investigate the use of SPs and the assessment and reflection tools developed for these studies within other simulated clinical contexts.