Although differences in clinical interactions with patients between students and experienced clinicians are well described, differences in therapeutic training behaviors have not been explored, especially in relation to motor learning principles.
This pilot study compared clinical behaviors between speech language pathology (SLP) students and experienced SLPs in a voice therapy task, using prepractice variables in the Motor Learning Classification Framework (MLCF).
Using a quasi-experimental design, five final-year undergraduate SLP students and four experienced SLPs with a voice therapy caseload taught a standardized patient to produce a vocal siren. Two trained raters categorized the clinicians’ behaviors using the MLCF.
High intrarater reliability (91.9%, 92.3%) and interrater reliability (89.6%, 82.1%) were shown across both raters. Both clinician groups used the same percentage of behaviors classified as verbal information but differed in the subtypes of these behaviors. Experienced clinicians used behaviors categorized as problem-solving and only experienced clinicians used repeated behavior sequences that included perceptual training. Both groups used significantly more talking behaviors than doing behaviors.
The MLCF can be reliably used to identify prepractice behaviors during client interactions in voice therapy. Students and experienced clinicians showed similarities in behaviors, but experienced clinicians used more problem solving and perceptual training behaviors than students. These differences have implications for student training. The greater use of talking behaviors than doing behaviors warrants further investigation into whether this impacts the subsequent quality of practice engaged by the client and ultimately treatment effectiveness.
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- Analysing aphasia treatment sessions.Clin Linguist Phon. 2001; 15: 229-243
- Functional dysphonia.Curr Opin Otolaryngol Head Neck Surg. 2003; 11: 144-148
- Motor Control and Learning: A Behavioural Emphasis, 4th ed, Human Kinetics.2005 (Champaign, IL)
- Classifying and Identifying motor learning behaviors in voice-therapy clinician-client interactions: a proposed Motor Learning Classification Framework.J Voice. 2019; 34: 806.e19-806.e31
- Principles of motor learning in treatment of motor speech disorders.Am J Speech Lang Pathol. 2008; 17: 277-298
- Modelling coaching practice: the role of instruction and demonstration.J Sports Sci. 2002; 20: 793-811
- Do principles of motor learning enhance retention and transfer of speech skills? A systematic review.Aphasiology. 2012; 26: 709-728
- Show and tell: video modeling and instruction without feedback improves performance but is not sufficient for retention of a complex voice motor skill.J Voice. 2019; 33: 239-249
- The effect of clinician feedback type on the acquisition of a vocal siren.Folia Phoniatr Logop. 2015; 67: 57-67
- Influence of order of stimulus presentation on speech motor learning: a principled approach to treatment for apraxia of speech.Aphasiology. 2000; 14: 653-668
- A treatment for apraxia of speech in adults.J Speech Hear Disord. 1973; 38: 462-472
- Modification of the eight-step continuum for treatment of apraxia of speech in adults.J Speech Hear Disord. 1978; 43: 89-95
- Talk in interaction in the speech-language pathology clinic: bringing theory to practice through discourse.Topics Lang Disord. 2008; 28: 229-241
- Voice therapy prepractice and the principles of motor learning, ACQuiring Knowledge in Speech.Lang Hear. 2010; 12: 29-32
- From beginner to expert: gaining a differentiated clinical world in critical care nursing.ANS Adv Nurs Sci. 1992; 14: 13-28
- From novice to expert: issues of concern in the training of psychologists.Australian Psychol. 2008; 43: 38-54
- Voice disorder management competencies: a Survey of school-based speech-language pathologists in nebraska.Lang Speech Hear Serv Sch. 2016; 47: 31-43
- Dysphagia management: a survey of school-based speech-language pathologists in Vermont.Lang Speech Hear Serv Sch. 2011; 42: 194-206
- Voicecraft Workshop Manual.Voicecraft International, Adelaide, SA1997
- Intensive voice treatment (LSVT) for patients with Parkinson's disease: a 2 year follow up.J Neurol Neurosurg Psychiatry. 2001; 71: 493-498
- Children with speech and language disability: caseload characteristics.Int J Lang Commun Disord. 2004; 39: 303-324
- The use of simulated patients in medical education: AMEE guide No 42.Medical Teacher. 2009; 31: 477-486
- A review of standardized patients in clinical education: implications for speech-language pathology programs.Int J Speech Lang Pathol. 2010; 12: 259-270
- Standardized patient methodology to assess refractive error reproducibility.Optom Vis Sci. 2009; 86: 517-528
- Standardized patients in educating student nurses: one school's experience.Clin Simulation Nurs. 2010; 6: e61-e66
- Use of actors as simulated patients in nutritional counseling.J Nutr Educ Behav. 2007; 39: 101-102
- A systematic review of the use of simulated patients and pharmacy practice research.Int J Pharm Pract. 2006; 14: 83-93
- Reproducibility of clinical performance assessment in practice using incognito standardized patients.Med Educ. 2002; 36: 827-832
- A comparison of resident performance on real and simulated patients.J Med Educ. 1982; 57: 708-715
- The Voice Clinic Handbook.Whurr Publishers Ltd, London, England1998
- Lessac-Madsen Resonant Voice Therapy.Plural Publishing, San Diego, CA2008
- Voice therapy: does science support the art?.Commun Disord Rev. 2007; 1: 49-77
- The Voice and Voice Therapy.8th ed. D.R. Boone, Allyn & Bacon, Boston, MA2010
- The implementation of evidence-based practice in the management of adults with functional voice disorders: a national survey of speech-language pathologists.Int J Speech Lang Pathol. 2013; 15: 334-344
- AB Voice International.1995
- Vocal function Exercises, in How to Series of Clinical Practicum.Communicare Publishing, Gainesville, FL2002
- Intraclass correlations: uses in assessing rater reliability.Psychol Bull. 1979; 86: 420-428
- Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology.Psychol Assess. 1994; 6: 284
- SPSS for Windows, Rel. 17.0.0.SPSS Inc., Chicago, IL2008
- An analysis of variance test for normality (complete samples).Biometrika. 1965; 52: 591-611
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- Active learning increases student performance in science, engineering, and mathematics.Proc Natl Acad Sci USA. 2014; 111: 8410-8415
- Routledge Handbook of Sports Exercise London)Baker J Farrow D Routledge/Taylor & Francis Group, 2015: 414-429 (ed) (
- The effects of proactive and retroactive demonstrations on learning signed letters.Acta Psychol. 1999; 101: 79-90
- Learning versus performance: an integrative review.Perspect Psychol Sci. 2015; 10: 176-199
- An analysis of practice activities and instructional behaviours used by youth soccer coaches during practice: exploring the link between science and application.J Sports Sci. 2010; 28: 483-495
- Practice, instruction and skill acquisition in soccer: challenging tradition.J Sports Sci. 2005; 23: 637-650
- From novice to expert: issues of concern in the training of psychologists.Australian Psychol. 2007; 43: 38-54
- Perceptual evaluation of voice quality: review, tutorial, and a framework for future research.J Speech Hear Res. 1993; 36: 21-40
- Can perceptual training alter the effect of visual biofeedback in speech-motor learning?.J Acoust Soc Am. 2019; 145: 805
- Perception-production relations in later development of American English rhotics.PLoS One. 2017; 12e0172022
- Implicit perceptual training: how, when, and why?.Hum Mov Sci. 2005; 24: 308-325
- A systematic observation of professional top-level youth soccer coaches.J Sport Behav. 2001; 24: 354-376
- Vocal hygiene education, voice production therapy, and the role of patient adherence: a treatment effectiveness study in women with phonotrauma.J Speech Lang Hear Res. 2008; 51: 350-366
Published online: January 16, 2021
Accepted: December 21, 2020
This study was financially supported by the Dr Liang Voice Program, The University of Sydney.
Crown Copyright © 2021 Published by Elsevier Inc. on behalf of The Voice Foundation. All rights reserved.