Student Perceptions of Simulation to Enhance Clinical Readiness for Assessment and Management of Adults With Voice Disorders

  • Anna F. Rumbach
    Correspondence
    Address correspondence and reprint requests to: Anna F. Rumbach, Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane 4072, Australia.
    Affiliations
    Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
    Search for articles by this author
  • Danielle Aldridge
    Affiliations
    Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
    Search for articles by this author
  • Anne E. Hill
    Affiliations
    Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
    Search for articles by this author
Published:November 27, 2021DOI:https://doi.org/10.1016/j.jvoice.2021.10.014

      Abstract

      Background

      Simulation is a safe, supported, and accessible learning method for students to gain skills and experience, especially in difficult to access range of practice areas such as voice.

      Objective

      The study aimed to explore change in students’ perceptions of knowledge, confidence, anxiety, and clinical readiness for assessment and management of an adult with a voice disorder after participation in simulation-based learning activities.

      Methods

      Participants (N = 113) were students enrolled in a mandatory course dedicated to the voice and voice disorders. Students completed 32 hours of academic coursework which included lectures and tutorials and two 30-minute simulation-based learning activities with a standardized patient playing the role of an adult with a voice disorder. The impact of the simulation-based learning activities on student perceptions of their knowledge, confidence, anxiety, and clinical readiness for work within the area of voice were surveyed at three time points: (1) pre lectures, (2) post lectures but pre simulation, and (3) post simulation. Change across time was analyzed using repeated measures analysis of variance with post hoc Bonferroni adjustment.

      Results

      All students perceived significant (P ≤ 0.001) positive changes in knowledge and confidence across time points for all activities, except for writing an assessment report. Anxiety related to the management of a client with a voice disorder fluctuated significantly (P ≤ 0.001) throughout the program. Overall, the majority (>90%) of students agreed or strongly agreed that the simulation-based learning activities were useful and helped them to develop clinical skills, apply content taught in lectures, and gain confidence and interest in voice.

      Conclusion

      This study supports incorporation of simulation-based learning as part of students’ clinical preparation for the assessment and management of voice disorders.

      Key Words

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. ACEN. National Strategy on work-integrated learning in university education. 2015. Available at: http://cdn1.acen.edu.au/wp-content/uploads/2015/03/National-WIL-Strategy-in-university-education-032015.pdf. Accessed May 25, 2020.

        • Hill AE
        • Davidson BJ
        • Theodoros DG.
        A review of standardised patients in clinical education: Implications for speech-language pathology programs.
        Int J Speech Lang Pathol. 2010; 12: 259-270
        • McAllister L
        • Lincoln M.
        Clinical Education in Speech-Language Pathology.
        Whurr, London2004
        • Sheepway L
        • Lincoln M
        • Togher L.
        An international study of clinical education practices in speech-language pathology.
        Int J Speech Lang Pathol. 2011; 13: 174-185
      2. Health Workforce Australia. Speech pathologists in focus. 2014. Available at: https://webarchive.nla.gov.au/awa/20160105170719/http://www.hwa.gov.au/sites/default/files/HWA_Speech_Pathologists_in_Focus_V1.pdf. Accessed May 25, 2020.

        • McAllister L.
        Issues and innovations in clinical education.
        Adv Speech Lang Pathol. 2005; 7: 138-148
        • Rodger S
        • Webb G
        • Devitt L
        • et al.
        Clinical education and practice placements in the allied health professions: an international perspective.
        J Allied Health. 2008; 37: 53-62
        • Ker J
        • Bradley P.
        Simulation in medical education.
        in: Swanwick T. Understanding Medical Education: Evidence, Theory and Practice. Wiley Blackwell, Chichester, West Sussex, UK2014 (Ed.)
        • Larue C
        • Pepin J
        • Allard E.
        Simulation in preparation or substitution for clinical placement: a systematic review of the literature.
        J Nurs Educ Pract. 2015; 5 (Doi:10.5430/jnep.v5n9p132): 132-140
      3. Council for Clinical Certification in Audiology and Speech-Language Pathology of the American Speech-Language-Hearing Association. 2014 Standards for the certificate of clinical competence in speech-language pathology. Available at: http://www.asha.org/Certification/2014-Speech-Language-Pathology-Certification-Standards/. Accessed May 25, 2020.

        • Dudding CC
        • Nottingham EE.
        A national survey of simulation use in university programs in communication sciences and disorders.
        Am J Speech Lang Pathol. 2018; 27: 71-81
        • MacBean N
        • Theodoros D
        • Davidson B
        • et al.
        Simulated learning environments in speech-language pathology: an Australian response.
        Int J Speech Lang Pathol. 2013; 15 (10.3109/17549507.2013.779024): 345-357
        • Clinard ES
        • Dudding CC.
        Integrating simulations into communication sciences and disorders clinical curriculum: impact of student perceptions.
        Am J Speech Lang Pathol. 2019; 28 (10.1044/2018_AJSLP-18-0003): 136-147
        • Hill AE
        • Davidson BJ
        • Theodoros DG.
        Speech pathology students’ perceptions of a standardised patient clinic.
        J Allied Health. 2013; 42: 84-91
        • Barrows HS.
        An overview of the uses of standardized patients for teaching and evaluating clinical skills.
        Acad Med. 1993; 68 (10.1097/00001888-199306000-00002): 443-451
        • Ward EC
        • Hill A
        • Nund R
        • et al.
        Developing clinical skills in paediatric dysphagia management using Human Patient Simulation (HPS).
        Int J Speech Lang Pathol. 2015; 17: 230-240
        • Ward E
        • Rumbach A
        • Nund R
        • et al.
        Student perceptions of simulation learning activities for clinical skill development in dysphagia management.
        Dysphagia. 2017; 32: 856
        • Penman A
        • Hill AE
        • Hewat S
        • et al.
        Students’ perceptions of simulation-based learning in speech pathology: a pilot study.
        IJPBL/HSC. 2020; 8: 1-14
        • Blackstock FC
        • Watson KM
        • Morris NR
        • et al.
        Simulation can contribute a part of cardiorespiratory physiotherapy clinical education.
        Simul Healthc. 2013; 8: 32-42
        • Hayden JK
        • Smiley RA
        • Alexander M
        • et al.
        The NCSBN National Simulation Study: a longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education.
        J Nurs Reg. 2014; 5: S3-S64
        • Hill A
        • Ward E
        • Heard R
        • et al.
        Simulation can replace part of speech-language pathology placement time: a randomised controlled trial.
        Int J Speech Lang Pathol. 2020; 25 (10.1080/17549507.2020.1722238): 1-11
        • Watson K
        • Wright A
        • Morris N
        • et al.
        Can simulation replace part of clinical time? Two parallel randomized controlled trials.
        Med Educ. 2012; 46: 657-667
        • Speech Pathology Association of Australia
        Competency-Based Occupational Standards (CBOS) for Speech Pathologists: Entry-Level (revised).
        Speech Pathology Association of Australia, Melbourne, Australia2011
        • Syder D.
        The use of simulated clients to develop the clinical skills of speech and language therapy students.
        Eur J Disord Commun. 1996; 31: 181-192
        • Zraick R
        • Allen R
        • Johnson S.
        The use of standardized patients to teach and test interpersonal and communication skills with students in speech-language pathology.
        Adv Health Sci Educ. 2003; 8: 237-248
        • Hill AE
        • Davidson BJ
        • Theodoros DG.
        An investigation of the Standardised Patient Interview Rating Scale (SPIRS) for the assessment of speech pathology students in a simulation clinic.
        Int J Pract-Based Learn Health Soc Care. 2015; 3: 58-76
        • Bovill C.
        Sharing responsibility for learning through formative evaluation: moving to evaluation as learning.
        Pract Evid Scholar Teach Learn High Educ. 2011; 6: 96-109
        • Hoon A
        • Oliver E
        • Szpakowska K
        • et al.
        Use of the ‘Stop, Start, Continue’ method is associated with the production of constructive qualitative feedback by students in higher education.
        Assess Eval High Educ. 2015; 40 (10.1080/02602938.2014.956282): 755-767
        • Jacobson BH
        • Johnson A
        • Grywalski C
        • et al.
        The voice handicap index (VHI): development and validation.
        Am J Speech Lang Pathol. 1997; 6: 66
        • Botma Y.
        Nursing student's perceptions on how immersive simulation promotes theory-practice integration.
        Int J Afr Nurs Sci. 2014; 1: 1-5
        • Dalwood N
        • Maloney S
        • Cox N
        • et al.
        Preparing physiotherapy students for clinical placement: Student perceptions of low-cost peer simulation. A mixed-methods study.
        Simul Healthc. 2018; (10.1097/SIH.0000000000000276)
        • Gibbs DM
        • Dietrick M.
        Using high fidelity simulation to impact occupational therapy student knowledge, comfort and confidence in acute care.
        J Occup Ther. 2017; 5 (10.15453/2168-6408.1225)
        • James D
        • Nastasic S
        • Horne R
        • et al.
        The design and evaluation of a simulated-patient teaching programme to develop the consultation skills of undergraduate pharmacy students.
        Pharm World Sci. 2001; 23: 212-216
        • Mandrusiak AM
        • Isles R
        • Chang AT
        • et al.
        Senior physiotherapy students as standardized patients for junior students enhances self-efficacy and satisfaction in both junior and senior students.
        BMC Med Educ. 2014; 14: 105
        • Rose TA
        • Copley A
        • Scarinci N.
        Benefits of providing an acute simulated learning environment to speech pathology students: an exploratory study.
        Health Prof Educ. 2017; 18: 44-59
        • Shorland J
        • Morris C
        • Stephens D.
        Simulation speaks for itself: building speech-language pathology students’ confidence through high quality simulation within a workplace clinical placement.
        Health Prof Educ. 2018; 19: 53-67
        • Bokken L
        • Rethans J
        • Scherpbier AJJA
        • et al.
        Strengths and weaknesses of simulated and real patients in the teaching of skills to medical students: a review.
        Simul Healthc. 2008; 3: 161-169
        • Becker KL
        • Rose LE
        • Berg JB
        • et al.
        The teaching effectiveness of standardized patients.
        J Nurs Educ. 2006; 45: 103-111
        • Littlewood S
        • Ypinazar V
        • Margolis SA
        • et al.
        Early practical experience and the social responsiveness of clinical education: Systematic review.
        Br Med J. 2005; 331: 387-391
        • Spencer J
        • Blackmore D
        • Heard S
        • et al.
        Patient-oriented learning: a review of the role of the patients in the education of medical students.
        Med Educ. 2000; 34: 851-857
        • Yoo MS
        • Yoo IY.
        The effectiveness of standardized patients as a teaching method for nursing fundamentals.
        J Nurs Educ. 2003; 42: 444-448
        • Cook DA
        • Hatala R
        • Brydges R
        • et al.
        Technology-enhanced simulation for health professions education: a systematic review and meta-analysis.
        J Am Med Soc. 2011; 306: 978-988
        • Schunk D.
        Self-efficacy, motivation and performance.
        J Appl Sport Psychol. 1995; 7: 112-137
        • Eva K
        • Regehr G.
        Self-assessment in health professions: a reformulation and research agenda.
        Acad Med. 2005; 80: 546-554
        • Alinier G
        • Hunt B
        • Gordon R
        • et al.
        Effectiveness of intermediate-fidelity simulation training technology in undergraduate nursing education.
        Issues Innov Nurs Educ. 2006; 54: 359-369
        • Wenk M
        • Waurick R
        • Schotes D
        • et al.
        Simulation-based medical education is no better than problem-based discussions and induces misjudgement in self-assessment.
        Adv Health Sci Educ. 2009; 14: 159-171
        • McAllister S
        • Lincoln M
        • Ferguson A
        • et al.
        COMPASS®: Competency Assessment in Speech Pathology Assessment Resource Manual (2nd Edition).
        Speech Pathology Australia, Melbourne2013
        • Finch E
        • Fleming J
        • Brown K
        • et al.
        The confidence of speech-language pathology students regarding communication with people with aphasia.
        BMC Med Educ. 2013; 13: 92
        • Lee C
        • Schmaman F.
        Self-efficacy as a predictor of clinical skills among speech pathology students.
        High Educ. 1987; 16: 407-416
        • Lincoln M
        • Adamson B
        • Covic T.
        Perceptions of stress, time management and coping strategies of speech pathology students on clinical placement.
        Adv Speech Lang Pathol. 2004; 6: 91-99
        • Chan J
        • Carter S
        • McAllister L.
        Sources of anxiety related to clinical education in undergraduate speech-language pathology students.
        Aust J of Human Comm Dis. 1994; 22: 57-73
        • Depreeuw EAM.
        A profile of the test-anxious student.
        Int Rev Appl Psychol. 1984; 33: 21-232
        • Hembree R.
        Correlates, causes, and treatment of test anxiety.
        Rev Educ Res. 1988; 58: 47-77
        • Morris LW
        • Davis MA
        • Hutchings CH.
        Cognitive and emotional components of anxiety: literature review and a revised worry-emotionality scale.
        J Educ Psychol. 1981; 73: 541-555
        • Cassady JC
        • Johnson RE.
        Cognitive test anxiety and academic performance.
        Contemp Educ Psychol. 2002; 27: 270-295
        • Blackstock FC
        • Jull GA.
        High-fidelity patient simulation in physiotherapy education.
        Aust J Physiother. 2007; 53: 3-5
        • Boud DKR
        • Walker D
        Promoting reflection in learning: a model.
        in: Boud D.K.R Walker D. Reflection: Turning Experience into Learning. Kegan Page, London1985: 18-40
        • Hill AE
        • Davidson BJ
        • Theodoros DG.
        Reflections on clinical learning in novice speech-language therapy students.
        Int J Lang Comm Disord. 2012; 47: 413-426
        • Cream A
        • O'Brian S
        • Jones M
        • et al.
        Randomized controlled trial of video self-modeling following speech restructuring treatment for stuttering.
        J Speech Lang Hear Res. 2010; 53: 887-897
        • Hitchcock CH
        • Dowrick PW
        • Prater MA.
        Video self-modeling intervention in school-based settings: a review.
        Remedia Spec Educ. 2003; 24: 34-36
        • Doherty-Restrepo J
        • Odai M
        • Harris M
        • et al.
        Students’ perception of peer and faculty debriefing facilitators following simulation-based education.
        J Allied Health. 2018; 47: 107-112
        • Secomb J.
        A systematic review of peer teaching and learning in clinical education.
        J Clin Nurs. 2008; 17: 703-716