The future of SLP clinical education

Simucase Education Division

Posted August 15, 2014

Leigha J. Jansen, EdD, CCC-A, Clint Johnson, MA, CCC-SLP, Stacy L. Williams, PhD, Brenda Pantalone, MEd, Katie Ondo, MA, CCC-SLP

Simucase is a web-based collection of virtual patients designed to exhibit communication disorders for determining proper assessment and intervention techniques. When combined with well-designed classroom instruction, Simucase provides students with a sophisticated, controlled, learner-centered experience that allows for repeated practice of clinical decision-making skills in a risk-free environment. Simucase demands higher levels of cognitive function, including analysis, synthesis, and evaluation (Bloom, 1956). These skills are integral to effective clinical decision-making and contribute to professional competence (Kneebone et al., 2004).

Simucase users can discover through simulated practice the best ways to interact with virtual patients, their caregivers and other interdisciplinary professionals, such as the child’s teacher, audiologist or physician. This training can occur anywhere, anytime, whenever the lesson is best for the clinician in training. By asking the right questions, collaborating appropriately and using proper assessment data, the Simucase user can more easily learn to formulate a diagnosis and determine if treatment is necessary. Virtual simulations such as Simucase are intended to build knowledge, skill and professional judgment; qualities that contribute to successful, competent clinicians (Kneebone et al., 2004). The key benefits of Simucase and simulation-based clinical education are illustrated in Figure 1.

Figure 1. The benefits of Simucase and simulation-based clinical education (Jansen, 2014)

future of slp education figure 1 image

Deliberate, Repeated Practice

Unlike a real patient, a Simucase patient provides students the opportunity for deliberate, repeated practice. Deliberate practice contributes to transitioning learners along the continuum of novice to expert clinician and simultaneously supports the development of ill-structured problem solving skills (Ericsson, 2008; Jonassen, 1997). Clinical decision-making represents ill-structured problem solving as clinical encounters require the application of rules, relationships, and judgments in often vague situations that have multiple solution pathways. Deliberate practice is more sophisticated than repetitive exercises. Instead, deliberate practice must include a task with a well-defined objective, performance feedback for the learner, and the opportunity to reflect and refine task actions. Also, the learner must be motivated to improve performance (Ericsson, 2008). In sum, deliberate practice scenarios, such as those offered by Simucase, “focus on activities... with opportunities for immediate feedback, reflection, and correction” (p. 993).

The Relationship Between Risk and a Safe Learning Environment

A safe learning environment reduces the perceived risk of failure for a learner. In turn, the probability of increasing self-confidence rises dramatically. A skilled instructor, or facilitator, is responsible for establishing a safe, respectful learning environment that promotes “active learning and reflection, and supports repetitive practice” (Boese et al., 2013, p. S24). Simucase encourages students to thoughtfully experiment, question and take risks without fear of repercussions.

Simucase virtual patients are not intended to replace contact with human patients. Instead, a learning tool such as Simucase offers students the opportunity to practice the assessment process and exercise clinical decision-making skills in an environment that is not limited by the constraints of time, cost or human behavior. Simucase allows students to make mistakes, reflect on actions and improve the application of clinical knowledge and skills without risk to the patient or sacrificing the quality of care.

Practical Application of Knowledge

Didactic knowledge is a significant component of speech-language pathology education, but students are often searching for a practical means to apply information prior to clinical education experiences. Simucase provides students the opportunity to bridge the gap between the classroom and the clinic prior to working with real patients in a clinical setting. It is important to understand that the expertise of the clinical instructor is paramount to Simucase and its simulation-based clinical education model. The clinical instructor serves as a facilitator, promoting guided instruction and supporting the learning and development of clinical decision-making skills in their students.

Guided instruction is an evidence-based, student-centered teaching paradigm that has been proven time and again as an effective strategy for learning (Clark, Yates, Early, & Moulton, 2010). It is the responsibility of the facilitator to evaluate the development of the student’s clinical decision-making skills by providing feedback that promotes reflection, expands the student’s knowledge base and prevents erroneous, habitual behaviors. In sum, an effective facilitator of simulation-based clinical education utilizes Simucase to identify the gap between knowledge and performance, and redirects the learner utilizing evidence-based practice.

Experiential and Reflective Learning

Simulation-based clinical education is a comprehensive, student-centered teaching approach that promotes experiential and reflective learning, both of which are critical to the transfer of learning from the classroom to the clinic (Motola, Devine, Chung, Sullivan & Issenberg, 2013). Simucase is an effective case-based learning approach and provides students with a novel experience that promotes thinking, reflection and learning through the use of simulated clinical practice. A quality, evidence-based case study, such as those found in Simucase, promotes reflective interactivity as the student works through the clinical assessment process of collecting information relevant to the patient and the problem, selecting and administering assessments based on a clinical hypothesis, critically analyzing assessment results to determine a diagnosis, and formulating recommendations to support an evidence-based treatment plan (McCabe et al., 2009). One of the greatest strengths of simulation-based clinical education, and the integration of Simucase, is the logical, documented relationship to both experiential and reflective learning.

Support of Critical Learning Areas

According to the World Health Organization (2010), “interprofessional education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (p. 7). The American Speech-Language Hearing Association (2013) identified interprofessional education as a critical area that requires improved understanding and integration by the profession of speech-language pathology. Simucase provides students with the opportunity to learn about other professions that are often represented in the collaborative care team dedicated to patients that are served by speech-language pathologists. Simucase virtual patients require students to contact potential collaborators, including (but not limited to) physicians, other allied health professionals, and educators. The Simucase collaborator experience allows the clinical instructor to introduce, define, and help establish the scope of practice for both speech-language pathologists and other care providers integral to interprofessional, collaborative patient care.

Each Simucase virtual patient was designed to support select competency based initiatives of the Knowledge and Skills Acquisition (KASA) summary form for certification in speech-language pathology (ASHA, 2009). To ensure evidence-based practice, each virtual patient is reviewed by two national experts in a specific topic category of speech-language pathology to assess the validity and reliability of the content prior to dissemination. The evidence-based opinions of multiple expert reviewers are procured as a means to acknowledge the fact that clinical assessment is a complex process with multiple solution pathways. Each Simucase experience provides both the facilitator and the student an evidence-based experience to build knowledge and improve clinical decision-making skills. Simucase, as a component of simulation-based clinical education, provides both instructors and students examples of both interprofessional education and evidence-based practice to facilitate the development of clinical decision-making.

Comprehensive Immersive Experience

As practicing, certified clinicians reflect upon their training, many are quick to note the lack of preparation for common areas within the scope of practice (Blood, Marnett, Gordon, & Blood, 2010; Compton, Tucker, & Flynn, 2009; Ratcli , Koul, & Lloyd, 2008; Schwartz & Drager, 2008). The literature suggests both practicing clinicians and program personnel perceive a lack of pre-service training and education opportunities in a variety of critical knowledge areas such as: receptive and expressive language, alternative and augmentative communication, hearing and the impact upon speech and language, and social aspects of communication (Council on Academic Accreditation in Audiology and Speech-Language Pathology, 2012).

Virtual patients, such as those included in Simucase, expose students to a collection of life-like patients exhibiting disorders and diseases that span the scope of practice - from the typical to the atypical. While the Simucase patient is not intended to serve as a total replacement for a human patient, the virtual experience mimics reality, allowing the student to become familiar with the exhibited patient behaviors associated with a disorder and/or disease process, practice administering appropriate assessments, select a diagnosis and formulate recommendations. Situational, simulated practice with Simucase better prepares the student for the real-life clinical encounter. The combination of a simulation-based clinical education model and the use of Simucase virtual patients that span the scope of professional practice is a direct answer to the call for innovative, clinical education reform that is needed in the field of speech-language pathology (American Speech-Language Hearing Association, 2007).

Conclusions

The integration of Simucase and a simulation-based clinical education model into speech-language pathology training represents an opportunity to positively impact the value, effciency, and quality of patient care. The model embraces a student-centered approach to education with guided instruction through the use of simulation technology to facilitate learning. It is the design of instruction, coupled with the expertise and teaching skills of the clinical educator, that is paramount to the successful use of Simucase in the speech-language pathology classroom and clinic. Simucase, when embraced as a comprehensive approach to teaching and learning, provides students with the opportunity for deliberate, repeated practice, negates patient risk, and minimizes risk for students in a safe learning environment. Students are encouraged to apply their clinical knowledge in a way that supports experiential and reflective learning across the scope of practice, and reinforces critical learning areas such as interprofessional education and evidence-based practice. Simucase represents an innovative tool for teaching and learning that supports the tenets of simulation-based clinical education and answers the call for future clinical education reform (American Speech-Language Hearing Association, 2007; American Speech-Language Hearing Association, 2013).

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