Using Simulation and Critical Thinking in Speech-Language Pathology: A University Case Study

Abstract Education is changing. Virtual learning is now a common occurrence. Along with this change, more and more virtual learning tools are being used in the educational setting. The American Speech-Language-Hearing Association (ASHA) has recognized this change and has modified certification standards to include clinical simulation experiences in graduate speech-language training programs. Along with this modification, critical thinking skills are an expected goal, not only in face-to-face experiences, but also in simulation experiences. Educators need to meet this expectation to ensure that future speech-language pathologists are fully prepared to make sound decisions within the clinical setting. Educators may benefit from the following suggestions in regards to the use of critical thinking skills within a clinical simulation experience

Developing a scalable training model in global mental health: pilot study of a video-assisted training Program for Generalist Clinicians in Rural Nepal.

BackgroundIn low- and middle-income countries, mental health training often includes sending few generalist clinicians to specialist-led programs for several weeks. Our objective is to develop and test a video-assisted training model addressing the shortcomings of traditional programs that affect scalability: failing to train all clinicians, disrupting clinical services, and depending on specialists.MethodsWe implemented the program -video lectures and on-site skills training- for all clinicians at a rural Nepali hospital. We used Wilcoxon signed-rank tests to evaluate pre- and post-test change in knowledge (diagnostic criteria, differential diagnosis, and appropriate treatment). We used a series of 'Yes' or 'No' questions to assess attitudes about mental illness, and utilized exact McNemar's test to analyze the proportions of participants who held a specific belief before and after the training. We assessed acceptability and feasibility through key informant interviews and structured feedback.ResultsFor each topic except depression, there was a statistically significant increase (Δ) in median scores on knowledge questionnaires: Acute Stress Reaction (Δ = 20, p = 0.03), Depression (Δ = 11, p = 0.12), Grief (Δ = 40, p < 0.01), Psychosis (Δ = 22, p = 0.01), and post-traumatic stress disorder (Δ = 20, p = 0.01). The training received high ratings; key informants shared examples and views about the training's positive impact and complementary nature of the program's components.ConclusionVideo lectures and on-site skills training can address the limitations of a conventional training model while being acceptable, feasible, and impactful toward improving knowledge and attitudes of the participants

Use of a Standardized Tracheostomy Patient Simulation to Evaluate Student Clinical Communication Skills

Simulation is a valid pedagogical tool used to teach students, observe student clinical skills, and to assess clinical competencies. During the COVID-19 pandemic, a lack of medical speech-language pathology placements required graduate programs to re-examine clinical training. Simulation has proven useful in providing an alternative and safe learning modality. Standardized patients, which are one simulation modality, provide increased standardization and higher fidelity than medical manikins. This is particularly true in the context of both student learning and demonstration of clinical communication skills (CCS) within a simulated learning environment where the simulated patient can interact authentically with the student clinician. CCS are important because they can lead to better treatment outcomes and strengthen the therapeutic alliance. The purpose of this study was to evaluate the evidence for a CCS training in the context of a speaking valve trial with a standardized tracheostomy patient. Results showed that students are demonstrating emerging skills or have already developed CCS in this context. Student questionnaire ratings suggest that this simulation was helpful to their learning as it provided a safe environment for them to practice valuable clinical skills. Simulation appears to be a viable modality to use when training CSD students to improve their CCS

The struggling infectious diseases fellow: Remediation challenges and opportunities

Remediation of struggling learners is a challenge faced by all educators. In recognition of this reality, and in light of contemporary challenges facing infectious diseases (ID) fellowship program directors, the Infectious Diseases Society of America Training Program Directors\u27 Committee focused the 2018 National Fellowship Program Directors\u27 Meeting at IDWeek on Remediation of the Struggling Fellow. Small group discussions addressed 7 core topics, including feedback and evaluations, performance management and remediation, knowledge deficits, fellow well-being, efficiency and time management, teaching skills, and career development. This manuscript synthesizes those discussions around a competency-based framework to provide program directors and other educators with a roadmap for addressing common contemporary remediation challenges

Using AR to Teach AR: Learning Outcomes of a Guided, Augmented Reality Hearing Loss and Auditory Rehabilitation Simulation with SLP Graduate Students

Recent research has found that practicing speech-language pathologists report feeling underprepared to provide services for individuals with hearing loss. At the same time, graduate SLP programs report that students have fewer training opportunities with low-incidence populations. This study examines learning outcomes for a cohort of graduate SLP students using a novel application of an immersive, augmented reality, hearing loss simulation. Results show encouraging outcomes for the simulation experience’s effects on empathy, knowledge, and clinical skills. This simulation offers a unique way to provide training related to auditory rehabilitation in SLP

Preparation of Clinical Nurse Educators Using Simulation: Developing Competencies in Providing Feedback

Nursing students require a competent nurse educator to support and evaluate their performance in order to learn and grow. Frequently, nurses who enter into educator roles are not prepared to support and evaluate nursing students. An important competency for nurse educators is the ability to give effective formative feedback in a supportive learning environment. Nurse educators who are not prepared for the teaching role might negatively impact the educational experience and preparation of nursing students. Simulation could be an effective method for developing evidence-based teaching competencies in nurse educators but there is limited evidence about this topic in the literature. The purpose of this study was to evaluate the effectiveness of simulation learning in the development of clinical teaching competencies in clinical nurse educators transitioning from the role of nurse clinician to nurse educator. The study intervention was a simulation learning experience for clinical nurse educators to learn effective formative feedback techniques. Theoretical frameworks guiding the research study included Meleis’ (2010) transitions theory and the National League for Nursing (NLN) Jeffries simulation theory (Jeffries, Rodgers, & Adamson, 2015). Transitions theory addresses the situational transition when a nurse clinician takes on the new role of nurse educator. Simulation iv theory provides structure and background for the concepts included in developing a simulation learning experience. Twenty nurses who worked with prelicensure nursing students were invited to participate. An online survey with demographic questions and the Clinical Nurse Educator Self Evaluation (CNESE) developed by the principal investigator—based on the Nurse Educator Self Evaluation tool with permission from the author and NLN—were completed before the simulation workshops. The simulation workshops focused on developing knowledge and skills to provide effective formative feedback to nursing students in clinical education. At the end of the workshop, participants repeated the CNESE and completed the Simulation Design Scale (NLN, 2018). A trained rater completed the Feedback Assessment for Clinical Education (FACE©) tool (Onello, Rudolf, & Simon, 2015b) during each simulation workshop scenario. The median and mean scores of the CNESE increased from pretest to posttest but the increase was not statistically significant. No significant differences were found in the means of pretest and posttest results on the CNESE between active and observer participants in the live simulation or between participants’ level of education in nursing. No significant differences were found in the means of pretest and posttest results on the CNESE between participants with less than three terms of experience and participants with four or more terms of experience. The design features for the simulation were rated positively by participants on the Simulation Design Scale (NLN, 2018) and there were no findings that indicated changes to the simulation design. The FACE tool (Onello et al., 2015b) ratings of active participants in simulation scenarios revealed the highest mean for the element Provokes an engaging conversation. The element with the lowest mean rating was Establishes an engaging learning environment. Despite a lack of statistical significance in the modified CNESE results, the participants in all five workshops indicated it was a good learning experience in group discussions. The CNEs of all levels of experience and clinical backgrounds were introduced to the NLN clinical nurse educator competencies and participated actively in their own skill development to provide effective formative feedback to students. Participants were introduced to the feedback conversation elements from the FACE tool (Onello et al., 2015b) and given opportunities to practice and receive feedback from their peers. This study contributed to nursing education research by describing the development of clinical nurse educators using simulation and theoretical frameworks that provided a basis for further studies. Simulation learning provides an experiential opportunity for educators to explore their own practice receiving feedback from peers. By focusing on the published and validated competencies from the National League for Nursing, educators could develop simulation learning workshops that develop knowledge and skills for clinical nurse educators. Key words: Clinical Nurse Educator, Formative Feedback, Simulation learning, Role Transition, Simulation Desig

Roundtable Discussion (RTD03) - Is there a downside to using Simulated Patients to teach and assess communication skills?

Background Simulated Patients (SPs) are widely used to facilitate the learning of communication skills enabling students to receive detailed feedback on experiential practice in a safe environment. They are also used in the assessment of students’ communication skills in Objective Structured Clinical Examinations (OSCEs). We have observed that our most experienced SPs are highly conversant with medical jargon and consultation skills and have almost become ‘medical faculty’. Consultations can therefore lack the true patient perspective, with SPs focussing their feedback on process rather than giving a true patient perspective. Roundtable objectives To consider the challenges in ensuring that highly experienced SPs continue to respond from a true patient perspective To critique whether the use of SPs in OSCE stations is a valid way to assess students’ communication skills with real patients To consider whether using consultations with Simulated Patients is useful for students in the later years of an Undergraduate medical course who are learning to integrate the different components of a consultation and reasoning clinically in a real-life clinical context To share best practice with colleagues Roundtable A brief interactive presentation including the authors’ experiences of working with experienced Simulated Patients which will draw on current literature regarding the evidence for using Simulated Patients in the teaching and assessing of communication skills Delegates will have the opportunity to take part in three roundtable discussions • OSCE Stations using SPs assess how good students are at communicating with SPs but not with real patients • Experienced SPs are in danger of responding with a faculty not a patient perspective • By using SPs in teaching we over focus on process and forget the global picture

WS19. From pedagogy to practice: implementing transformative learning in clinical reasoning

BackgroundHealthcare professionals must provide high quality care that is both efficient and safe. Underpinning this requirement is a presumption that individuals are able to make accurate clinical decisions. Knowledge is not sufficient: judgment and reasoning are required to translate clinical information into accurate decisions to produce effective care. Clinical reasoning skills need to be developed in healthcare professionals in a way that produces change in behaviour. This is aplies to the spectrum of healthcare education: from undergraduate to postgraduate to lifelong practice. Though much is understood about clinical decision-making theory, direction for systematic implementation of teaching in both undergraduate and postgraduate medical education programmes is lacking. In particular, evidence describing transformative teaching methods is limited. This workshop will explore how to design effective spiral curricula in clinical reasoning, compare and contrast experiences from three medical schools in the UK, discuss challenges in implementation, share a variety of teaching methods, provide hands on demonstration of technological resources that have produced changes in learner behaviour and support attendees to adapt methodology to their programmes.Structure of workshopWe will briefly review current knowledge on clinical decision-making learning before sharing experiences from three UK medical schools.Attendees will participate in discussions supported by interactive exercises to explore each subtopic. These exercises will include role play, video and trial of electronic teaching tools used in our current practice. The session will conclude with a reflection on principles and ideas shared during the event

Virtual reality simulation for the optimization of endovascular procedures : current perspectives

Endovascular technologies are rapidly evolving, often - requiring coordination and cooperation between clinicians and technicians from diverse specialties. These multidisciplinary interactions lead to challenges that are reflected in the high rate of errors occurring during endovascular procedures. Endovascular virtual reality (VR) simulation has evolved from simple benchtop devices to full physic simulators with advanced haptics and dynamic imaging and physiological controls. The latest developments in this field include the use of fully immersive simulated hybrid angiosuites to train whole endovascular teams in crisis resource management and novel technologies that enable practitioners to build VR simulations based on patient-specific anatomy. As our understanding of the skills, both technical and nontechnical, required for optimal endovascular performance improves, the requisite tools for objective assessment of these skills are being developed and will further enable the use of VR simulation in the training and assessment of endovascular interventionalists and their entire teams. Simulation training that allows deliberate practice without danger to patients may be key to bridging the gap between new endovascular technology and improved patient outcomes