Graduate programs in the discipline of communication sciences and disorders (CSD) are looking toward technology—specifically, simulations—to meet the clinical education needs of students (Dudding & Nottingham, 2018). This change is occurring at a time when programs are facing challenges of program expansion, availability of off-campus supervisors and preceptors, and expectations for interprofessional education (IPE) within the context of increasingly complex service delivery systems (ASHA, 2014; Dudding, 2015). Additionally, in 2014, the Council for Clinical Certification in Audiology and Speech-Language Pathology (CFCC) changed the implementation language for Speech-Language Pathology Standard V-B to allow up to 20% of the required 375 direct clinical hours to be obtained through simulation. This article provides an introduction to health care simulation technologies, current evidence, and health care simulations for clinical education.
Healthcare Simulation Technology
Healthcare simulations focus on the creation of realistic learning environments that allow students to practice and learn without risk to patients/clients. In other disciplines such as nursing and medicine, simulations are used to evaluate student skills and competencies. A key principle to keep in mind is that simulations are more than a technology—they are a learning tool.
Simulations can take several forms, utilizing a range of technologies. Standardized patients—that is, the use of a trained person or persons to portray a patient or family member—have a long history of use in CSD and other health care arenas (Zraick, 2012). The use of manikins (whole body) and part-task trainers (partial body) may be familiar to those with a simulation lab on campus. These technologies range in the level of fidelity (i.e., realism) and cost. A full-body manikin may be used to simulate a patient who has suffered a stroke. Many of us were trained in cardiopulmonary resuscitation (CPR) using Resusci-Annie. Resusci-Annie is a great example of a part-task trainer in that it is dedicated to training in a very specific skill set. Some computer-based simulations are based on interactive gaming technologies and allow for repeated practice in a safe environment. Emerging technologies are being explored in the areas of virtual and augmented reality and computer-based game scenarios to offer immersive and realistic simulation experiences for learning.
Research on Health Care Simulations
Health care simulations for clinical education have been researched extensively in medical and nursing education programs. In 2014, the Journal of Nursing Regulation published the results of a landmark study investigating the use of simulations in pre-licensure nursing education (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). The results of this study of more than 660 nursing students from 10 programs revealed no significant between-group differences for clinical competency, critical thinking, or preparedness to practice as a registered nurse. In fact, the authors recommended that up to 50% of required clinical hours in pre-licensure nursing education programs could be replaced with simulations with no foreseen adverse effects on student training. Cook et al.’s (2011) meta-analysis of simulation studies revealed equally promising results, based on which the authors concluded that simulations have a positive impact on the ability of students to gain knowledge, skills, and behaviors. These results support the use of simulations as a viable supplement to traditional clinical practicae with real patients.
Studies conducted within CSD add to the body of research supporting the application of simulations for clinical education. The use of standardized patients is probably the oldest and most researched form of simulation in our discipline. Evidence clearly demonstrates that use of standardized patients serve as a viable instructional strategy (Hill, Davidson, & Theodoros, 2013; Zraick, 2012). Studies on the use of part-task trainers (Benadom & Potter, 2011) and high-fidelity manikins (Estis, Rudd, Pruitt, & Wright, 2015) indicate that CSD students demonstrate an increase in comfort levels with various techniques and gain foundational knowledge for working with a variety of different disorder groups.
Best Practices In Health Care Simulations
A common misconception is that assigning students to complete a simulation, whether high-fidelity or computer-based, is all that is necessary to achieve student learning. Long-established best practices in health care simulations include three critical components: (1) the pre-brief, (2) the scenario, and (3) the debrief (Jeffries, 2005). Prior to engaging in the simulation experience, students meet with an instructor to orient to the technology and the specific case profile. Students share their initial thoughts relative to their clinical hypothesis and plan for assessment and/or intervention. This encounter is known as the pre-brief and serves to set expectations for performance and learning. Subsequently, students engage in the simulation activity (i.e., the scenario). In some cases, when occurring live, the experience is guided by a knowledgeable facilitator. Following the simulation experience, students conduct the debrief, in which they work with clinical instructors to review the events and reflect on their learning. Research shows that the debrief process is where and when true learning occurs within the simulation experience (Dieckmann, Friis, Lippert & Ostergaard, 2009).
There is a growing interest in simulations within CSD. Simulations can serve several purposes as part of the CSD curriculum, including (1) training students on specific skills and competencies, (2) offering students exposure to experiences that they otherwise would not have, and (3) conducting simulations with individual students or as part of a group training experience. In particular, group training lends itself to interprofessional education opportunities, which can be incorporated into treatment planning to extend student learning. Simulations also hold promise in the area of competency-based assessment—for example, objective structured clinical examinations (OSCES), an evidence-based approach to test clinical skill performance and competence with a hands-on, real-world approach to learning on the basis of evidence-based practice for real-world responsibilities.
Closing Thoughts
Simulations are a viable alternative to traditional hands-on experiences and promote clinical competency, critical thinking, and preparedness. They may serve to enhance students’ clinical experiences by increasing the frequency of client diagnostic and treatment opportunities; expanding the diversity of clinical experiences across the life span, including low-incidence populations; flexing the pace of learning to accommodate individual students’ needs; and supporting clinical decision making in a risk-free condition. Simulations also align with increased expectations for IPE learning experiences to prepare future clinicians for interprofessional collaborative team practices. The use of simulations in clinical education in CSD is likely to continue and grow. It is imperative that this growth is guided by evidence from within and outside our discipline as well as the existing best practices. Those considering incorporating simulations into a CSD program are encouraged to seek training and resources provided by those engaged in the practice.
References
American Speech-Language Hearing Association. (2014). How ASHA and others are addressing the greatest challenges facing clinical educators in audiology and speech-language pathology today. Retrieved from https://www.asha.org/articles/challenges-facing-clinical-educators/.
Benadom, E. M., & Potter, N. L. (2011). The use of simulation in training graduate students to perform transnasal endoscopy. Dysphagia, 26,352–360. doi: 10.1007/s00455-010-9316-y
Cook, D. A., Hatala, R., Brydges, R., Szostek, J. H., Wang, A. T., Erwin, P. J., & Hamstra, S. J. (2011). Technology-enhanced simulation for health professions education: A systematic review and meta-analysis. Journal of the American Medical Association, 306, 978–988.
Council for Clinical Certification in Audiology and Speech-Language Pathology. (2014). 2014 standards and implementation procedures for the certificate of clinical competence in speech-language pathology. Retrieved from http://www.asha.org/Certification/2014-Speech-Language-Pathology-Certification-Standards.
Dieckmann, P., Friis, S. M., Lippert, A., & Ostergaard, D. (2009). The art and science of debriefing in simulation: Ideal and practice. Medical Teacher, 31, e287–e294.
Dudding, C. (2015). Full class. The ASHA Leader, 20, 36–39. Retrieved fromhttps://doi.org/10.1044/leader.FTR1.20012015.36.
Dudding, C. C., & Nottingham, E. E. (2018). A national survey of simulation use in university programs in communication sciences and disorders. American Journal of Speech-Language Pathology, 27, 71–81. doi: 10.1044/2017_AJSLP-17-0015
Estis, J. M., Rudd, A. B., Pruitt, B., & Wright, T. (2015). Interprofessional simulation-based education enhances student knowledge of health professional roles and care of patients with tracheostomies and Passy-Muir® valves. Journal of Nursing Education and Practice, 5(6), 123–128. doi:10.5430/jnep.v5n6p123
Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBSN National Simulation Study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2), S4–S41.
Hill, A. E., Davidson, B. J., & Theodoros, D. G. (2013). The performance of standardized patients in portraying clinical scenarios in speech-language therapy. International Journal ofLanguage and Communication Disorders, 48, 613–624. doi: 10.1111/1460-6984.12034
Jeffries, P. R. (2005). A framework for designing, implementing, and evaluating simulations used as teaching strategies in nursing. Nursing Education Perspectives, 26(2), 96–104.
Zraick, R. I. (2012). A review of the use of standardized patients in speech pathology clinical education. International Journal of Therapy and Rehabilitation,19(2), 112–118.
