Abstract
Clinical education rotations typically involve an initial training phase followed by supervised clinical practice. However, little research has explored the separate contributions of each component to the development of student confidence and treatment fidelity. The dual purpose of this study was to compare the impact of clinical training format (synchronous vs. asynchronous) and education model (traditional vs. collaborative) on student confidence and treatment fidelity. Thirty-six speech-language pathology graduate students completed this two-phase study during a one-term clinical rotation. Phase 1 investigated the impact of training condition (synchronous, asynchronous guided, asynchronous unguided) on student confidence and treatment fidelity. Phase 2 explored the impact of education model (traditional vs. collaborative) on student confidence and treatment fidelity. Treatment fidelity was measured at the conclusion of Phases 1 and 2. Students rated their confidence at six-time points throughout the study. Our results indicate that training condition did not differentially impact student confidence or treatment fidelity; however, education model did: students in the collaborative education model reported increased confidence compared to students in the traditional education model. Students in the collaborative education model also trended towards having higher treatment fidelity than students in the traditional education model. These results demonstrate that pre-clinical trainings can be effective in several different formats provided they cover the discrete skills needed for the clinical rotation. While preliminary, our results further suggest that students may benefit from working with peers during their clinical rotations.
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Data availability
A de-identified limited data set that support the findings of this study and the fidelity checklist are available from the corresponding author (G.W.) upon reasonable request.
Notes
All students also received a second training in Supported Conversation for Adults with Aphasia (SCA; Kagan et al., 2001); however, this paper solely focuses on VNeST due to unbalanced SCA experiences between the cohorts.
Two initial treatment fidelity data points are missing due to video recording errors: one in the asynchronous unguided group and one in the synchronous group. These two participants are excluded from the analyses in Phase 1.
One T5 data point from traditional cohort 3 is missing due to a data collection error.
Overall, there was substantial variability within each group regarding confidence (see Fig. 4). However, only one participant, in the traditional group (the unfilled circle that is furthest left in Fig. 4), was deemed an outlier (i.e., confidence less than three standard deviations below the collaborative and traditional groups’ means). To explore the impact that this outlier had on the confidence analyses, we ran the VNeST and SLP confidence ANOVAs with this participant removed. The VNeST confidence results remained consistent with what is reported in Table 4. For SLP confidence, the main effect of Cohort became marginally significant (F(2,39) = 2.73, p = .078): the trend was for the collaborative cohort to have increased confidence compared to the Traditional cohort with the outlier removed (t(39) = 2.34, p = .074). All other SLP confidence results remain consistent with what is reported in Table 5.
The student in the traditional cohort whose T5 confidence rating was not collected due to a technical error is not represented in Fig. 4. While this student’s confidence is unknown at T5, their T4 VNeST confidence was 87.5, their T6 VNeST confidence was 100, and their final fidelity was 88%.
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GW, AL, and EW contributed to project conceptualization. AL and EW contributed to project administration. EW and AL contributed to supervision. GW and AL contributed to the initial draft, visualization, and data analysis. All authors contributed to draft reviewing, draft editing, and data coding/curation.
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Appendix A
Appendix A
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1.
Providing effective individual therapy for persons with aphasia (Aphasia 1)
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2.
Responding to unexpected events (Unrelated 1)
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3.
Providing VNeST treatment with fidelity (VNEST 1)
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4.
Implementing high quality speech/language therapy for all clients (SLP 1)
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5.
Providing effective group therapy for persons with aphasia (Aphasia 2)
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6.
Managing the telehealth therapy environment (Tele 1)
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7.
Carrying on a conversation with a stranger in any topic for any amount of time (Unrelated 2)
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8.
Providing effective therapy via telehealth for persons with aphasia (Tele 2)
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9.
Following Supported Conversation for Adults with Aphasia (SCA) with fidelity (SCA 1)
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10.
Lifting a 50 pound box (Unrelated 3)
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11.
Lifting a 200 pound box (Unrelated 4)
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12.
Providing an effective speech-language evaluation for a person with aphasia (Aphasia 3)
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13.
Treating a person with aphasia with respect/dignity (Aphasia 4)
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14.
Managing the in-person therapy environment (SLP 2)
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15.
Taking data while attending to the client (SLP 3)
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16.
Using SCA strategies to facilitate communication with a person with aphasia (SCA 2)
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17.
Following the VNeST prompting hierarchy (VNEST 2)
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18.
Providing an effective speech-language evaluation via telehealth for a person with aphasia (Tele 3)
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Wolford, G.W., Wash, E.J., McMillon, A.R. et al. How does training format and clinical education model impact fidelity and confidence in a speech-language pathology rotation?. Adv in Health Sci Educ (2023). https://doi.org/10.1007/s10459-023-10276-1
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Accepted:
Published:
DOI: https://doi.org/10.1007/s10459-023-10276-1