Sue McAllister

Faculty perceptions of interprofessional education

Nurses and other health professionals are required to demonstrate broad levels of expertise and service to ensure quality patient-centred health care. Interprofessional practice aligned with interprofessional education (IPE) has been promoted as a vehicle to promote broad levels of expertise. However, challenges remain for universities and other higher education institutions to successfully provide IPE opportunities for students. This paper presents perceptions of academic staff towards IPE from one Australian multi-campus health faculty. Perceptions were collected using interviews and two workshops. Findings are themed under the categories of faculty barriers, industry challenges and future opportunities. The perceptions of one health faculty regarding the fundamental factors required for IPE success were executive leadership of IPE, a supportive funding framework and an IPE based curricula. Nursing education can play a key role in embracing and leading future IPE approaches given that nurses are the numerically dominant health professional group and work collaboratively with other professionals to deliver patient-centred care.

Use of AAC by individuals with acquired neurologic communication disabilities: Results of an Australian survey

A demographic survey of speech pathologists was conducted in Australia to investigate the use of augmentative and alternative communication (AAC) with adults with acquired neurologic communication disabilities. Questionnaires were distributed to all speech pathologists who were members of the Australian Association of Speech and Hearing and listed themselves as working with an adult or mixed caseload. Questions related to the clinicians background, experience and interest in AAC, knowledge of and expertise with high and low technology systems, and factors related to successful outcomes for clients. Subjective data from the questionnaire were collated and the results and their implications are discussed.

Health-Service Organisation, Clinical Team Composition and Student Learning

Although clinical placements are an integral part of health-profession education, in contrast to university settings where education is a primary focus of activity, the health services that host these placements are primarily configured for clinical services. As a result, health-service staff supervise students in an environment where work priorities are centred on patient care rather than on student learning. Moreover, health services are complex and dynamic environments where student-learning opportunities vary greatly. As part of a project to identify and build leadership capacity for quality student learning within clinical teams, a model for team development was tested in three different health-service teams. The process of identifying and enrolling the selected teams permitted some observations to be made by the project team regarding the ways in which the organisation of health services shaped student-learning opportunities. The more complex the health service in terms of size, clinical team composition and patient or client care responsibilities, the fewer opportunities staff had to come together as a team to discuss and plan student learning. In addition, the more complex the health service, the greater the number of universities placing students and the greater the number of different programmes and levels of study represented, rendering the task of planning more difficult. It is proposed that what is required are negotiations across institutions that are sensitive to the complexities of clinical practice and also mindful of the need for students to be supported and engaged in ways that allow them to contribute and learn effectively in doing so.

Nationwide collaborative development of learning outcomes and exemplar standards for Australian pharmacy programmes

Internationally, the preparation of pharmacy graduates for professional practice has evolved from educating for capacities for practice, to a focus on competencies, and most recently, on assuring graduate outcomes. Consequently, there is an increasing emphasis on the specification of and accountability around student learning outcomes. This, in turn, has implications for teaching and assessment. The aim of the study was to harmonise the various expectations and regulatory requirements for Australian pharmacy education programmes through the development of learning outcomes and exemplar standards for all entry‐level pharmacy graduates.

International students in speech-language pathology clinical education placements: Perceptions of experience and competency development

Abstract Purpose: This study aimed to describe perceptions of clinical placement experiences and competency development for international speech-language pathology students and to determine if these perceptions were different for domestic students. Method: Domestic and international students at two Australian universities participated in nine focus group interviews. Thematic analysis led to the identification of two themes shared by international and domestic students and several separate themes. Result: Shared themes identified the important influence of students’ relationships with clinical educators, unique opportunities and learning that occurs on placement. International student themes included concerns about their communication skills and the impact of these skills on client progress. They also explored their adjustment to unfamiliar placement settings and relationships, preferring structured placements to assist this adjustment. Domestic student themes explored the critical nature of competency attainment and assessment on placement, valuing placements that enabled them to achieve their goals. Conclusion: The findings of this study suggest that international students experience additional communication, cultural and contextual demands on clinical placement, which may increase their learning requirements. Clinical education practices must be responsive to the learning needs of diverse student populations. Strategies are suggested to assist all students to adjust to the professional and learning expectations of clinical education placements.

Implications of Variability in Clinical Bedside Swallowing Assessment Practices by Speech Language Pathologists

Speech language pathology (SLP) clinical bedside swallowing assessments (CBSA) are a cornerstone of quality care for patients in acute hospitals who have dysphagia. The CBSA informs clinical diagnosis and decisions regarding further instrumental assessment, and is used to develop a management plan and monitor progress. However, self-report and retrospective research shows that SLPs are highly variable in their use of assessment components considered by experts to be important for quality CBSA, casting doubt on the validity and reliability of CBSA. This prospective study describes the components included by SLPs when designing a standardised evidence based dysphagia assessment protocol for acute care patients and observed patterns of component use. The findings confirm that SLPs use the CBSA for multiple purposes beyond diagnosis of aspiration risk and dysphagia presence/severity. They are highly variable in their use of certain components, but also demonstrate consistent use of a core set. It is apparent that SLPs prioritise the application of clinical reasoning to tailor their CBSA to the patient over following a highly structured item-based protocol. The variability in component use likely reflects a complex clinical reasoning process that draws on a wide variety of information combined with expert knowledge as is also observed in many other medical specialties. Rather than promoting the standardisation of CBSA protocols that constrain SLP practice to strict item-based assessment protocols, consideration should be given to promoting the value and facilitating the clinical reasoning process that supports the utility of the CBSA for diagnosis, patient centred management and treatment planning.

Student diversity and implications for clinical competency development amongst domestic and international speech-language pathology students

Abstract International students graduating from speech-language pathology university courses must achieve the same minimum competency standards as domestic students. This study aimed to collect descriptive information about the number, origin, and placement performance of international students as well as perceptions of the performance of international students on placement. University Clinical Education Coordinators (CECs), who manage clinical placements in eight undergraduate and six graduate entry programs across the 10 participating universities in Australia and New Zealand completed a survey about 3455 international and domestic speech-language pathology students. Survey responses were analysed quantitatively and qualitatively with non-parametric statistics and thematic analysis. Results indicated that international students came from a variety of countries, but with a regional focus on the countries of Central and Southern Asia. Although domestic students were noted to experience significantly less placement failure, fewer supplementary placements, and reduced additional placement support than international students, the effect size of these relationships was consistently small and therefore weak. CECs rated international students as more frequently experiencing difficulties with communication competencies on placement. However, CECs qualitative comments revealed that culturally and linguistically diverse (CALD) students may experience more difficulties with speech-language pathology competency development than international students. Students’ CALD status should be included in future investigations of factors influencing speech-language pathology competency development.

Supervising international students in clinical placements: perceptions of experiences and factors influencing competency development

BackgroundHealth professional education programs attract students from around the world and clinical supervisors frequently report that international students find learning in clinical placement contexts particularly challenging. In existing literature clinical supervisors, who support international students on placement have identified concerns about their communication and interactions within clinical environments.However, clinical supervisors’ perspectives about their experiences with international students on placement and the strategies they utilise to facilitate international student learning have not been described. As a result we have little insight into the nature of these concerns and what clinical supervisors do to support international students’ competency development.MethodsFive focus group interviews were conducted with twenty Speech-Language Pathology clinical supervisors, recruited from 2 Australian universities. Interview data were analysed thematically. Themes identified were interpreted using cognitive load and sociocultural learning theories to enhance understanding of the findings.ResultsFour themes were identified: ‘Complex teaching and learning relationships’, ‘Conceptions of students as learners’; Student communication skills for professional practice’, and ‘Positive mutual learning relationships’.ConclusionsFindings indicated that clinical supervisors felt positive about supporting international students in clinical placements and experienced mutual learning benefits. However, they also identified factors inherent to international students and the placement environment that added to workload, and made facilitating student learning complex. Clinical supervisors described strategies they used to support international students’ cultural adjustment and learning, but communication skills were reported to be difficult to facilitate within the constraints of placements. Future research should address the urgent need to develop and test strategies for improving international students’ learning in clinical settings.

Assessment of student competency in a simulated speech-language pathology clinical placement

Abstract Clinical education programs in speech-language pathology enable the transition of students’ knowledge and skills from the classroom to the workplace. Simulated clinical learning experiences provide an opportunity to address the competency development of novice students. This study reports on the validation of an assessment tool designed to evaluate speech-language pathology students’ performance in a simulated clinical placement. The Assessment of Foundation Clinical Skills (AFCS) was designed to link to concepts and content of COMPASS®: Competency Assessment in Speech Pathology, a validated assessment of performance in the workplace. It incorporates units and elements of competency relevant to the placement. The validity of the AFCS was statistically investigated using Rasch analysis. Participants were 18 clinical educators and 130 speech-language pathology students undertaking the placement. Preliminary results support the validity of the AFCS as an assessment of foundation clinical skills of students in this simulated clinical placement. All units of competency and the majority of elements were relevant and representative of these skills. The use of a visual analogue scale which included a pre-Novice level to rate students’ performance on units of competency was supported. This research provides guidance for development of quality assessments of performance in simulated placements.

Rethinking attitudes to student clinical supervision and patient care: a change management success story

BackgroundThe aim of this project was to explore the process of change in a busy community dental clinic following a team development intervention designed to improve the management of student supervision during clinical placements.MethodsAn action research model was used. Seven members of a community dental clinic team (three dentists, two dental therapists, one dental assistant and the clinic manager), together with the university clinical placement supervisor participated in the team development intervention. The intervention consisted of two profiling activities and associated workshops spread six months apart. These activities focused on individual work preferences and overall team performance with the aim of improving the functioning of the clinic as a learning environment for dental students. Evaluation data consisted of 20 participant interviews, fourteen hours of workplace observation and six sets of field notes. Following initial thematic analysis, project outcomes were re-analysed using activity theory and expansive learning as a theoretical framework.ResultsAt project commencement students were not well integrated into the day-to-day clinic functioning. Staff expressed a general view that greater attention to student supervision would compromise patient care. Following the intervention greater clinical team cohesion and workflow changes delivered efficiencies in practice, enhanced relationships among team members, and more positive attitudes towards students. The physical layout of the clinic and clinical workloads were changed to achieve greater involvement of all team members in supporting student learning. Unexpectedly, these changes also improved clinic functioning and increased the number of student placements available.ConclusionsIn navigating the sequential stages of the expansive learning cycle, the clinical team ultimately redefined the ‘object’ of their activity and crossed previously impervious boundaries between healthcare delivery and student supervision with benefits to all parties.