Promoting the transition from theory to practice has always been a prime priority in the training of speech-language pathologists. Traditionally, students learn the theoretical and clinical knowledge of communication disorders through coursework. They then apply the knowledge and skills learned from coursework to clinical practicum where they work with real patients. However, the transition from theory to practice is not always smooth. Some students struggle in transforming their theoretical knowledge to practical application. The term “theory-practice gap” has been used to describe the struggles and challenges students encounter in clinical practice (e.g., Allmark, 1995; Kenny, Lincoln, & Killian, 2015; Sun & Hung, 2018). There are several reasons for the challenges in bridging the theory-practice gap: 1) a lack of self-confidence; 2) a lack of effective consultation (interpersonal and communication) and noticing skills, and 3) a lack of opportunities to practice with individuals with communication disorders (Davenport et al., 2017). Providing students with timely practice of consultative and clinical skills can promote better generalization from theory to practice. Ideally, such practice should be integrated as part of the coursework, by providing students with authentic clinical practice opportunities at designated times to supplement classroom instructions. Unfortunately, there are clear practical and logistic constrains (e.g., time, venue, accessibility) accessing patients with communication disorders at these designated timepoints.
In recent years, there has been a fast-growing body of healthcare education research on promoting students learning through the use of simulations. Different modalities of patient simulations, ranging from low- to high-fidelity and technological levels, have been used in healthcare education, including manikins, part task trainers, patient simulators, computer-based programme using virtual reality and augmented reality, and simulated patients (Dudley, 2018). In speech-language pathology, live simulation using simulated patients is a popular teaching and learning tool (Dudding & Nottingham, 2018). Simulated patients refer to individuals who do not have a health or communication condition, but they role-play to be a patient by simulating the physical appearance, symptoms, needs and perspectives of the given health problems (Dudley, 2018). They are trained to behave like real patients by reproducing the clinical symptoms of a given disorder or health condition. The term “simulated patient” is similar to “standardized patient” and has been used interchangeably in many studies, yet the two terms are technically different. Standardized patients are required to reproduce the clinical symptoms with high level of consistency across examiners. Hence, in performance-based clinical assessment (e.g., Objective Structured Clinical Examination, OSCE) where consistency of the simulation is crucial for fair evaluation of the clinical skills competencies of healthcare students, standardized patients are used.
A typical simulation-based learning session comprised of three parts: prebriefing, simulation, and post-simulation debriefing. In the prebriefing, the case scenario is introduced, together with an open discussion on the learning outcomes and the expectations from students. In the simulation session, students work with the simulated patient as if they are working with a real patient. They obtain case history information, carry out clinical examinations, or prescribe treatment with the simulated patient, depending on the learning objective of the session. Debriefing immediately follows the simulation session, in which students are guided by the simulated patients and the observing clinical educators to reflect on their performance in the session. The reflective discussion drives students’ learning through an evaluation of what went well in the session, what needs to be changed, how to change, as well as a better understanding of their own strengths and weaknesses. There are a number of advantages of using simulated patients in practicing consultation and clinical skills. The simulated patient and case scenario can be strategically designed to promote specific learning outcomes. For example, the simulated patient can portray someone who is not compliant with the clinician’s instructions, or with depression who suddenly breaks into tears in the middle of the case history taking session, or with a medically-complex condition. These simulated learning experiences provide students with opportunities to practice and learn core clinical skills as well as how to manage challenging situations or behaviours, before they see real patients in a clinical context. Moreover, students can apply clinical skills in a controlled, “risk-free” and safe learning environment.
Simulated patients have been applied successfully in developing clinical competencies in physiotherapy students (Watson et al., 2012), nursing students (Howard et al., 2011), and medical students. In speech-language pathology, simulated patients have been used for training and assessing students in range of courses such as aphasia (Edwards et al., 2000; Moineau et al., 2018; Zraick et al, 2003), fluency disorders (Penman et al., 2021; Penman et al., 2022), swallowing disorders (Sharma et al., 2011; Ward et al., 2015) and voice disorders (Rumbach et al., 2022). Incorporating simulated patients in clinical training has been regularly reported by students as encouraging and rewarding learning experiences. Students reported feeling significantly more comfortable, significant increase in confidence levels and significant decrease in perceived anxiety interacting with patients after simulation. Impacts of simulation-based learning experiences do not appear to be restricted by the mode of implementation. Similar positive outcomes were reported whether the simulation was delivered in-person face-to-face or online through telepractice (Howells et al., 2019; Sharma et al., 2011). Different speech-language pathology boards recognize the educational value of simulation in developing students’ clinical competence. Simulation is now recognised as a formal learning experience in the clinical training of SLPs in Australia, Canada and the United States, and as an approved method in contributing to students’ direct clinical practice hours.
Early introduction of opportunities to interact and practice with patients in preclinic years, provided through simulations, can help students develop their clinical competency and enhance their confidence for the later clinical placements. Most importantly, it allows students to reflect on what and how to better equip themselves for working with real patients in clinical settings. Nevertheless, the bulk of the evidence on simulations have been in the health education literature for nursing education and students (e.g., Bremner et al., 2008; Howard et al., 2011; Gore et al., 2011). There is a need for more research on the effectiveness and impacts of simulations for the SLP profession. The aim of this study was to evaluate the effectiveness of preclinical simulation-based learning experiences in reducing students’ anxiety with interacting with real patients and in enhancing their self-perceived clinical competence.