1. Applied clinical research Evaluation of a Quality Improvement Project in clinical education
Lynsey Parrott M.Hlth.Sci. (Sp.-Lang. Path). RegMRCSLT.MSPA.
& Esther Pettit MSc. RegMRCSLT.

2. QI model
PLAN DO
STUDY
ACT

3. Context & Problem The format of clinical exams at Marjon.
8 of 46 (21%) failed to demonstrate their clinical reasoning & professional skills at more than a satisfactory level in clinical exams (CE).
Considered “at-risk” of failing in final year.

4. Research question
Does tutorial support during year 3 enable student speech and language therapists to develop their clinical reasoning & professional skills, rated as satisfactory after year 2 clinical exams?

5. Project progression Review CE ax to identify at-risk students1
Review CE ax to identify at-risk students 2
Focus group & reflection 3
Identification & sharing of needs & reasons for low achievement

6. 4
Establish common learning objectives 5
Pilot tutorial structure, content & feedback schedules 6
Run tutorials & evaluate outcomes (including clinical exam outcomes)

7. 46 8 6 18 Student performance 0 – 39 % 40 – 49 % 50 – 59 % 60 – 69 %
70 %
Total
Fail
Satisfactory
Able
Excellent
Outstanding 46 8 6 18

8. Relevant knowledge & skills Clinical skills on placement
Student 1 2 3 4  5  6  7 8 
Relevant knowledge & skills PE
Teach/ CO
SLTA
Age 30
30+
40+
20+
Academic status
On entry
Grad. A
PTQ HE
Current academic band
2:1
2:2
Clinical skills on placement S

9. Focus group comments
“Heightened anxiety affected word finding skills”.
Challenged by “thinking on-line”.
“Difficulty understanding the questions.”
“Nervous & lacking in confidence.”
“No idea what questions would be asked”.
Lack of feedback from CE was “unsettling”.
“One-sided interrogation”.

10. Agreed learning objectives
Aims 1 2 3 4 5 6 7 8 9 10 11
N =
Aims 1 2 3 4 5 6 7 8 9 10 11
N =

11. Tutorial content 8 x 90 min sessions adhering to a set format.
On-going practice of presentation skills.
On-going practise in professional discussion.
On-line discussion on diagnosis and appraisal.
Focuses on giving & receiving feedback.
Case based discussion.

12. Theoretical components
of tutorial structure.
Underpinning successful learning is the…. “wanting (or needing), doing, feedback & digesting” (Race 2002).
Peer Assisted Learning (PAL) (Cross et al. 2006) and feedback.
Role of Facilitator rather than a Teacher.
Learning theory - “conscious-unconscious competence-incompetence” framework.
5. “thinking out aloud” (Scott 2004) skills in the development of their clinical reasoning skills.

13. P.A.L. Warmth & trust Talking Thinking Effective Group process Respect
independence
Effective
Group
process
Talking
Thinking

14. 4 stages of learning skills
Clinical competence
Unconscious incompetence
Conscious incompetence
Conscious competence
Unconsciously competent
(second nature)

15. Thinking aloud strategies
Use plain words to tell yourself what you did & why.
“Director’s commentary”
It’s okay to make mistakes.
Tell your client’s story.
Mind map your information.
Talk at your own speed.
Talk about how you felt, the jargon you knew….

16. Evaluation Completion of evaluation questionnaire Qualitative feedback
Outcomes from year 3 placement
Outcomes from year 3 clinical exam

17. Example of evaluation form
How confident do you feel now in recognising symptoms of communication disorders?
How confident do you feel now in discussing the process of differential diagnosis?
How confident are you that weekly tutorials will provide you with frequent and regular learning opportunities to improve your competency at establishing a diagnosis of communication disorders?

18. 3 - 4 3 2 - 4 3 - 5 4 2 - 5 4 - 5 4 - 6 1 Identification of signs 2
Question
Range of responses
Mean 1
Identification of signs
3 - 4 3 2
Description
2 - 4
Recognizing signs
3 - 5 4
Differential diagnosis
2 - 5 5
Confidence in tutorials
4 - 5 6
Providing feedback 7
Feedback from peers
4 - 6

19. Qualitative comments Format of tutorials
Liked the structure and predictability
Content
Worked well; change nothing
Facilitation
Very supportive; good atmosphere; positive vibe.
Input from specific clinical examiners needed.

20. Student outcome Pass 65% A 72% E 45% S 48% 40% 52% Y No ? Stud. 1 2 3
Final
CP result
Pass
Final clinical exam
65% A
72% E
45% S
48%
40%
52%
Job
status Y No ?

21. In module content Students Clinical educators Feedback schedule
Facilitators
Feedback
schedule
Thinking
aloud
Making mistakes
Peer
Assisted
Learning

22. References
Cleland, Arnold, R., & Chesser, A. (2005).Failing finals is often a surprise for the student but not the teacher: identifying difficulties and supporting students with academic difficulties. Medical Teacher. Vol. 27, no. 6, pp
Cross, V., Moore, A., Morris, J., Caladine, L., Hilton, R. & Bristow, H. (2006). The practice-based educator. London: Wiley.  
McAllister, L. & Lincoln, M. (2004). Clinical Education in Speech-Language Pathology. London, Whurr.
Murdoch-Eaton, D. & Levene, M. (2004). Formal appraisal of undergraduate medical students: is it worth the effort? Medical Teacher. Vol.26, no.1, pp. 28 – 32.
Race, P. (2002). The lecturer’s toolkit. A Practical Guide to Learning, Teaching and Assessment. U.K. Kogan Page Limited.
Rose M. & Best D. (2005). Transforming practice through Clinical Education, Professional Supervision and Mentoring. China, Elsevier.
Scott, I. (2004). ‘Teaching clinical reasoning: a case based approach’ In Higgs, J. & Jones, M. (2004). Clinical Reasoning in the Health Professions. U.K., Butterworth-Heinemann.