Blogging about research: Confidence of speech-language pathology students regarding communicating with people with aphasia

Admittedly, I was running short of ideas on what to review this month as I haven’t been reading much while I’ve been trying to make headway on my own projects. So I was grateful to come across Tricia McCabe’s (@tricmc) tweet linking to the following paper presenting results of a questionnaire of speech pathology students on their confidence in communicating with people with aphasia.  While the content of the paper may be fairly niche, I think it’s a topic that many clinicians will empathise with.

A review of:

Finch, E., Fleming, J., Brown, K., et al. (2013). The confidence of speech-language pathology students regarding communicating with people with aphasia. BMC Medical Education, 13:92.

Premise of the article

Communicating with people with aphasiaThe article begins by outlining the familiar sentiments that aphasia is a condition that has limited public awareness and that people with aphasia encounter participation restrictions as a result of difficulties in communicating with people who are generally unable to communicate effectively with people with aphasia. It There is then evidence cited that has suggested that practicing speech pathologists are not always able to effectively communicate with people with aphasia. The article then leads quite naturally to its main question of investigating how confident speech pathology students are in their ability to communicate effectively with people with aphasia.

This is an important question as essentially, the research presented here is also asking the question of ‘how effective is theoretically-based teaching on assessment, diagnosis and intervention management in preparing students for actually interacting with people with aphasia?’ This is an important issue to consider, as by graduation, speech pathology students are expected to meet certain occupational standards whereby they can communicate effectively with a range of people including their clients. Naturally, clinical placements are the natural complement to classroom-based learning but as the authors highlight: students undertaking speech pathology degrees rarely, if ever receive equivalent amounts of experience in all areas of speech pathology, even in those areas which may be considered more ‘core’ or representative of a general clinical caseload (if such a thing exists). Even if students receive the same total hours working with people with aphasia, the fact that they are will be working with different clients will mean that their clinical skills will be honed in different ways. This suggests that while students may generally meet a certain standard of communication skills upon graduation, there will be occasions where new (or even more experienced) clinicians struggle to effectively communicate with people with aphasia.  The importance of this being that once in the real-world of speech pathology, there will be limited opportunities to undertake further formal training to enhances one’s own communication and that skills will be more or less developed ‘on the job’. Following this through, there is also the likelihood that clinicians will be required to deliver training to other people on how to effectively communicate with people with aphasia (e.g. family, carers, other health professionals, and so on). So while it’s not quite a situation of ‘the blind leading the blind’, it does lead to a semi-ironic situation where people who may not be wholly confident or skilled in communicating with people with aphasia, will be offer guidance on how best to communicate with people with aphasia. This is not to suggest that the new clinician will be incapable of maintaining a conversation with all clients they come across, but as we know, there’ll always be those clients who are more ‘difficult’ for one reason or another for want of a better term. Such clients will always exist and they’ll always be a test of the clinician’s abilities to facilitate communication, however, the point is that confidence in one’s own ability can go a long way in actually facilitating communication effectively.

Methods

Essentially, the research conducted a brief questionnaire of speech pathology students who had reached a certain point in their degree. This point being where they had received classroom-based teaching on aphasia but had yet to experience clinical placements with people with aphasia. Both undergraduates and graduate entry students were included and a total of 49 students completed the survey.

The questionnaire consisted of three sections. Section 1 required participants to give brief demographic information including information about their current level of experience in communicating with people with aphasia. Section 2 probed participants’ perceptions of their skills by asking them to rate their overall confidence in their ability to communicate with people with aphasia. This was done using a visual analogue scale ranging from 0 (not very confident) to 100 (very confident). Section 3 probed participants’ knowledge by asking them to offer suggestions of ‘specific strategies that could be used in clinical settings to assist communication between health professionals and people with aphasia’.

Results

The results themselves are fairly easily reported and provide evidence to support the working hypothesis that in general, speech pathology students lack confidence in their ability to communicate with people with aphasia.

Confidence ratings of speech pathology students in their ability to communicate with people with aphasia

Finally, participants offered a median of four strategies to facilitate communication with people with aphasia. There were some strategies for facilitating communication that were more frequently reported than others. These popular responses included supporting communication with the use of images, writing down key words, the use of gesture, and slowing the rate of speech.

Discussion

The article closes with discussion around the implications of such results. The discussion itself opens with the succinct and sobering summary statement:

 “SLP students in the present study did not report high levels of confidence at the prospect of communicating with PWA, despite having completed academic coursework about aphasia”

If you follow this to its natural conclusion this suggests that theoretical teaching is not effective in preparing students for actually talking to people with aphasia. There is obviously the argument that this would depend on exactly how the theory is taught and whether there are more practical components incorporated into subject teaching. As a subject coordinator of a subject covering aphasia, I would comment that it would be highly desirable to guarantee that such elements are included as they often help to place the theory into context. However, often the restrictions of the hours available means that teaching has to be very focused on the precise learning outcomes and how these are assessed and these are not always very conducive to working towards development of more clinical-type skills. However, the authors do also comment that if more is done to prepare students prior to undertaking clinical placements, then students will be freer to focus on development of other vital skills such as clinical reasoning:

 “Ensuring students have confidence and knowledge of a range of potential communication strategies to assist in basic communication with PWA might alleviate students’ focus on developing foundation level interpersonal communication during clinical placements and allow the students to instead maximize their learning experiences in more specific clinical domains; such as clinical reasoning”

Again, for my part: I often refer students to a particular chapter entitled Facilitating communication in the book ‘Beyond Aphasia: Therapies for Living with Communication Disability’ by Carole Pound and colleagues. I generally find this a very informative and readable overview of various methods and I suggest this to students in the hope that they will have some point of reference when the time comes to actually apply their clinical skills with such clients. While there are many other good sources of information out there, this just tends to be my default preference and has been since I first picked it up myself.

Ultimately, one of the main conclusions of the article is that it would be useful for students to receive some form of conversation-partner training prior to working with people with aphasia. This indeed seems very sensible for many reasons that should be obvious, not least in relation to the issue raised previously that clinicians will more than likely have to be the ones to deliver such training in future.

Evaluation

In general, it’s often very satisfying to be reading through an article and identify what appears to be a fairly obvious limitation only for the authors to then acknowledge this towards the end of their discussion. This is reassuring that everyone has done a good job: the authors have done a good job in acknowledging the limitations of their own research and the reader has done a good job in reading the article critically. This fairly obvious limitation is that the participants (of which there were not a huge number) were all drawn from one particular University at one particular point in time. This therefore means that caution needs to be applied before generalizing the results of the study. It would be irresponsible to assume that all speech pathology students are generally lacking in confidence when it comes to communicating with people with aphasia just based on this one study. As alluded to earlier, students’ knowledge of facilitating communication and their confidence to carry this out may be influenced by how the theoretical components have been taught and whether any practical skills activities have been incorporated into these subjects or more generally into the speech pathology course in which the subject is situated.

Another important point highlighted by the authors is that perception of one’s own abilities does not necessarily always reflect actual competence. Therefore, students who may have reported themselves to be lacking in confidence, may actually have been reasonable competent in facilitating communication with people with aphasia (they just hadn’t had the opportunity to demonstrate this to themselves). These confidence ratings may therefore be essentially reflecting a ‘fear of the unknown’.

In closing, in addition to the further research suggested by the authors, such as triangulation of student’s perceptions with actual observations of students engaged in conversation with people with aphasia, other areas to pursue may generally include replicating these types of questionnaires on a grander scale. This may include questioning students across a number of different Universities and across different countries. Such research, if conducted, may allow educators to identify the elements of speech pathology teaching that may contribute towards students having improved knowledge, skills, and self-confidence in their ability to communicate effectively with people with aphasia. And this would seem like a good thing to know.

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About chrissp1980
Currently a lecturer in speech pathology in North Queensland, Australia. I'm lecturing in acquired disorders of speech and language and also attempting to enthuse students in conducting clinically-relevant projects using principles of Evidence-Based Practice. Wish me luck!

One Response to Blogging about research: Confidence of speech-language pathology students regarding communicating with people with aphasia

  1. Pingback: Research Tuesday – September Roundup | "Talks Just Fine"

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