The qual-CAT: Applying a rapid review approach to qualitative research to support clinical decision-making in speech-language pathology practice

AbstractEvidence-based practice (EBP) is a well-established framework for supporting clinical decision making in the discipline of speech-language pathology. The benefits of using evidence to inform clinical practice are acknowledged by clinicians and researchers alike. Even so, after over two decades of EBP advocacy, much clinical uncertainty remains and models supporting the evaluation of interventions require review and reconsideration. The EBP model, while promoting positive principles, can be argued to be conceptually flawed because it suffers from a lack of attention to and explicit valuing of other forms of knowledge crucial to the formation of realistic and judiciously informed decisions. We propose that the evaluation of interventions would be better supported by an explicit knowledge management approach reflecting a range of evidence and knowledge. One worked example is presented to demonstrate what using such an approach can produce in terms of intervention information.

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The Influence of Linguistic Bias Upon Speech-Language Pathologists’ Attitudes Toward Clinical Scenarios Involving Nonstandard Dialects of English

American Journal of Speech-Language Pathology ◽

10.1044/2021_ajslp-20-00382 ◽

2021 ◽

pp. 1-17

Author(s):

Catherine Easton ◽

Sarah Verdon

Keyword(s):

Decision Making ◽

Service Provision ◽

Clinical Decision Making ◽

Linguistic Diversity ◽

Clinical Decision ◽

Assessment Tools ◽

Speech Language Pathology ◽

Speech Language Pathologists ◽

Clinical Scenarios ◽

Language Pathology

Purpose Variation within languages, including dialects, takes on an indexical function, marking belonging and connection. Meanwhile, attitudes toward these speech varieties become marked by linguistic bias. Within the speech-language pathology profession, research evidence, assessment tools, and intervention programs have largely been designed for and by the White, English-speaking middle class. As such, linguistic bias with a preference for standardized dialects is prevalent in the training and practice of the speech-language pathology profession, resulting in discriminatory and racialized practices. Method To investigate the influence of linguistic bias upon speech-language pathologists' (SLPs') clinical decision making, data were collected from 129 Australian SLPs via an online survey. Inferential statistics were used to investigate the relationship between clinical decision making and SLPs' attitudes toward nonstandard dialects as well as personal and professional factors. A content analysis of extended responses was conducted to identify themes in clinical decision making. Results SLPs with more years of experience and those who had received professional development were significantly more likely to seek out more information before making a diagnosis, while those with more negative attitudes toward linguistic diversity were significantly more likely to identify a disorder than a difference. SLPs provided a range of justifications for their clinical decision making, but few acknowledged the influence of their own attitudes and bias upon their decision making. Conclusions SLPs' linguistic bias towards speakers of nonstandard dialects has the potential to impact upon their clinical judgment of difference versus disorder and lead to inequality of service provision for speakers who do not express themselves in standardized forms. Before the profession can truly move toward an antiracist approach of equitable service provision for all, SLPs must engage in critical self-reflection to disrupt the adherence of the speech-language pathology profession to standardized “White” norms of communication.

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Clinical Decision-making in Speech-Language Pathology Graduate Students: Quantitative Findings

10.30707/tlcsd2.1dudding ◽

2018 ◽

Vol 2 (1) ◽

Author(s):

Carol C. Dudding ◽

◽

Danika L. Pfeiffer ◽

Keyword(s):

Decision Making ◽

Graduate Students ◽

Clinical Decision Making ◽

Clinical Decision ◽

Speech Language Pathology ◽

Language Pathology

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How To Practice “Undefensively”

Perspectives on Gerontology ◽

10.1044/gero15.2.54 ◽

2010 ◽

Vol 15 (2) ◽

pp. 54-64 ◽

Cited By ~ 2

Author(s):

Paula Leslie ◽

Kate Krival

Keyword(s):

Decision Making ◽

Best Practice ◽

Clinical Decision Making ◽

Clinical Decision ◽

Evidence Based ◽

Speech Language Pathology ◽

Speech Language Pathologists ◽

Internal Resources ◽

Language Pathology ◽

Decision Making Processes

Speech-language pathologists (SLPs) are increasingly challenged by the medical complexities our patients present and gripped by the fear of litigation, if patients decline physically under our care. One response to these pressures may be to practice defensive medical speech-language pathology. We propose that best practice is ethically achieved by deliberately using specific external and internal resources to practice undefensively. We suggest how consideration of these materials and processes will help SLPs ensure evaluation and clinical decision-making processes are as effective, evidence-based, and transparent to patients, caregivers, administrators, and payers as possible.

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Conscious Clinical Education: The Evidence-Based Education—Clinical Education Model

Seminars in Speech and Language ◽

10.1055/s-0040-1713779 ◽

2020 ◽

Vol 41 (04) ◽

pp. 279-288

Author(s):

Mark DeRuiter ◽

Sarah M. Ginsberg

Keyword(s):

Clinical Education ◽

Teaching And Learning ◽

Clinical Decision Making ◽

Graduate Programs ◽

Clinical Decision ◽

Evidence Based ◽

Speech Language Pathology ◽

Clinical Educators ◽

Language Pathology ◽

Education Model

AbstractThe fields of speech-language pathology and audiology, collectively referred to as communication sciences and disorders, are driven by evidence-based practice (EBP). As accountability in clinical service delivery continues to increase, there are few who would argue that encouraging clinicians to engage in methods that have withstood the rigors of peer-review is the wrong approach. Graduate students are typically given many opportunities to learn about the evidence for their discipline, and graduate programs are required to provide these opportunities under accreditation standards. While EBP is critical to our discipline's clinical function, we assert that evidence-based education (EBE) is equally as important as EBP to our discipline's function in educating our students. This article discusses EBP and EBE with a focus on elements that may not have been considered in the past, particularly within the complex dynamic of the EBE and clinical education interface. We present current and proposed models, including a new model of EBE in clinical education. We share insights into how the new and proposed models fit within the broader context of clinical decision making and the scholarship of teaching and learning. We conclude by addressing future needs for the education of clinical educators.

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Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing shoulder pain in Alberta, Canada

BMC Family Practice ◽

10.1186/s12875-021-01544-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Breda H. F. Eubank ◽

Sebastian W. Lackey ◽

Mel Slomp ◽

Jason R. Werle ◽

Colleen Kuntze ◽

...

Keyword(s):

Primary Care ◽

Decision Making ◽

Shoulder Pain ◽

Clinical Decision Making ◽

Clinical Decision ◽

Primary Care Providers ◽

Rapid Review ◽

Diagnosis And Management ◽

Joint Health ◽

Decision Making Tool

Abstract Background Shoulder pain is a highly prevalent condition and a significant cause of morbidity and functional disability. Current data suggests that many patients presenting with shoulder pain at the primary care level are not receiving high quality care. Primary care decision-making is complex and has the potential to influence the quality of care provided and patient outcomes. The aim of this study was to develop a clinical decision-making tool that standardizes care and minimizes uncertainty in assessment, diagnosis, and management. Methods First a rapid review was conducted to identify existing tools and evidence that could support a comprehensive clinical decision-making tool for shoulder pain. Secondly, provincial consensus was established for the assessment, diagnosis, and management of patients presenting to primary care with shoulder pain in Alberta, Canada using a three-step modified Delphi approach. This project was a highly collaborative effort between Alberta Health Services’ Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI). Results A clinical decision-making tool for shoulder pain was developed and reached consensus by a province-wide expert panel representing various health disciplines and geographical regions. This tool consists of a clinical examination algorithm for assessing, diagnosis, and managing shoulder pain; recommendations for history-taking and identification of red flags or additional concerns; recommendations for physical examination and neurological screening; recommendations for the differential diagnosis; and care pathways for managing patients presenting with rotator cuff disease, biceps pathology, superior labral tear, adhesive capsulitis, osteoarthritis, and instability. Conclusions This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of shoulder pain, and assist in clinical decision-making for primary care providers in both public and private sectors.

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Cultural Proficiency: Supporting the Development of Cultural Competence in Mentoring Relationships

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp1.sig14.104 ◽

2016 ◽

Vol 1 (14) ◽

pp. 104-115 ◽

Cited By ~ 1

Author(s):

Nathan Cornish ◽

Melissa White

Keyword(s):

Cultural Competence ◽

Clinical Decision Making ◽

Cultural Proficiency ◽

Clinical Decision ◽

Mentoring Relationships ◽

Speech Language Pathology ◽

Language Pathology ◽

Potential Impact ◽

Linguistic Influences ◽

Culturally Proficient

The American Speech-Language-Hearing Association's (ASHA's) Strategic Pathway to Excellence calls for increased cultural competence of association members (ASHA, 2016a). This objective, fueled by a longstanding recognition of the need to educate ASHA members about the influence of culture and language on assessment and intervention (ASHA, 1985, 2004), has resulted in a greater number of resources for acquiring these knowledge and skills. However, little has been written about how mentors can facilitate the development of cultural competence among new and future professionals. In order to share this knowledge, mentors must exercise “cultural proficiency” (ASHA, 2016b). Culturally proficient mentors demonstrate an awareness of the variables that exist between the mentor and mentee as well as the clinician and client. They work strategically to help mentees develop their own awareness of cultural and linguistic influences, and apply this during clinical decision making. This article explores the critical need for cultural proficiency in mentoring relationships with our students and clinical fellows, methods for exercising cultural proficiency, and its potential impact on service provision in speech-language pathology and audiology.

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Three Speech-language Pathology Graduate Programs, One Model: Using Systematic Instruction to Develop Students’ Clinical Decision-making Skills

Teaching and Learning in Communication Sciences & Disorders ◽

10.30707/tlcsd5.1.1624982519.497197 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Bryan Ness ◽

Therese O'Neil-Pirozzi ◽

Peter Meulenbroek

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Assessment Tool ◽

Communication Disorders ◽

Clinical Decision ◽

Systematic Instruction ◽

Student Knowledge ◽

Educational Approach ◽

Language Pathology ◽

Based Instruction

To prepare graduate students to implement evidence-based practice effectively, educators must integrate instruction on rational clinical decision-making into course curricula. Three faculty members at different universities adopted an educational approach derived from the Rehabilitation Treatment Specification System (RTSS) to teach and assess clinical decision-making in the context of treating acquired cognitive-communication disorders for people with traumatic brain injury. Using treatment theory illustrated in the RTSS, the authors piloted instruction and assessment materials to examine potential usefulness of the approach and effects on student knowledge and confidence in clinical decision-making. The results indicated that the instructional approach effectively bolstered students’ knowledge of and confidence implementing memory-based cognitive-communication intervention. Additionally, using a case-based assessment tool, the authors were able to measure how students modified treatment activities in response to different contextual variables. Implications and suggestions for implementing theory-based instruction in graduate education are discussed.

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Guided Online Case Scenarios Support Development of Clinical Decision-Making Skills in Speech-Language Pathology Master’s Students

Teaching and Learning in Communication Sciences & Disorders ◽

10.30707/tlcsd4.2/zhvo5761 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

Krystal Werfel ◽

Gabriella Reynolds

Keyword(s):

Teaching And Learning ◽

Clinical Decision Making ◽

Clinical Decision ◽

Speech Language Pathology ◽

Master's Students ◽

Aural Rehabilitation ◽

Self Reflection ◽

Language Pathology ◽

Flipped Classrooms

Flipped classrooms are increasingly recommended by scholars of teaching and learning, and some have argued that active learning is the key ingredient in this model’s success. This paper describes the creation and implementation of online guided case study scenarios using the test function of a learning management system, as well as evaluation of their effectiveness based on (a) performance of students on separate graded case study assignments and (b) student self-reflection of learning and feedback elicited in an end-of-course survey. The case studies were developed for use in a master’s level speech-language pathology course on aural rehabilitation that occurs during the summer semester.

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Beyond the Big Screen: Avatars Prepare Graduate Students for Real-World Practice

Perspectives on School-Based Issues ◽

10.1044/sbi11.2.50 ◽

2010 ◽

Vol 11 (2) ◽

pp. 50-55 ◽

Cited By ~ 1

Author(s):

Stacy Williams ◽

Linda R. Schreiber

Keyword(s):

Real World ◽

Best Practice ◽

Clinical Decision Making ◽

Clinical Decision ◽

Virtual Simulation ◽

Speech Language Pathology ◽

Web Based ◽

Client Data ◽

Language Pathology ◽

Virtual Simulations

Abstract This article explores the potential of virtual simulation technology in preparing university students for real-world experiences. SimuCase™, a Web-based virtual simulation application designed to support best practice in speech-language pathology, is described. The research base for learning via virtual simulations also is described. This type of simulation using case studies encourages the user to select and analyze client data to improve clinical decision-making skills in the area of assessment and supports Knowledge and Skills Assessment competencies of the American Speech-Language-Hearing Association.

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