What do speech pathology students gain from virtual patient interviewing? A WHO International Classification of Functioning Disability and Health (ICF) analysis

2020 ◽  
pp. bmjstel-2020-000616
Author(s):  
Anna Miles ◽  
Sarah Hayden ◽  
Stephanie Carnell ◽  
Shivashankar Halan ◽  
Ben Lok

BackgroundVirtual patients have an established place in medical education but do virtual patient interviews train holistic clinicians or just diagnosticians? This study explored speech pathology students’ virtual patient interviews using WHO International Classification of Functioning Disability and Health (ICF).MethodsEighteen speech pathology students in their final year of training participated. Students interviewed virtual patients with dysphagia (swallowing difficulties) as part of their curriculum. Student questions and patient responses were coded using established ICF coding. Codes were tallied and compared under categories of body structures, body functions, activities/participation and environmental factors. Flesch Reading Ease was calculated as a measure of health literacy.ResultsConversational turns primarily focused on the ICF component—activity and participation in both student questions and virtual patient responses: 0.03% body structures, 30% body functions—swallowing, 7% body functions—associated, 43% activities/participation and 19% environmental factors. Personal factors such as gender, ethnicity, age or socio-economic situation were not mentioned by student or patient. Patients commented on social impact on self and/or family, sometimes in the absence of targeted student questions. Student and virtual patient Flesch Reading Ease scores were congruent.ConclusionSpeech pathology students naturally matched their virtual patient’s health-literacy level and asked a range of medical and daily living questions. Virtual patients readily offered social impact information to student questions. Computer science: healthcare teams should consider creating virtual patients who challenge students to practise asking sensitive questions and in doing so develop holistic thinkers with competent communication skills.

2014 ◽  
Vol 28 (1) ◽  
pp. 2-23 ◽  
Author(s):  
Allison R. Fleming ◽  
Michael J. Leahy

Researchers and policy makers have proposed that quality of life (QOL) is an important and useful way to measure the impact of services, although practical application of QOL in rehabilitation has been limited. In this study, a comprehensive framework (the International Classification of Functioning [ICF]) is used to compare the relationship between QOL and function in key life areas in a sample of adults with disabilities receiving vocational services (n = 224). Results of a multiple regression analysis indicated that level of education, duration of disability, difficulty with social relationships and inclusion, the impact of the disability or health condition on the person or his or her family, and relational support and attitudes of family, friends, and acquaintances showed significant relationships with QOL. This study highlights the role of the social impact of disability on QOL and provides support for the use of the ICF for conceptualizing disability and its impact in a way that is inclusive of personal and environmental factors.


2022 ◽  
Vol 2 ◽  
Author(s):  
Stephanie Carnell ◽  
Anna Miles ◽  
Benjamin Lok

Previous research in educational medical simulation has drawn attention to the interplay between a simulation’s fidelity and its educational effectiveness. As virtual patients (VPs) are increasingly used in medical simulations for education purposes, a focus on the relationship between virtual patients’ fidelity and educational effectiveness should also be investigated. In this paper, we contribute to this investigation by evaluating the use of a virtual patient selection interface (in which learners interact with a virtual patient via a set of pre-defined choices) with advanced medical communication skills learners. To this end, we integrated virtual patient interviews into a graduate-level course for speech-language therapists over the course of 2 years. In the first cohort, students interacted with three VPs using only a chat interface. In the second cohort, students used both a chat interface and a selection interface to interact with the VPs. Our results suggest that these advanced learners view the selection interfaces as more appropriate for novice learners and that their communication behavior was not significantly affected by using the selection interface. Based on these results, we suggest that selection interfaces may be more appropriate for novice communication skills learners, but for applications in which selection interfaces are to be used with advanced learners, additional design research may be needed to best target these interfaces to advanced learners.


2020 ◽  
Vol 51 (4) ◽  
pp. 914-938
Author(s):  
Anna Cronin ◽  
Sharynne McLeod ◽  
Sarah Verdon

Purpose Children with a cleft palate (± cleft lip; CP±L) can have difficulties communicating and participating in daily life, yet speech-language pathologists typically focus on speech production during routine assessments. The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY; World Health Organization, 2007 ) provides a framework for holistic assessment. This tutorial describes holistic assessment of children with CP±L illustrated by data collected from a nonclinical sample of seven 2- to 3-year-old children, 13 parents, and 12 significant others (e.g., educators and grandparents). Method Data were collected during visits to participants' homes and early childhood education and care centers. Assessment tools applicable to domains of the ICF-CY were used to collect and analyze data. Child participants' Body Functions including speech, language, and cognitive development were assessed using screening and standardized assessments. Participants' Body Structures were assessed via oral motor examination, case history questionnaires, and observation. Participants' Activities and Participation as well as Environmental and Personal Factors were examined through case history questionnaires, interviews with significant others, parent report measures, and observations. Results Valuable insights can be gained from undertaking holistic speech-language pathology assessments with children with CP±L. Using multiple tools allowed for triangulation of data and privileging different viewpoints, to better understand the children and their contexts. Several children demonstrated speech error patterns outside of what are considered cleft speech characteristics, which underscores the importance of a broader assessment. Conclusion Speech-language pathologists can consider incorporating evaluation of all components and contextual factors of the ICF-CY when assessing and working with young children with CP±L to inform intervention and management practices.


2008 ◽  
Vol 13 (1) ◽  
pp. 1-12
Author(s):  
Christopher R. Brigham ◽  
Robert D. Rondinelli ◽  
Elizabeth Genovese ◽  
Craig Uejo ◽  
Marjorie Eskay-Auerbach

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, was published in December 2007 and is the result of efforts to enhance the relevance of impairment ratings, improve internal consistency, promote precision, and simplify the rating process. The revision process was designed to address shortcomings and issues in previous editions and featured an open, well-defined, and tiered peer review process. The principles underlying the AMA Guides have not changed, but the sixth edition uses a modified conceptual framework based on the International Classification of Functioning, Disability, and Health (ICF), a comprehensive model of disablement developed by the World Health Organization. The ICF classifies domains that describe body functions and structures, activities, and participation; because an individual's functioning and disability occur in a context, the ICF includes a list of environmental factors to consider. The ICF classification uses five impairment classes that, in the sixth edition, were developed into diagnosis-based grids for each organ system. The grids use commonly accepted consensus-based criteria to classify most diagnoses into five classes of impairment severity (normal to very severe). A figure presents the structure of a typical diagnosis-based grid, which includes ranges of impairment ratings and greater clarity about choosing a discreet numerical value that reflects the impairment.


2014 ◽  
Vol 19 (5) ◽  
pp. 13-15
Author(s):  
Stephen L. Demeter

Abstract A long-standing criticism of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) has been the inequity between the internal medicine ratings and the orthopedic ratings; in the comparison, internal medicine ratings appear inflated. A specific goal of the AMA Guides, Sixth Edition, was to diminish, where possible, those disparities. This led to the use of the International Classification of Functioning, Disability, and Health from the World Health Organization in the AMA Guides, Sixth Edition, including the addition of the burden of treatment compliance (BOTC). The BOTC originally was intended to allow rating internal medicine conditions using the types and numbers of medications as a surrogate measure of the severity of a condition when other, more traditional methods, did not exist or were insufficient. Internal medicine relies on step-wise escalation of treatment, and BOTC usefully provides an estimate of impairment based on the need to be compliant with treatment. Simplistically, the need to take more medications may indicate a greater impairment burden. BOTC is introduced in the first chapter of the AMA Guides, Sixth Edition, which clarifies that “BOTC refers to the impairment that results from adhering to a complex regimen of medications, testing, and/or procedures to achieve an objective, measurable, clinical improvement that would not occur, or potentially could be reversed, in the absence of compliance.


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