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

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.

scholarly journals Moving Beyond Traditional Understandings of Evidence-Based Practice: A Total Evidence and Knowledge Approach (TEKA) to Treatment Evaluation and Clinical Decision Making in Speech-Language Pathology

2019 ◽  
Vol 40 (05) ◽  
pp. 370-393 ◽  
Author(s):  
Arlene McCurtin ◽  
Carol-Anne Murphy ◽  
Hazel Roddam
Keyword(s):  
Decision Making ◽  
Explicit Knowledge ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Total Evidence ◽  
Management Approach ◽  
Evidence Based ◽  
Speech Language Pathology ◽  
Language Pathology

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.

scholarly journals Enhancing Student Knowledge of Diabetes through Virtual Choose Your Own Adventure Patient Case Format

Pharmacy ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 87
Author(s):  
Tyler Marie Kiles ◽  
Elizabeth A. Hall ◽  
Devin Scott ◽  
Alina Cernasev
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Diabetes Management ◽  
Group Discussion ◽  
Clinical Decision ◽  
Pharmacy Students ◽  
Patient Case ◽  
Student Knowledge ◽  
Innovative Teaching ◽  
Significant Difference

Educational strategies to teach pharmacy students about diabetes are necessary to prepare future pharmacists to manage complex patients. The Choose Your Own Adventure (CYOA) patient case format is an innovative activity that presents a patient case in an engaging way. The objectives of this study were (1) to describe the development of the innovative teaching activity and (2) to assess its effect on student knowledge and confidence in outpatient management of diabetes. The CYOA patient case activity was designed by transforming a traditional paper patient case involving outpatient diabetes management into an interactive format utilizing an online platform. The activity was conducted with 186 second-year pharmacy students in a skills-based course. This activity was administered virtually through a combination of small group work and large group discussion. After completion of the activity, students completed an online self-assessment questionnaire. Of 178 completed questionnaires, there was a statistically significant difference in students’ self-ratings after versus before the activity for all survey items (p < 0.001). The CYOA activity improved self-reported knowledge of outpatient diabetes management and increased self-reported confidence in clinical decision-making skills. This format shows promise as an educational tool that may be adapted for other disease states to enhance clinical decision-making skills.

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

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.

The Readiness to Change for Bariatric Surgery Assessment Tool: Validity, Factor Structure, and Reliability

2017 ◽  
Vol 31 (4) ◽  
pp. 393-401
Author(s):  
Susan M. S. Carlson
Keyword(s):  
Bariatric Surgery ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Assessment Tool ◽  
Readiness To Change ◽  
Clinical Decision ◽  
Obesity Research ◽  
Bariatric Patients ◽  
Diet And Lifestyle ◽  
Decision Making Tool

Background and Purpose: Currently, there is no guideline or standard of practice for performing the psychiatric/psychological evaluation that is a requirement for approval for bariatric surgery. The Readiness to Change for Bariatric Surgery Assessment Tool (RCB-SAT) establishes a means for psychiatric evaluators to objectively assess the patient’s cognition, beliefs, and motivation around the bariatric diet and lifestyle changes. Development of a clinical decision-making tool for assessing readiness to change in bariatric patients will be useful regarding The Strategic Plan for NIH Obesity Research. The strategic plan outlines 6 overarching themes, with the last 3 centering around creation of such a clinical decision-making tool to assess a bariatric patient’s readiness to change: evaluate promising strategies for obesity prevention and treatment in real-world settings and diverse populations, harness technology and tools to advance obesity research and improve health care delivery, and facilitate integration of research results into community programs and medical practice (National Institutes of Health, 2011). Methods: The pilot tool was administered to 153 potential bariatric patients, with 61 patients completing the survey a second time. Face and content validity of the items were established through an expert review process. Results: Principle axis factoring by means of varimax rotation with Kaiser normalization identified 15 items loading on 3 factors associated with Prochaska and DiClemente’s transtheoretical model of health behavior change: precontemplation, contemplation, and action (DiClemente & Prochaska, 1998). Test–retest reliability was also established for the tool. Implications for Practice: The proposed RCB-SAT demonstrates potential for assessing a patient’s readiness to change regarding the bariatric diet and lifestyle.

How To Practice “Undefensively”

2010 ◽  
Vol 15 (2) ◽  
pp. 54-64 ◽  
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.

Family-AiD: a family-centred assessment tool in young-onset dementia

2014 ◽  
Vol 15 (3) ◽  
pp. 136-150
Author(s):  
Pamela Roach ◽  
John David Keady ◽  
Penny Bee
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Assessment Tool ◽  
Clinical Decision ◽  
Family Assessment ◽  
Content Type ◽  
Young Onset ◽  
People With Dementia ◽  
Young Onset Dementia ◽  
Family Aid

Purpose – Standards of care and care pathways for younger people with dementia vary greatly, making clinical development and service planning challenging. Staff working in dementia services identify that they use biographical knowledge of families to influence clinical decision making. This information is not collected or implemented in a formal manner; highlighting an important knowledge-practice gap. The paper aims to discuss these issues. Design/methodology/approach – The development of a family-centred assessment for use in dementia care has three core components: first, thematic development from qualitative interviews with younger people with dementia and their families; second, clinical input on a preliminary design of the tool; and third, feedback from an external panel of clinical and methodological experts and families living with young-onset dementia. Findings – The 12-item Family Assessment in Dementia (Family-AiD) tool was developed and presented for clinical use. These 12 questions are answered with a simple Likert-type scale to determine areas of unmet need and identify where families may need additional clinical support. Also included is a series of open-ended questions and a biographical timeline designed to assist staff with the collection and use of biographical and family functioning information. Originality/value – A dementia-specific clinical family assessment tool, which also collects background biographical data on family units may be a useful way to document information; inform clinical decision making; and address otherwise unmet needs. Family-AiD has potential to improve clinical care provision of people with dementia and their families. Evaluation of the feasibility and acceptability of its implementation in practice are now required.

scholarly journals the Use of Tailored Feedback to Improve Hematologist Competence and Clinical Decision Making for the Treatment of Patients with Multiple Myeloma: a Novel Web-Based Educational Solution

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3570-3570
Author(s):  
Patricia Repetto ◽  
Noopur S. Raje ◽  
Sara R Fagerlie
Keyword(s):  
Decision Making ◽  
Multiple Myeloma ◽  
Effect Size ◽  
Clinical Decision Making ◽  
Conflicts Of Interest ◽  
Clinical Problem ◽  
Clinical Decision ◽  
Patient Specific ◽  
Web Based ◽  
Based Instruction

Abstract Introduction/Background: Recent advances in the understanding and treatment of multiple myeloma (MM) have led to improvements in patient management, including stratifying patients according to disease- and patient-specific risk factors, identifying appropriate patients for autologous stem cell transplantation, selecting treatment and incorporating new therapies into practice, and managing adverse effects. Materials and Methods: An online educational program using clinical problem-based instruction methodology was developed for hematologists and posted November 30, 2015 (http://www.medscape.org/viewarticle/853712). Each patient case included interactivity in the form of clinical decision questions and knowledge assessmentquestions. Tailored feedback and potential consequences in response to clinical decision questions was provided to each learner. Learners who answered a question incorrectly on the first attempt were provided feedback without revealing the correct answer and given the opportunity to answer the question again (second attempt) [Figure 1]. To determine measurable improvements in competence and clinical decision making, first and second attempt answer choices were evaluated for the clinical decision questions. Overall effect size was calculated using Cohen's d to show the magnitude and strength of the consequence-based feedback learning method. Data were collected through February 17, 2016. Results: A total of 404 hematologists participated in the activity during the study period, and responses from 129 (those who completed all clinical decision questions) were assessed. Responses to the 6 clinical decision questions show that a range of 28% to 67% of learners answered a question correctly on the first attempt. After receiving feedback specific to each incorrect answer, there was an overall 71% relative improvement in hematologists/oncologists who answered a question correctly on the second attempt [Figure 2]. The consequence-based feedback had a large impact on hematologists' ability to make clinical decisions correctly as demonstrated by the overall effect size of d=.94. Conclusions: This study demonstrated the success of a web-based CME activity with tailored feedback to learners' responses. Participation in this activity led to large improvements in clinician knowledge and the ability to select appropriate evidence- based practice choices, which may ultimately improve outcomes of patients being treated for multiple myeloma. Disclosures No relevant conflicts of interest to declare.

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