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JCPSLP
Volume 15, Number 2 2013
Journal of Clinical Practice in Speech-Language Pathology
ethnicity/culture and life experience among other areas
(including physical and mental health). At Nottingham
Medical School, the less significant risk factors were being
male, lower science grade at school and “not being white”.
They found that in the clinical portion of the course
“non-white ethnicity” was the most consistent predictor of
“struggling”. The researchers found these unsurprising,
“being the opposite of those factors that have been
reported to predict success” (p. 1011). They did not assess
factors such as cultural influences or communication ability
but acknowledged these as important issues in medical
education. Kay-Lambkin, Pearson, and Rolfe (2002) aimed
to observe the relationship between student background
information and academic success in the first year of
medicine at the University of Newcastle, NSW. Aboriginal,
Torres Strait Islander or overseas students had increased
academic difficulty in the first year. The need for additional
support for these students was identified. Kay-Lambkin
also recommended following the progression of these
students in later years of the course. Chew-Graham,
Rogers, and Yassin (2003) discussed the underreporting of
mental health issues by medical students. It is likely that this
is also common in other health sciences students.
Recently, many universities have made commitments to
social inclusion, including widening participation in further
education (University of Sydney, 2012). Students from
more varied backgrounds may have problems developing
their clinical competencies (Attrill, Lincoln, & McAllister,
2012), which may in turn be due to weaker oral and written
communication skills as well as cultural differences. These
students may be more likely to require supplementary
placements or additional support on placement in order to
develop the required competencies.
3. Students’ own learning skills
The learning skills of students in the health professions have
not been widely researched. Zoghi et al. (2010) surveyed
the learning style preferences of Australian health science
students; however, there were no SLP student respondents
identified.
Sharby and Roush (2009) reviewed the literature on allied
health university students with disabilities. They identified
that the most common disabilities reported by university
students, including those of allied health disciplines
(specifically physiotherapy), were learning disabilities.
These included language-based learning disabilities such
as “acquisition and use of listening, speaking, reading,
writing [and] reasoning … skills” (p. 55). As most learning
at university is language based, these students tend
to struggle, particularly in the rigorous environment of
allied health professional education. Sharby and Roush
(2009) reported that language-based learning disabilities
are deeply concerning to university staff, who feel that
accommodating specific learning needs will “diminish
academic integrity” or “compromise patient safety” (p.
55). They listed a range of behaviours of students with
learning disabilities, many of which can also be seen in
SLP students struggling to develop their clinical skills:
verbal problem-solving difficulties, over-focusing on details,
difficulty distinguishing important from less important
information, ineffective written expression including narrative
disorganisation, and cognitive inflexibility. Luhanga, Yonge,
and Myrick (2008) described similar difficulties in “unsafe”
nursing students, who were either providing unsafe care
or having “marked deficits in knowledge and psychomotor
skills, motivation, or interpersonal skills” (p. 214).
Studies from Nottingham University in the UK (Yates, 2011,
2012; Yates & James, 2006, 2007, 2010) have described in
increasing detail a range of predictors of “struggling”
medical students who have significant academic and/or
clinical difficulties. These predictors can be categorised into
three main areas: prior academic performance, the
students’ background and learning skills as shown
graphically in Figure 3.
1. Prior academic performance
The Nottingham Medical School studies (Yates & James,
2006, 2007) identified significant predictors of poor
performance to be lower school leaving exam results,
negative comments in academic references and late offer of
a place. In their 2007 study, they identify that the students
with lower school leaving results were indeed at greater risk
of failure in the first two “preclinical” years.
The limited amount of information available in SLP
comes from a small number of studies undertaken in the
USA. These studies were driven by the oversubscription of
accredited graduate programs and their need to select the
candidates most likely to develop into competent clinicians
(Forrest & Naremore, 1998). As in the Nottingham studies,
prior academic performance was identified as a predictor
of overall success for SLP students. For instance, Forrest
and Naremore (1998) sampled a small number of students
(n = 45) from four cohorts in the 1990s and reported
that the best predictor of success in a postgraduate SLP
course was undergraduate grade point average (GPA).
Somewhat surprisingly, SLP students with a major in a
subject that was not speech, language and hearing were
more successful. Halberstam and Redstone (2005) also
found that the strongest correlation associated with both
academic and clinical success was undergraduate GPA,
and that letters of recommendation were also significant
indicators. Additionally, there were weak and non-significant
correlations in the areas of age (also suggested by
Forrest and Naremore (1998) and a first language other
than English, with Halberstam and Redstone reporting
that these students were “more likely to be rated as
weak” in the research process (p. 269). Halberstam and
Redstone (2005) did not observe or describe clinical
skills development in detail, as their focus was on overall
academic and clinical success outcomes. Kjelgaard and
Guarino (2012) reviewed the records of several cohorts of
students and also found that undergraduate GPA was a
strong predictor of success.
It is difficult to apply these results to Australian SLP
programs, where selection does not generally include letters
of recommendation and there are dual entry pathways to
the profession (under- or postgraduate degrees), while the
USA has postgraduate only. It is also difficult to compare
a postgraduate program with an undergraduate program
due to the very different starting points of the students,
even though the outcome of both is qualification as a
speech-language pathologist. It may be that the results are
more applicable to SLP masters programs, depending on
admission processes. In any case, these results seem to
indicate that those students with high tertiary entry scores
are more likely to succeed overall in the degree than their
peers with lower scores.
2. Student background
The effect of students’ background on their learning has
been more widely studied in medicine than SLP and other
allied health professions. This includes their gender, age,