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JCPSLP Volume 15, Number 2 2013 63
to facilitate learning rather than identifying early predictors
of difficulties.
Ho and Whitehill (2009) researched the effectiveness
of two different models of supervision: immediate verbal
feedback in a group and delayed individual written
feedback (self-reflection and from the CE). Some students
in their study identified that their spoken language was
superior to their written language, which had impacted on
their feelings about and success in the written feedback
group. Joshi and McAllister (1999) also discussed
supervision styles of CEs within SLP, and mention that
most studies in the area identify that CEs do not alter their
supervisory style in response to the needs of the student
(including learning style level of experience or dependence)
even when prompted by self-critiques.
The possibility that students have learning difficulties
rather than simply different learning styles was not
considered in these studies. Further research in this area
is essential to fully understand the underlying needs of
these vulnerable students and to plan effective support
mechanisms for them where possible.
Identification of students with
marginal clinical skills
The underlying communication, reasoning and thinking skills
of SLP students have rarely been researched. Most of the
literature discusses both clinical and academic learning. It
seems that it has been assumed that all prequalification SLP
students have excellent skills in these areas. This is unlikely
to be the case for “traditional” students and with present
university commitments to social inclusion it is less likely.
Yates (2011) described a “toolkit” of predictors to identify
these marginal medical students – these are: failure in three
or more academic modules, a low overall pass mark in the
early years, poor attendance at meetings or compulsory
teaching, unprofessional behaviour, health or social
problems and failure to complete compulsory vaccination
schedules on time. They suggest that using a combination
of markers is likely to give a more accurate prediction of
overall success on the course than academic results alone.
We believe that this approach would be easily transferable
to identifying similar predictors in SLP students.
Limitations
This paper highlights the lack of research into the influence
of student characteristics on clinical success or failure. It is
possible that a systematic review may identify further
studies. However, this was beyond the scope of this review
and our search was comprehensive. Further investigation
and research in the areas discussed is clearly warranted.
Conclusion
There is a range of literature regarding clinical education in
SLP and other health sciences. This material mainly addresses
the academic and clinical education variables that are in the
control of the universities. The literature rarely discusses the
students’ own skills or attempts to identify predictors of
successful clinical learning. Early identification of students
at high risk of failing clinical placements would allow their
learning to be better supported. It is hoped that the additional
learning support will reduce the number of students who fail
clinical placements. In addition, the interventions used with
these students could be reviewed and their efficacy
assessed. Further research is needed to help SLP
programs identify and support these marginal students.
There are no published studies to date regarding
language-based learning disabilities in SLP students. Given
the high level of verbal and written communication skill
required to be a competent speech pathologist, it may
be that such language-based learning disabilities would
present a more significant barrier to achieving clinical
competence in our field. Further research in this area is
warranted to discover if this is the case.
Shapiro et al. (2002) described the prevalence of
marginal students in American Speech Hearing Association
accredited graduate programs as around 8% and
discussed the significant impact this small proportion
of students has on the process of clinical education.
The prevalence of these difficulties in undergraduate
prequalification SLP courses is not known nor are the
markers identifying such students known. A small number
of studies (Dowling, 1985; Nemeth and McAllister, 2010)
have described a range of characteristics of marginal SLP
students. These characteristics include interpersonal,
written/verbal communication and cognitive difficulties and
reflect those of students with language learning disabilities
described by Sharby and Roush (2009).
There is a consensus that all health professionals need
effective communication skills (Australian Physiotherapy
Council, 2006; Clouten et al., 2006; Sharby & Roush, 2009).
For SLPs, there is arguably an even greater requirement of
proficiency in both verbal and written communication skills
(Speech Pathology Australia, 2011) as they need to be able
to communicate clearly with others about communicating
– and many of these others are clients who may have
significant communication difficulties. In clinical interactions,
speech language pathologists must be able to 1) understand
and synthesise information which may not be presented
clearly, 2) quickly compare this with literature and their own
clinical experience, then 3) translate essential points into
language the client will understand. All speech-language
pathologists must be able to use these very high-level
communication skills in order to be competent as clinical
specialists in the area. The first author worked with
communication impaired adolescents for many years and
now works as a full-time clinical educator (CE). Her clinical
impression is that some SLP students fail clinical placements
due to high-level communication difficulties. We need to
understand whether these difficulties do in fact contribute to
poor performance on clinical placements. This would provide
a useful addition to a toolkit aiming to identify students who
are likely to struggle in clinic as early as possible.
Skills of educators/supervision
styles
There is a wide range of literature discussing the skills of
clinical educators in nursing and SLP literature. In SLP, this
makes up a large proportion of the current literature around
clinical learning.
Luhanga et al. (2008) referred to the distressing (to
both CE and student) nature of providing clinical teaching
to “unsafe” nursing students. As in SLP, these marginal
students were identified through observation and close
monitoring by the CE, usually early in the placement. The
CE then sought additional support from academic staff at
the university and from colleagues, and the concerns were
discussed with the student. Hopkins (2008) described the
importance of early identification of potential barriers to
learning in an associate nursing degree and monitored the
students closely during one first-semester subject (of a four-
semester degree). Both of these papers discuss strategies