JCPSLP Vol 15 No 2 2013

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,

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JCPSLP Volume 15, Number 2 2013

Journal of Clinical Practice in Speech-Language Pathology