JCPSLP Vol 15 No 2 2013

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

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.

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JCPSLP Volume 15, Number 2 2013

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