Impact of a Novel Hybrid Computer-Based Simulation Adult Dysphagia Training on the Confidence and Clinical Knowledge of Speech-Language Pathology Graduate Students

The purpose of this project was to examine the impact of a novel hybrid computer-based dysphagia simulation training on student confidence and clinical decision-making in the area of adult dysphagia. We developed a pilot SBT database, including computer-based simulations utilizing real-life actors who simulated standardized adult patients with dysphagia. Students completed a comprehensive bedside swallowing evaluation and analysis of a videofluoroscopic swallow study (VFSS) as part of the training. We evaluated confidence and clinical decision-making through the following outcome measures: student self-rated confidence levels using a self-efficacy survey and agreement levels with our gold standard rater on clinical evaluation forms. Data for self-rated confidence were collected at three time points and organized into three composite areas (Treatment, Evaluation, and Personal & Interpersonal Skills). Clinical knowledge was measured at two time points using clinical evaluation forms, including a cranial nerve exam form, a VFSS analysis form, an Overall Impressions and Recommendations form, and the Functional Oral Intake Scale (FOIS). A repeated measures design was utilized to compare outcomes between time points. Results showed that student confidence in the evaluation, treatment, and personal and interpersonal composite areas of the self-efficacy survey increased significantly. While clinical performance for FOIS ratings and VFSS analysis did not significantly improve, ratings for the cranial nerve exam and choice of recommendations improved significantly between the first and second simulations. These results suggest that the students benefited from completing this novel hybrid computer-based SBT in dysphagia and support the use of our evidence-based methods for the development of future training approaches.