Enhancing Clinical Reasoning for Speech Sound Disorders: A Randomized Trial of Online Learning Modules

Training clinical reasoning skills remains a critical challenge in speech-language pathology education. This study aimed to evaluate the effectiveness of two cloud-based, self-directed instructional modules-diagnostic report viewing and reasoning demonstration-in enhancing students' reasoning skills for speech sound disorders (SSDs) assessment.

In a randomized between-group design, 51 undergraduate students in Taiwan were assigned to one of two video-based training modules in Mandarin. The control group viewed clinicians' presentations of diagnostic reports of SSD cases, while the experimental group watched the same reports accompanied by explicit demonstrations of clinical reasoning. Training effectiveness was evaluated using a Script Concordance Test (SCT) and self-report questionnaires on viewing experience.

Across all participants, SCT scores significantly improved from pre- to post-training (t = 2.82, p = 0.007), with no significant pre-training difference between groups. The experimental group showed significant within-group gains in diagnostic reasoning (z = -2.731, p = 0.006, r = 0.54) and total SCT scores (z = -2.623, p = 0.009, r = 0.51), though between-group comparisons of gain scores did not reach statistical significance (p = 0.31). Questionnaire responses indicated high engagement with the content for both groups. The experimental group showed a trend towards viewing the training materials in two or three segments and engaging in deeper metacognitive reflection, suggesting a potential difference in cognitive engagement patterns.

Both instructional modules improved students' clinical reasoning for SSD assessment. The demonstration-based module, which explicitly modelled expert decision-making, showed indications of additional benefits in supporting reflective clinical reasoning. Delivered through a cloud-based, self-directed format, this approach offers a scalable instructional framework applicable to broader areas of speech-language pathology education.

What is already known on the subject Training clinical reasoning skills remains a challenge in speech-language pathology education. Illness scripts-structured knowledge frameworks-help explain both analytical and non-analytical reasoning processes. Experienced clinicians rely on well-developed scripts to make accurate decisions in familiar cases, with reasoning effectiveness shaped by both script accessibility and clinical complexity. What this paper adds to existing knowledge This randomized controlled trial compared two self-directed, cloud-based instructional modules for SSD assessment. While both improved SCT scores, only the reasoning-demonstration group-designed to model expert thinking based on illness script theory-showed significant within-group gains and deeper engagement. These findings support the use of illness script-informed training as a scalable and pedagogically sound alternative to supervision-based instruction, particularly in pre-placement settings with limited faculty resources. What are the potential or actual clinical implications of this work? The clinical reasoning and decision-making modules examined in this study-featuring either explicit modeling of expert reasoning or engagement with comprehensive diagnostic reports-can address diverse learning needs and better prepare students for real-world clinical complexity. Together, these complementary instructional approaches have the potential to foster informed clinical reasoning, support effective decision-making, enhance service quality, and improve client outcomes in SSD assessment and broader speech-language pathology practice.