A Comparison of Simulation Modalities to Train Graduate-Level Clinical Reasoning for Clinical Swallow Evaluation

Changes in graduate-level clinical reasoning for clinical swallow evaluation were examined and compared between video simulation and standardized patient simulation training. The purpose of this study was to provide information for speech-language pathology programs to consider when integrating simulation for clinical reasoning for clinical swallow evaluation within the graduate-level curriculum to support intentional, evidence-based use of academic resources for teaching and learning.

A randomized pretest/posttest mixed-methods design was implemented to compare a video simulation training group and a standardized patient simulation training group. Stratified randomization was used to assign first-year graduate speech-language pathology students to either a video simulation (n = 15) or standardized patient simulation (n = 15) group. Before and after participating in either video simulation or standardized patient simulation, participants completed concept maps to evaluate changes in cognitive schema development for clinical reasoning and clinical vignettes to evaluate changes in clinical reasoning within a novel written case. Participants rated the design of their assigned simulation modality following the simulation using the National League for Nursing Simulation Design Scale (SDS; Student Version). Participants also provided qualitative responses to question prompts based on the Lasater Clinical Judgment Rubric following the simulation to detail clinical reasoning that was employed during the simulation.

There were no significant differences in total scores between groups for concept maps, clinical vignettes, and SDS. Within-group differences demonstrated a significant gain from pretest to posttest for concept map performance for both groups. Qualitative analysis of participant responses yielded insight into group differences in clinical reasoning development, with qualitative analysis suggesting that video simulation-based learning aligned more closely with participants' level of experience.

Both video simulation and standardized patient simulation were effective for training clinical reasoning. Video simulation may be particularly appropriate for novice learners. Given the cost of high-fidelity simulation, video simulation may be beneficial to consider for contextualized learning at the novice level followed by standardized patient simulation as students gain experience.