Supervising ComputerBased Simulations Effectively and Efficiently Clint Johnson

Supervising Computer-Based Simulations Effectively and Efficiently Clint Johnson, M. A. , CCC-SLP, CHSE

Clint Johnson, M. A. , CCC-SLP, CHSE • • Financial Disclosures: Vice President of Simucase Education Nonfinancial Disclosures: None Certified Healthcare Simulation Educator (SSIH) 25 years of experience, including 13 years in educational publishing and software development • Supervises clinical simulations at four universities

Simulation based education John O’Donnell Dr. PH, CRNA

Benefits of Simulations • Opportunity to bridge the gap from classroom to clinic • A safe learning environment – opportunity for repeated practice to learn from mistakes • Guaranteed exposure to low incidence populations and opportunity to earn clock hours in those areas • Technical and non-technical skills training • Opportunity for confidence building and reflective practice • Equitable Learning opportunities (Gaba, 2004, Ker & Bradley, 2014)

Challenges of Incorporating Simulations � � � Time to prepare simulation scenarios The cost of establishing a simulation laboratory Scheduling issues surrounding simulations Learning to use new technologies Coordinating experiences with other disciplines Bethea, Castillo, & Harvison (2014)

Benefits of computer-based simulations ● ● ● Simulations are repeatable and can be accessed 24/7 The simulation scenarios are already created with new cases added regularly Can be designed to teach complete processes (e. g. , evaluation and treatment protocols) and/or teach specific skills (e. g. , use of adaptive devices, administration of standardized test, documenting plan of care) Feedback and Scoring algorithms are built into the system Supervision is typically asynchronous Reporting systems identify students’ strengths and weaknesses

Simucase tele-supervision program � Collaborate with clinical director/program director to create a syllabus that meets the goals and objectives for a particular course or clinical practicum � Provide students the opportunity to earn up to 30 hours in a semester � Facilitate implementation and training � Conduct all pre-brief and debrief sessions � Track and approve clinical clock hours � Rating student competencies for targeted ASHA standards and providing evaluations

Simucase Demonstration

Decide on the types of simulations that would meet your goals and objectives � � � Assessments Interventions Part-Task Trainers Screens Observation video library

Complete multiple simulations on a weekly or biweekly basis � Debrief sessions are more meaningful � A majority of the part-task trainers have at least two simulations � Group cases by diagnosis (school-age language, aphasia, etc. ) � Pair cases that have similar issues (ex. Audrey, Karen, Jim, all have significant counseling issues) � Students must at least be enrolled in the courses that the simulations cover � If the debrief session is one hour, then time you are awarding can not exceed 4 hours

Simulations that may be debriefed together � Kelly (School-Age Lang/Dyslexia) and Latreece (School-age language and CAPD), Deon (Schoolage lang/ASD) � Bubby (Pediatric Feeding Assessment and Treatment � Alex and Anna (Pediatric Artic Treatment � Dora and Felix (language, multi-cultural) � Michaela and Jeannie (School age, EVT-2 admin) � Jordan, Lilly, and Alexis (Preschool, Phonological and Print Awareness Scale admin) � Karen (PPA) and Audrey (Lewy Body Dementia/Dysphagia), good one to group and discuss counseling � Paul (Broca's) and Robert (Wernicke's)

Simulations that may be debriefed together � Rob, Dave, Joseph (Adult Motor Speech) � Cameron, Hadley and Kara Lynn (Articulation and Phonology assessment, two treatment sessions) � Devin, Angie, and Felicity (Stroboscopy rating) � JJ and Duane (CELF -5 Screening) � Lebron (OWLs-2 and OPUS) � JJ and Duane (Full CELF-5) � Amy, Sarah, Colt (Voice) � Bob, Julia, Larry, Megan (CLQT+ administration) � Witten and Jonas (Early intervention) � Julie, Leah, Everett, and Jordan Z. (all AAC Evals) � Jim, Joseph, Audrey (swallowing) � Dan and Don, (Aphasia intervention)

The Big 3 are the key � Pre-brief prior to the CS � Feedback during the CS � Debrief following the CS

Prebriefing Simulation(s) � Review the Simucase platform with students to ensure they understand the technology � Introduce the clinical simulation by reviewing the referral and answer any questions prior to beginning the simulation � Tell students the number of minutes the clinical simulation is worth by using the Clinical Clock Hour Guidelines Chart � Provide them with the deadline for completing the clinical simulation � Students must reach a competency score of 90% to participate in the debriefing

Providing feedback as students complete the simulation(s) � Provide feedback prior to the due date for completing the assignment � Allow opportunities for students to ask general questions about the clinical simulation � Feedback may be directive or facilitative depending on the experience level of the students � Use the faculty dashboard to monitor student progress and identify areas of strength and weakness for discussion � Discussion boards have proven to be one of the best ways to provide feedback, but you can also use email, phone, etc.

Debriefing simulation(s) � Students must receive a 90% competency score to particpate in the debrief session. � Students should come prepared to, “Tell their client’s story. ” � Identify the areas where the students excelled any areas of weakness � Spend 15 minutes per clock hour debriefing (ex: if a simulation is worth 60 minutes, you would debrief for at least 15 minutes) � Include a written assignment for larger groups. � Review what was learned during the simulation and highlight how this information might be applied to the clients they see in the future

Debrief Questions for Kelly’s Case (found in the faculty Debrief questions are provided in the answer key guide for every simulation) ● ● ● What impact can a language disorder have on classroom performance? What is the relationship of a language-learning disorder and a reading disability? Review cognitive and achievement test results. Discuss the phonological and orthographic components of dyslexia. Does Kelly exhibit one or the other, or both? Expand upon the recommendations for Kelly. What would be some of your long and short term goals? Compare and contrast Kelly and Latreece (if you choose to have students to complete paired cases).

Fire up the debrief session! Facts – Does the student know the facts of the simulation? Interpretation – Did they understand the facts and how they related to the patient? Do they understand the emotional components of the simulation? Reflection – Is the student able to answer why questions about specific choices made during the simulation? Expansion – Are they able to reflect upon their performance and apply it to their future clinical Practice? Adapted from Tanner’s Model for Clinical Judgment (2006); Johnson and Ondo (2019)

Student expectations during the simulation practicum � � � Reach out to your supervisor if you need assistance or have questions All simulations should be completed by 12 am EDT the day before the debrief session Expect to answer questions about the simulations throughout the debrief. You may bring your final reports to the debrief session You will need to have your camera and mic on during the sessions. Please do not attend in a noisy environment. The debrief sessions will typically last an hour: � Review the completed simulations � Prebrief the next simulations that will be due � Award hours and enter in CALIPSO/Typhon, etc. � Hours must be entered within 24 hours or they will not be counted

Recording hours in CALIPSO � Add Simucase as an off-site clinical placement � Choose Clinical Simulation as the Clinical Setting � Have students enter hours just as you would normally � Supervision is 25% � Record the completed simulations in the note box

Telesupervision Summer of 2019 Sample Syllabus Dates Week Simucase Clients Hours May 13 -19 1 Intro to Simucase May 20 -26 2 CLQT+ Larry, Bob 2: 45 May 27 -June 2 3 CLQT+ Megan, Julia 2: 45 June 3 -9 4 Robert, Paul, 4: 00 June 10 -16 5 OUT 2: 00 June 17 -23 6 Karen, Steven 2: 00 June 24 -30 7 Joseph, Dave 2: 30 July 1 -7 8 Rob, Julie 3: 15 July 8 -14 9 Sarah, Amy 3: 15 July 15 -21 11 Fiona 1: 30 July 22 -28 12 Jim, Audrey 2: 30 26: 30: 00 � 5 universities participated in the telesupervision program � 106 total students � Four clinical supervisors � Two administrative assistants tracked scores on simulations � Students were divided into sections of 10 -14 students � On average, they earned between 25 -30 hours

Telesupervision survey � 28 students participated in telesupervision at two universities � Supervision for one group was provided for 11 weeks and the other was 6 weeks � Both universities were online programs � Zoom teleconferencing software was used � 24 surveys were returned � Surveys were anonymously submitted � Attendance was mandatory; if an emergency occurred and a student could not attend, they completed a written debrief

Survey results - 5 point scale ranging from strongly disagree to strongly agree 1. I enjoyed participating in a virtual clinical practicum: 4. 2 2. I gained knowledge about various disorder areas: 4. 6 3. I gained clinical skills with patients with various speech, language and swallowing disorders: 4. 4 4. The level of clinical supervision was appropriate: 4. 6 5. The clinical supervisor was knowledgeable: 4. 7 6. The debriefing sessions helped me understand the simulation and my questions were answered: 4. 6 7. Telesupervision was commensurate with face to face supervision: 4. 3 8. Overall experience with the practicum: 4. 3

What were the biggest strengths? � � � Training on assessment instruments The variety of patients we were able to work with enabled us to gain experience in areas we may not see in our clinical practicum settings The debrief sessions helped to gather my thoughts and ask questions about the cases. It also helped to hear the perspectives of other peers on what they learned from the cases. Some of the biggest strengths were the diversity of patients offered in one place. Also, the debriefings were very educational and the students were encouraged to apply the knowledge and consider application to future clients The Simu. Case assignments have been very helpful for me when completing real-life evaluations. My supervisor was very knowledgeable and was great at further explaining the case and challenged us to think beyond the case and how this can be applied to our practice.

Any suggestions for improvement? � � � It is hard when sometimes you answer and get it wrong, and then have to redo the entire thing in order to achieve a certain % in order to pass the simulation. By, changing this option it would allow you to not feel stressed by if your choices are absolutely correct considering we are still learning. I would prefer more opportunities to administer and analyze assessments. Although I understand the importance of gathering information by asking appropriate interview questions, what I need is more exposure to assessments. Perhaps more pre briefing on the simulations assigned would be helpful for students to know exactly what the case would be about and what to keep in mind when approaching these cases (going over this in a group discussion before completing the simucase)

Questions? Clint Johnson, clint@simucase. com