Re-Envisioning Introduction to Speech-Language Pathology

I have been teaching Introduction to Speech-Language Pathology (SPLH 571) since 1997 and had made minor adjustments over the years, but this course had not undergone a complete ‘revamp’ other than updated readings. From 2012-2016, I left the University of Kansas to return to a clinical service position. During this time, I taught two graduate courses as an adjunct faculty member at Fort Hays State University. The opportunity to build the curriculum from scratch provided an opportunity for me to critically reflect on how I thought students would best learn course content. When I returned to a clinical faculty position at KU, this new perspective led me to overhaul the goals, content, and teaching format of the course. This portfolio focuses on a broad overview of the course redesign and outlines improvements in course structure, content, and teaching.

Introduction to Speech-Language Pathology is intended for juniors and seniors majoring in Speech-Language-Hearing but in the last few years, more sophomores have begun taking the course. Enrollment for the course can range from 23-38 but is typically 28-30 students. The course is intended to teach the concepts and basic components of clinical methods in speech-language pathology.

Course Design

Prior to this course, students have taken courses on normal speech-hearing-language development and anatomy. SPLH 571 is intended to incorporate the student’s fundamental knowledge of typical communication and provide more information on:

• The profession of speech-language pathology and the requirements to practice in the United States
• A brief overview of the different types of communication disorders with more in-depth information on three common types of disorders in adults and children
• Concepts of assessment (briefly)
• Concepts of intervention including:
  • Outcomes and goals
  • Teaching strategies
  • Measurement of progress

Course Expectations

For students to be able to independently plan and implement speech-language therapy they need to understand the concepts behind treatment. This requires critical thinking and reflection throughout the treatment process. Utilizing Bloom’s Taxonomy, I created goals for the course.

At the end of this course, it is anticipated that students will be able to:

1. Have a sense of professional identity.
2. Be aware of the professional practices, issues, and responsibilities involved in the delivery of speech-language pathology services.
3. Understand the principles and practices of assessment in speech-language pathology.
4. Understand and apply the principles and practices of intervention in speech- language pathology when doing intervention planning.
5. Demonstrate a basic understanding of five major categories (child language, child speech disorders, adult language and cognition, motor speech disorders, and AAC) of communication disorders and be able to create an intervention plan (outcomes, goals, and teaching strategies) that is appropriate for each.

Achievement of course goals are assessed through individual written syntheses, feedback from clinical observations, and team projects in which students create an intervention plan based on a case study presented to them in the form of a written assessment.

The content of the course was very broad prior to its restructure. In our program, there are no courses before SPLH 571 that provide extensive information about the profession’s national governing body, the clinical side of the profession, and exposure to individuals with disorders. Currently, the content for this course is geared toward preparing students for graduate study in speech language pathology but is also essential for students seeking positions as support personnel in the areas of special education and speech-language pathology (often known as paraprofessionals). The current implementation of the course includes an increased focus on intervention concepts and application of methodology and a significantly decreased focus on assessment. In addition, the course adopted more engaged learning strategies and less lecture.

The course consists of 11 units organized by topic. Each unit consists of one to four class periods, with the methods units each consisting of four 50-minute class periods. Prior to each unit, students complete required readings and an accompanying Blackboard quiz. This facilitates student familiarity with the readings so that class time can be used to talk about the application of the content. Readings are chosen from books that review assessment and intervention concepts, as well as goal writing for nine different disorder areas. These primary readings are supplemented by selected readings that focus on professional terminology and documentation.

There are two class sessions and a lab component that meets weekly. The lab integrates the students into a clinical team that provides services to individuals who have communication disorders at the University of Kansas’s Schiefelbusch Speech-Language-Hearing Clinic.

After the initial interactive lecture within each unit, class periods focus primarily on integration of learning through application. Activities that occur in application-based learning include:

• Identification of aspects of goals in preparation for the students to write goals for hypothetical clients
• Differentiation of long-term and short-term goals
• Practice writing and reflecting on the goals in small groups or pairs and then presenting to the class
• Practice taking data on a specific skill or communicative behavior from a video or live interaction
• Paired or small group practice with identification of teaching strategies and activities to be used in intervention for a hypothetical client (video or written presentation of individual)
• Observation of a video clip with integration of class discussion about what they are observing, how it impacts communication, methods of data collection that would be appropriate, ideas for appropriate intervention strategies and discussion of rationale for each of those areas.

The students are required to do 25 hours of observation in the clinic during the semester. This allows them to see speech-language therapy being implemented. Individual students complete an observation sheet for each session they observe. In addition, based on their observations, they turn in monthly 3-2-1 Journals. The intent of the journal is to provide a space for personal reflection, growth in critical thinking skills, problem solving, and overall preparation for clinical work. Each journal requires them to identify and expand on:

• Three teaching strategies they observed
• Two sets of data that they obtained during observations
• One thing they learned in a clinical team meeting.

For each of these areas, students are encouraged to reflect on the purpose of the targeted area, how it could be applied in different contexts, and why strategies were effective or ineffective.

There are two group projects for the course. The intent is to teach collaboration and team skills and provide an opportunity to create a cohesive plan of care for the clinical treatment of an individual with a communication disorder. Students are grouped into six teams and attend clinical team meetings with the same students throughout the semester. These teams are given an assessment report for two mock clients (one with a speech disorder and one with a language disorder) and asked to create a plan of treatment. These projects are completed in the second half of the semester.

The class-based activities, discussion, lectures, involvement in team meetings, clinical observations, reflective journals, and individual synthesis are all targeting at least one aspect of a clinical method and are based on the concepts behind evidence-based intervention. It should be noted that these students have had minimal exposure to each disorder, so grading and feedback are not based on the appropriateness of the specific content of the treatment plan but on how well the components of the plan are created and how well they connect to the indicated outcome.

The purpose of the course is to provide foundational clinical skills that the students can apply across a variety of contexts and with a variety of populations in future clinical practicum experiences. My initial look at student performance and learning included a survey of small groups of students who took the course pre (n=22) and post transformation (n=15) who were in practicum at the time of the survey. There was a notable difference in their perception of preparedness after the transformation.

Observations

Observations of clinical treatment sessions are consistently reported to be the best learning experience of the course. I believe this is because the students can see the plans created for sessions and have discussions with faculty, student clinicians, and sometimes families. I also frequently ask students about observations they have completed that included a specific skill reviewed in class. Students are often more engaged when talking about the sessions they observed than when talking about concepts without an example to tie it to. During in-class activities and in written team projects, I notice that many ideas appear to be gleaned from the sessions they have observed, which I feel demonstrates good synthesis of the concepts and specific information being taught. Due to COVID-19, we began using an online library for observations.

3-2-1 Journals

I implemented these journals to encourage students to apply the information and concepts that we are learning through readings, lecture, class activities and discussion to the observations they are doing in the clinic. The three journals are completed in the second half of the semester when students have the necessary training to document teaching strategies, record data, and understand the type of information they should be getting from weekly clinical team meetings. The timing also coincides with the transition from primarily lecture to primarily in-class activity-based learning.

The stronger students tended to have a higher level of reflection present throughout each of the three journals. However, for an estimated one-third of the students there was significantly more depth in Journal 3 compared to Journal 1. This demonstrated increased understanding and application of the skills that we focus on during in class activities. I believe the journaling process is valuable for all students but perhaps more so for those who need more support in the process of learning how to use reflection and critical thinking to develop and apply clinical skills.

Synthesis and Team Projects

These assignments (two synthesis and two team projects) are written assignments but are diverse in terms of content. The case studies used for the project changed post revision, so the comparison is not for the same case study. However, both case studies received an A grade. My criteria for a well-written treatment plan is that someone who knows nothing about the individual’s treatment could implement it in a therapy session. When I compare team intervention projects pre and post-course revision, I notice some significant qualitative differences in the goal writing and rationale for the teaching strategies between the projects.

For example, student notes post-revision showed more context within each goal. For example, instead of “G will produce /p/ and /b/ with 60% accuracy in isolation in CV, and CVC contexts,” the post revision goal was “C will accurately produce the ‘sh’ sound in the final position in mono-syllabic words with the use of only one model across three sessions 50% of the time as judged by the clinician by the end of the semester.” The information in the second goal would allow two different people to target the goal with less variation in focus. Neither group provided a description of how they would use teaching strategies or strong definitions for most strategies. However, when considering the rationale for why they used given strategies, the post-revision group focused more on the teaching strategies and were provided greater depth with their rationale, including references.

In general, I note an improvement in their ability to write goals more effectively as the most consistent change. The team projects reflect some difficulty with integration of all of the information into a whole. I am observing greater strength with individual skills, but there is still some difficulty when applying those skills to an overarching intervention plan.

Overall, I feel that the changes made during the initial course revision improved the learning and application of the content of the course, resulting in improved preparedness for practicum experiences. Reducing content in assessment and decreasing breadth from nine to three disorder areas has allowed greater depth in the concepts, skill development, and application related to intervention. Changing the format of teaching from primarily lecture to approximately one third lecture and two-thirds application and discussion-based learning has also been significant.

In-class activities and related discussion were perceived to be much more beneficial post revision and were one of the most valuable learning opportunities. Readings and lecture were both perceived as slightly more important or moderately helpful in comparison to pre course revision, when some students perceived them as not at all helpful. Observations were consistently rated as very helpful. My interpretation of this data is that reducing lecture time and replacing it with more in-class activities and discussion had the greatest impact on the student’s perceptions of readiness for clinical practicum and on student learning in the class.

The most significant change in content was to briefly overview concepts of assessment to increase the amount of time spent on intervention concepts and skills. I believe this is the primary reason that students reported feeling more prepared for practicum post-course revision. The one area of concern is that students do not seem to have a conceptual knowledge of the “Six-steps of clinical problem solving” that were repeatedly practiced prior to the course revision. Creating a class activity focused on this and providing a mini lecture online may help with internalization and maintenance of this concept.

The in-class activities and discussion-based learning following one day of lecture within each disorder area has been a very positive change. When students were paired for in-class activities, I observed greater engagement, sharing of ideas, open discussion and problem solving. Working with a variety of individuals had the potential to increase the ability to collaborate and share ideas. In the future, I plan to initially pair students and have them create a specific component of a skill-based activity (create a short-term goal building toward a given long-term goal) and then join with another pair and integrate both goals together and reflect on how the two goals would or would not support each other. I believe this may result in greater reflection on how the portion of the activity that they are developing fits into a bigger picture (the communication plan).

The 3-2-1 Journals were a significant addition that I hoped would result in greater reflection on how content in the classroom could be applied to clinical observations. However, I do not feel that these journals accomplished that goal.

In summary, while the course revision increased learning, there is always room for improvement. Prior to teaching the class in Fall 2020, I plan on moving more information online, incorporating the online activities from Spring 2020 to in-class if we meet face to face, beginning peer review’ with either team projects or in-class activities, and utilizing online observation to create a more integrated experience for students.