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Certification Standards for Speech-Language Pathology Frequently Asked Questions: Clinical Simulation

Clinical simulation (CS) is the use of alternative methods of clinical practicum and is part of Standard V-B and V-C. Programs accredited by the Council for Academic Accreditation in Audiology and Speech-Language Pathology (CAA) have the option of obtaining up to 75 hours of direct clinical contact through the use of CS, which allows students to obtain a sufficient variety of supervised clinical experiences in different work settings, with different populations, regardless of geographic location. The use of CS is optional; it is another tool available to students to develop clinical knowledge and skills.

CS experiences should allow students to (a) interpret, integrate, and synthesize core concepts and knowledge; (b) demonstrate appropriate professional and clinical skills; and (c) incorporate critical thinking and decision-making skills while engaged in identification, evaluation, diagnosis, planning, implementation, and/or intervention. 

What may the use of CS include?

The use of CS may include:

  • standardized patients
  • virtual patients 
  • digitized mannequins 
  • immersive reality 
  • task trainers 
  • computer-based interactive experiences 
  • other simulation technologies

The Council on Academic Programs in Communication Sciences and Disorders (CAPCSD) offers a wide range of resources in clinical simulation, including podcasts, webinars, and Best Practices in Healthcare Simulations in CSD [PDF].

How does CS differ from Alternative Clinical Education (ACE)?

There is no difference between clinical simulation and Alternative Clinical Education (ACE). CS is recognized across healthcare disciplines, and using CS aligns our terminology with our colleagues in the healthcare professions.

What does not count as CS?

All CS cases should be viewed and treated in the same manner that they have traditionally done through didactic and clinical experiences with live patients. Watching a live or recorded video is not an example of a CS. Additionally, observational experiences (i.e., video clips, watching live or recorded sessions) do not meet the criteria of CS. Observing sessions and watching videos are valuable educational experiences but, as always, they may count as guided observation only and cannot be counted as ASHA supervised clinical practicum hours. When counting guided observation and supervised clinical practicum hours, remember that hours earned on or before December 31, 2019, need only meet the 2014 standards. Hours earned on or after January 1, 2020, must be completed in accordance with the 2020 standards. (See Standard V-C.)

What does CS supervision look like?

Supervision presents in many forms, and it includes a debriefing component for the purposes of meaningful learning. Supervision can be asynchronous (not at the same time as the clinical learning experience) or synchronous. In the instance of a virtual client, debriefing sessions should be conducted after the completion of the CS in order to meet the 25% observation requirement. For example: Student A can complete a simulation for 60 minutes followed by a 15-minute debriefing with the clinical supervisor, and receive credit for a 60-minute session that was observed 25% of the time.

What is debriefing?

Debriefing activities may include face to face discussion, self-reflection with feedback, and/or written self-evaluation with feedback. Debriefing never counts as part of an ASHA clock hour; however, it can meet the 25% supervision requirement in asynchronous learning situations only. In synchronous learning, the observation is taking place while the student is completing a task with either a live patient or with a simulation, such as a virtual mannequin. 

Do the minimum supervision requirements apply to CS?

Yes, 25% of a student’s total contact with each client or patient must still be met as adapted above for CS. In a typical 60-minute session with a standardized patient, the supervisor must observe 15 minutes (i.e., 25%). While additional time may be spent debriefing as part of clinical education, the additional debriefing time could be part of your supervision plan.

Do students need to be supervised while they are completing computer-based CS tasks?

No. Often, the supervision occurs asynchronously followed by debriefing sessions.

If an entire class of students is simultaneously accessing one CS case, how should the clinical supervisor handle observing the students?

The clinical supervisor should observe these students as if they were a group of students completing "live" cases. Structuring this situation as an asynchronous learning task would be a good approach.

How are clock hours determined when using computer-based simulation?

The time students spend on CS can vary greatly, particularly at the beginning of their clinical practicum experiences. Companies who offer CS technologies often publish the average amount of time each session should take to be completed. If there is no such published average, an academic program can do one of two things: (a) use the average time that the majority of the students spend on the simulation, given the cohort and the simulation and per the clinical supervisor’s judgment; or (b) make its own determination and apply it fairly and equitably.

Can students use the same CS experience for more than one clock hour?

One of the benefits of having access to CS is the ability to complete the same CS case multiple times, particularly in an area in which a student is struggling. While students do have the option to complete the same case several times for practice as the immersive experience of repetitive practice is highly valuable, clinical hours are only counted once.

What percentage of supervision is required for simulated cases?

The percentage of supervision required for simulated cases is the same as the percentage of supervision required for "live" clients/patients: 25% of the total contact time with each simulated client/patient.

If students are not actively engaged or interacting with the CS software, does this observation time count toward part of the 25 clinical observation hours?

Yes, similar to when a student observes another speech-language pathologist or student clinician leading a therapy or evaluation session.

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