The use of reflective practice activities by speech-language pathology students and clinicians.

Abstract

Reflective practice (RP) is a teaching and learning approach utilised with students engaged in clinical education programs for speech language pathology (SLP). RP activities such as written reflective practice (WRP), RP groups, dialogic teaching of RP, questionnaires, and discussions with a supervising SLP, provide students with a number of learning opportunities as they complete clinical placements (e.g. demonstrating clinical reasoning, clinical skill development, client centred practice, examining and evaluating self, and considering alternate perspectives). Research has shown that SLP students can demonstrate positive change in WRP abilities in as little as six weeks (Cook et al., 2019) and that, in general, students perceive they learn something from engaging in RP activities (Tillard et al., 2019). To date, there has been limited research investigating the use of RP activities with SLP students across different timepoints of the clinical program, or examination of how SLP engage in RP in the workplace. Therefore, the thesis investigated the use of reflective practice activities with SLP students and clinicians. Specifically, the thesis aimed to understand student perceptions and learning as a result of engaging in RP activities, and to better understand SLP clinician’s engagement in RP in the workplace. Four studies were conducted with SLP students and practicing SLPs.

The first study, detailed in chapter two, aimed to investigate students’ demonstration of breadth of WRP across and within the clinical education program. Participants were seventy-seven SLP students in their first, second or final professional year of the clinical program. They wrote critical reflections following an interaction with a client/s as part of their clinical education experiences. In total, four written reflections per participant were coded for breadth of WRP utilising a modification of Plack et al.’s (2005) coding schema. Results revealed a statistically significant association between time (i.e., professional year of the program) and likelihood of demonstration of breadth of reflection for the lower-level reflective element of “attend” and higher- level reflective element of “re-evaluate”. Final professional year students exhibited significant enhancements in the higher-level elements (e.g. “premise”) compared to first professional and second professional year students.

A follow up study, detailed in chapter three, aimed to determine overall RP skill in this same cohort and determine whether there was a relationship between RP skill and clinical competency. Therefore, chapter three (1) reanalysed the same WRP samples from chapter two to examine the impact of time on depth of WRP, and (2) examined a possible relationship between depth of WRP and clinical competency for SLP students. Depth of WRP for each participant was assessed utilizing a modification of Plack et al.’s (2005) coding schema. SLP student clinical competency was assessed using Competency Assessment in Speech Pathology (COMPASS®). There was a significant association between time and development of depth of WRP for final professional year students only. No association was identified for depth of WRP and clinical competency.

Both chapter two and three described instruments that could be utilised to either measure and develop WRP processes over time, or provide a judgment of WRP skill as judged by educators. The focus of chapter four, however, was SLP students and their perception of how RP supported their learning, or otherwise. Chapter four aimed to: (1) determine perceptions of RP capacity and outcomes of engaging in RP in three groups of SLP students (following their second, fourth or sixth clinical placement experience), utilising a validated and reliable instrument, and (2) examine patterns of perceptions of RP capacity and outcomes of engaging in RP across SLP students utilising hierarchical clustering (Manhattan distance). Seventy (70) SLP students completed the Reflective Practice Questionnaire (RPQ) (Priddis & Rogers, 2018; Rogers et al., 2019) following their second, fourth or sixth clinical placement experience. The majority of SLP students perceived they had high levels of reflective capacity and, in general, their perception of their RP abilities and subsets associated with RP increased as their clinical experience increased. A significant positive effect for three subsets of the RPQ (communication confidence, confidence general and job satisfaction) was found as clinical experience increased. Three groupings were identified as a result of hierarchical clustering (reflective and confident group, non-reflective group and a low confidence group). Overall SLP students perceived that RP activities had a positive impact on their learning and, as such, these findings offer further support for the use of RP activities in SLP clinical programs.

The final study, detailed in chapter five, sought to further inform the use of RP in clinical programs through an examination of RP in the workplace. Thirty SLPs working in health, education, and private practice sectors, shared their experiences and perspectives of RP in the workplace through individual semi-structured interviews. Thematic analysis was used to analyse the interviews. Three themes were developed from these data, describing what SLPs use RP for, what SLPs perceive as important in order to engage in RP in the workplace as well as the barriers they have identified, and how SLPs have observed a change in engaging in RP as they have progressed in their careers. The three themes highlighted that RP is valued in the workplace for supporting client focused care, problem-solving, and lifelong learning. Moreover, SLPs wanted time to be protected for RP at all stages of their career (both early career and experienced) and valued the relationships with others as contributing positively to RP.

Overall, the results of the four studies described in this thesis support the teaching and use of RP activities in clinical education programs for SLP students. RP activities offer SLP students’ opportunities for purposeful examination of self, clinical skill development, and client centred practice. The three RP assessment tools utilised in this thesis—breadth of WRP, depth of WPR, and the RPQ—have provided evidence supporting both the assessment and use of RP activities across different stages of SLP clinical education programs.