Background

Increasing use of evidence-based principles
By revising SPLH 880 Seminar in Speech Language Pathology: Clinical Treatment of Phonological Disorders, I increased students usage of evidence-based principles in clinical practice. In the past, I have been disappointed in the ability of students to adequately use academic literature without my intervention. They needed to increase their own ability to deeply understand professional scholarly research that forms the basis for phonological disorders treatment. In the future, I plan to again revise the course to further develop students abilities to judge the severity of a departure from standard research practices and integrate skills learned in the course. In addition, I will refine the grading rubric to define intermediate levels of performance for students case reports.

The available evidence is continually changing as research progresses and advances are made in our understanding of the nature of sound delays in young children. The most effective clinician is the one who has the most up-to-date evidence. In the 2004 version of this course, students appeared to understand course topics, but that assessment did not measure their ability to find the research evidence independently. Also, they had difficultly synthesizing, integrating, and applying the evidence to clinical practice, a skill that is essential if they are to keep up with the field.

Implementation

Shifting responsibility
A series of student behaviors that I observed in the 2004 offering led me to re-evaluate my current teaching plan: I found that students were relying on me to walk them through the scholarly literature, and they had difficulty synthesizing, integrating, and applying the evidence. My goal for the 2005 offering was to increase student responsibility for seeking out information on their own and applying information to clinical cases by revising the course goals, student objectives, and course activities.

To accomplish this, I developed new materials in four areas that I believed would increase student learning: improve online reading quizzes, identify search terms for scholarly readings, adapt three clinical cases for in-class application of research evidence, and adapt 17 clinical cases for assessment of student performance.

Student Performance

Evaluating the impact
I established three criteria that I used to evaluate the impact of the new teaching methods on student learning. First, students completed reading quizzes for each assigned reading prior to class discussion to examine their independence in consuming research. Second, students independently created treatment plans for two different clinical cases. Finally, I compared the results from the revised 2005 course to that of the 2004 course.

Reading quiz comparisons showed higher performance in 2005 than in 2004, indicating that students ability to independently read and evaluate research improved. This translated into less class time devoted to understanding basic aspects of each article and more class time devoted to discussion of the merits of each article and application to clinical cases.

In 2004, even students earning an A had difficulty integrating and applying all the evidence discussed in class to their assigned clinical case. Students earning lower grades had even greater difficulty integrating and applying evidence and also demonstrated fundamental misunderstanding of some pieces of evidence.

In 2005, students had two opportunities to create treatment plans for different clinical cases. Their first attempt at creating plans yielded performance similar to the 2004 students. Students were still having difficulty integrating and applying evidence. This prompted a clinical grand rounds where possible treatment plans for each case were discussed with a specific focus on integrating evidence. The second and final attempt at creating treatment plans showed marked improvement in the ability to integrate and apply evidence to clinical cases.

Reflections

Making a difference
The change in the approach to the readings was valuable. Students benefited from explicit instruction on how to read and evaluate a research article, and the consistent format of the reading quizzes helped students internalize this framework. However, students still need greater experience judging the severity of departures from typical research practices. That is, they do not know when a particular weakness is fatal versus a minor flaw.

Greater emphasis on in-class application of evidence to clinical cases helped students appreciate the link between research and clinical practice, giving them a more in-depth understanding of how to apply specific pieces of evidence to clinical practice. However, integration was still problematic until specific feedback and discussion was provided through written case reports. The approach to in-class applications may need to be revised to continually demonstrate integration of old topics with new topics. Development of a grading rubric also may be helpful in communicating this goal to students.