<p>  </p> <p>With fewer speech-language pathology (SLP) clinical training opportunities, it is difficult for students to gain the experience necessary to display proficiency and confidence in treating patients with dysphagia. To address this gap, many educators have turned to simulation-based training (SBT). This project examined the impact of a novel computer-based simulation dysphagia training implemented into Purdue University’s core Dysphagia course on students’ confidence and competence. During this training, students completed a comprehensive bedside swallowing evaluation and analysis of a videofluoroscopic swallow study (VFSS) of 2 simulated patients. </p> <p>A repeated measure design was utilized. Data were collected on 27 SLP graduate students (n=27; 26 females, 1 male; age range: 21-27 years) at baseline, Post-Simulation 1 and Post-Simulation 2. We evaluated confidence and clinical knowledge through the following outcome measures: students’ self-rated confidence levels rated using an adapted Self-Efficacy survey, and agreement levels with our gold standard rater on clinical evaluation forms. Data for students’ self-rated confidence were collected at three time points (baseline, Post-Simulation 1, Post-Simulation 2), and organized into three composite areas (Treatment, Evaluation, and Personal & Interpersonal Skills). Clinical knowledge was measured at two time points (Post-Simulation 1 and Post-Simulation 2 ) using clinical evaluation forms, which were completed for each of our two simulated patients. Clinical evaluation forms included a cranial nerve exam form, a videofluoroscopic swallow study (VFSS) analysis form, and an Overall Impressions and Recommendations form, including the Functional Oral Intake Scale (FOIS) and a recommendation list. </p> <p>Significant increases in confidence in the Evaluation (t(26)= -8.22, p < .0001), Treatment (t(26)= -5.06 , p < .0001) and Personal & Interpersonal (t(26)= -10.31, p < .0001) composite areas of the Self-Efficacy survey were seen from baseline to Post-Simulation 2. While students did not show significant improvements in clinical performance for FOIS ratings and VFSS analysis, they did show significant improvements in their ratings for the cranial nerve exam (t(26)= -5.728, p < .0001), and in their choice of recommendations (t(26) = -5.247, p < .000 1) between the first and the second simulation. </p> <p>In this sample of participants, students had significant improvements in confidence and clinical competence in several clinical knowledge areas. These paired results suggest that these participants benefitted from completing our SBT dysphagia training. Although our findings provide some initial insight into the impact of this novel computer-based SBT for graduate dysphagia education, additional research is required to further validate these findings. </p>

Les travaux réalisés dans cette thèse proposent une aide à la décision pour améliorer la qualité de l’apprentissage. L’apprentissage scolaire englobe deux dimension; une dimension humaine et une dimension pédagogique. La dimension humaine inclut l’apprenant et l’enseignant. La dimension pédagogique, représentée par le programme fixé par l’établissement éducatif, correspond au savoir. Ce dernier va se transformer en connaissance chez l’apprenant. Les deux notions de connaissance et savoir sont donc tout à fait différentes. La distance entre les deux représente la distance entre ce que l’enseignant présente (le savoir) et ce que l’apprenant acquière (la connaissance). La qualité de l’apprentissage concerne les apprenants qui vont à l’école pour acquérir le savoir. En fait, apprendre consiste à intérioriser le savoir. Cette intériorisation demande des efforts pour un changement intellectuel persévérant et exige une continuité basée sur les expériences antérieures. L’acquisition du savoir et sa transformation en connaissance par l’apprenant sont influencées par plusieurs facteurs qui interviennent positivement ou négativement sur la quantité et la qualité de cette connaissance. Il peut résider chez l’apprenant une confusion entre les deux notions qui peut l’amener à valoriser ou ignorer sa connaissance. Le processus de construction des connaissances par le savoir diffusé exige une constante mise en œuvre de procédures d’évaluation. Le processus d’évaluation apprécie alors la structure de la connaissance pour prendre des décisions destinées à la faire évoluer. Cependant, lors d’une évaluation, la confusion entre connaissance et savoir peut amener l’apprenant à valoriser le score, négligeant ainsi le regard qu’il pourrait porter sur les processus de transformation des connaissances au profit d’une restitution la plus fidèle possible du savoir. Cette confusion peut être mise en évidence pourvu que l’évaluation intègre une dimension processuelle. Dès lors, l’évaluation peut être mieux associée à des actions d’amélioration et de transformation des connaissances. L’évaluation peut alors être abordée dans une logique d’aide à la décision. Dans ce travail nous montrerons donc qu’une situation d’apprentissage s’apparente à une situation d’aide à la décision. / The research realized in this thesis proposes a decision support to improve the quality of learning. The learning includes two dimensions; human dimension and pedagogic one. The human dimension includes the learner and the teacher. The pedagogic dimension represented in curriculum set by the educational establishment; it is the know. The learner is going to transform the know into knowledge. Thus the know and the knowledge are two notions completely different. The distance between both is the distance between what the teacher presents (the know) and what the learner acquires (the knowledge). The quality of the learning concerns the learners who go to the school to acquire the know. In fact, learning consists in interiorizing the know. This internalization requires the efforts for persistent intellectual change and demands continuity based on past experiences. The acquisition of knowledge and its transformation into knowledge by the learner is influenced by several factors that affect positively or negatively on the quantity and quality of this knowledge. The confusion between the know and the knowledge guide the learner to value or to ignore his knowledge. The knowledge construction process by the diffused know requires an constant evaluation process. The process of evaluation then appreciates the structure of knowledge to make decisions intended to make it evolve. However, during an evaluation, the confusion between knowledge and knowledge can bring learner to value the score so neglecting the importance which he must give for the transformation knowledge process in favor of the highest possible fidelity of knowledge. This confusion can be detected provided that the evaluation includes a processual dimension. Therefore, the evaluation may be better associated with improvement actions and transformation of knowledge. Then the evaluation can be addressed in a logical decision support. Therefore In this research we demonstrate that the learning situation is a decision aiding situation.