Reviewing Clinical Skills

Guest Blog Series: The Clinical Connection

Intelligent Video Solutions proudly presents a guest blog series by an experienced Clinical Educator, Professor and Communicative Disorders Clinic Director:  Ms. Angie Sterling-Orth.  Angie will be drawing on over 15 years of Clinical Education experience and 5+ years using software developed by the team at IVS to reflect on a variety of topics important to many Health Sciences Education stakeholders.

Using Evidence and Wisdom-of-Practice to Elevate Clinical Instruction with Video

Reflect… something I direct my practicum students to do every single day. Something I must force myself to do in a purposeful and productive way. Easier said than done, that is for certain. Reflect… why? Why do we insist on this activity? Is it just busywork? Where’s the value? I pause to pose all of these questions as I begin this blog dedicated to the uses of video in clinical learning applications. What I do know about reflecting, is that when done in an intentional and structured way, it allows us as clinicians and instructors to wring every ounce of learning from an experience. Simply having participated in an event is like water dripping from a soaked cloth. Reflecting on the event is the twisting and squeezing of every drop of liquid from the cloth. The Clinical Connection will be a place I can stop and reflect on my specific use of the most powerful and career-changing tool I have encountered during my 20+ years of practice as a speech-language pathologist and clinical professor in communication sciences and disorders (CSD). This first reflection is related to one of the first efficiencies and obstacles I encountered when we hit the ground running with the IVS video observation and recording system implemented in 2010… work-world efficiencies and multi-tasking demands!

I need to take you back to the very beginning. I started as a clinical instructor in a CSD program in 2001. Just starting out I had a supervision load of about 25-30 clinician-client pairs each semester. I spent approximately 6 hours per day, four to five days per week, 12 weeks each semester, on a hard bench (without back support), in the dark, in the observation deck. I’d shift from window-to-window, catching 10- to 30-minutes or so of each session, hour-after-hour. I had my clipboard and notepad (not even a laptop at that time!) and I would scribble notes the best I could all day long. I would crawl from the dark depths of the observation deck around suppertime. I would run a copy of my notes and toss the originals into grad student mailboxes. Then I would return to my office to an answering machine full of voicemails and an email inbox loaded with new messages. To this day, I have to pause to wonder what made that daily schedule appealing to me. The answer comes quickly though, I am passionate about my field of speech-language pathology and I thoroughly enjoy guiding undergrad and graduate clinicians to greater heights of clinical practice. However, our outdated clinical observation system was putting up obstacles for all clinical instructors (not to mention, giving me a sore back!). In addition, it was preventing us from using evidence-based techniques in our clinical instruction (such as video modeling). Finally, in 2010 we gained funding for installation of the new video system throughout our entire speech and language clinic (over 20 therapy rooms!). From that point on, my professional world changed. I was now able to observe several sessions at once, all from my office computer! I could see daylight out my window at all times (which improved my disposition). I was able to see when a clinician was struggling and focus specifically in on that session. I could catch phone calls as they came in, thus bringing a quicker end to games of “telephone tag” with colleagues, students, parents, caregivers, and off-campus supervisors. I was in my office when a struggling student would stop in for a quick assist or to schedule an appointment. I had my computer in front of me the entire time so I could type more written feedback to my clinicians as I watched their sessions and I could respond to emails rather than letting them pile up and bury important notifications. The list could go on. I’m certain the benefits and efficiencies are apparent. However, what caught me by surprise was how I needed to educate myself about working memory risks associated with so much multi-tasking. This was not something I anticipated, even though I work in a field that is quite understanding of the risks associated with challenging our working memory. Once I stepped back and became aware of my shortcomings that were associated with my use of the of our new video recording and observation system, I developed some intentional strategies and “rules” for my own practice. I share these with you in case they are much-needed or to help you prevent some of my mistakes from entering your practice. These include:

  • Turning my email off (i.e., closing Outlook) when I am trying to watch more than one therapy session at one time.
  • Checking the caller ID on the phone and only picking up calls from “essential” callers while I’m watching sessions of struggling or beginning clinicians, or when a “can’t miss” task is happening in the session.
  • Hanging a “stop light” sign on my office door, as needed, while I’m supervising sessions. (As an aside, it was interesting to me that when I was supervising on the observation deck all of those years, students never came back there to disturb me to ask questions. As soon as I started to supervise from my office using our new networked video system, students came in constantly to ask for assistance (colleagues were culprits too). I actually now have a “Yellow Light” sign for my door for whenever I’m watching sessions. It says “Your signal is YELLOW, so proceed with CAUTION! I’m supervising therapy sessions, but if your question is critical, you are welcome to enter. If it can wait, stop back later or shoot me an email. Thanks!”)
  • Making sure all of my clinicians know that if there is something specific they want me to view from a session, they should let me know. They can usually tell from my notes or from our discussion in our meetings if I have missed something because my attention was focused on a different session, or I was on the phone, etc. I rely on them to tap me on the shoulder if they need or want me to go back to past footage. The new video capture and review system made that a snap!
  • More than anything else, being very mindful about my online supervision. I make sure my Word document for written notes is up side-by-side with my streaming video windows of my current session(s). I also have an electronic copy of the clinician lesson plan(s) up and on a separate monitor. This way, I know what I’m supposed to be watching for and I can structured my observation and feedback very strategically. (P.S. Having a dual-monitor workstation is SO helpful when using a network based video observation system.)

So none of this is rocket science and every clinical instructor will have his/her own procedures and practices that will be customized around the use of an online application for video capture and observation of practicum students. What will be universal is the need to keep an eye on challenges to working memory so that we get the most from this robust system to benefit the development of critical clinical skills.