This document discusses the development of a questionnaire to identify common errors made by audiology students during clinical training. The questionnaire covers 8 areas of routine audiology assessments. Student errors will be categorized based on feedback from audiology preceptors. Identifying these common errors will help in developing formative feedback modules for a new high-fidelity simulated learning environment in audiology education. Future work includes validating the questionnaire, identifying the most common errors, and integrating them into the simulated learning environment training.

1. Developing a high-fidelity simulated-learning environment
(SLE) in audiology education: A preliminary investigation
Nur ‘Ain Fathanah Mohd Puzi1
, Ahmad Aidil Arafat Dzulkarnain1
, Sarah Rahmat1
, Mastura Badzis2
, Mohd Zulfaezal Che Amin3
Table 1 shows example of the statement for each of the questionnaire
CONCLUSION
• Input gathered from this study will be used as the basis for developing formative feedback
modules in the development of a new high-fidelity SLE in audiology.
1
Department of Audiology & Speech-Language Pathology, Kulliyyah of Allied Health Sciences, International Islamic University
Malaysia, Kuantan, Pahang
2
Kulliyyah of Education, International Islamic University Malaysia, Kuala Lumpur
3
Department of Optometry & Vision Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia,
Kuantan, Pahang
INTRODUCTION
•The use of Simulated learning environment (SLE) training is aimed to fully or partially substitute the real clinical working environments and have been
reported to provide positive outcome to students in various fields (Butter et al, 2010; Cook, 2014). The SLE is categorized according to the degree of
fidelity (low, medium and high).
•In Audiology, most of the SLE training reported in the literature consist of either low-fidelity or medium fidelity (Dzulkarnain et al, 2015). Only few of
the SLEs are of high-fidelity in nature, however the focus of the training is limited to only one or few specific testing (does not consist of all routine
testing) (Wilson et al, 2011). This gap suggests the need of developing a high-fidelity comprehensive SLE module, which also requires inclusion of
feedback components. In any training methodology including SLE, feedback is important for ensuring that students can determine whether or not they are
fulfilling the requirements of the respective learning task (Issenberg and Scalese, 2008). To develop a feedback module in SLE training module, the
knowledge of the typical errors made by the students in a specific task need to be systematically determined.
•This study therefore aims to investigate the common errors regularly made by audiology students in the clinic during routine-audiology assessments. The
overview of the development stage of a high-fidelity audiology training module is in figure 1 (this project is funded by Malaysian government under
Ministry of Education, fundamental research grant scheme).
ACKNOWLEDGEMENT
The authors wish to acknowledge the Ministry of Higher Education through the Fundamental Research Grant Scheme
(FRGS) (Grant numbers: FRGS15-236-0477) for their financial support in conducting this study. The authors declare
there is no conflict of interest.
QUESTIONNAIRE DEVELOPMENT
1. IIUM audiology clinic protocol and IIUM audiology clinical rubric were
reviewed to identify any sentence highlighting possible errors made by the students
during clinical placement.
2. Information gathered in (1) were used in the development of a survey
questionnaire to identify possible common errors.
3. The questionnaire was reviewed by two audiology clinical preceptors (2nd
and 3rd
authors) based on; i) their experience in supervising students in the clinic, ii) the
learning outcome (LO) for audiology clinic courses (basic to advance courses)
4. The survey questionnaire were divided into 8 areas of testing (case history,
otoscopic examination, pure tone audiometry, tympanometry, acoustic reflex,
management and plan, case note, and professionalism):
•In each area, several close-ended statements were added to list the possible
common errors made by students in the audiology clinic.
•In general, all of the 8 areas pointed towards four general themes: (i) error because
of lack of knowledge e.g. from the cognitive learning domains; (ii) error because of
the incompetency in the practical skill involving psychomotor and cognitive
domains; (iii) errors involving professionalism involving cognitive, psychomotor
and affective learning domains; (iv) errors involving communication skills.
•Four categories of Likert scale consist of ‘not at all’, ‘rarely’, ‘occasionally’ and
‘frequently’ were provided at the end of each statements for evaluation by clinical
preceptor.
•In addition to that, one blank section is added in each of the areas to allow
feedback from audiology preceptors on additional possible common error that are
not listed in the close ended statement.
•Table 1 shows the example of common errors from each of the 8 sections of the
questionnaire
5. This methodology was chosen to expedite the process of gathering feedback from
the respondents.
FUTURE DIRECTION: PHASE 3
1. Content validation of the finalized survey of the questionnaire will be conducted
among 7 audiologists.
2. The relevancy of each item in pointing towards the common errors, and in assessing
four domains (communication technique, clinical skill, knowledge, and
professionalism) will be evaluated by the audiologists.
3. The relevancy score will be statistically evaluated using content validity ratio (CVR)
and Fleiss’ kappa statistics. Items that does not meet statistical accepted value will be
removed from the questionnaire to produce final version of the questionnaire.
4. 30 audiologists will be recruited to answer the final version of the questionnaire to
identify the common errors made by the student during clinical training.
5. Identification of errors from the least to most common based on the agreement
towards statements from the questionnaire and any subjective feedback will also be
conducted.
FUTURE DIRECTION: PHASE 4
1. Wherever possible, these errors (especially the most common) will be integrated in
the feedback module of high-fidelity SLE (formative and/or summative).
2. Some clinical cases will be developed with the emphasis on the common errors to
determine the ability of the student to deal with these errors in real clinical sessions.
REFERENCE
1. Butter J. , Mcgaghie W.C., Cohen E.R., Kaye M. & Wayne D.B. 2010. Simulation-based mastery
learning improves cardiac auscultation skills in medical students . J Gen Intern Med , 25 , 780 – 85.
2. Cook D.A . 2014. How much evidence does it take? A cumulative meta-analysis of outcomes of
simulation-based education. Medical Education , 48, 750– 760.
3. Dzulkarnain, A. A. A., Wan Mhd Pandi, W. M., Rahmat, S. & Zakaria, N. 2015. Simulated learning
environment (SLE) in audiology education: A systematic review. Int Audiol J, 22: 1-8.
4. Scalese, R. J., Obeso, V. T. & Issenberg, S. B. (2008). Simulation technology for skills training and
competency assessment in medical education. Journal of General Internal Medicine, 23(1): 46-49.
5. Wilson W.J. , Goulios H. , Kapadia S. , Patuzzi R. , Kei J. et al . 2011. A national approach for the
integration of simulated learning environments into audiology education . Australia: Health
WorkforceAustralia.
FACE VALIDATION
1. Face validation was performed by language experts (one professional proofreader
who is an English native speaker and one linguist).
2. Some of the amendments were made based on the opinions from the two evaluators:
•Deletion of repetitive words across statements (e.g. ‘Student’ that was originally spell
out in each sentence).
•Re-arrangement of section according to audiology clinic session’s flow
•Correction of sentence structure and grammar check
3. The questionnaire will be further validated and piloted in future study.
Figure 1: Overview of the development stage of a high a high-fidelity Audiology
Section Statement Not at all Rarely Occasionally Frequently
Case history Use of jargon when
conversing with patient
Otoscopic
examination
Wrong speculum size
Pure tone
audiometry
Unable to perform masking
procedure
Tympanometry Unable to determine
tympanogram type
Acoustic reflex Unable to determine AR
threshold
Management and
plan
Fails to interpret and
integrate all results
Case note Unable to provide a
comprehensive case note
Professionalism Unable to handle patient
with care to ensure their
safety