













































Journal of Teaching and Learning with Technology, Vol. Vol. 11, Special Issue, pp.57-61. 
doi: 10.14434/jotlt.v11i1.34352 

Using Video Simulations for Assessing Clinical Skills in Speech-
Language Pathology Students 

Abby Hemmerich 
University of Wisconsin-Eau Claire 

Jerry Hoepner 
University of Wisconsin-Eau Claire 

Abstract: A common challenge for clinical training programs is helping students apply academic 
knowledge to clinical settings. Authentic assessment using simulation offers a unique approach to 
bridging this gap. Miller’s pyramid provides a framework for competency-based education that 
integrates formative assessment and feedback at each stage of student learning. A multi-part 
assignment that builds from gathering data following a specific protocol (i.e., basic level), moves through 
interpretation of data (i.e., intermediate level), and then using that data to direct next steps (i.e., 
advanced level) scaffolds student learning toward clinical practice. Review of past student assignments 
indicated better performance on intermediate and advanced skills when using a video-based, multi-
component assignment as compared to the original assignment design. Incorporating video components 
allows simulation of rare clinical populations, while also replicating current telepractice service 
provision. By simulating patient interactions, the instructor replicates real world challenges, allowing 
the students to demonstrate in-the-moment problem solving and clinical responsiveness. 

Keywords: competency-based education, video, videoconferencing, formative assessment 

Like other clinical disciplines, education in the field of speech-language pathology is increasingly 
shifting towards competency-based education practices (Hoepner & Hemmerich, 2020). Historically, 
students received knowledge-based education with descriptions of skills in their academic courses, 
often without practice implementing those skills. Students were expected to apply their knowledge 
and skills in clinical practicum. Clinical supervisors supported the application and implementation 
processes but did not always share the same approach or perspectives of the course instructors.   

Competency-based education (CBE) systematically and incrementally implements knowledge 
and skills training, ultimately measuring readiness for clinical practice (McAllister et al., 2011). Medical 
educators often use Miller’s pyramid as a framework for developing knowledge, skills, and 
preparedness for clinical practice (Lockyer et al., 2017; Miller, 1990). At the base of the pyramid, 
instruction focuses on building declarative knowledge (i.e., knowing). The next level, knowing how, 
prepares students to interpret and apply that knowledge through guided demonstrations and models. 
In level three, showing how, students demonstrate their knowledge and skills through formative and 
summative competencies. Finally, students are transitioned to clinical contexts, where performance is 
integrated into practice (i.e., doing). Of course, learning and refining one’s approach still takes place 
in that final level (i.e., doing), but they have reached entry-level clinical competence. Hoepner and 
Hemmerich (2020) modified this framework to encompass knowledge, skills, and professional 
dispositions necessary to competently enter clinical practice in speech-language pathology. 
Competency-based instruction and assessment in courses only addresses the bottom three levels of 
Miller’s pyramid, since doing occurs in clinical practice. Taking this one step further, Figure 1 depicts 
how iterative assignments can move students through all three course-based levels of the pyramid. 
Each level is addressed within each assignment (i.e., knowing, knowing how, and showing how); 
however, expectations for skills move from basic to advanced. Feedback for all levels is formative, 



Hemmerich and Hoepner 

Journal of Teaching and Learning with Technology, Vol. 11, Special Issue, jotlt.indiana.edu 

providing guidance for the levels that follow, as well as summative feedback in the form of grades on 
each assignment. Formative feedback at the final level is intended to carry over to clinical practice.   

Figure 1. Modified Miller’s pyramid mapped to three levels of course assignments. 

Mapping a field-specific example to Miller’s pyramid. 

Within the field of speech-language pathology, like other clinical fields, there are populations that are 
rare, making it difficult for students to have hands-on contact. In these cases, providing a simulated 
experience can be a valuable substitute. In speech-language pathology, children with cleft lip/palate 
are one example of a challenging population to access, as many of these children are seen in large 
medical centers where few graduate students get placements.   

The role of the speech-language pathologist (SLP) with children with cleft palate involves 
multiple steps. Initially, SLPs must evaluate the child and their family to identify areas of concern. This 
includes reviewing medical and educational documents, interviewing the family and other healthcare 
and educational professionals, and completing a hands-on examination of the child. Once a plan of 
treatment is determined, the SLP plays a role in feeding, swallowing, speech, and language 
development, as well as serving as a resource and counselor for the patient and family. Students require 
opportunities to practice all of these skills and receive formative feedback to hone their skills. Table 1 
provides an example of a multi-part assignment to address these complex and interrelated levels 
required for student learning.   

Multi-part Assignment Components  

Following the protocol and gathering data   

As students tackle a new topic, they first need a chance to demonstrate prerequisite, foundational 
knowledge and basic skills for gathering relevant data. This can take multiple forms, such as 
completion of fact-based assignments or quizzes, but can also span higher levels of Miller’s pyramid, 
such as demonstrating a skill with a standard case. In assignment 1 (see Table 1), students first review 
materials and complete a protocol-based assignment by creating a plan for their oral mechanism exam 
and speech sound testing (i.e., planning data collection), and then implement that plan in a video-
recorded submission where they complete the exam and testing on another person (i.e., actual data 

58



Hemmerich and Hoepner 

Journal of Teaching and Learning with Technology, Vol. 11, Special Issue, jotlt.indiana.edu 

collection). This fits into the basic skills level for multiple reasons. First, the oral mechanism exam and 
speech testing students perform is relatively standardized; we are building skills in systematic data 
collection, ensuring the quality of their data for interpretation. Second, the video recording submission 
demonstrates that they know how to complete these skills and does not require a higher-level skill of 
interpretation. Multiple repetitions of this exam with individuals who have typical function provide a 
good baseline for assessing individuals who demonstrate deviations from that norm.  

Interpreting and reporting data 

Once students are comfortable with discipline-specific techniques for gathering information or data, 
they must learn what to do with that data (i.e., intermediate skill level). Interpretation of data requires 
a deeper level of knowledge and the ability to compare results to expectations. In the example in Table 
1, this means applying their knowledge of normal oral motor function and typical speech to the results 
provided by the instructor. In this specific situation, the instructor provides a video recording with 
atypical findings because students do not have access to this clinical population. Thus, this becomes a 
simulation out of necessity and provides the option of viewing the video multiple times. Students 
review the video clinical exam and speech testing results, where they simulate the interpretation that 
would occur if this patient were present, distinguishing typical from atypical performance. Their 
interpretations lead them to final clinical decisions (i.e., conclusions), and they create a clinical report 
following disciplinary guidelines.   

Using data to direct next steps 

Once students have skills in data collection and interpretation, the next step is applying that knowledge 
to new or more complex situations. In some fields, this may entail designing a new experiment to test 
new hypotheses. In other fields, like speech-language pathology, this entails addressing their findings 
or remediating patient skills. Using role play to complete this step pushes students to a more advanced 
level, where they must carry out intervention and parent education, while responding in the moment 
to human variability enacted by the instructor (see Table 1). This spans nearly all levels of Miller’s 
pyramid, which include collecting data, interpreting data, and making adjustments based on that data 
in a live interaction.   

59



Hemmerich and Hoepner 

Journal of Teaching and Learning with Technology, Vol. 11, Special Issue, jotlt.indiana.edu 

Table 1. Assignment components by levels of Miller’s pyramid 
Assignment  Knows Knows How Shows How Assessment 

Basic:   
Following the 
protocol  
& gathering 
data (video 
submission)  

Structures of 
head & neck  

Oral 
mechanism 
exam plan 

Demonstrates oral 
mechanism exam 
on a partner  

Feedback on process of exam 

Speech sound 
characteristics  

Speech sound 
testing plan  

Implements speech 
sound testing on a 
partner (no 
scoring)  

Feedback on speech sounds 
used and techniques for 
eliciting sounds  

Intermediate:*  
Interpreting & 
reporting the 
data (video 
review, written 
submission)  

Parent input Interview plan  Interprets findings 
from listening to 
parent input  

Feedback on summary of 
parent concerns  

Speech sound 
errors & 
patterns  

Speech sound 
testing plan  

Interprets findings 
from listening to 
child’s speech  

Feedback on speech sound 
summary – did you hear what 
you should have heard?  

Advanced:*  
Using data to 
direct  
next steps   
(role-play tele-
session)  

Techniques for 
remediating 
speech sound 
errors  

Techniques & 
therapy plan  

Role play – teach 
instructor to make 
sounds  

1) in-the-moment adjustments
based on what instructor does
2) coaching by instructor on
alternative approaches

Parent 
education 

Parent 
education plan  

Verbalize parent 
education & 
respond to 
questions  

1) in-the-moment
responsiveness to instructor
questions
2) coaching by instructor on
alternative topics or ways to
explain

*Higher levels implicitly subsume prior levels

Evaluating assignment approach 

Prior iterations of this course included a similar competency-based assignment compressed into a 
single live meeting with the instructor. Students received client information (i.e., case history and 
demographics) and planned a brief assessment to carry out in a role-play simulation with the instructor. 
Immediately following the assessment role-play, they interpreted their results and implemented a 
parent education and treatment simulation in the same meeting. This approach required some data 
collection skills but omitted a critical element—the oral mechanism examination—given time 
constraints. Compressing all elements into a single interaction put students under tremendous pressure 
to perform efficiently and did not always allow them to show their full skillset.  

Student performance on both iterations of this assignment were compared through a review 
of common errors (see Figure 2). The multi-part assignment provided more opportunities for 
formative feedback regarding clinical skills employed in assessment and intervention. This led to fewer 
errors in interpretation and parent education as compared to the time-constrained condition. The 
expanded treatment role-play allowed the instructor to identify more nuanced challenges, evidenced 
by more support required during the live interaction (Figure 2), and provide formative, in-the-moment 
feedback.  

60



Hemmerich and Hoepner 

Journal of Teaching and Learning with Technology, Vol. 11, Special Issue, jotlt.indiana.edu 

Figure 2. Student performance summary on assignment iterations. 

Implications   

Video and video chat simulations are an innovative approach to implementing competency-based 
instruction. Students are engaged in video development, along with data collection and interpretation, 
which provides a realistic representation of clinical workplace contexts. The use of multi-component 
assignments allows instructors to divide content into manageable segments. These segments are linked 
to a single case, allowing learners to make connections across contexts. Using multiple segments 
provides repeated opportunities for formative assessment of knowledge and skills prior to the final 
portion of the assignment. Instructor-student interactions within simulations via video conferencing 
provide exposure to the teleservice context, which is integral to contemporary service provision. The 
competency-based framework ensures development and assessment of skills for entry-level clinical 
work. These skills are measured authentically in the context of a simulated clinical experience, allowing 
assessment of in-the-moment problem solving.   

References 

Hoepner, J.K. & Hemmerich, A.L. (2020). Using formative video competencies and summative in-
person competencies to examine preparedness for entry-level professional practice. Seminars 
in Speech and Language, 41(04), 310-324. https://doi.org/10.1055/s-0040-1713782  

Lockyer, J., Carraccio, C., Chan, M.K., Hart, D., Smee, S., Touchie, C., Holmboe, E.S., Frank, J.R., 
& on behalf of the ICBME Collaborators. (2017). Core principles of assessment in 
competency-based medical education. Medical teacher, 39(6), 609-
616. https://doi.org/10.1080/0142159X.2017.1315082

McAllister, S., Lincoln, M., Ferguson, A., & McAllister, L. (2011). A systematic program of research 
regarding the assessment of speech-language pathology competencies. International Journal of 
Speech-Language Pathology, 13(6), 469-479. https://doi.org/10.3109/17549507.2011.580782 

Miller, G.E. (1990). The assessment of clinical skills/competence/performance. Academic 
medicine, 65(9), S63-7. https://doi.org/10.1097/00001888-199009000-00045 

0

10

20

30

40

50

60

70

80

90

100

Error in interpretation or
diagnosis

Parent education errors Required support for
treatment in live interaction

Pe
rc

en
ta

ge
 o

f s
tu

de
nt

s

Single session Multi-part assignment

61




