COVID-19 Stories: Dr Donna Thomas

Could you please tell us a little bit about yourself and your work pre-COVID-19?
I am a lecturer in the Speech Pathology discipline at the Cumberland campus.  I provide clinical education for undergraduate and masters Speech Pathology students at on-campus Speech Pathology clinic.  Our clinic is busy, with up to 200 clients attending each week, and a team of 10 speech pathologists providing clinical education.

Our physical clinic is perfectly set up for student supervision, with all clinic rooms having one-way mirrors and CCTV cameras.  The CCTV cameras allows educators to watch their students’ sessions in real time from another room within the same building.  This allows the student independence, but also provides a safety net, should the educator to need to come in and provide extra support. There’s great camaraderie between the Clinical Educators in the AV room – with regular discussions ranging from clinical challenges, student learning, to breakfast options on a Friday morning!

Our clinic is fully student-led, so students manage the files, book the clients in for appointments and mostly mange the entire Patient Management System.  We also have a very extensive Test and Materials (TAM) room, with physical resources for students – tests, toys and therapy materials.

In five words or less, what was your reaction when you heard of the restrictions put in place?

Alert but not alarmed

I knew that our clinic had the capacity to provide telepractice.  If we made a wholesale move to telepractice, we could save the clinical placement for the 137 students with us at that time, but the scale up would require a huge effort, and necessitate changes in work practices for all concerned.

How did you overcome the challenges of COVID-19?
We moved our whole clinic to telepractice, using Zoom as the platform. In the space of a week, we developed procedures for students, clients and educators, to enable this rapid telepractice scale-up.  Our clinic was well placed for a scale-up because, prior to the pandemic, approximately 5% of our sessions were provided via telepractice.

During this period, our students conducted their clinical sessions via Zoom and their educators watched live. During the sessions, the educators made use of the ‘chat’ function in Zoom to provide real-time feedback for students.  Students and educators used a variety of cloud-based systems for transferring documents and providing feedback.  Rather than physical assessment and therapy materials, we purchased on-line tools.  Prior to the pandemic, our Patient Records system was paper-based.  During the pandemic, we instituted an emergency measure, where students emailed their progress notes to a specially designed university-based address.   We also transferred the maintenance of the Patient Management Software transferred from students to staff, to ensure confidentiality of data.

Did you find many positive outcomes?

• We learnt that a fully remote clinic was possible. Although staff and students found it more time consuming than face-to-face initially, it was possible.
• Adapting to online was less challenging for many of our students than we had anticipated. It’s possible that because they hadn’t had extensive experience in face-to-face services, there was less for them to ‘unlearn’.
• A telepractice placement allowed our students to experience this modality and see it as a viable alternative.
• Some of our students commented on the benefits of learning a new treatment modality alongside their educators, and how this led to a greater depth of collegiality with the educator.
• Students and staff liked using the ‘chat’ function and felt that this was a less intrusive way of providing real-time direction for students than entering the clinic room, as we had done prior to the pandemic.
• Many of our clients enjoyed the telepractice experience, as there was less time spent travelling and it allowed parents to care for the client’s younger siblings.

What surprised you about your work during the pandemic?
Lots of things!

• How extraordinary our speech pathology students are. They adapted to the change in their clinical placement like the proverbial duck to water.  They sourced amazing online therapy materials for their clients, and generously shared their knowledge with each other via a student-led forum called ‘Tuesday Telehealth Tips’.
• How time consuming it was to move fully online. It took longer to access client notes and reports, and to make those available for students. Some of this was because our patient management system wasn’t yet configured for a fully online operation.
• How much I missed my colleagues. I think I had taken for granted how easy it was to find a colleague prior to the pandemic to ask a question or to debrief with.  Although it was still possible to seek out a colleague, I needed to be much more intentional about this than I did prior to the pandemic.
• That many people were trying to meet many and varied responsibilities, with less distinction between work and home. Personally, I found it hard to balance work and carer responsibilities – work was crazier than it ever had been and, at the same time, I had my own three children home from school doing remote learning.

If you had to build a health service from scratch knowing what you know now, what would that look like?

• Telepractice would be seen as a consideration for all clients, not just those in rural and remote areas. Infrastructure to support telepractice would be available at all clinics, along with training for all clinicians.
• Clear clinical pathways would be developed, with consideration for the client’s technology access, the efficacy of telepractice delivery for various diagnoses and treatments, and for clinician factors.
• Remote access of Patient Management System and Electronic Medical Record would be available.

Connect with Donna:

Communication Disorders Treatment and Research Clinic

Email Donna

A huge thank you to Donna for sharing her experiences and story!