The Impact of an Online Cultural Simulation Activity on the Development of Speech Pathology Students’ Cultural Empathy: A Pilot Study

A pilot study

Keywords: cultural empathy, online, practice learning, simulation, speech pathology


Despite the cultural and linguistic diversity of the Australian population, research suggests that speech pathologists do not feel confident when providing services to Cultural and Linguistic Diversity (CALD) clients and would benefit from further education and training in this area. Cultural empathy has been described as a precursor to cultural competence and previous research has demonstrated the positive impact on nursing students’ cultural empathy toward CALD clients following an interactive cultural simulation experience. This study investigated the feasibility and effectiveness of an online cultural simulation activity in developing the cultural empathy of speech pathology students. Students completed an online cultural simulation in their own time, followed by a tutorial debrief. Both the simulation and debrief were considered to comprise the ‘simulation activity’; which was a component of a first-year introduction to clinical practice course. Participants completed a pre-survey and post-survey, containing the Comprehensive Empathy Scale (CES) and demographic questions. Results were analysed using the Wilcoxon Signed Rank test and a Paired Sample t-test, and a power analysis was conducted to direct future studies. Ten students participated and improved an average of 11.3 on the CES (p=0.14). A power analysis revealed that a minimum of 45 participants would be needed in future studies to observe any statistically significant results. The online application of the cultural simulation activity was feasible, and results indicate an improvement in cultural empathy, although the improvement did not reach statistical significance. Implications for future studies are discussed.


ABS (Australian Bureau of Statistics). (2012). Cultural Diversity in Australia (No. 2071.0).

ABS (Australian Bureau of Statistics). (2017). Census of Population and Housing: Reflecting Australia - Stories from the Census, 2016 (No. 2071.0).

Balandin, S., Lincoln, M., Sen, R., Wilkins, D. P., & Trembath, D. (2007). Twelve tips for effective international clinical placements. Medical Teacher, 29(9–10), 872–877.

Batson, C. D. (2009) These things called empathy: Eight related but distinct phenomena. In J. Decety & W. Ickes (Eds.), The social neuroscience of empathy (pp. 3–16). MIT Press.

Bausell, R. B., & Li, Y. F. (2002). Power analysis for experimental research: A practical guide for the biological, medical and social sciences. Cambridge University Press.

Brown, T., Williams, B., Boyle, M., Molloy, A., McKenna, L., Molloy, L., & Lewis, B. (2010). Levels of empathy in undergraduate occupational therapy students. Occupational Therapy International, 17(3), 135–141.

Campbell, D. T., & Stanley, J. C. (2015). Experimental and quasi-experimental designs for research. Handbook of research on teaching. Ravenio Books.

Campbell, M. (2016). Getting to grips with statistics: Understanding variables. British Journal of Midwifery, 24(10), 738–741.

Campbell, M., Fitzpatrick, R., Haines, A., Kinmonth, A. L., Sandercock, P., Spiegelhalter, D., & Tyrer, P. (2000). Framework for design and evaluation of complex interventions to improve health. British Medical Journal, 321(7262), 694–696.

Cheng, L., Battle, D., Murdoch, B., & Martin, D. (2001). Educating speech-language pathologists for a multicultural world. Folia Phoniatrica et Logopaedica, 53(3), 121–127.

Cocks, N., & Cruice, M. (2010). The experiences and perspectives of overseas trained speech and language therapists working in the United Kingdom. International Journal of Speech-Language Pathology, 12(3), 271–282.

Cohen, J. (1992). Statistical power analysis. Current Directions in Psychological Science, 1(3), 98–101.

Crawley, M. (2015) Statistics: An introduction using R (2nd ed.). Wiley.

Drwecki, B. B., Moore, C. F., Ward, S. E., & Prkachin, K. M. (2011). Reducing racial disparities in pain treatment: The role of empathy and perspective-taking. Pain, 152(5), 1001–1006.

Ebert, K. D., & Kohnert, K. (2010). Common factors in speech-language treatment: An exploratory study of effective clinicians. Journal of Communication Disorders, 43(2), 133–147.

Eng, J. (2003). Sample size estimation: How many individuals should be studied? Radiology, 227(2), 309–313.

Everson, N., Levett‐Jones, T., Lapkin, S., Pitt, V., Riet, P., Rossiter, R., Jones, D., Gilligan, C., & Courtney‐Pratt, H. (2015). Measuring the impact of a 3D simulation experience on nursing students' cultural empathy using a modified version of the Kiersma‐Chen Empathy Scale. Journal of Clinical Nursing, 24(19–20), 2849–2858.

Eymard, A. S., Crawford, B. D., Keller, T. M., & Campbell, S. L. (2010). "Take a walk in my shoes": Nursing students take a walk in older adults' shoes to increase knowledge and empathy. Geriatric Nursing, 31(2), 137–141.

Gibson, D., & Zhong, M. (2005). Intercultural communication competence in the healthcare context. International Journal of Intercultural Relations, 29(5), 621–634.

Guiberson, M., & Atkins, J. (2010). Speech-language pathologists' preparation, practices, and perspectives on serving culturally and linguistically diverse children. Communication Disorders Quarterly, 33(3), 169–180.

Harder, B. N. (2010). Use of simulation in teaching and learning in health sciences: A systematic review. Journal of Nursing Education, 49(1), 23–28.

Health Workforce Australia. (2014). Speech pathologists in focus. Australia's Health Workforce Series.

Henderson, S., Kendall, E., & See, L. (2011). The effectiveness of culturally appropriate interventions to manage or prevent chronic disease in culturally and linguistically diverse communities: A systematic literature review. Health and Social Care in the Community, 19(3), 225–249.

Howells, S., Barton, G., & Westerveld, M. (2016). Exploring the development of cultural awareness amongst post-graduate speech-language pathology students. International Journal of Speech-Language Pathology, 18(3), 1–16.

Jakes, M. A. (1999). Trained empathy: A simulated patient experience (Doctoral dissertation).

Johnson, R. L., Saha, S., Arbelaez, J. J., Beach, M. C., & Cooper, L. A. (2004). Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. Journal of General Internal Medicine, 19(2), 101–110.

Juergens, C. P., Dabin, B., French, J. K., Kritharides, L., Hyun, K., Kilian, J., Chew, D., & Brieger, D. (2016). English as a second language and outcomes of patients presenting with acute coronary syndromes: Results from the CONCORDANCE registry. Medical Journal of Australia, 204(6), 239.

Kelly, M. A., Hopwood, N., Rooney, D., & Boud, D. (2016). Enhancing students' learning through simulation: Dealing with diverse, large cohorts. Clinical Simulation in Nursing, 12(5), 171–176.

Kent-Wilkinson, A., Leurer, M.D., Luimes, J., Ferguson, L., & Murray, L. (2015). Studying abroad: Exploring factors influencing nursing students' decisions to apply for clinical placements in international settings. Nurse Education Today, 35(8), 941–947.

Kim, S. S., Kaplowitz, S., & Johnston, M. V. (2004). The effects of physician empathy on patient satisfaction and compliance. Evaluation and the Health Professions, 27(3), 237–251.

Komaric, N., Bedford, S., & van Driel, M. (2012). Two sides of the coin: Patient and provider perceptions of health care delivery to patients from culturally and linguistically diverse backgrounds. BMC Health Services Research, 12(1), 322.

Kraemer, H. C., & Thiemann, S. (1987). How many subjects? Statistical power analysis in research (1st ed.). Sage.

Kritikos, E. P. (2003). Speech-language pathologists' beliefs about language assessment of bilingual/bicultural individuals. American Journal of Speech-Language Pathology, 12(1), 73–91.

Lazewnik, R., Creaghead, N., Combs, S., & Raisor-Becker, L. (2010). Perspectives on preparing graduate students to provide services to diverse populations in schools. SIG 16: Perspectives on School-Based Issues, 11(2), 33–39.

Levett-Jones, T. (2015). Cultural Empathy Toolkit. Newcastle, NSW: The University of Newcastle.

MacBean, N., Theodoros, D., Davidson, B., & Hill, A. E. (2013). Simulated learning environments in speech-language pathology: An Australian response. International Journal of Speech-Language Pathology, 15(3), 345–357.

MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999). Sample size in factor analysis. Psychological Methods, 4(1), 84–99.

McAllister, L. (2005). Issues and innovations in clinical education. Advances in Speech-Language Pathology, 7(3), 138–148.

McCrum-Gardner, E. (2008). Which is the correct statistical test to use? British Journal of Oral and Maxillofacial Surgery, 46(1), 38–41.

Ng, P., Goddard, T., Gribble, N., & Pickard, C. (2012). International placements increase the cultural sensitivity and competency of allied health students: A quantitative and qualitative study. Journal of Physical Therapy Education, 26(1), 61–68.

NHMRC (National Health and Medical Research Council). (2006). Cultural competency in health: A guide for policy, partnerships and participation.

Pang, S., Mok, Z., & Rose, M. (2015). Time for change: Results of a national survey of SLP practice in CALD aphasia rehabilitation. Journal of Clinical Practice in Speech-Language Pathology, 17(1), 20–26.

Papadopoulos, I., Tilki, M., & Taylor, G. (1998). Transcultural care: A guide for healthcare professionals. Quay Books.

Pettigrew, T. F., & Tropp, L. R. (2008). How does intergroup contact reduce prejudice? Meta‐analytic tests of three mediators. European Journal of Social Psychology, 38(6), 922–934.

Pickering, M., & McAllister, L. (2000). A conceptual framework for linking and guiding domestic cross-cultural and international practice in speech-language pathology. Advances in Speech Language Pathology, 2(2), 93–106.

Reichard, R., Serrano, S., Condren, M., Wilder, N., Dollwet, M., & Wang, W. (2014). Engagement in cultural trigger events in the development of cultural competence. Academy of Management Learning & Education, 14(4), 461–481.

Rogers, G. D., McConnell, H. W., De Rooy, N. J., Ellem, F., & Lombard, M. (2014). A randomised controlled trial of extended immersion in multi-method continuing simulation to prepare senior medical students for practice as junior doctors. BMC Medical Education, 14(1), 90–100.

Roseberry-McKibbin, C., Brice, A., & O'Hanlon, L. (2005). Serving English language learners in public school settings: A national survey. Language, Speech and Hearing Services in Schools, 36(1), 48–61.

Saha, S., Beach, M. C., & Cooper, L. A. (2008). Patient centeredness, cultural competence and healthcare quality. Journal of the National Medical Association, 100(11), 1275–1285.

Sales, I., Jonkman, L., Connor, S., & Hall, D. (2013). A comparison of educational interventions to enhance cultural competency in pharmacy students. American Journal of Pharmaceutical Education, 77(4), 76.

Scott, H. (2011). Empathy in healthcare settings (Doctoral dissertation).

Speech Pathology Australia (2001). Competency-based occupational standards (CBOS) for speech pathologists. SPA Limited.

Speech Pathology Australia. (2009). Working in a culturally and linguistically diverse society. SPA Limited.

Speech Pathology Australia. (2018) Clinical Education in Australia: Building a Profession for the Future. SPA Limited.

Stephenson, J., & Imrie, J. (1998). Why do we need randomised controlled trials to assess behavioural interventions? British Medical Journal, 316(7131), 611–613.

Stow, C., & Dodd, B. (2003). Providing an equitable service to bilingual children in the UK: A review. International Journal of Language & Communication Disorders, 38(4), 351–377.

Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach's alpha. International Journal of Medical Education, 2(1), 53–55.

Verdon, S. (2015). Enhancing practice with culturally and linguistically diverse families: 6 key lessons from the field. Journal of Clinical Practice in Speech-Language Pathology, 17(1), 2–6.

Verdon, S., McLeod, S., & Wong, S. (2015). Reconceptualizing practice with multilingual children with speech sound disorders: People, practicalities and policy. International Journal of Language & Communication Disorders, 50(1), 48–62.

Wang, Y. W., Davidson, M. M., Yakushko, O. F., Savoy, H. B., Tan, J. A., & Bleier, J. K. (2003). The scale of ethnocultural empathy: Development, validation, and reliability. Journal of Counselling Psychology, 50(2), 221–234.

Ward, E. C., Baker, S. C., Wall, L. R., Duggan, B. L., Hancock, K. L., Bassett, L. V., & Hyde, T. J. (2014). Can human mannequin-based simulation provide a feasible and clinically acceptable method for training tracheostomy management skills for speech-language pathologists? American Journal of Speech-Language Pathology, 23(3), 421–436.

Wells, M. (2000). Beyond cultural competence: A model for individual and institutional cultural development. Journal of Community Health Nursing, 17(4), 189–199.

Williams, C., & McLeod, S. (2012). Speech-language pathologists' assessment and intervention practices with multilingual children. International Journal of Speech-Language Pathology, 14(3), 292–305.

How to Cite
Hewat, S., Walters, J., & Lee, M. (2020). The Impact of an Online Cultural Simulation Activity on the Development of Speech Pathology Students’ Cultural Empathy: A Pilot Study: A pilot study. International Journal of Practice-Based Learning in Health and Social Care, 8(2), 16-28.
Research Articles