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Purpose: Given the impact of COVID-19 on patients and the overall effects of COVID-era precautions on medical systems, the typical practice of speech-language pathologists (SLPs) has no doubt been impacted. The purpose of this study was to investigate practice patterns, experiences, and changes in referrals to medically based SLPs since the onset of COVID-19. The collective aim is to illuminate the unique perspectives and experiences of medically based SLPs during the COVID-19 era. Method: A national Qualtrics survey was conducted to capture the experiences and perspectives of SLPs in medical settings within the United States both before and since the onset of the pandemic. A total of 208 participants responded to the survey, and a mixed-methods design was implemented to examine responses regarding changes in patient populations, experiences with COVID-19 precautions, and overall impression of practice and patient impacts. Results: Results indicate SLPs in medical settings have seen a significant self-reported shift in referral patterns since the onset of COVID-19. Results of qualitative analyses revealed clinician perspectives regarding impacts to their settings in regard to COVID-19 precautions; patient flow; patient characteristics; and the mental health of staff, families, and patients. Conclusions: Overall, the impacts to SLPs' typical practice in medical systems appears to be pervasively negative and deeply interwoven from the clinician perspective. The relationships between changes in the medical systems as a whole during the pandemic era and patient population, acuity, and outcomes have created difficult practice conditions for practitioners in medical settings from the clinician vantage point.

Purpose: Lack of preparation for working with patients near the end of life (EoL) can lead to poor outcomes for patients and burnout for clinicians. Additionally, graduate students must also receive preparation in professional communication skills necessary for family and interprofessional interactions. Simulation provides an opportunity to practice and demonstrate these skills in a safe environment. This study examined student performance and perceptions following a simulation of clinical communication in the context of an EoL care (EoLC) conference discussion. Method: By utilizing a formative simulation with standardized patients, students demonstrated skills associated with navigating an EoLC conference discussion. The supervising educators and standardized patients evaluated students on their clinical communication and debriefing skills through rubrics. Students also provided feedback on the simulation experience. Results: Results from this simulation indicated that most students demonstrated effective clinical communication skills. Judgments from educators and standardized patients corroborate students' skill demonstration in the areas of content delivery, delivering compassionate care, communicating evidence, representing their roles, and reflection. Students struggled more in the areas of terminology use and using summary and validation skills. Student feedback about the simulation was resoundingly positive. Students remarked how the simulation advanced their learning, helped them reflect on their clinical communication skills, and provided them with exposure to fragile medical patients. Conclusion: This study provides an example of a high-fidelity replicable simulation that can be implemented to measure and encourage student skill development in clinical communication and EoLC.