In the contemporary landscape of higher education, the production and distribution of professional knowledge are increasingly conditioned by what may be termed a "poly-crisis": a confluence of diminishing clinical placement opportunities and heightened trainee-to-trainer ratios. As clinical placements become scarce due to socio-economic and geographic peripheries, higher education institutions must innovate to ensure the development of "situated" professional competence. This study investigates the effectiveness of clinical simulations—a high-fidelity pedagogical tool—in fostering professional efficacy and managing the psychological dynamics of stress among students in Communication Disorders (CD).

Drawing on Bandura’s (1997) theoretical framework, professional efficacy is defined as a student’s belief in their ability to master professional tasks and meet clinical challenges. Scientific knowledge in clinical fields is not merely an abstract set of rules; it is a lived, "time- and place-bound" performance. Simulations provide a "safe" yet realistic ecosystem where this knowledge is taken up by its users through cycles of experience, feedback, and reflection. This research explores whether these simulations successfully mediate the transition from academic theory to clinical readiness, particularly regarding interpersonal therapeutic skills and professional identity, and thus is relevant to all CD practitioners, regardless of their institution of learning.

This investigation employed a mixed-methods design involving 64 first- and second-year CD students. Quantitative data were gathered via a customized Professional Efficacy Questionnaire (adapted from the SLP-CSEI) and self-reported stress scales administered pre- and post-simulation. The qualitative dimension utilized semi-structured interviews with 21 participants, analyzed through phenomenological content analysis to capture the "lived experience" of the simulation.

Quantitative results indicated a robust and statistically significant increase in both general and simulation-specific professional efficacy. For general efficacy, mean scores rose from M=3.59  to M=3.99 (p<.001,d=0.73), demonstrating a large effect size. Interestingly, while the quantitative data showed no significant reduction in immediate stress levels, the qualitative findings revealed a more nuanced reality. Students described simulations as "emotionally charged" threshold experiences. Six core themes emerged from the qualitative analysis: the emotional response to participation, observation as a form of "embodied learning," the instructor as an affective-cognitive scaffold, navigating complex communication with families, the emergence of professional identity, and the development of empathic communication.

The findings suggest that simulations serve as a "lived crucible" where theoretical knowledge merges with practice. Crucially, the study highlights that observation is not a passive act but a deeply "embodied" form of learning where students experience vicarious stress and rehearse emotional regulation. Furthermore, the role of the moderator as a "scaffold" was identified as essential for transforming raw experience into reflective insight. Despite the high economic cost—estimated at three times the cost of traditional placements—the study justifies simulations as a necessary intervention in a shifting academic ecosystem. By fostering professional identity and empathic dialogue in a controlled environment, simulations address the need for creative and caring education research that prepares professionals for a complex, fluctuating world.

The study utilized a concurrent mixed-methods design, integrating quantitative hypothesis testing with qualitative phenomenology to explore the subjective experiences of CD students. Participants: The sample comprised of 64 unique students (62 female, 2 male) aged 20–30 (M=23.5), predominantly in their first or second year of a Communication Disorders program. For the qualitative phase, 21 female students volunteered for semi-structured interviews. Procedure and Context: Simulations were embedded within the clinical practicum rather than academic coursework, focusing on seven clinical areas: case history taking, Autism, Stuttering, Special Education, Developmental Communication Disorders, and Adult Neurological Disorders. Each workshop featured a 5–7 minute interaction between a student volunteer and a professional actor portraying a family member or colleague, while the remaining students observed. Every session concluded with a formal debriefing led by a content expert and a simulation specialist. Instrumentation: 1. Professional Efficacy: A customized version of the Speech-Language Pathology Clinical Self-Efficacy Inventory (SLP-CSEI) was used, focusing on communication, collaboration, and counseling. 2. Stress Measure: A 5-point Likert scale measured self-reported stress before and after the session. 3. Qualitative Interviews: Semi-structured protocols addressed expectations, emotional experiences, and reflections on professional growth. Data Analysis: Quantitative analysis utilized Linear Mixed-Effects Models (LMM) to account for the nested structure of data (91 paired observations from 64 participants). This approach adjusted for individual differences and variations across the seven simulation types. Frequentist p-values were supplemented with Bayes Factors (BF10) to quantify the strength of evidence for observed changes. Qualitative data were processed through content analysis (Elo & Kyngäs, 2008), which involved coding meaningful segments, identifying categories related to stress and efficacy, and consolidating these into recurring themes. To ensure data quality, quantitative analysis was performed both with and without smaller subgroups (e.g., Special Education) to confirm the stability of the findings. This multimodal approach ensured that the "how" of knowledge uptake was investigated alongside the "what" of skill acquisition.

This research confirms that clinical simulations are a highly effective, albeit resource-intensive, component of professional training in higher education. The primary pedagogical contribution is the finding that simulations significantly enhance professional efficacy by providing "mastery experiences" and "vicarious learning" opportunities early in the training sequence. While simulations do not necessarily mitigate immediate stress, they function as "productive stress" environments—a "stretch zone" that promotes learning without reaching the "panic zone". The study offers several critical insights for the "Network 22" subtheme of teaching and supervision: 1. The Scaffolding Presence: The moderator’s role is not merely evaluative but serves as an affective-cognitive scaffold, enabling students to transform vulnerability into relational competence. 2. Observation as Embodied Pedagogy: Higher education must re-evaluate the role of the observer. Observation fosters analytical distancing and empathic identification, proving to be a deeply active form of knowledge production. 3. Justifying the Ecosystem: In an economic climate where simulations cost three times more than traditional placements, their value lies in providing exposure to complex, low-frequency clinical scenarios that a standard practicum cannot guarantee. 4. Empathy as a Situated Skill: Simulations successfully bridge the gap between abstract technical knowledge and the "empathic dialogue" required in real-world professional practice. Ultimately, this study demonstrates that education research can be "creative and caring" by prioritizing psychological safety and professional identity. By situating learning within authentic emotional challenges, higher education institutions can better equip students to navigate the complexities of their future professions in a world of flux.

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