ON RECORD

00:00:01:18 - 00:00:33:12
Unknown
Welcome to the On Record Podcast, a podcast where we talk with professionals and subject matter experts from diverse markets that are using video and audio technology and innovative ways to support their organizations objectives. My name is Carmen Haak and my co-host today is Kyle Shelstad. Today our guest is Annie Holland Temple, a faculty member in the Communication Sciences and Disorders department at the MGH Institute of Health Professions, one of the country's top rated SLP programs and part of the prestigious Mass General Brigham Health System.

00:00:33:17 - 00:01:08:03
Unknown
And he's also the inaugural recipient of the CAPCSD IVS Clinical Education Seed grant. Welcome, Annie. Thank you for joining us. Thank you. Annie, would you share a bit about yourself with our listeners, about your journey and how you came to be in your current role at MGH? Sure. I'm a speech language pathologist, and I had always been really interested in communication and connection from a very early age, and that really led me to the profession when I was, you know, selecting what I was going to do for my career.

00:01:08:05 - 00:01:30:07
Unknown
And then as I was practicing as a speech language pathologist, I specialized in pediatrics. I loved working with my clients who were very young and their families. And as I worked more with them, I really found myself wanting to teach more and, you know, engage with people who were interested in the field, students who were pursuing a degree in Speech Pathology.

00:01:30:07 - 00:01:55:12
Unknown
And so as I started supervising more students and engaging more in teaching than I transitioned to my current role, where I'm teaching full time and I get to teach graduate students, mostly speech language pathologist, master's students. But we also do a lot of inner professional teaching as well. So that's how I ended up where I am. And it's it's been such a such an awesome journey and I love every minute of it.

00:01:55:13 - 00:02:20:05
Unknown
I understand that you've worked across some really diverse clinical settings. Would you share more about that with us? Sure. I think that's one of the big benefits of being in a health profession, like speech language pathologist, is that you really can work in different kinds of settings with different groups of people as your interests change, or as your personal needs or family needs may change.

00:02:20:07 - 00:03:00:12
Unknown
And so I've been really fortunate to be able to work within school systems. I've worked in the pediatric hospital systems, which has been really excellent. In my time at a pediatric hospital, I was doing some work in the neonatal intensive care unit, which was awesome. Our neonatal follow up clinic there. So lots of lots of different ways have I been able to work with children and their families in the Speech Pathology realm and working on communication, and then also on feeding, which is another aspect of Speech Pathology that we get to work with children and adults on as feeding and swallowing, so doing that in different settings too.

00:03:00:14 - 00:03:25:15
Unknown
Does that follow or is that fall into your published research? We tell us more about your published research that you focused on. Sure. One of my more recent publications is within my teaching of speech with graduate students. One of the things that I teach a lot about is clinical writing. And so I have really seen the power that good clinical writing can have.

00:03:25:15 - 00:03:52:16
Unknown
And also other clinical writing can have. You know, the way that we write about the sessions we conduct can really do a lot to educate a family on our impressions. It can let other people on the care team know what we're thinking or what the recommendations are. And clinical writing that's done in such a way that is inaccessible or laden with biases and things can do a lot to harm that message.

00:03:52:16 - 00:04:14:08
Unknown
And so I really feel passionate about teaching my graduate students how to be really strong clinical writers, so that all the important work that we do is communicated and really accessible and accurate ways for the family, for the patient, and for the whole care team. So everybody knows what's going on, what we're thinking, what we bring to the care plan.

00:04:14:10 - 00:04:41:20
Unknown
And so one of our more recent projects we did was have the students look at a piece of clinical writing. And in that piece we put in lots of instances of problematic or biased language with the intention that our students could see some of those pop out and flag them as problematic, and have a chance to rewrite those instances.

00:04:41:20 - 00:05:09:08
Unknown
And so we gave them that piece of writing and had them go through that exercise, identifying any of those pieces of language and trying to correct it. And then we engage them in a training module where we talked about clinical writing, we talked about anti-predator practice. We talked about how we can make our clinical writing a lot stronger, a lot more accurate, and move away from using bias language.

00:05:09:08 - 00:05:38:12
Unknown
And then we had them do that same piece of writing again and complete the activity. After the training. And in our research project, we were able to compare pre to post training and see the change that our students were able to demonstrate after they received the information, which was really fun. The ability to keep bias out of this practice seems like it would be incredibly challenging, especially what you're talking about clinical writing.

00:05:38:12 - 00:06:09:14
Unknown
So do you have any specific examples of somebody who was able to remove their bias from their clinical writing, or specific tools they might use? Sure. Yeah. I mean, it's important in Speech Pathology at in other fields, but especially in Speech Pathology where we work on communication. And communication is so deeply tied to a person's identity, to their culture, to things that are really important for us to know about and to be able to talk about.

00:06:09:14 - 00:06:33:01
Unknown
It's important for us to know different aspects of a part of a person's race or ethnicity or cultural factors that are important, because when we're thinking about their communication, there are really real pieces that we we want to make sure we don't misidentify as a disorder if it's something that actually is very acceptable given parts of their background.

00:06:33:01 - 00:07:20:00
Unknown
And so, you know, in thinking about different times that we sometimes see biases. We have worked with our students a lot about the gender binary. So we have students who sometimes come into our program and will come from the lens of having this idea of a more rigid gender binary, and especially in working with children, you know, boy, using the he series pronouns only and girl use it and and really working with our students to say, you know, these are pediatric patients and these are they're coming from families of all different kinds and all different feelings around this, and teaching students how to talk with families about how they want us to address their children

00:07:20:00 - 00:07:47:01
Unknown
and speak with their children. I think that's really important for our students to know that we don't just see something and immediately make an assumption and let that sort of direct our work and show up in the writing, but just really open things up for conversations with our families and with our patients, so that we're using the language that matters to them and makes sense for how they want us to talk with them, talk about them.

00:07:47:01 - 00:08:14:16
Unknown
And that carries over into how we write about them. I. That's excellent. I was going to ask you to elaborate on some examples of white matter so much in speech language. But you you tackled that. That's incredibly interesting from the perspective of health care in general. But speech language pathologist specifically, is there a room for AI to assist in this space, or is this human thought only that should be documented?

00:08:14:18 - 00:08:40:14
Unknown
I think we've seen so much good that can come from AI. I think especially for me, I love learning about new technologies that can help me spend more time with the people that I work with and spend more time in my teaching with students. And so I'm really excited to learn about how artificial intelligence and different programs can give me back some of that patient care or student teaching time.

00:08:40:14 - 00:09:04:16
Unknown
And I think that we're seeing a lot of strengths in some of these programs for assisting us in writing our clinical reports. It's an important piece of any speech language pathologist and many other health care professionals. Day is the documentation. It's important for reimbursement. It's important for communication among the care team. So it's something that we all need to do in our daily practice.

00:09:04:16 - 00:09:26:05
Unknown
And we're seeing that there are there are many AI programs that are able to take in a session or take in our notes and create something that could be very workable and could save us a lot of time. As far as you know, a session note or an evaluation report. Even so, we are seeing a lot of strengths.

00:09:26:05 - 00:09:59:14
Unknown
But then I think it's also important. And the reason why I engaged in this particular research study I'm doing now is we also have to be really aware and open about the the risks as well, because there are things that we're seeing in the output of generative AI platforms that we need to be aware of and we need to correct, and we need to make sure don't perpetuate, you know, long term biases and healthcare inequalities that we know exist and can easily be perpetuated.

00:09:59:15 - 00:10:48:19
Unknown
Do you see these tools as as potentially replacing speech language pathologist, or are they more of just a way to assist you in your workload? I think one of the things that really makes me happy about Speech Language Pathology right now, and I think for the future, is that it is pretty resilient to being fully replaced by AI systems, because the human connection piece of the communication and the feeding that we do is something that incorporates a human to human response and interaction that cannot be duplicated by these, these various algorithms or machines.

00:10:48:19 - 00:11:14:04
Unknown
But I do see a lot of artificial intelligence really assisting us and being able to do our jobs better, not only with the clinical documentation, but in our augmentative communication systems, the AI that's being put into systems that are helping give voice to the people that we work with, are showing such incredible strides in what they're able to help our patients communicate.

00:11:14:04 - 00:11:46:20
Unknown
And so in those ways, knowing how AI works and being able to be the human that uses the AI and in responsible and smart ways is helping our patients make so many more improvements, so much faster. And so I do see it as something that really, really supplements and enhances what we do. But I'm happy to say that I don't think it can replace the human component that is so, so important to speech, language, mythology, communication, the feeding.

00:11:47:00 - 00:12:26:07
Unknown
But it can really help. That was a really brave question, Kyle. I wasn't sure that response was, I'm just I ask because like you always see people marketing their AI tools as as a piece that can, you know, one, make your job easier. Like this is the solution for everything. Whereas like, I just I wonder if clinicians, pathologists like yourself or necessarily interested in that or just interested in ways to kind of lighten your workload, make it give you more time to focus on the patient.

00:12:26:12 - 00:12:48:15
Unknown
I never even thought about the augment, the augmentation part for the communication of the patient. I never thought about it that way to it's not just the benefit of the the communicator. It's also like the learner or the the recipient of the therapy. That's fascinating. Sorry, I don't there was a question in there, probably, but I thought that was cool about the augment augmented communication.

00:12:48:17 - 00:13:23:07
Unknown
Sure. Yeah. And we know we've had certain aspects of our jobs that have had artificial intelligence sort of woven in for a long time, that we have really benefited from our patients in using. And so there are aspects of the care that we provide and some of the assessment and treatment that we do that have been successfully transferred over to certain AI systems, especially if there's a patient who's working on voice and they're able to see their, you know, their various voice outputs on a computer and be able to self-monitor.

00:13:23:07 - 00:13:47:19
Unknown
It's especially powerful for adult clients. So there are particular things that we had always been doing face to face, provided by humans, that we transitioned certain things over to using AI systems with the help of a human facilitator. And we're really open to that, because, again, it makes it makes us be able to do our jobs better and it makes us even more effective.

00:13:47:19 - 00:14:11:13
Unknown
So I think there there's always, always room for the human connection piece in Speech Pathology. We, you know, are still going to be the the humans driving behind all of these things. But I think it's important for us to learn about the advances and be able to bring these things in, especially where it makes sense given the diagnosis.

00:14:11:14 - 00:14:34:15
Unknown
And you had introduced a little bit about what that current research looks like and how it relates to the conversation we're having. Well, the cat's out of the bag. You are not your recipient of the caps at Ivy's Clinical Education Seed grant. So congratulations to you for our listeners. Ivy's Clinical Education Seed grant is a financial award that was offered through Capsid and funded by Intelligent Video Solutions.

00:14:34:15 - 00:15:02:11
Unknown
It's designed to support innovations in clinical education, training and service delivery, and communication sciences and disorders. And what does this funding now make possible that you may have not been able to do otherwise? Yes. So we've been so happy to be able to use this funding to create a research project where we have generative AI platforms generate speech language evaluation reports.

00:15:02:11 - 00:15:32:17
Unknown
So part of this funding has made it so that we can access various platforms. We don't want to be biased and only look at one program and how that is generating speech and language reports. We wanted a variety. So in that way we've been able to use this grant for access to those. And then we also have used this grant to be able to put together a team of experts, which is really important in this kind of research, because we know that we're talking about biased language.

00:15:32:17 - 00:16:03:10
Unknown
There's so much that comes with that. Language is an ever evolving piece of human life. And we, when we're thinking about what we would consider to be biased or problematic language, we need many different minds to think about that. And we need people who do research in that particular space who have interest in AI as well, to really be able to comment on what they see to be potentially biased language in those reports.

00:16:03:10 - 00:16:42:12
Unknown
And so this C grant has allowed us to put together a team of a variety of individuals, all of whom have extensive experience in biased language, all of whom also have a strong interest in artificial intelligence. And they come from all over. We connected with colleagues from many different universities, health care systems, and we were able to present our ideas for the project, and every single one, for the most part, was fully on board to review the reports generated by the various AI platforms and then comment on the bias language that they found.

00:16:42:12 - 00:17:12:19
Unknown
And so it's really made made it possible so that we could assemble that team and be able to generate these reports in a way that really is representative of how people are working right now, because we also wanted it to be using systems and using those systems in a way that we know our students are using in their work right now with their in their clinical placements, and that practicing speech pathologist are using right now to help them in their work.

00:17:12:20 - 00:17:41:08
Unknown
If you were referenced by a colleague to help them implement AI documentations tools in their student body, or to help them use and implement documentation tools, AI, is there a warning you'd give? Is there a caveat? What would you advise if someone was looking to explore these tools? Maybe an adjacent industry? Sure, I would definitely point them to the prompt research.

00:17:41:08 - 00:18:07:05
Unknown
The research that we've seen in terms of how we prompt these systems and that letting that organization know that there are risks, there are biases, and we need to be sure we're doing this in really smart and ethical ways, and directing them to some of the literature in prompting these systems so that the output they receive is hopefully the best representative of the output.

00:18:07:05 - 00:18:50:09
Unknown
Because we've been learning a lot about the way that these various platforms are prompted can result in, in a lot of different kinds of outputs. So that's that's what I would probably mostly caution the person against is not to just fly in with no plan, because there are these risks of problematic language showing up, perpetuation of bias. You know, some issues with ethics here, I would say tailoring your prompts and making sure that the people in your organization are using really well written prompts so that the output is more of what they're looking for, and so that they aren't having to prompt and and edit.

00:18:50:09 - 00:19:11:15
Unknown
Because again, we know that with that comes more and more use of these systems. And that has environmental impacts. The amount of times that we're doing all of these things. So if we can teach people the importance of prompting and very smart and efficient ways, that's another way that we can support better outputs. I think that's very interesting.

00:19:11:17 - 00:19:40:01
Unknown
The fact that what you put in will ultimately get you more quality on the other end, and how you're wording things. Obviously, adoption has to be there, and there has to be a belief that this is going to be a tool that helps save time or or money or has a good investment on the output. Is there adoption concerns or do you see peers or colleagues you are working with?

00:19:40:01 - 00:20:04:05
Unknown
A lot of people excited about AI. What is the other side of the coin look like? The resisters? Yes for sure. So when we started as a department talking about how we were going to bring AI into our teaching and think about it for teaching our students, we know that practicing clinicians are using this, so we know our students are going to be asked to use this in their clinical placements.

00:20:04:06 - 00:20:39:18
Unknown
We expected there to be pushback. And and there were some good discussions, you know, among different members and talking about it. But what we didn't expect was how much pushback we would receive from our students. And so that's been a really interesting, interesting piece that we didn't fully prepare for, is that a lot of our students there in their early 20s, and they have a lot of very legitimate reasons for why they do not want to engage with AI in their practice as speech language pathologist.

00:20:39:18 - 00:21:06:03
Unknown
And so we've actually had to do a lot of thinking about that and talking with our students about the reality that this is something that they will very likely be tasked to use in their clinical placements or in jobs. And so how can we teach them to use it in ways that feel comfortable for them, given that there's some very strong resistance there for very legitimate reasons?

00:21:06:05 - 00:21:31:07
Unknown
Honestly, that's that's something we've seen in the past conversations that that demographic is most resistance. Do you think it'd be maybe the alternative, but no. Sorry. No, I was just yeah. That was I'm surprised that it came from students. Not like tenured faculty. And and it is completely irrelevant. But I saw some real the other Instagram real the other day where it was some commencement speaker.

00:21:31:08 - 00:21:49:04
Unknown
You're not even getting your news from TikTok. I don't know if I can trust TikTok, but but basically the same thing. Whatever. But the commencement speaker started like talking about AI in the future of it and the whole all the graduates. Yeah, you saw that. That was a couple months ago. I saw it probably just recently for you on reels.

00:21:49:06 - 00:22:09:18
Unknown
Yeah. That was like my first exposure to like, oh, maybe students like, aren't fully on board with this. Yeah. And you know, we make these we make these assumptions and we think, oh, we know exactly how how to advance our teaching. And we need to bring in the best and the newest and the and the most sort of next, next step sorts of things.

00:22:09:21 - 00:22:34:10
Unknown
But I think it's really important for anybody in any line of work that we do to to really kind of gauge with our engage with our audience and figure out, okay, actually, let's let's take a needs survey here, or let's actually figure out what what the students are feeling about it, so that again, we need we have the responsibility to teach them about artificial intelligence.

00:22:34:11 - 00:22:54:05
Unknown
We must teach them about how it's being used in speech language pathologist clinical practice. We would be doing our students a disservice to just say, oh, forget it, then we won't teach it. If you if you all don't want to use it, we won't teach it. That would be a real disservice to them. So we do need to be honest with them about that.

00:22:54:06 - 00:23:27:02
Unknown
Be really transparent with the fact that this is something it's going to show up, and your ability to use it in ethical and responsible ways is going to make it so that it provides the best with the least amount of negative impact or resource use as possible. I'm curious all of the focus that's going on this research and your work in this space, how does that impact your video observation and recording in these clinical education environments?

00:23:27:02 - 00:23:51:16
Unknown
Do they go hand in hand? Are they separate? How are you using them together or do you keep some maintain different spaces for these two topics? We keep it all all folded into. So all of our in our on campus clinic, all of our sessions are video recorded, and we are watching our students via that live stream video in the moment.

00:23:51:16 - 00:24:23:07
Unknown
And for that, we are able to give the students the space in that treatment room with the patient and with the family to take some risks and to, to feel like they can try out things without their faculty member being physically in that space. And so in that way, we're able to let our students have some of that autonomy and learn how to be a practicing clinician without us necessarily jumping in at every, at every moment.

00:24:23:07 - 00:24:56:12
Unknown
And in terms of our use of AI, we are able to fully fold in the fact that they're going to be writing a session note about what's happening in that recorded session for every single time they see a patient in our clinic, and so we're able to work with them and replay that video recording of the session and pull things out and, you know, work with them to use different, different ways of of writing up that session note in a way that is accurate to what happened.

00:24:56:12 - 00:25:21:17
Unknown
And we're always talking to our students about using objective language and removing any bias language that we find. So when we have AI supports in helping us with that session note output, we want our students to know there is a strong potential, that there will be some bias or some some subjective language here. So I need you to be able to identify it.

00:25:21:17 - 00:25:45:09
Unknown
And I need you to be able to rewrite those moments and come to me with any questions that you might have about that, because it's really difficult, especially as a new clinician who is just learning how to do the job, to then learn how to write about it is so new. And it's really it's really tricky when you haven't put those various things into words many, many times already.

00:25:45:10 - 00:26:28:21
Unknown
It does require some help and that's why we're there for them. So all these technology is reflection is a huge theme. Reflecting on the auto prompts, reflecting on what you're getting as the quality output from AI, reflection on the physicality and what's happening in the actual spaces with AV capture. What is a positive outcome that has come from using AV, whether it's in tandem with your clinical documentation, with AR, if it's just Avi, I think one of our most favorite things that we do is at the end of every semester, I students picked a video clip from their sessions that they've had in the on campus clinic, and they share it with everybody.

00:26:28:21 - 00:26:49:03
Unknown
So we have a very large cohort of students, and each student has two patients in our on campus clinic their first year. And so at the end of every semester, we all get together. That large cohort is able to put up a selected clip by them, and they're able to explain to their classmates, here's the patient I'm going to show you.

00:26:49:04 - 00:27:09:02
Unknown
Here's what we're going to do in the session, and what I was really proud of or what I was really challenged with, or what I really would love your would love your input on. And then they show a clip from those recorded sessions, and then every student in the cohort is able to see a patient that they're not familiar with, which is really important.

00:27:09:03 - 00:27:45:07
Unknown
They get more exposure and variety, and they're able to think about, okay, what would I have done in this situation? Or I really appreciated how my my peer did something in this way. I'm going to do that with my, my client that I have or my patient that I've got. So that's probably the most fun thing that we can use our video recordings for, is really celebrating each other's successes and exposing the whole cohort to all the various different patients that come through our on campus pro-bono clinic.

00:27:45:10 - 00:28:05:20
Unknown
It's really, really fun to do that at the end of every semester, and we have a lot of listeners that might be interested in contacting you to learn more about your work, or just to follow you and your research. How was the best? What is the best way for those listeners to get Ahold of you? Sure, I'm more than happy to connect via email.

00:28:05:21 - 00:28:12:11
Unknown
My email is A.K. Holland at.

00:28:12:13 - 00:28:37:15
Unknown
And you can find our more recently published report on the biased language in the pre and post training that I talked about earlier. That's in the Teaching and Learning and Communication Sciences and Disorders journal, which is open access, so you can find that there. I'm also on LinkedIn Anneke Holland. So I'm happy to connect with anyone any time.

00:28:37:17 - 00:29:03:15
Unknown
Thank you Annie. It was very enlightening. We learned a lot today. And it's it's good practice and information for every individual human being to hear. It's really nice to know that people are doing some research on these AI tools. And and so maybe we have some like facts grounded in data as to how they should be used. And we aren't just kind of like going with it and hoping that it all works out.

00:29:03:15 - 00:29:17:20
Unknown
So we really appreciate you doing this work. Yes. Thank you so much. And if you or someone you know is interested in learning more about the IVS Clinical Education seed grant visit capcsd.org/scholarships.

00:29:18:00 - 00:29:21:08
Unknown
We'll see you next time. Thank you.

00:29:21:10 - 00:29:35:21
Unknown
On Record is a podcast presented by Intelligent Video Solutions, hosted by Mike Anzalone and Carmen Haak and produced by Kyle Shelstad. Find us online at IPIVS.com/onrecord and on social media at Intelligent Video Solutions.