Recently, ASHA posted an article in the ASHA Leader focusing on how to better prepare graduate students to enter the healthcare arena upon graduation. The article, penned by Dr. James Coyle of the University of Pittsburgh’s Communication Sciences and Disorders department, really got me thinking about my own education as a speech pathology grad student.
I often hear the words “I wish they taught this in grad school”, escape my mouth. I realize graduate school is meant to cover a large breadth of information in a brief amount of time, and nothing can compare to hands on experience. This is what your clinical fellowship is intended for.
I feel that changing the curriculum for graduate education is a necessary for future speech pathologists to remain relevant in the medical setting. However, I would like to take the point of the article one step further and focus on the clinical fellowship year. I feel it would be just as advantageous to focus on improving the clinical fellowship process, as it is to revamp graduate education.
Prepared to treat dysphagia?
Because I work in the medical setting, I find up to 70% of my caseload at times can have patients with some degree of dysphagia. I have to admit, I did have an awesome dysphagia professor during my graduate studies. However, without the hands-on component during the course, I was not able to apply the knowledge as I was learning.
Like most graduate students across the nation I did not have a clinical rotation with a focus in swallowing disorders. Our in-house clinic did not provide services for treatment or diagnostics for dysphagia because it was considered a liability without having other auxiliary professionals, including nurses or physicians.
I did not have the opportunity to work with dysphagia until I completed an externship at a VA hospital for 9 months. It was a fast-paced environment and I often had many patients to see; very different from the 1-2 patients I had at my university clinic. This often made it difficult to ask questions or think critically. I did not worry; however, as I assumed I would be able to continue learning once in my clinical fellowship year.
Once I started my fellowship period, things went from bad to worse. Like many recent speech pathology grads, I found myself very alone. I had to learn to make some very tough clinical decisions, at the same time that I was trying to navigate Medicare, billing, and the dreaded “P” word (productivity). My CFY supervisor was off-site, and could not always come to my aid. She was very helpful by phone, but after a three-day orientation, I did not get very much one on one time with her as a mentor.
This is why I think the biggest impact on clinical education could occur at the clinical fellowship level.
Identifying and Resolving Problems within the Clinical Fellowship
The first problem is often even finding a medical placement. I had an extremely difficult time finding a medical fellowship site. I had to move 1,500 miles away just to get a fellowship position. I was lucky, as quite a few of my classmates didn’t find a placement for several months.
I think what may be best is to streamline the search process for graduates by providing a network of fellowship supervisors willing and able to have students. It’s impossible to contact every facility in your state, let alone talk to the right person at that facility to see if they will accept a clinical fellow. Perhaps eligible supervisors can register through ASHA, that way new graduates will have the opportunity to search by geographic area to find fellowship opportunities. ASHA already provides mentorship for students called S.T.E.P., or Students to Empowered Professionals, so I think creating a supervisor network could be a doable task.
I also think that it would help to increase the minimum amount of time a student has to be supervised. Currently, according to the ASHA website, clinical fellows are only required to receive 6 hours of direct supervision during each 3 month segment of the fellowship. That means if a fellow completes their fellowship in the standard 9 months, they received a minimum of 18 hours of direct supervision.
In my personal opinion, that is not enough time for an individual to learn and adequately apply effective treatment for difficult disorders often encountered in the medical setting. Swallowing disorders can lead to life threatening complications, which is why diagnostic and treatment skills need to be practiced in a safer environment with more supervision and guidance provided.
I think improving clinical and classroom education has many facets that can’t be solved, or even completely summarized in one small article. I do however, think that more work needs to be done to better prepare students to become effective professionals. Your clinical fellowship year should not be a time “to just get through”. It should be a time for applying knowledge and critical thinking skills in real situations. My hope as a speech pathologist is to be not only a CFY supervisor for a 9-month stent, but a mentor, teacher, and colleague.
Latest posts by Brittany Wingo (see all)
- Improving Graduate Education Through the Clinical Fellowship Process - February 16, 2016