Rethinking Clinical Education To keep pace with the demand for SLPs, graduate programs need to increase their capacity. But for that to happen, the rules for clinical education must change. From My Perspective
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From My Perspective  |   January 2015
Rethinking Clinical Education
Author Notes
  • James M. Mancinelli, MS, CCC-SLP, is director of clinical education in the Department of Communication Sciences and Disorders at La Salle University in Philadelphia. He is an affiliate of ASHA Special Interest Groups 10, Issues in Higher Education, and 11, Administration and Supervision. mancinelli@lasalle.edu
    James M. Mancinelli, MS, CCC-SLP, is director of clinical education in the Department of Communication Sciences and Disorders at La Salle University in Philadelphia. He is an affiliate of ASHA Special Interest Groups 10, Issues in Higher Education, and 11, Administration and Supervision. mancinelli@lasalle.edu×
  • Barbara J. Amster, PhD, CCC-SLP, is professor, chair and graduate director in the Department of Communication Sciences and Disorders at La Salle University. She is an affiliate of SIGs 10, 11 and 4, Fluency and Fluency Disorders. amster@lasalle.edu
    Barbara J. Amster, PhD, CCC-SLP, is professor, chair and graduate director in the Department of Communication Sciences and Disorders at La Salle University. She is an affiliate of SIGs 10, 11 and 4, Fluency and Fluency Disorders. amster@lasalle.edu×
  • © 2015 American Speech-Language-Hearing Association
Article Information
Professional Issues & Training / From My Perspective
From My Perspective   |   January 2015
Rethinking Clinical Education
The ASHA Leader, January 2015, Vol. 20, 6-7. doi:10.1044/leader.FMP.20012015.6
The ASHA Leader, January 2015, Vol. 20, 6-7. doi:10.1044/leader.FMP.20012015.6
It’s not news that most, if not all, speech-language pathology graduate programs turn away a number of qualified applicants every year. The competition for admission to speech-language pathology programs is fierce and seems to continue to get even more competitive.
Yet, there is no shortage of employment opportunities for SLPs. The ability of master’s programs to train more students, therefore, is critical to the future of speech-language pathology.
So why can’t master’s programs take more students? An obvious answer is that they are constrained in size because it is increasingly difficult to find clinical practicum placements for students. The existing 1:1 supervisory model of clinical education has been used since the 1970s. However, there is no evidence that it is the best model for clinical education.
Practical constraints at clinical sites affect clinical placements:
  1. The 1:1 supervisor/supervisee model of training is unrealistic and stresses the external affiliate’s resources and manpower.

  2. Fiscal constraints are affecting staffing and resources.

  3. With staff attrition, there is no guarantee that new staff will/can be hired.

  4. Productivity requirements are imposed on staff due to (1) and (2) above.

The 2014 ASHA certification standards require that the student enrolled in a master’s degree program in speech-language pathology obtain 400 clinical hours “across the lifespan with varied disorders.” This is a broad guideline and superficially seems reasonable and achievable.
Unfortunately, the current service delivery contexts in which SLPs practice are affected by fiscal constraints, staffing shortages and productivity requirements, rendering the requirement of 400 clinical practicum hours using the 1:1 supervisory model unrealistic.
Although the three factors noted above may not necessarily affect the quality of care, they are seriously affecting programs’ ability to place graduate students in clinical practicum experiences. A serious and committed review of our training methods is warranted.
Many professions—including medicine and aviation—use technology successfully to train students. Medicine has also been using standardized patients (actors who are trained to portray a particular patient type) for student training. Not incorporating these alternative teaching methods into our clinical training and educational model is shortsighted.
These types of approaches to clinical education should be implemented, and the contact hours spent in these approaches should count toward certification.
We suggest that the Council for Clinical Certification and the Council on Academic Accreditation in Audiology and Speech-Language Pathology consider the following:
  • Reduce the total requirement of clinical contact hours. There is no evidence to suggest that 400 hours is the “magic” number necessary to create an entry-level clinician. We are not suggesting totally eliminating the contact hour requirement. Perhaps a new minimum number of hours could be considered in combination with some alternative methods for counting hours of clinical training.

  • Introduce the standardized patient into the clinical education programs. This model is part of medical student training and has great value, especially for teaching entry-level skills such as gathering case histories, conducting evaluations and practicing treatment protocols.

  • Allow students in school-based practicums to count hours spent in Individualized Education Program preparation and meetings. These meetings are integral parts of school-based practice and there is no logical reason why the hours should not be counted. From a “workload vs. caseload” perspective, it is counterintuitive not to count them.

  • Broaden the 1:1 supervision model to include other types of mentoring. For example, have two students working together with one field supervisor and allow both students to count the contact hours for that specific patient/client.

  • Take advantage of modern technology by counting clinical training hours obtained through simulation as well as other future applicable technological advances.

Efficacious clinical education for graduate students in our discipline has become more difficult. As a profession, we must address this issue by facing the facts directly and adjusting our educational model so that it reflects the realities of our time.
1 Comment
January 6, 2015
Edie Jansen
Agree and disagree
As a person who went through an on campus graduate program for my MA-SPED and an online graduate program many years later for my SLP-CCC I preferred that I had to set up my own clinical experiences-which was the requirement for the SLP program. Since most of the typical placements were already swamped with students in locally based graduate schools, I had to think outside the box and got great experiences! However, not everyone has my fortune and may end up with sub-par placements. I wholeheartedly agree that utilizing technology more to facilitate clinical experiences is a good way to move forward. A few of my supervision experiences were conducted over Skype sessions with the Supervisor sitting in a room 300 miles away from me watching me and my clients over the Skype broadcast in real time. Additionally, I agree there should be "standardization" in the client experiences we encounter. I was fortunate to have children with apraxia and dysarthria to work with, plus some other low-incidence kids and adults that helped make my experience more meaningful, but I think many students miss out on having those experiences because they work with certain populations only. For example, a clinical experience set up in an Autism program is wonderful, but it may never offer an opportunity to learn or experience articulation therapy techniques, or the opposite-a student may only work on articulation and never get to explore the differences between articulation and phonological processing errors or even get a look at a person with swallowing or language issues. I am seeing many people graduate from programs who are not effective with clients because they've never even seen a client with that particular disorder/need. Technology could allow better access to a larger variety of issues; both those commonly seen and those that are less common. I do not believe; however, that the amount of time should be lessened. It was a major struggle to get those hours, and the struggle was part of what I believe made me a better clinician.
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January 2015
Volume 20, Issue 1