How We Can Better Prepare Students for Modern Health Care Students preparing to treat swallowing disorders need a solid grounding in physiology to effectively treat patients. Academic Edge
Free
Academic Edge  |   October 01, 2015
How We Can Better Prepare Students for Modern Health Care
Author Notes
  • James Coyle, PhD, CCC-SLP, BCS-S, is an associate professor in the University of Pittsburgh Department of Communication Sciences and Disorders and a clinician at the University of Pittsburgh Medical Center. He is an affiliate of ASHA Special Interest Group 13, Swallowing and Swallowing Disorders. jcoyle@pitt.edu
    James Coyle, PhD, CCC-SLP, BCS-S, is an associate professor in the University of Pittsburgh Department of Communication Sciences and Disorders and a clinician at the University of Pittsburgh Medical Center. He is an affiliate of ASHA Special Interest Group 13, Swallowing and Swallowing Disorders. jcoyle@pitt.edu×
Article Information
Swallowing, Dysphagia & Feeding Disorders / Academic Edge
Academic Edge   |   October 01, 2015
How We Can Better Prepare Students for Modern Health Care
The ASHA Leader, October 2015, Vol. 20, online only. doi:10.1044/leader.AE.20102015.np
The ASHA Leader, October 2015, Vol. 20, online only. doi:10.1044/leader.AE.20102015.np
Health care has changed dramatically, mostly because of technological advances that have increased survival of patients with previously life-threatening diseases and trauma. Often these conditions adversely affect communication and swallowing function.
As a result, the speech-language pathologist’s caseload in health care settings has grown to include patients with an array of diseases and disorders (like post septic-shock syndrome, metabolic encephalopathy, pulmonary fibrosis, pneumonia) that are not covered in traditional textbooks used in accredited speech-language pathology graduate programs.
Speech-language pathology anatomy and physiology textbooks tend to present the structure and functions of the aerodigestive tract as if it was designed for speech production. They tend not to delve into the physiologic functions of these organ systems that have been adapted for the production of speech and used for the life-preserving performance of swallowing.
The respiratory system does not facilitate vocal fold vibrations that create a sound that is then shaped in the upper parts of the vocal tract. It is a physiologic system designed to extract respiratory gases from the atmosphere, facilitate transport of these gases into arterial blood, and extract waste gases produced in metabolizing organs to be transported back into the atmosphere.
Humans and other creatures have cleverly adapted this system for use in communication. When alveoli, lung segments or lobes, or airways are diseased, their ability to perform these physiologic functions is altered. As a result, things like vocal fold vibration, phrase length, loudness of speech, quality of phonation, and swallow-respiratory coordination are altered. It’s all about the physiology.
Physiology comes first
Like physicians-in-training, student SLPs must understand the normal structure and function of the organ systems involved in speech production and swallowing—as well as the systems’ central and peripheral neural substrates—before the students learn how to manipulate those same systems to improve communication and swallowing function.
A physician does not prescribe a blood pressure medication because it lowers blood pressure. He or she prescribes it because it causes vasodilation or prevents vasoconstriction or inhibits autonomic mechanisms that raise blood pressure in a way that is compatible with the patient’s other conditions and offers the best reduction in risk or hypertension-related adverse events for that patient. Likewise, the SLP should know how to analyze how a given disease state alters the physiological functions of organ systems that support communication and swallowing function before formulating logical intervention plans. This process cannot happen without appropriate preparatory education. And this all starts in the classroom.

Student SLPs must understand the normal structure and function of the organ systems involved in speech production and swallowing—as well as the systems’ central and peripheral neural substrates—before the students learn how to manipulate those same systems to improve communication and swallowing function.

Instructors’ responsibility
How can instructors ensure this education? For starters, they need to know the basic anatomy and physiology of the systems involved in functions and disorders. For example, we shouldn’t teach students that the area between the diaphragm and the lips is the “vocal tract” as if it were a strictly communicative organ. We must teach students about the respiratory system’s healthy structure and function, and then layer on the adaptations made to produce speech, and then how disease changes physiology, which (in a chain reaction) alters communication function.
The same is true with swallowing. There is not a “swallowing mechanism”; rather, there is the upper portion of the aerodigestive tract, which alternates between its respiratory and swallowing functions many hundreds of times per day to sustain life. The muscles of mastication are first muscles and, second, used for mastication.
Students’ responsibility
What can the student do? First, ask yourself if you want to be a health care professional. If the answer is yes, then take the same human anatomy and physiology courses that pre-med, nursing, dentistry and pharmacology students take as undergraduates. Understand how healthy muscles, lungs, joints, tendons, digestive organs, kidneys, nerves and central nervous structures work at the cellular, tissue and organ levels.
Then learn about diseases of these organ systems and how they affect normal function. Then when you learn about “respiration for speech” you will already “get it.”
Altering our instructors’ way of teaching our students is the slow, long-term solution, but it can result in a permanent solution that fosters thinking as medical professionals as medical technology advances. Altering our students’ way of preparing to be an SLP is a quicker solution because the entire cohort of future speech-language pathology students can start to upgrade now. Yes, we may lose some potential SLPs to medical schools. That is not such a bad outcome; we will all appreciate having more physicians who started off as interested in communication and swallowing disorders.
3 Comments
October 9, 2015
Jennifer Wood-Coyle
SLPs need medical training
Amen. This article is strong and onpoint and a wake-up call for staying relevant in the health care field. I was never in favor of a medical tract for SLPs, but am re-thinking that based on reality and what I would want as a patient in need of an SLP. Incidentally, I would love this to appear in the print version of ASHA Leader since I rarely have the opportunity (or preference) to read online journals. Several of my colleagues also feel strongly about this preference. I think it would get more exposure in print among those in the positions to affect change.
October 14, 2015
Roberta Fast
SLP's furthering areas of expertise
As a doctor must take courses to stay relevant, it seems prudent to offer certifications for areas of expertise so we can have specialties. Too many therapists contend that our field is too broad and requires a chosen specialization before a masters program is complete. In lieu of that or even post masters, it seems prudent to offer "Specialization Certifications " in a similar vein to grow in an area of expertise AFTER one is in the health arenas to hone in on APPLYING course work to a day's work (now there's a new concept!--using what we learn in the classroom for the field work). ASHA needs to create re-cert programs that encourage specializations while encouraging professional growth that health care employers will recognize and reward. But lets not let it take 7 years of supervision as is currently the method. Its too arduous and expensive. It needs to be smaller in time investment so SLP's can actually do this with relative ease and apply it all the sooner in their day's work.
November 8, 2015
Rebecca Inzana
Hear hear!
A sound appreciation for and understanding of the underlying physiologic systems is imperative for all practicing clinicians in medical settings, and therefore needs to be addressed educationally. At Massachusetts General Hospital, we designed a Graduate Student Experience in Medical SLP that incorporates workshops in underlying physiologic systems and medical themes within our clinical practicum for CSD Masters level students at MGH Institute of Health Professions. The student and supervisor feedback has been phenomenal. We've been running this program since 2013, and I'll be presenting on this innovative model at the ASHA Convention.
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
October 2015
Volume 20, Issue 10