Nobody Told Me There’s No Supervision Manual!: Proposed phased-in training for supervisors in the professions seeks to provide them with long-sought resources and support.

Elizabeth Thompson Beckley

doi:10.1044/leader.FTR1.22102017.44

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Features | October 01, 2017

Nobody Told Me There’s No Supervision Manual!Proposed phased-in training for supervisors in the professions seeks to provide them with long-sought resources and support.

Elizabeth Thompson Beckley

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The ASHA Leader, October 2017, Vol. 22, 44-49. doi:10.1044/leader.FTR1.22102017.44

For decades, audiologists and speech-language pathologists have stepped into new roles as supervisors with little preparation. After all, supervision wasn’t the focus of their graduate school training.

Nevertheless, most have entered the role with hopeful assumptions: Surely their education, knowledge, and experience in clinical practice would be enough to make them effective.

But then many discovered they lacked concrete information, methods and support to feel as confident as they wished to be as a clinical educator, preceptor, mentor or supervisor. The fact is, even though supervision has been recognized since at least the 1970s as a distinct area of practice, most supervisors have had to learn these skills on their own through trial, error and improvisation.

A number of seasoned professionals share stories of “cramming” to acquire the clinical or technical knowledge they thought would be adequate to guide others. Several say they patterned their efforts on what they preferred—or did not—about their own supervisor’s actions back in the day. Not exactly a scientific, proven or reliable approach.

Supervision can broadly be defined as overseeing and directing the work of others. But once someone has taken on the actual responsibility, they soon discover that a good clinical supervisor needs to teach specific skills, clarify concepts, aid critical thinking, conduct performance evaluations, mentor, advise and model professional behavior, among other obligations. And they need to do all of this while attending to their regular workload.

To help better support supervisors who find themselves in this predicament, an ASHA group has worked up a new, more disciplined approach to supervision training. The 2016 final report from ASHA’s Ad Hoc Committee on Supervision Training (AHCST) provides a thoughtful roadmap that seeks to shift the culture of supervision training from one of flying blind to one that ensures all clinical educators and preceptors will have professional development training in supervision. It offers a systematic six-year plan to develop resources and opportunities for supervision training.

The committee identified the knowledge and skills needed to supervise in many different settings: clinical educators of graduate students in university training programs or in externships in off-campus clinical settings; preceptors of audiology students in the final externship; mentors of clinical fellows; supervisors of support personnel; and supervisors of professionals transitioning to a new practice area or re-entering the workforce.

It has recommended to the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) and Council for Clinical Certification in Audiology and Speech-Language Pathology (CFCC)—standards-setting bodies for accreditation of academic programs and certification of practitioners, respectively—that they consider incorporating standards language addressing the need for clinical supervisors to have training in supervision. (The CAA has to date adopted standards language regarding students learning more about supervision in their academic programs.) The committee also recommends that clinical educators and preceptors acquire professional development training in supervision, but this would ultimately be determined by the CFCC.

Even though supervision has been recognized since at least the 1970s as a distinct area of practice, most supervisors have had to learn these skills on their own.

Improvisation by the unprepared

As more communication sciences and disorders (CSD) professionals recognize the value of formal, structured supervision training, they also see how the benefits affect them on personal, professional and practical levels. Audiologist Nancy Nelson, an AHCST member, says those who seek opportunities and resources discover how the training can help them better balance their supervision duties with their daily practice. It also can help one handle a difficult conversation, or a student who is acting unprofessionally, says Nelson, hearing clinic director and clinical associate professor in the Department of Speech and Hearing Sciences at Indiana University in Bloomington.

Nelson recalls that when she was hired as a clinical supervisor in 1990, she felt confident that her five years’ experience in practice at Boys Town National Research Hospital in Omaha, Nebraska, and some adjunct teaching at nearby Creighton University, had prepared her for what seemed like a “fun” new opportunity. But she says it quickly became apparent that it hadn’t.

“Training students who were new to the field was wildly different than discussing with clinical fellows the nuances of a case, because [the students] were meeting the world from the ground up,” Nelson says. “I felt like, ‘I’m not really prepared for this.’”

Seeing patients that first Monday morning was a breeze compared with the unnerving new responsibility of having a student who rarely left her side, she says.

“I drew very heavily on my own experience,” Nelson says. “What did my own supervisors do? What did I like? I’ll try to do a lot of that. What didn’t I like? I’ll try to avoid that.”

The long-time standard was that if you’ve worked more than three years, then you can start being a supervisor, she says. But the technical skills that come from training for a long time on how to be an audiologist—how to do procedures, talk to people and run a business—just don’t always transfer to being able to teach and mentor.

“Without supervision training, they might feel like I did at the beginning: Gosh, I’m really overwhelmed by this. I’m not sure if I like this,” Nelson reflects. “You could potentially lose really valuable people, because if they don’t have anything to help them in the beginning, they might decide this isn’t really for me. I loved the work of being an audiologist, but sometimes it felt like, being a supervisor, things were a little out of my control.”

Nelson’s early supervision experience is not unique. SLP Kevin McNamara, director of the Center for Communication Disorders at Southern Connecticut State University and clinical director in the Department of Communication Disorders, says he, too, was “pretty much flying by the seat of my pants” with his first formal supervisory experience of a clinical fellow one year after he graduated from his master’s program.

“I’m not sure what I did beyond being a good listener and supportive,” says McNamara, another member of the AHCST. “That’s important, but in retrospect, what I was able to offer at that point was not well-informed in terms of best practices.”

As he went on to supervise five more clinical fellows, he says he relied on his memories of what worked for him—could he replicate the good experiences and avoid what went poorly?

“That’s a good opportunity to develop your own style, but it is not a very strategically informed way of looking at the process,” McNamara says.

He added another piece of his understanding and contribution to the knowledge base of clinical supervision when he stepped into the role of clinical director. When he had to assess other clinical supervisors’ skill sets, McNamara says, he saw there had to be something more systematic. He joined a close-knit group of clinical directors at other New England universities and began to interact with people nationwide in similar situations. He had opportunities to see how people in different settings dealt with their practices, while he had much more access to continuing education, peers doing research, and an influx of other information.

“I realized that people who were still in the trenches, who were out in practice settings not linked to the academic community, did not have access to any of this, and those are the people who really needed this information on the front lines of practice,” McNamara says. “Understanding that that gap existed—that a huge, important part of our community was in an information desert—was a strong incentive for me personally to see what I could do to be part of the movement for mandatory training.”

“I loved the work of being an audiologist, but sometimes it felt like, being a supervisor, things were a little out of my control.”

Developing a literature

Another supervisor who remembers feeling the sting of inadequate preparation is Vicki McCready, chair of the AHCST and professor emerita in the Department of Communication Sciences and Disorders at the University of North Carolina at Greensboro. After accepting a position in 1977 as a clinical supervisor at the University of Maine after 10 years of clinical work at hospitals and with the Head Start program in Denver, she arrayed all her textbooks on a large bed in an attempt to become an expert in every area. She soon recognized this was “ludicrous.”

Luckily, she says she had the good fortune to receive mentoring from Marisue Pickering, a pioneer in the area of CSD supervision research, and to benefit from a surge in emphasis on supervision in the 1970s, with research appearing in conference proceedings, presentations at national conventions, and several book publications. Surveys found supervisors expressing a need for training, and some universities began offering supervision coursework and in-services.

The Council of Supervisors in Speech-Language Pathology and Audiology (CSSPA), originally established for supervisors in universities, provided McCready with the support and training she needed in supervision in the 1970s and 1980s. CSSPA eventually evolved into one of ASHA’s Special Interest Groups—SIG 11, Administration and Supervision.

ASHA “legitimized” supervision as a distinct area of expertise and practice that warranted specialized training when it issued recommendations in a 1985 position paper on clinical supervision in audiology and speech-language pathology, McCready says. Supervision gained even more recognition in 1988, when Jean Anderson published her seminal work, “The Supervisory Process in Speech-Language Pathology and Audiology.” Anderson’s work, McCready says, “cannot be overestimated.”

She is not sure why, with the activity and research around supervision building steam, attention seemed to wane in the late 1990s and early 2000s. She surmises that other demands could have been responsible for the shift.

“So much else was happening in our professions in terms of certification and pressures to produce in different employment settings,” she says.

And still today, McCready says, some people express concerns that they have their hands full with existing responsibilities, requirements and paperwork, a situation she understands. At the same time, she says she would like to help them with a paradigm shift, to see that by becoming a trained supervisor, they might actually become more efficient in their supervision.

The more typical response is a welcoming one, McCready says, where professionals see supervision training as an opportunity to provide the most competent services they can to their patients and clients, and to the students they are supervising.

“If we get people voluntarily engaged in supervision training now, it won’t be a huge leap should a requirement go into effect in the future.”

Training roadmap

So how do the AHCST plan architects hope to unroll training to the supervisors out there seeking it? The plan calls for a six-year phase-in period that will culminate with an obligation for clinical educators and preceptors to acquire a minimum of two hours of professional development training in supervision in an ASHA certification cycle.

“That ‘dosage’ [the two-hour minimum requirement] isn’t enough to get the entire body of knowledge and skill sets,” McNamara acknowledges, “but hopefully it launches them into a more active and thoughtful clinical education experience throughout their career.”

Advocacy among members and CSD groups will be key, McCready says, and a big part of that is having answers to the question: Why should I supervise a clinical fellow or graduate student? Many of those answers have been addressed in the Supervision Training Brand Essence and Positioning Statement, free tools that help organizations market their supervision training offerings.

These documents offer strategic thinking and guidance for the creators of supervision training programs and resources as they develop continuing education (CE) products that will appeal to their target audiences of new and existing supervisors. For example, ASHA Professional Development held a Clinical Supervision Symposium in July and recorded it for further dissemination later this year. AHCST members hope that CE providers begin to offer formal supervision training when they see that supervisors want to “pay it forward” and “do as others have done for me.”

By understanding that audiologists and SLPs value evidence-based supervision research and specific knowledge and skills, CE providers can explain how supervision training will help supervisors build relationships and develop communication skills while ultimately benefitting those they serve (their clients) by contributing to the continued growth and stronger development of their profession.

“Our training culture is that people out in the field give back to the professions,” McNamara says. “Our whole profession is based on this culture of collegiality and growing our next generation of colleagues.”

To help convey a better understanding of the value of supervision training, many of the ad hoc committee’s recommendations are being implemented by ASHA staff and ASHA entities and affiliates.

Specifically, ASHA Professional Development and Continuing Education are working to expand and enhance web programs and develop stand-alone courses. They’ll also offer links to the AHCST topics for supervision training, such as collaborative models of supervision, adult learning styles, and teaching techniques, including reflective practice and questioning techniques. Methods for building relationships, setting goals and assessing supervisee performance are among the concrete skills and knowledge the AHCST plan has identified. In addition, a tool for self-assessment of competencies for supervision is available to help supervisors identify their own goals and determine if they are meeting them.

“We’ve been trying to get the word out through presentations at different conferences, articles in newsletters, and by promoting resources available to ASHA members and CE providers,” says Loretta Nunez, ASHA director of Academic Affairs and Research Education and ex officio member of the ad hoc committee.

Nunez says while the feedback received thus far has been mostly positive, some people are worried about yet another requirement they have to fulfill.

“We see now a real attempt to formalize and shift the professional culture that said supervision was just going to happen out of a goodness of heart.”

“People invested in clinical education and supervision and mentoring are very excited about having training opportunities and evidence-based resources to help them move forward in that direction,” she says. “As people take part in activities that will enhance their knowledge as to best practices, they will realize the benefits are that the supervision will go more smoothly and be more effective and efficient. It’s a win-win for the supervisor and supervisee.”

So ASHA is building an infrastructure for training opportunities and an awareness of the importance and value of those, Nunez notes.

“If we get people voluntarily engaged in supervision training now, it won’t be a huge leap should a requirement go into effect in the future. People will already be there mentally,” she says.

Indeed, people who are invested have begun to understand the need for more formal supervision training, McNamara reiterates. Despite the fact that it was in the literature 20 to 30 years prior, and that anyone working in the trenches understood it, only now is that understanding starting to come to fruition, he says.

“We see now a real attempt to formalize and shift the professional culture that said supervision was just going to happen out of a goodness of heart,” McNamara says. “We need to be more strategic. And we are using a full-court press to get the mechanisms in place to get everyone access to training and to get people to accept the need for training. The ultimate recommendation of the 2016 committee [AHCST] was that it is time to stop talking and make this happen.”

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Nobody Told Me There’s No Supervision Manual!Proposed phased-in training for supervisors in the professions seeks to provide them with long-sought resources and support.

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