June 24, 2003 Feature

The Ethics of Competence

Audiology and speech-language pathology are dynamic professions. Our scope of practice broadens on a regular basis in order to encompass an ever-expanding knowledge base and resulting advances in evaluation and treatment techniques. Professionals in communicative disorders are expected to embrace "lifelong learning" and, as a result, will often be called upon to develop clinical skills beyond those developed during graduate training or in the process of acquiring the Certificate of Clinical Competence (CCC).

Although the dynamic nature of our professions provides the potential for exciting and rewarding careers, it also may create potentially unsettling situations for the professional. For example, how does a professional determine his or her own competency in new areas of clinical practice? When is training acquired "on the job"—or from the supervised mentoring of a professional colleague—sufficient to be incorporated into a practitioner's clinical repertoire? These questions often have implications that extend into the area of professional ethics.

ASHA's Code of Ethics provides "inspirational and aspirational" guidance to professionals in audiology and speech-language pathology. Although the Code cannot determine when a given practitioner is competent to perform a clinical procedure or participate in a particular area of clinical practice, it can assist the practitioner in making this determination. Principle of Ethics I, Rule A insists that clinicians provide all services "competently," while Principle of Ethics III, Rule A admonishes against misrepresenting one's competence. Principle of Ethics II, Rule A provides specific guidelines by stating that an individual's level of education, training, and experience must be considered in determining the scope of their competence.

But how does an individual determine if his or her "education, training, and experience" is sufficient to constitute competence? Does attending a continuing education course and perhaps earning a certificate for successfully completing the course make one competent in a particular clinical procedure or area of clinical practice? Or can competence be achieved without attending a course? To answer these questions, the professional would be wise to consult documents such as ASHA's scope of practice statements, certification standards, guidelines, position statements, and knowledge and skills practice policy documents.

Even though a practitioner has established competence for a new clinical procedure or a new area of practice, there remains the ethical responsibility to evaluate outcomes. Principle of Ethics I, Rule G states, "Individuals shall evaluate the effectiveness of services rendered…" It is imperative that every professional evaluate not only his/her individual competence, but also the value of new clinical techniques to the populations served. This means becoming familiar with and critically assessing existing research and, should there be a paucity of information available, making plans to personally acquire new clinical data to add to the existing store of knowledge.

Every professional has an ethical responsibility to continue their professional development throughout their careers. This involves not only acquiring new knowledge and skills, but assessing personal competence and patient benefit. This process will help assure that our dynamic professions continue to meet their ethical responsibilities.

William Mustain, is chief of the division of communicative sciences at the University of Mississippi Medical Center and a member of ASHA’s Board of Ethics. Contact him by e-mail at wmustain@ent.umsmed.edu.

cite as: Mustain, W. (2003, June 24). The Ethics of Competence. The ASHA Leader.


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