A few years ago, I wrote about difficulties balancing my checkbook (Apel, 1999). I had one of two options for dealing with this difficulty: 1) I could take a scientific approach by reconciling my checkbook with my monthly bank statement, or 2) I could use the "it works" method of refraining from writing checks for a few weeks and then taking the bank's word on my balance. I used the checkbook dilemma as an analogy for recognizing discrepancies in the profession's clinical and research endeavors and determining how to reconcile these inconsistencies.
Over the last six years, there have been two major outcomes of this article. First, everyone now knows (and frequently comments) on my checkbook-challenged behavior. Second, I now can use Option 2 more frequently and directly with online banking.
I was thinking about this analogy of checks and balances when I was asked to discuss how communication sciences and disorders programs can achieve true collaboration when integrating clinical and research knowledge and skills into their graduate curriculum. Frankly, my first thought was, "Why is this even a question? Do we still need to discuss how to do this?" Apparently, we do.
Kamhi (2004) recently wrote an article about memes. In a nutshell, a meme, as originally coined by Dawkins (1975), is an aspect of culture that is passed on socially (vs. genetically) when individuals imitate or continue ideas, events, customs, or behaviors across the years. It is like a virus, passed down from one individual or group to another, mostly because it is effortless to do so. Memetic theory helps explain why some ideas or habits continue even in the face of opposing or contradictory beliefs or evidence. Ease of transmission outweighs reality or truth. A savings of energy wins over a fund of knowledge.
Perhaps the fact that we still are discussing how to integrate clinical and research curricula suggests that we are dealing with a meme. It may be that clinical and research aspects of graduate education were not integrated for those who are currently teaching our future professionals. As a consequence, some educators are teaching the way they've always done it. They are teaching the way they were raised. They are operating out of a frozen account.
I believe many educators were raised in educational environments and still operate in them, where differences between the clinical and research aspects of our field are as strongly acknowledged as are the similarities. One difference often mentioned has to do with work environments. Academic educators, or researchers, work in their "ivory towers" and clinical educators, or clinicians, work in "the trenches."
Such phrases imply not only inappropriate hierarchical differences but also seem to endorse differences in how "in touch" with research and clinical matters different participants are. "Academic educators or researchers do not care about clinical matters." "Clinical educators or clinicians do not care about research." Truthfully, I have encountered a few who match these preconceptions. However, most educators do not fit these stereotypes at all. Interestingly though, these terms and supposed differences continue to be promoted, allowing the meme to continue to live, breathe, and even gain interest.
Does focusing on the differences between academic and clinical educators jeopardize any possible integration of research and clinical curriculum components? Not necessarily. Talking about differences is not in itself negative or meme-promoting. In fact, discussions of differences may be as much an asset to a program's growth as are discussions of similarities, precisely because these discussions clarify the degree and importance of those differences. For example, although academic and clinical educators want to increase students' knowledge and skills, they may draft different means of doing so. Academic educators may favor addressing academic knowledge. Clinical educators may favor addressing clinical skills. Without attention to both, our future professionals post a negative balance in their competencies.
The key to living with these differences is moving beyond talking about them and, instead, deciding how to work with them. Academic educators must acknowledge how academic content relates to clinical services. Clinical educators should acknowledge how clinical services are guided by research and theory. If certain academic or clinical educators are not able to address these links, possibly because clinical expertise or content knowledge is lacking or minimal, then they should either acknowledge missing information and guide students to helpful resources or a different educator needs to be brought in to fill the void.
As a second example, even though academic and clinical educators strive to facilitate students' ability to ask questions and answer them, they may differ in their focus. Academic educators may encourage students to ask empirical questions whereas clinical educators may push students to ask clinical questions. Again, both types of questions need to be asked and answered for future professionals to keep the research and clinical aspects of the profession alive. However, integration of academic and clinical questions does not mean the questions must be asked at the same time and same place. Rather, students must be shown how to ask these questions, and how questions from either aspect of our profession affect the other. An average daily balance of academic and clinical questions asked and answered across a curriculum ensures a healthy return on educators' invested efforts.
Crediting the Present, Banking on the Future
How then do we mutate this meme so that integration of clinical and research aspects of graduate education occurs routinely? One mechanism that comes to mind is the "Law of the Few" as discussed by Malcolm Gladwell, author of The Tipping Point (2000). The title refers to a time or event that, though it may seem insignificant, greatly affects the way issues are handled. The Law of the Few suggests that just a few individuals can change an entire situation, tipping the balance to a new way of operating. To accomplish this change, the few need to be made up of individuals who have the information needed for change, who have the communication skills to effect change, and a special gift for bringing together different worlds (or, in our case, different educators).
Luckily, the Law of the Few appears to be working in our profession. By nature of their education, most communication science and disorders educators are good information gatherers. They also understand, and hopefully practice, communication skills that lead to effective interactions. Finally, many have a gift that allows them to bring different worlds together that are focused on a particular goal or vision. Interestingly, these three characteristics really are the same as those needed to be effective collaborators. Many academic and clinical educators know about collaboration and already have been involved in successful collaborations. Academic educators often collaborate on research lab teams. Clinical educators often collaborate on clinical staffing teams.
All educators, then, have the basic capital needed to collaborate. They understand and have personal experiences with successful collaboration strategies. Educators within the same graduate programs just need to practice it among themselves. Integrating research and clinical aspects across the curriculum will occur only through collaboration among educators who have the understanding of how research informs clinical practice and vice versa.
In the end, the integration of research and clinical aspects of the curriculum is not really that difficult. Educators all know the important collaboration skills required for successful integration of information and, if they don't, they know there are ample resources to learn more (e.g., ASHA, 2005; Coufal, 1993). In fact, there are graduate programs already succeeding in this area of integration of research and clinical knowledge (e.g., ASHA, 2005). Undoubtedly, these programs are succeeding because a few educators gathered information, used effective communication skills to argue why old ways of educating needed to be changed, and used their gifts of recognizing the strengths in the similarities and differences of academic and clinical educators to effect change.
It may not have been an easy task; the new way of conducting business was probably not the way they were raised. But the balance changed. They caused a tipping point, and the old meme was cast off. It now is time for all communication sciences and disorders programs to slough off the old meme. Programs need to look at their practices and ask themselves, "Are we promoting a 'that's the way we've always done it' meme?" If so, it seems timely to take a stand and tip the scales into a new way of conducting business.
A Final Account
The ideas expressed above are musings on the topic, and I would never mean to imply all in our profession operate in a specific way. It may seem I am pigeonholing different educators into stereotypic roles, thus being as guilty of promoting a meme as the next writer. This is not my intent. In fact, the dichotomy between academic and clinical educators does not exist in some programs. Academic educators are the clinical educators and vice versa.
But the real issue isn't about the differences among educators. The issue is how much interest we place on these differences when it comes to integrating information across the curriculum. We can bank the old way, the "well-it's-always-worked-that-way" approach. Or, we can choose to reconcile our statements with our practices and move forward in the common interest and to the benefit of all. My money is on the latter.