Speech-language pathologists today are routinely working in fast-paced and demanding environments to serve people with highly complex disorders such as medically fragile infants in neonatal intensive care units, children with tracheostomies and dysphagia in public schools, individuals with autism spectrum disorders, and adults with traumatic head injuries in polytrauma units. We are facing problems and working with populations we knew little about 15 or 20 years ago. The profession has changed.
Each blip in technology and expansion of clinical practices into new populations and environments challenges educators to provide the basic foundations that will prepare clinicians for their future jobs. Graduate programs have done a good job of adapting curricula in response to new clinical certification and program accreditation standards by grafting new classes, course content, or practicum on to the entry-level master's program. We have stretched and stuffed more and more into the master's program over the years without straying very far from the basic master's-level preparation model laid down in 1965.
Bernthal (2007) discusses the history of the speech-language pathology education and certification standards in an earlier article in this series. He acknowledges the profession has reached a point at which tiers, tracks, or new levels of clinical preparation are being considered. He observes the long-discussed notion of a clinical doctorate in speech-language pathology; yet we continue a firm grip on the master's degree as our entry-level degree.
As professionals, we are identified with the master's degree. The preparation of the master's-level practitioner is our "established academic culture" (Silliman, 2007). Silliman argues this preoccupation with the preparation of the master's-degree practitioner has stifled our ability to build a continuum for intellectually gifted students to move seamlessly into doctoral studies. Silliman suggests the prominence of the master's-level practitioner in our academic programs has jeopardized the generation of new knowledge within our profession (Silliman, 2007).
Building the research capacity of our profession is undeniably a crucial objective. Equally vital to the future is generating highly skilled and qualified clinicians capable of competing with colleagues as the experts in communication disorders, and meeting the knowledge and technical skill demands of the workplace. SLPs are no longer the only professionals on the team with graduate degrees. Clinicians are working in settings with colleagues who are better trained than they were in the past. In both medical and school settings, we have seen a gradual "credential creep"—doctor of pharmacy (PharmD), doctor of physical therapy (DPT), and doctor of occupational therapy (OTD). School psychologists are increasingly holding doctor of psychology (PsyD) degrees. Teachers, particularly special educators, are expanding their qualifications by earning graduate degrees and special certificates. As a result, they are better-educated, better-prepared, and better-paid.
At the 2007 ASHA-sponsored Speech-Language Pathology Education Summit, titled "The Subject is Change," a panel of presenters was asked to consider the changing demands of the current and future work settings and to create a picture of clinicians who will be ideally prepared for those demands. The panel agreed that even though certain areas and skill requirements are setting- or population-specific, there are more commonalities than differences; ideal attitudinal characteristics of clinicians of the future are essentially the same regardless of work setting—and the future is now.
The panelists noted that clinicians entering the work force today bring the same attitudes and passions for the profession as those of us who were trained in past decades. Unlike training in medicine, where scientists take clinical courses to learn how to express empathy and communicate with patients, SLPs are generally great at communicating and empathizing, but need to become better scientists.
At the close of the conference, the summit participants—from both academic programs and clinical work settings—concluded that graduate programs are doing a good job of preparing entry-level clinicians in the master's-level model. That conclusion may be short-sighted or an example of cognitive dissonance—holding on to established notions while acknowledging evidence to the contrary. Research tells us the discomfort of cognitive dissonance can be relieved in two ways: develop rationalizations for not changing or change.
There is a saying that goes—and forgive the grammar—"If you always do what you've always done, you'll always get what you've always got." The subject is change. The question today ought not to be is change necessary? The expanding scope of practice has already answered that for us. The question is: What changes are we willing to make?