New graduates rarely have difficulty finding speech-language pathology jobs in schools. But those interested in acute-care positions face a more difficult job search, as most employers are looking for speech-language pathologists with at least a year of acute-care experience. If your medical clinical experience is limited, what can you do to improve your competency and candidacy for a hospital position?
That's the question I was asking myself last year, when I started looking for a hospital position while finishing my clinical fellowship at a skilled-nursing facility. I was eager to know what to expect and how to prepare. Now, I'm the main SLP in a 300-plus-bed hospital.
Here are some tips I picked up that may be useful for SLPs seeking to work with adults in hospitals.
Try to do all or part of your clinical fellowship in an acute or subacute medical setting. This experience is the best advantage you can give yourself as a new graduate. If those settings are not an option, start taking medical continuing education courses and attending medical speech-language pathology workshops that will enhance your knowledge base. You can take courses (some that are CEU-eligible) in voice-strengthening techniques, fiberoptic endoscopic evaluation of swallowing, the modified barium swallow study, and working with tracheostomy and ventilator-dependent patients. You can also take CEUs to review indications for different parenteral and enteral feeding options, as hospital SLPs make recommendations for alternative nutrition to physicians.
Shadow SLPs who do the kind of work you're interested in. For example, you can contact the SLP at a local hospital and ask if you can observe an outpatient modified barium swallow study (these are often scheduled in advance). If you're interested in working with patients with laryngectomies and tracheotomies, find a hospital that provides speech-language services for these populations. First-hand experience with both MBSS and tracheostomy patients is usually a must for hospital settings.
Master essential medical knowledge. You'll need this information to understand the bigger picture of a patient's medical condition and history: common medical conditions and abbreviations; pertinent findings on chest X-rays and brain scans; the significance of different lab values; norms for vital signs; medications that have an impact on cognition, speech or swallowing; and the scope of practice for various medical specialists. You can find this information in medical speech-language pathology textbooks or even on the Internet.
Perfect your bedside swallow evaluation skills. Swallowing evaluations will make up the majority of your consults. Review cranial nerve testing for speech and swallowing. Get to know the various dysphagia protocols used in hospitals (for example, the National Dysphagia Diet) so that you can monitor the accuracy of your patients' meal consistencies in collaboration with dieticians.
Master quick, standardized screens for cognition and language. Because of the priority given to swallowing consults, cognitive and language testing sometimes gets placed on the back burner in hospitals. I've found that I can fit these assessments in by using a collection of quick standardized screeners that take 10 to 20 minutes to administer. Take the time to look up and practice administering some of these screens, some of which are available free online.
If you are successful in finding and landing a hospital position, you still have work to do. Find out which rehabilitation facilities are nearby and what services each provides. A main goal of your assessment in the hospital setting will be to communicate with the patient, family, case managers, and occupational and physical therapists to plan for the patient's discharge. If you stay informed about the specific rehabilitation programs in your area—those for stroke or brain injury, for example—and recommend them when appropriate, you can play a huge advocacy role in ensuring successful recovery for your patients.