American Speech-Language-Hearing Association

Responding to the Changing Needs of Speech-Language Pathology and Audiology Students in the 21st Century

A Briefing Paper for Academicians, Practitioners, Employers, and Students

This briefing paper outlines some of the key challenges that face anyone involved in the education of graduate students in speech-language pathology and audiology. It is intended to open conversation and provide initial resources for faculty members, clinical supervisors, employers, students, and anyone else interested in the academic preparation of speech-language pathologists and audiologists.

The information and resources presented here were obtained in collaboration with members of ASHA Special Interest Division 10-Issues in Higher Education, ASHA Special Interest Division 11-Administration and Supervision, the Academic Affairs Board, ASHA members, and the Academic Affairs unit.

Contact us at academicaffairs@asha.org if you have any comments to share or suggestions about further resources.

Introduction: Challenges for the Educational Preparation of Future Speech-Language Pathologists and Audiologists

In 1999, ASHA identified five priority issues for the Association, including the following:

The current model(s) for education/preparation of speech-language pathologists, audiologists, and speech, language, and hearing scientists does not address the conflicting expectations of academicians, practitioners, and employers that confront students upon graduation.

ASHA determined that the best way to address this priority was to disseminate information on the changing characteristics of the workplace, the related competencies needed by entry-level professionals, and innovative ways that academic programs and employers can foster the development of these competencies in new professionals. This briefing paper is intended to fulfill that objective.

Data indicating the need to develop this priority issue came from the skills and practice studies ASHA has conducted in conjunction with the Educational Testing Service (ETS). These studies

indicate that there is a discrepancy in the perception of when and where students should acquire knowledge and clinical skills. According to the 1994 ASHA Audiology Skills Validation Study, recently certified audiologists believed that 90% of the knowledge assessed, although acquired after certification, should have been acquired in school. Similarly, Clinical Fellowship supervisors believed that 69% of the clinical activities listed, though learned during the Clinical Fellowship, should be learned in school.

In 1997, in response to the impact of external factors such as technology, demographics, changing practice patterns, and scope of practice, ASHA with the assistance of ETS conducted a practice analysis of the profession of speech-language pathology. The purpose of this study was to identify and document the clinical activities and knowledge areas judged to be important for the "competent" performance of newly certified speech-language pathologists. As part of this study a survey was sent to educators (i.e., academic and clinical program directors of speech-language pathology programs), practicing speech-language pathologists, clinical fellowship supervisors, and clinic directors in health care delivery programs. More than 2,800 speech-language pathologists responded to the survey. The results indicated that:

  • Fifty-three clinical activities and 85 knowledge areas were judged to be important for speech-language pathologists by all respondent groups. There was very strong agreement among educators, clinic directors, practicing speech-language pathologists, and clinical fellowship supervisors regarding the importance of clinical activities and knowledge areas.
  • Practitioners, clinical fellowship supervisors, and clinic directors believed that the majority of clinical activities and knowledge areas were not being learned in the appropriate place. There was a consistent pattern indicating that they believed that more of the clinical activities and knowledge areas should be learned in school. Practitioners believed that only 24% of the clinical activities and 20% of the knowledge areas were being learned where they should be learned. Clinical fellowship supervisors believed that only 20% of the clinical activities and 28% of the knowledge areas were being learned where they should be learned. Clinical directors believed that only 16% of the clinical activities and 21% of the knowledge areas were being learned where they should be learned. In contrast, 95% of educators believed that both the clinical activities and knowledge areas were being learned where they should be learned.

The discrepancy between the perceptions of educators and practitioners as to where and when students should acquire skills may be the reason for the conflicting expectations of academicians, practitioners, and employers regarding the skills needed by entry-level professionals in speech-language pathology and audiology.

This briefing paper addresses some of the changing characteristics of the clinical workplace for speech-language pathologists and audiologists, defines some specific skills needed to achieve workplace success, and presents examples of how academic programs, clinical externships, and employers prepare students in speech-language pathology and audiology to meet the rigorous demands of today's clinical environment. One of the goals is that the ideas brought forth in this paper will serve as a springboard for further educational programming offered by ASHA and more collaborative efforts between the academic community, practitioners, employers, and students.

There are many challenges to address in attempting to achieve this collaboration. External factors, such as reimbursement trends, affect the services provided to clients with speech, language, and hearing disorders. In turn, these factors impact the educational preparation of our students. Many academic programs are having difficulty finding clinical externships for students, especially in the adult rehabilitation setting and in skilled nursing facilities. Faculty, clinical supervisors, and students are feeling overwhelmed by the quantity of skills employers expect students to have when entering the work force, and given current economic and societal trends, the demands of employers will more than likely increase rather than decrease.

In the face of these challenges, academicians, clinical supervisors, and employers must share the responsibility of educating tomorrow's professionals in speech-language pathology and audiology. Students too have responsibility for being proactive in developing their clinical skills. There must be greater communication and partnering among all the stakeholders in the clinical education of students in speech-language pathology and audiology. Better communication and stronger partnering in the education of future speech-language pathologists and audiologists will result in more realistic expectations on the part of each group as to where and when clinical skills should be attained in the educational process.

The challenge facing our profession is how to prepare audiology and speech-language pathology graduates to enter clinical work settings that are driven by economic, political, and technological forces. The question that academicians, clinical supervisors, and employers must address is "How can we best prepare our graduates to have the myriad of skills necessary to be successful in the work place and to become leaders in the clinical arena?" The answer may lie in adapting our current model of clinical education to better meet the external demands imposed by society and the marketplace.

The Changing Workplace for Entry-Level Audiologists and Speech-Language Pathologists

Past decades have seen an increased demand for the services of speech-language pathologists and audiologists. This increased demand is due to a number of factors, including changing demographics as well as an increased public awareness of communication disorders and their effect on people's lives. Public policy over the last several years favored funded mandates and fee for service, which further contributed to the increased use of the clinical services of ASHA members. Such policies helped ensure that children and adults with communication and related disorders had access to needed services. These policies, however, had another unintended result. They contributed to the rapid escalation of education and health care costs and the subsequent reactive measures to curb those rising costs.

Speech-language pathologists and audiologists are dealing with higher caseloads, personnel shortages, reduced number of treatment sessions in which to accomplish specified outcomes, and an increased amount of documentation required by third-party reimbursement or funding sources.In order to prosper in today's demanding clinical environments speech-language pathologists and audiologists must be able to prove to third-party payers, employers, and clients that their services are measurable and cost-effective.

Today as never before, practitioners in speech-language pathology and audiology need to enter the clinical setting from graduate school immediately able to demonstrate the value of their services. There is little tolerance on the part of employers for entry-level employees learning skills as part of the job. In the past, most employers allowed time on the job for new professionals to develop some of the required clinical and management skills. Today's entry-level clinicians need to be able to engage in the following activities in order to provide clinical services:

  • Navigate reimbursement systems
  • Understand the complexities of the managed care system (e.g., HMOs)
  • Understand recent legislation, such as IDEA '97
  • Advocate for services using efficacy and outcomes data (e.g., National Outcomes Measurement System)

In addition, as a result of the technological advances occurring in the professions of speech-language pathology and audiology, entry-level professionals need to be independent life-long learners and must enter the work force with an entrepreneurial attitude and management skills that will help ensure success.

A successful clinician, in addition to having the appropriate skills and a solid academic knowledge base, must be skilled in problem solving and have the ability to continually analyze his or her methods to seek better ways of accomplishing a task. As academicians know, no student will leave graduate school having acquired all the knowledge and skills required for success in the workplace. The amount of information in the professions increases too rapidly for that to. Students entering the fields of clinical audiology and speech-language pathology must be active learners, independent thinkers, and critical analyzers of information.

Every employer wants an employee who can bring added value beyond his or her specific discipline. In today's workplace, there is a new appreciation for the multiskilled, the multifunctional, and the cross-trained professional. Many of these multiple skills must be learned independently through a process of constantly seeking new opportunities for learning.

In order to help students become lifetime learners, academic programs must emphasize the development of critical thinking and problem-solving skills. Students need to understand systems and how to work through processes such as the health care arena, school systems, reimbursement requirements, and the dynamics of organizations. Graduate programs can best prepare students for the workplace by helping them develop an entrepreneurial attitude toward their careers. Entry-level professionals entering today's clinical environment need not only to be technically competent, they also need to have a myriad of entrepreneurial skills.

An entrepreneurial approach to advancing one's career goes beyond the exercise of any one set of workplace skills. Maintaining an awareness of societal trends, discerning how these trends may affect the profession, and responding to any perceived future changes by developing new skills and capabilities are hallmarks of the entrepreneurial attitude.

The speech-language pathologist and the audiologist with an entrepreneurial mindset will have the ability to identify and/or create new approaches to accomplishing goals. A huge number of resources support small business and teach business skills to entrepreneurs. Future professionals in speech-language pathology and audiology need to be exposed to the information and business tools that will help them keep pace with the changing workplace. Following are several links and print references that may be valuable for faculty, clinical supervisors, and employers to share with students and entry-level professionals:

Yahoo Business and Economy
This site includes features, news, how-to, and links to numerous other business-related sites.

Yahoo Small Business
This site includes business tools and featured articles on business topics.

Virtual Business Information Center
A resource of the University of Maryland School of Business, this site provides a wealth of business resources by topic, including Management, Marketing, Associations, and Demographics; general business reference tools by type, such as almanacs and encyclopedias; and business publications such as magazines and trade journals, newsletters, and market research reports.

Dingman Center for Entrepreneurship
This is an independent unit of the Robert H. Smith School of Business at the University of Maryland. The Center facilitates, supports, and encourages entrepreneurship in the Mid-Atlantic region. The site includes links to other sites in academia, electronic commerce, government, management, marketing, and technology. Also includes a link to business news services.

Learn2.com
A real mixed bag of resources, this site includes online courses offering in-depth training on a variety of computer and business topics. Learn2 University provides corporate training by means of intranet delivered tutorials.

Small Business Classroom
A service of the Small Business Administration, this site offers online courses, the Harvard Business Review Article of the Month, and useful links to other sites.

U.S. Small Business Administration
A wealth of information and free services to anyone involved or interested in entrepreneurship. The site includes information on government initiatives and local SBA resources, along with many other topics.

Recommended Print Resources on Business Skills

Bolles, R. (1997). What color is your parachute? A practical manual for job-hunters and career changers. Berkeley, CA: Ten Speed Press. This is the quintessential book for people in pursuit of a satisfying and fulfilling career

Davis, B. L. (Ed.). (1996). Successful manager's handbook: Development suggestions for today's managers. Personnel Decisions International.

Searing, J. A., and Lovett, A. B. (1995). The career prescription. Englewood Cliffs, NJ: Prentice-Hall.

Nine Workplace Success Skills Graduate Students Need to Learn

In many current work environments, technical knowledge is not sufficient for success; it must be supplemented with the ability to access, analyze, and effectively use information. Given the value placed on these skills, it is not surprising that a wealth of professional development resources and tools have emerged to help individuals acquire these skills. Some valuable workplace skills that would be beneficial for audiologists and speech-language pathologists to develop may include

Each of the following skills will be defined briefly. Several resources are provided to help develop these skills. These resources can be used in courses, independent study, or self-learning activities.

  1. Planning and priority setting
  2. Organizing and time management
  3. Managing diversity
  4. Team building
  5. Interpersonal savvy and peer relationships
  6. Organizational agility
  7. Conflict management
  8. Problem solving, perspective, and creativity
  9. Dealing with paradox and learning on the fly

1. Planning and Priority Setting

Most successful projects start with planning and setting priorities. A person who is able to plan effectively accurately scopes out the length and difficulty of a task, sets objectives, breaks down the work into steps, and adjusts for problems and roadblocks. The speech-language pathologist or audiologist who possesses skills in planning and priority setting is able to make maximum use of resources.

Recommended Resources on Planning and Priority Setting

Covey, S., Merrill, A. R., & Merrill, R. (1994). First things first. New York: Simon & Schuster.

This book goes beyond the simple quick fixes with the premise that where you're headed is more important than how fast you're going. It emphasizes relationships and results rather than time and things.

FlowCharter (Version 7.0) [Software program]. Micrografx, Inc.

This software creates flowcharts and Gantt charts that will help communicate your plans to others. Flowcharts are diagrams that represent the workflow among process components and are especially effective at conveying a process in which several tasks occur simultaneously. Gantt charts are graphic representations of the time relationships in a project; they work particularly well for projects that involve simple, repetitive tasks.

Frame, D. (1994). The new project management. San Francisco: Jossey-Bass.

The author establishes a set of core competencies that take the project manager through all steps involved in successful project management.

2. Organizing and Time Management

It is easier to perform a task when one has all the tools and resources one needs, including time. Organization helps a person make use of needed tools. An organized person can orchestrate multiple activities at once to accomplish a goal, use resources effectively and efficiently, and arrange information and files in a useful manner. A person who is skilled in time management gets more done in less time than others and can attend to a broad range of activities. For the clinician, this includes making and keeping records-including treatment notes, progress reports, and documentation related to reimbursement and federal mandates for services.

Organization and time management are highly valued skills in the professions of speech-language pathology and audiology. In most employment settings, an immense amount of paperwork must be completed to document that appropriate services are being provided. In schools, clinicians may have as many as 70 students for whom they have to provide documentation. In medical settings, high caseloads are combined with the complication of HMOs, Medicare, and Medicaid all requiring different documentation. Entry-level practitioners need to be able to balance their time effectively between providing clinical services, documenting treatment outcomes, and billing for services. The clinician who is skillful in time management will be able to function more efficiently and effectively in the demanding clinical environment.

Recommended Resources on Organization and Time Management

Covey, S. (1989). The seven habits of highly effective people. New York: Simon & Schuster.
The author presents a holistic, integrated, principle-centered approach for solving personal and professional problems. Covey introduces his "Time Management Matrix," a tool to help you increase your focus on things that are important, but not urgent-the things that would make a positive difference in your life if you did them on a regular basis.

Lakein, A. (1989). How to get control of your time and your life. New York: NAL-Dutton.
Using practical wisdom and simple but effective rules, this book addresses a variety of topics, including how to build your willpower, how to work smarter, and how to "waste" time for pleasure and profit.

3. Managing Diversity

A person able to manage diversity is one who appreciates and welcomes different personal styles and different styles of working. This person recognizes and acknowledges all contributions made by staff members. In addition to different personal styles, speech-language pathologists and audiologists work with a diverse clientele and within a diverse workforce and must take cultural differences into account when providing clinical services.

Recommended Resources on Managing Diversity

Gentile, M. C. Differences that work. (1994). New York: McGraw-Hill.
This book establishes a framework in which diversity can be constructively debated. Its premise is that diversity is a resource that makes companies more productive.

Thomas, R. R., Jr. Beyond race and gender. (1992). New York: ANACOM.
This book outlines an action plan for transforming the roots of corporate culture to reflect diversity.

4. Team Building

Teams are the most effective way of producing a complex product or sustaining a coordinated effort. High performing teams have all the talent they need to accomplish a task, but no one member has all of the talent. This kind of collaborative system is being used more and more in clinical work settings. The more team-based projects are used during academic preparation, the better prepared students will be for today's workplace realities. The use of teams in sharing and managing clients and resources can be vital for the cost-effective delivery of services.

Recommended Resources on Team Building

Argyris, J. (1990). Overcoming organizational defenses: Facilitating organizational learning. New York: Allyn & Bacon.
This book describes some of the common problems that block teams' peak performance and offers strategies for undoing these behaviors.

Fisher, K., Rayner, S., & Belgard, W. (1995). Tips for teams. New York: McGraw-Hill.
Designed by a team, this book is a guide for overcoming obstacles and achieving success with teams on a daily basis.

Parker, Glenn M. Cross-functional teams. San Francisco: Jossey-Bass. 1994.
This book shows how teams composed of individuals from different departments can achieve success, especially when the task is complex and requires speed, creativity, and special customer attention.

5. Interpersonal Savvy and Peer Relationships

These skills have to do with knowing how to work with others within an organization or profession. In the clinical setting, these interpersonal skills are especially important. Not only must clinicians work effectively with peers, but they must also be able to relate to colleagues outside of the specific clinical setting. For example, the clinician should be able to form working partnerships with other professionals in the educational, medical, and public service arenas in the larger community.

Recommended Resources on Interpersonal Savvy and Peer Relationships

Alessandra, T., & O'Conner, M. J. (1994). People smarts. San Diego: Pfeiffer & Company.
This book is helpful in identifying behavioral styles and learning how to adjust your behavior to increase trust, credibility, and cooperation.

Arnold, W. W., & Plas, J. M. (1993). The human touch. New York: Wiley.
Arnold, the president of a leading medical center, stresses the crucial role of the individual in the organization.

Carnegie, D. (1981). How to win friends and influence people. New York: Pocket Books.
This book is a classic. First published in 1937, it is every bit as relevant today as it was then. The author believes that 15% of our success is attributed to professional knowledge and 85% is attributed to "the ability to express ideas, to assume leadership, and to arouse enthusiasm among people." These are the skills Carnegie emphasizes in his book.

6. Organizational Agility

Organizational agility is the ability to successfully find one's way through an organizational maze and its politics to achieve one's goals. Most organizations have a formal organizational chart, but behind the formal structure is an informal system driven by individual alliances and interests. Understanding these informal paths requires being sensitive to the individuals who make up an organization. There are good reasons to hone one's organizational agility. First, people who know how to navigate the informal system often get more accomplished than those who try to maneuver according the official map. Furthermore, a person who has organizational agility doesn't have to be in a position of power to get things done.

Recommended Resources on Organizational Agility

Bellman, G. M. (1992). Getting things done when you are not in charge. San Francisco: Berrett-Koehler.
This book offers practical approaches for effectively enlisting key players and earning the respect of management. Bellman presents insights on teamwork, empowerment, and organizational politics.

Cohen, A. R., and Bradford, D. F. (1991). Influence without authority. New York: Wiley.
The authors present a practical method for creating change and partnership in contemporary organizations.

7. Conflict Management

Most organizations today are decentralized and compartmentalized which may set the stage for group-to-group conflict. The opposite of conflict is cooperation, focusing on the mutual issues and interests of both sides. A person with conflict management skills is a skillful negotiator. This person can gain others' trust quickly and has a good sense of timing. These skills are important for clinicians in helping them to respect the opinions of colleagues, patients, families, and administrators and in helping all concerned find common ground.

Recommended Resources on Conflict Management

Fisher, R., & Ury, W. (1991). Getting to yes: Negotiating agreement without giving in. New York: Penguin.
The authors provide a straightforward, universally applicable method for negotiating disputes; they offer the reader a concise, step-by-step, proven strategy for coming to mutually acceptable agreements.

Weisbord, M. R. (1993). Discovering common ground. San Francisco: Berrett-Koehler.
The author presents a new way for organizations of all types to apply global thinking and democratic values in order to achieve rapid, whole system improvement.

8. Problem Solving, Perspective, and Creativity

These skills have to do with innovation, learning to identify an issue and view it objectively, seeing connections, and thinking globally. Creativity involves immersing oneself in a problem, looking broadly for connections, letting the ideas incubate, and allowing the breakthrough that usually occurs when one is in a relaxed state. The creative process does not follow the formal rules of logic-concepts can be changed, and a thing can be imagined to be something else. Issues can be looked at from a new perspective, and the least likely and the oddest can be given serious attention. These skills can be useful for speech-language pathologists and audiologists, allowing them to identify or create new approaches to accomplishing goals and giving them the ability to create new work opportunities.

Recommended Resources on Problem Solving, Perspective, and Creativity

Ackoff, R. (1987). The art of problem solving accompanied by Ackoff's fables. NY: Wiley.
This book describes the creative art of problem solving and managerial decision making.

Campbell, D. (1985). Take the road to creativity and get off your dead end. Center for Creative Leadership.
This is an interesting and fun book on the subject of creativity. In the search for solutions, the author encourages the reader to retreat and ask the broader question.

de Bono, E. (1990). Lateral thinking. NY: Harper Collins.
The author presents and illustrates a number of techniques for solving problems.

Naisbitt, J. (1995). Global paradox. NY: Harper.
This book explores the new wave of global economic change predicted after the fall of the Soviet Union and identifies the opportunities and challenges for nations, businesses, and individuals.

Popcorn, F. (1992). The Popcorn report: Faith Popcorn on the future of your company, your world, your life. Harper Business.
The author describes consumer trends and emerging patterns and offers insight into charting the future's impact on your work, home life, and leisure.

9. Dealing With Paradox and Learning on the Fly

These skills have to do with flexibility and the ability to adjust one's behavior to the situation, learning whatever is necessary to help one perform in changing conditions. Dealing with paradox means being able to shift gears. This requires having flexibility in approach, tone, and style and then matching those to the demands of the situation. The workplace for the speech-language pathologist and audiologist is undergoing rapid changes, necessitating the ability to learn new techniques and procedures rapidly and to perform flexibly. The clinician is often faced with contradictory situations and conflicting demands. Speech-language pathologists and audiologists who can be independent learners will be better prepared to enter an ever-changing workplace.

In order to create a more comprehensive educational experience, schools are exposing students to a variety of settings and methods. Faculty members and clinical supervisors can help students become flexible so that they can better adapt to a variety of clinical work settings and caseloads. This flexibility will help students function more effectively and efficiently across a variety of clinical settings.

Recommended Resources on Dealing With Paradox and Learning on the Fly

Dawson, R. (1992). The confident decision maker. New York: William Morrow.
This book explains the core of confident, effective, systematic decision making. The author includes methods for identifying, analyzing, and responding to problems and opportunities.

Handy, C. (1995). The age of paradox. New York: McGraw-Hill.
The author suggests that in order to succeed in this rapidly changing world, we must come to grips with the confusion generated by these changes. Managing business, family, and education are just a few of the topics covered. Strategies are presented for maintaining a sense of continuity and direction and for balancing one's responsibilities.

Evaluating and Implementing Instructional Technology and Distance Education

There are many changes occurring in the undergraduate and graduate education of speech-language pathology and audiology students. One of the major changes affecting higher education and our professions is the increased use of and demand for instructional technology. Distance education is proving to be a useful technique for bringing different experiences and viewpoints into the classroom. The use of new technologies to link with other institutions and clinical sites is an efficient way to bring different talents to the educational process. This is especially important when a program is not tied to a major medical facility.

Technology can also be used to deliver instruction to students at geographically remote locations-"distance education." ASHA-accredited programs are beginning to offer distance education courses as an alternative along with offerings taught through traditional methods, and there are some ASHA-accredited programs in which degrees can be earned solely through distance methods. Distance education in AuD programs has become particularly popular because audiologists are returning to school to get their doctorates in preparation for the year 2007 when a doctorate will be required for ASHA-certified audiologists. Some speech language pathology programs also offer distance education opportunities. To find out more about distance education opportunities in speech-language pathology and audiology, look at the program descriptions in the online guide to graduate programs .

Keep in mind that distance education is not limited to the use of computers. The "technologies" available to facilitate distance learning are numerous and include everything from the use of pencil and paper to the use of the Web. The University of Wisconsin-Extension lists 13 alternatives in the course catalog on their Web site including videoconference, broadcast and cable television, email, "snail" mail, and the World Wide Web.

Although distance education holds great promise for reaching students who are geographically remote from a university, there are several concerns raised by its increasing use. Faculty involved with distance education programs need to be sure that students graduating from distance programs have comparable academic and theoretical knowledge to students graduating from traditional academic programs. This concern is not confined to speech-language pathology and audiology programs, but the use of distance education does hold unique challenges for the preparation of audiologists and speech-language pathologists because our students must have solid clinical preparation as well as sound theoretical information.

As universities increasingly offer distance education courses and degrees, educators and students are learning more about what works and what doesn't. Some recent topics of discussion about distance education include issues of fairness, access, intellectual property, cheating, and fears regarding faculty employment. The following list of resources is intended as a starting point for keeping abreast of the latest issues in technology and education, including distance education, and for learning how to use technology in the classroom.

Recommended Resources on Instructional Technology and Distance Education

Academy Online
This online journal provides an exploration of online learning and evolving trends in distance education.

Keating, A. B., & Hargitai, J. (1999). The wired professor: A guide to incorporating the World Wide Web in college instruction. New York: New York University Press.
A guide geared to the comfort level of most faculty members-neither a "dummies" manual nor one you need to know Perl script in order to follow. The authors cover everything from building simple Web sites announcing office hours to building distance-education sites.

The Technology Source
This online journal published articles on distance learning and includes sections on faculty development, case studies, and visions for the future of learning and technology.

The Chronicle of Higher Education Web Site
This Web site lists the most recent Chronicle articles on distance education as well as providing an archive of articles from the past 10 years. Particularly useful are the links to other sites such as the Web Based Learning Resources Library. A subscription is required in order to view articles on this site.

Models and Suggestions for an Effective Clinical Practicum

Faculty, clinical supervisors, prospective employers, and students need to develop strategies for better partnership in the educational process. All need to be aware that they have a joint responsibility in this area. Essential to any training program is collaboration-a sense of working together to achieve a common goal.

ASHA's Special Interest Division 11-Administration and Supervision developed and distributed a survey to its membership addressing collaboration between university and off-site practice settings ( Doran, Solomon, & Brasseur, 1997, May). Respondents represented universities, medical settings, private practice, and school settings. Comments included:

  • It is important to keep university staff in tune with the "real world" and to stimulate off-site supervisors to keep abreast of current research, treatment, etc.
  • Collaboration is essential for a successful training program.
  • Collaboration can enhance the preparation of new professionals, serve as a reality check for universities, and update theoretical information for the practice setting.
  • It is important to maintain consistent expectations of supervisees between universities and off-campus supervisors.
  • Students need "real-world exposure and practice."

Respondents to the survey identified several features of successful collaboration with university and off-site practice settings:

  • Good communication and frequent interaction among off-site practitioner/supervisor, university personnel, and students (3-way communication)
  • University liaisons who are able to conduct off-site supervision visits to understand better the types of settings and populations their students are involve in
  • Shared responsibility for academic preparation and clinical teaching
  • Written plan of goals and expectations by both student and supervisor

The following are examples of various models of interaction between academic programs and clinical externships that exemplify collaboration in the sense that they encourage an ethic of shared responsibility for student outcomes. Although some models are setting specific, they could be implemented with some modifications across clinical settings.

University and Professional Setting: An Example of Collaboration

Barbara Mastriano, assistant professor in Communication Sciences at Temple University in Philadelphia, Pennsylvania, describes how the university has been able to link with supervisors in the community. The Supervisory Advisory Committee, established in 1992, comprises representatives from the range of clinical settings and one faculty member. This body plays a pivotal role in the reciprocal flow of information and ideas between the university and the professional community. For example, clinical practitioners have input in the graduate curriculum, and the University has input in program development and evaluation at off-site facilities. In another instance of collaboration, affiliates have served as instructors in mini-seminars and as lecturers in core courses ( Mastriano, 1996, April).

University and School: An Example of Collaboration

Deborah King, director of clinical services; Carol C. Sheridan, clinical coordinator at the University of Tennessee; and Ann Hake of the Sevier County Schools in Sevierville, Tennessee, describe an instance of collaboration between a university and a public school system. In order to facilitate off-campus relationships, a university supervisor has been designated practicum coordinator. This person is responsible for assisting students to locate off-campus clinical sites and for developing and maintaining a relationship with the off-campus supervisors.

During initial contact, the coordinators discuss the school's needs as well as the students' needs. All placement decisions are therefore joint decisions. An on-site review supports new supervisors and assists students who are having problems in the assignment.

At the end of the semester, the student evaluates the supervisor's performance, and feedback is obtained from the supervisor regarding the supervisory experience. Another result of this close collaboration is seen in a course, "Speech-Language Services in the Schools," which is taught by a speech-language pathologist practicing within the school system. Additionally, several off-campus supervisors have given lectures in academic courses ( King, 1996, April).

University and Medical Setting: Examples of Collaboration

Anthony P. Salvatore, professor and program director at Jersig Communication Disorders Program, Harry Jersig Center, Our Lady of the Lake University in San Antonio, Texas, describes the training of students in a medical setting. To improve the performance of graduate students with adult and child patients in medical clinical settings, the university initiated a rotational practicum sequence program for first-year graduate students.

This program follows a medical school model of rotation through five different settings: (1) an acute medical facility, gaining experience in bedside speech, language, cognitive screening, and treatment; (2) an acute medical facility, gaining experience in the diagnosis and treatment of dysphagia; (3) an outpatient genetic disorders clinic at an urban children's hospital; (4) the school's campus based high volume clinic for children in Head Start; and (5) the campus early intervention group. The feedback has been positive from practicum supervisors. As a result of this program, supervisors in both school and medical settings report that students are clinically more mature and more independent than previous graduates of the program ( Salvatore, 1996, April).

Richard K. Peach and Dianne H. Meyer ( 1996, April) at the Department of Communication Disorders and Sciences, Rush University, Rush-Presbyterian-St. Luke's Medical Center in Chicago, IL, describe an academic training program that actively participates in the delivery of clinical services in an urban medical setting. Teaching is not detached from practice in such a setting. Rather, the teacher-practitioner model used here is implemented by faculty members who take on dual roles as academicians and clinicians.

The link between academics and patient care is emphasized and modeled in such an environment. (The teacher-practitioner model is not a new concept; early professional programs typically utilized a faculty of accomplished practitioners who had special interests in education and the development of the profession.) This model encourages teacher-practitioners to participate in the management of the medical center; that is, corporate officers are practitioners with faculty appointments at the university, and the deans of the colleges are practitioners. Throughout the organization, teacher-practitioners unify operations, academics, and patient care.

Because the academic and clinical programs are closely linked, faculty move more easily from one role to another. Protocols developed for use in the clinic are taught in the classroom. Clinical issues (reimbursement, quality improvement, cultural diversity) are infused into practicum and classroom education.

The Division of Speech and Hearing Sciences, School of Medicine, at the University of North Carolina-Chapel Hill is another training program within a school of medicine. (There are only six programs in the United States in which this is the case.) Here, as at Rush University, every faculty member has a clinical caseload. Celia Hooper, clinical professor of speech-language pathology at UNC, feels that this arrangement ensures a unity among faculty members that would not be present if there were separate clinical faculty and academic faculty, as in many programs. The program being contained within a medical faculty offers an excellent opportunity to work in a medical setting. It is, however, a challenge to find opportunities in other settings, such as nursing homes.

Universities can encourage partnership with outside clinical settings by offering continuing education, book store discounts, and so forth, to supervisors in these settings. Also, it is important to remember to show appreciation for their contribution. Additionally, at UNC, when a student is placed in an outside setting, the student is accompanied by a supervisor from the university. This supervisor's salary is paid by both the school and the clinical site.

Universities need to keep in mind that the supervisor is part of the training picture. One means to this end is to provide training in supervision. Universities should also view the supervisory process as an opportunity to exchange resources, to ask what each has to give the other.

Steps for Facilitating University-Practicum Collaboration

We know that there is no single model program that is the sole answer for facilitating collaboration between the clinical site and the university. We offer the following as suggestions for the kinds of steps that need to take place in order to ensure that the practicum is useful to students. Some of these steps may not be feasible for a particular program-other steps that accomplish the same end might work better. The challenge is to take a look at what does work to prepare students for the today's workplace, welcoming input from all those involved in the practicum, and then to innovate and make changes where changes are needed.

  • University supervisor makes periodic visits or phone call to the off-site supervisor during the practicum
  • A supervision course is taught to off-site supervisors
  • Off-site supervisors teach a course or guest lecture at the university
  • Off-site supervisors serve on a university advisory board
  • Off-site supervisors are involved in curriculum development
  • University faculty/supervisors work part time in off-site practice settings
  • Off-site supervisors are hired part time to supervise on campus
  • University supervisors hold part-time private practice in the university clinic
  • Off-site supervisors participate in a mentoring program
  • Advanced methods course team-taught by off-site supervisors and on-site supervisors
  • Continuing education course is taught in collaboration with medical facility

References

Doran, M. C., Solomon, B. S. W., & Brasseur, J. A. (1997, May). Partners in professional preparation: Collaboration between universities and off-site settings, Administration and Supervision Newsletter, 17-21.

Henri, B. P. (1993). Graduate school preparation: Community speech and hearing centers. Proceedings of the 14th Annual Conference on Graduate Education (pp. 37-66). Minneapolis, MN: Council of Graduate Programs in Communication Sciences and Disorders.

King, D. (1996, April). Collaborative-consultative model for training students in a public school practicum. Administration and Supervision Newsletter, 5-7.

Mastriano, B. (1996, April) Maximizing clinical education: University-community practice interface. Administration and Supervision Newsletter, 4-5.

Peach, R. K., and Meyer, D. H. (1996, April). The teacher-practitioner model at Rush University. Administration and Supervision Newsletter, 9-13.

Salvatore, A. P. (1996, April). Preparing students for field practicum: One solution. Administration and Supervision Newsletter, 7-9.

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