2007 Student Ethics Essay Award - 1st Place

Developing Professional Competence During the Clinical Fellowship

By Carolyn Stephenson Gosse
University of Virginia
Charlottesville, Virginia
NSSLHA Chapter Advisor: Jessica J. Norton

Graduate students who are preparing to begin their Clinical Fellowship (CF) should take particular notice of the American Speech-Language-Hearing Association's (ASHA) Principle of Ethics II and the corresponding Rules of Ethics which provide guidance as to how to "achieve and maintain the highest level of professional competence" (ASHA Code of Ethics, Principle II). Both Supervisors and Fellows must rely on the Code of Ethics to guide their relationship and the activities they engage in during the CF. The integrity of this important training period depends upon adherence to the ethical standards set forth by ASHA and should be approached seriously and openly by both the Fellow and the Supervisor. Given careful consideration, the guidelines set forth by ASHA for professional competence will prepare both parties to meet their ethical responsibilities both in clinical service provision and supervision. Fellows must ensure that they are adequately supervised, engage in activities that are within their scope of competence, and continue to acquire the new knowledge and skills necessary to be considered competent in our dynamic profession.

Supervisors are obligated to adequately mentor Fellows in clinical skill, intervention implementation and assessment, ethical decision making, and work with culturally and linguistically diverse populations. The Fellow must take an active role in monitoring whether this relationship is effective and beneficial. For example, Fellows may engage in service provision only "when they are supervised by an individual who holds the appropriate Certificate of Clinical Competence (CCC)" (ASHA Code of Ethics, Principle II, Rule A). Armed with this information, Fellows would be wise to verify their Supervisor's certification before committing to supervision. If supervisors unknowingly allow their ASHA membership to expire, then Fellows may not be able to receive credit for clinical hours logged under the supervision of the uncertified individual. Clearly, Fellows must become familiar with the implementation of the Code of Ethics in order to complete the requirements necessary to earn the CCC.

During their CF, Fellows may be asked to do a variety of tasks, and they must be forthcoming in discussing their level of competence with their supervisors. Fellows must never put themselves in situations in which they are providing services for which they do not have adequate education, training and experience (ASHA Code of Ethics, Principle II, Rule B). As a student, I have sometimes felt it difficult to discuss my limitations with my supervisors. However, I have found that by familiarizing my mentors with my past experiences and education before they assign me a clinical task, I am successful in achieving the appropriate level of supervisory support. I plan to continue using this strategy when I begin my CF. I have found that it allows me to stay within my scope of competence while providing services, yet it allows me to gain the training and experience necessary to expand the clinical services I am qualified to provide.

Individuals who are completing their CF should be aware that the ASHA Code of Ethics has guidelines for the delegation of the provision of services. A Supervisor may delegate responsibilities, but must carefully consider who is qualified to perform clinical tasks and whether or not supervision will be provided- and at what level. Fellows who feel overwhelmed by the level of responsibility given to them can refer their Supervisors to Principle II, Rule D. Rule D is not necessarily intended to confine provision of clinical services to those who hold their CCC, but provides for the inclusion of assistants who are adequately supervised. When thinking of the Code of Ethics, it is common to remember rules that govern what individuals should not do, but it is important to note that they also specify what is allowable within our profession, as well.

In addition to assisting Fellows in making decisions about what services they are competent to provide, the Code of Ethics also addresses the requirements that Supervisors can make of their staff. Specifically, they should not "require or permit their professional staff to provide services or conduct research activities that exceed the staff member's competence, level of education, training, and experience" (ASHA Code of Ethics, Principle II, Rule E). This Rule is not meant to excuse Fellows who have forgotten how to perform tasks for which they have received training, but is meant to guide Supervisors in the delegation of responsibility. For example, if a Supervisor wants to conduct a research study and asks the Fellow to design the intervention and data collection portion of the study, the Supervisor may be in violation of Rule E. In general, Master's level students do not have an extensive background in research design and methodology, and this assignment may be outside the level of the Fellow's competency. Therefore, the Fellow may be justified in declining this task. When asked to perform a task for which they do not feel adequately prepared, the first step a Fellow should take is to review the Code of Ethics and follow the guidelines it provides

Fellows are justified in asking for equipment that is in good repair and properly calibrated during their CF. In fact, it is their responsibility to ensure that all their equipment is in good condition, for Fellows must abide by the ASHA Code of Ethics, Principle II, Rule F. Especially when providing hearing screenings, Fellows should make certain that audiometers are professionally calibrated on a yearly basis. By taking proper care of equipment, Fellows will be able to obtain valid and reliable results from assessments and provide high quality clinical services.

Finally, Fellows should not leave the Code of Ethics behind when they complete their CF. Our dynamic profession requires that Fellows continue to build their knowledge base long after they complete graduate school and their CF. As they venture out on their own, Fellows should rely on the code as they "continue their professional development throughout their careers (ASHA Code of Ethics, Principle II, Rule C) and work to maintain a high level of professional competence.

American Speech-Language-Hearing Association. (2003). Code of Ethics [Ethics]. Available from www.asha.org/policy.