Ethics Roundtable: When Student and Supervisor Disagree About Patient Care

Response by Julia Ferre' Shuler

Julia Ferre' Shuler
Assistant Professor/Clinical Supervisor
University of Redlands.
Redlands, CA

This situation is an example of the importance of a mediated learning experience between a supervisor and student. In the mediated learning experience the supervisor provides information and opportunities in which a student can gain independence in clinical decision making. This type of learning experience requires constant dialogue between the supervisor and student. These dialogues facilitate an interchange of information and opportunity for development of critical thinking skills. Dialogues benefit supervisors as much as students and can make clinical supervision a rewarding experience.

In Scott's situation, if he and his supervisor were involved in such a learning relationship, decision-making conversations could help both he and his supervisor with this clinical case. Unfortunately it appears that there is more of an authoritarian relationship, which precludes productive discussions. In a case such as this, the ASHA Code of Ethics could be used to help Scott initiate a discussion with his supervisor. The following is an example:

Principle of Ethics I, B: Individuals shall use every resource, including referral when appropriate, to ensure that high-quality service is provided. A discussion could be initiated in regards to requesting follow-up referral of a bedside swallow evaluation for Ms. Robertson. The bedside swallow evaluation could then determine the necessity of the Modified Barium Swallow procedure.

Scott should feel that he can advocate for Ms. Robertson, however, he is limited to what he can do independently as a student clinician (ASHA Code of Ethics: Principle of Ethics II; A&B). Scott would need to view this experience as a test of his interpersonal skills, challenging his ability to enter into a productive discussion with a superior for the sake of client advocacy. This type of discussion with his supervisor would benefit him in the future when engaging in similar conflict situations with colleagues in the professional setting. In making the assumption that Scott is at an externship clinical placement, if he has difficulty engaging his supervisor in a productive dialogue, he should contact his University for guidance.

A discussion that could arise from a case such as Scott's is if he is at an externship placement, it is his University's responsibility to assure that his placement is a quality learning experience. His case then highlights the need for Universities to provide clinical supervision training for external practicum placements. With the ASHA requirement of completion of 300 supervised clinical hours in a minimum of three clinical practicum sites, Universities must send their students to quality externship experiences. This places the responsibility of training students on Speech-Language Pathologist professionals. Typically, Speech-Language Pathologist professionals have expansive technical training in regards to treatment of speech and language disorders, but have not had the opportunity for training in clinical supervision methods. Clinical Supervisors must be trained in methodology of student learning and teaching. It is a University's responsibility to provide such training. This type of training will improve the richness of the clinical experience for the student, as well as the supervisor.

Recommended Readings

Clark, L.W. (1993). Faculty and Student Challenges in facing Cultural and Linguistic Diversity. Illinois: Charles C. Thomas Publisher.

Gillam, R.B., Pena, E.D. (1995). Clinical Education: A Social Constructivist Perspective. The Supervisors Forum., 2, 24-29.

Hagler, P., McFarlane, L. (1991). Achieving maximum student potential: The Supervisor as Coach. Canadian Journal of Rehabilitation, 5, 5-16.

Pickering, M., Hagler, P., Rassi, J.A. (1994). Identification of clinical education constructs and principles. Canadian Journal of Rehabilitation, 7, 185-192.

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