Supervision of Student Clinicians: Modeling Ethical Practice for Future Professionals
by Deborah King
(This article originally appeared in the May 27, 2003 issue of The ASHA Leader.)
Clinical supervisors or clinical instructors are defined as "individuals who engage in clinical teaching through observation, conferences, review of records, and other procedures related to the interaction between a clinician and a client and the evaluation and management of communication skills" (Current status of supervision of speech-language pathology and audiology [Special Report]. Asha, 20, 478–486).
The new standards for the Certificates of Clinical Competence in speech-language pathology and audiology require that students demonstrate knowledge and skills in prevention, assessment, and treatment of communication disorders and differences across the life span and in individuals from culturally and linguistically diverse backgrounds. Applicants for certification also must demonstrate knowledge of ethical conduct, research principles, and contemporary professional issues, as well as the workplace skills essential for success (see the Membership and Certification Requirements page).
Given the skills, knowledge, and workplace behaviors important for the success of future professionals, the role of clinical supervisor offers many challenges. Supervisors must mentor students in the areas of clinical skill development, cultural sensitivity, professional behavior, and ethical decision making.
Some examples of situations in supervision that may result in ethical misconduct are:
- failure to provide the appropriate amount of supervision
- failure to educate students regarding confidentiality
- failure to assure that students have needed competencies before delegating tasks to students
- failure to evaluate client outcomes to demonstrate benefit to the client/patient
- failure to provide appropriate tools to students for self-assessment
- failure to alert the client/patient that services are being provided by a student in the educational process
The Issues in Ethics Statement, "Clinical Fellowship Supervisor's Responsibilities" (ASHA, 1980), provides examples of other issues that might arise when supervising, as well as guidance on ethical decision making in supervision.
When providing supervision of students, the clinical supervisor is to hold paramount the welfare of the client/patient, as well as the welfare of the student. Students should never be placed in situations that result in questionable practice. Conflict between supervisor and student can arise when a student is assigned clients for whom the student does not feel adequately prepared.
Open, honest communication between the supervisor and student is crucial. Supervisors must provide maximum support for the student, which often means allowing the student to initially observe the supervisor providing services, moving to co-assessment or co-treatment, and continuing to delegate more responsibility only when the student has demonstrated the necessary competencies. New clinical experiences offer new challenges and require more intense supervision/direction by the supervisor.
Individuals who supervise students should demonstrate competencies in the tasks outlined in the position statement, "Clinical Supervision in Speech-Language Pathology and Audiology" (ASHA, 1985), as well as with the clinical skills necessary for client care. As with all areas of professional practice, supervisors must continue to enhance and improve supervisory skills throughout their career.
New supervisory models raise other ethical questions. In video supervision of distance education students, for example, how does the supervisor obtain sufficient client information to assure that clients' needs are being met? If concerns arise regarding diagnosis, length/type of treatment, client management, and so on, what is the responsibility of the supervisor if he or she is not employed by the facility? What are the ethical considerations regarding client/student confidentiality?
As the professions change and scopes of practice expand, supervisors must remain current in their practice and must model ethical practice for students, our future professionals.
Deborah King, speech-language pathologist, is director of clinical services at the University of Virginia communication disorders program in Charlottesville. Contact her by e-mail at firstname.lastname@example.org.