The scope of this Practice Portal page is the clinical education and supervision of graduate students in audiology and speech-language pathology in university and off-site settings.
Many of the principles included in this page also apply to the mentoring and supervision of speech-language pathology clinical fellows and professionals transitioning to a new area of practice, as well as to the supervision of support personnel.
For information related to mentoring clinical fellows, see Issues in Ethics: Responsibilities of Individuals Who Mentor Clinical Fellows in Speech-Language Pathology (ASHA, 2013a). For information specific to support personnel, see audiology assistants, speech-language pathology assistants, and speech-language pathology assistant scope of practice (ASHA, 2013b).
The terms clinical supervisor and clinical supervision are often used in reference to the training and education of student clinicians, recognizing that supervision is part of the training and education process. Supervision can be broadly defined as overseeing and directing the work of others. However, clinical supervisors do more than oversee the work of the student clinician. They teach specific skills, clarify concepts, assist with critical thinking, conduct performance evaluations, mentor, advise, and model professional behavior (Council of Academic Programs in Communication Sciences and Disorders [CAPCSD], 2013).
Many professionals involved in the supervisory process suggest that the terms clinical educator and clinical instructor more accurately reflect what the clinical supervisor does (CAPCSD, 2013). The term clinical educator is used here to refer to individuals involved in the clinical training, education, and supervision of audiology and speech-language pathology graduate students at all levels of training.
According to the ASHA Ad Hoc Committee on Supervision's Final Report on Knowledge, Skills and Training Consideration for Individuals Serving as Supervisors [PDF] (ASHA, 2013c):
A prevailing philosophy suggests that competency in clinical service delivery translates into effective clinical supervision. However, leaders in education have long argued that this is a flawed assumption and that effective supervision requires a unique set of knowledge and skills.
The Ad Hoc Committee acknowledges that supervision is a distinct area of practice and, as in other distinct areas, individuals must receive training to gain competence before engaging in the activity. Education in the supervisory process should begin early, with—as a minimum—an introduction to the subject as part of the graduate curriculum and more extensive training readily available to practicing and aspiring supervisors. Effective education for supervision should focus on unique aspects of knowledge and specialized skills for the supervisory process and should not be limited to regulatory aspects (e.g., observation time, clock hours) of the process. (pp. 3–4)
CAPCSD also recognizes that clinical supervision is a distinct area of expertise and practice, and that clinical supervisors of student clinicians need to have the requisite knowledge and skills (CAPCSD, 2013). As such, clinical education requires training to ensure that individuals gain the necessary competence (ASHA, 2013c). ASHA and other stakeholders agree that appropriate training programs need to be developed.
In their final report to the ASHA Board of Directors, the Ad Hoc Committee on Supervision (ASHA, 2013c) outlined the knowledge and skills required of individuals engaging in clinical training.
Overarching Knowledge and Skills
Knowledge and Skills Specific to Student Training in the University Clinic or Off-site Setting
Knowledge and Skills Specific to the Clinical Educator Working With Students in the Culminating Externship in Audiology
For more detailed information about the knowledge and skills needed by clinical educators, see the Final Report on Knowledge, Skills and Training Consideration for Individuals Serving as Supervisors [PDF] (ASHA, 2013c) and CAPCSD'S white paper titled Preparation of Speech-Language Pathology Clinical Educators [PDF] (CAPCSD, 2013). See also the American Academy of Audiology's Clinical Education Guidelines for Audiology Externships (American Academy of Audiology, n.d.)
Both ASHA (2013c) and CAPCSD (2013) suggest the need for systematic approaches to the training and preparation of clinical educators, and both organizations outline the following issues related to the development of training:
Effective supervision ensures that new clinicians are well prepared and that individuals with communication disorders receive quality services (ASHA, 2013a).
Clinical educators integrate theoretical, evidence-based knowledge with clinical practice to help student clinicians
Competency-based education focuses on student learning. It is a system of instruction, assessment, grading, and reporting based on students' ability to demonstrate expected learning of knowledge and skills as they progress through their education. The goal of competency-based education is to ensure that students acquire the knowledge and skills they need to be successful in school, in their careers, and in their adult lives (Hidden Curriculum, 2014).
Competency-based approaches to clinical education and assessment of student learning focus more on the knowledge, skills, and competencies that a student demonstrates than on a record of clinical hours obtained. This Practice Portal page is consistent with a competency-based approach to clinical education. See Frank et al. (2007) for a discussion of a competency-based approach in clinical (medical) education.
Anderson's (1988) Continuum of Supervision is a conceptual model of supervision often referred to in the communication sciences and disorders (CSD) literature. The model describes supervision as a continuum of stages (evaluation-feedback, transitional, and self-supervision) that allows a student to move from interdependence to independence. These stages are not time-bound; the student may be at any point along the continuum, based on his or her knowledge and skills, as well as situational variables.
The continuum comprises changes over time in the amount and type of involvement of both supervisor (clinical educator) and student clinician—as the amount of direct supervision (e.g., direct instruction; modeling or demonstration) decreases, the amount of student participation increases (e.g., the student directs by proposing clinical decisions).
Supervisory styles are adjusted in response to the needs of the student, expectations and philosophies of the supervisor and supervisee, and specifics of the situation (e.g., task difficulty; familiarity with the task or procedure; client needs and preferences; setting).
Anderson (1988) emphasizes five components of the supervisory process to facilitate movement of the student along the continuum:
By actively participating in all aspects of the clinical process—including data collection, problem solving, and strategy development—the student ultimately develops the ability to use the strategies needed to function independently (Dowling, 2001).
Applications and research relevant to these components are discussed in McCrea and Brasseur's (2003) update of Anderson's seminal work.
Success in facilitating clinical and professional development ultimately rests on the relationship between clinical educator and student clinician and on the ability of the clinical educator to communicate effectively with the student clinician.
Effective interpersonal communication requires
When clinical educators adopt an effective communication style, student clinicians are more willing to participate in conferences, share ideas and feelings, and positively change clinical behaviors (e.g., Hagler, Casey, & DesRochers, 1989; McCready et al., 1996; Pickering, 1987).
Clinical behaviors also change in positive directions when students perceive genuineness, empathetic understanding, positive regard, and concreteness on the part of the clinical educator (Ghitter, 1987 [building on the research of Caracciolo, 1976; Caracciolo, Rigrodsky, & Morrison, 1978a, 1978b; McCrea, 1980; and Pickering, 1979, 1984]).
Critical thinking allows the clinician to access knowledge about the field, determine how that knowledge can be applied in clinical situations, evaluate outcomes, modify his or her thinking, and make appropriate clinical adjustments.
"Educational and professional success require developing one's thinking skills and nurturing one's consistent internal motivation to use those skills" (Facione, 2000, p. 81). The clinical educator must not only teach critical thinking skills but also nurture the disposition toward clinical thinking (Gavett & Peapers, 2007). One way to accomplish these objectives is by asking questions that activate the student's knowledge and promote analysis, synthesis, and evaluation of the situation.
Feedback is an informed (data-based), nonevaluative, objective appraisal of the student clinician's performance intended to improve his or her clinical skills (Ende, 1983). It is given to confirm or reinforce behavior, correct behavior, and promote improvement in future performance (Barnum, Guyer, Levy, & Graham, 2009; Ende, 1983; Nottingham & Henning, 2014a).
Common types of feedback (Dowling, 2001) include
Factors that can influence the effectiveness of feedback include
Each feedback exchange can include different combinations of these components; thus, each exchange is unique (Nottingham & Henning, 2014a, 2014b).
Ende (1983) offers the following guidelines for giving feedback:
Factors that can affect how receptive a student clinician is to feedback include
See Nottingham and Henning (2014b) for a discussion of student preferences with regard to feedback.
Feedback-seeking behavior is a conscious effort to determine the correctness and adequacy of one's own behavior for the purpose of attaining a goal (Ashford & Cummings, 1983). Research suggests that feedback-seeking behavior can facilitate an individual's adaptation, learning, and performance (Crommelinck & Anseel, 2013).
Not all individuals seek feedback, possibly because of differences in the perceived value and costs associated with feedback seeking (Ashford, Blatt, & Vande Walle, 2003). However, given the potential benefits, encouraging feedback seeking is an important educational strategy (Crommelinck & Anseel, 2013; Bose & Gijselaers, 2013).
Mentoring is the relationship between two people in which one person is dedicated to the personal and professional growth of the other (Robertson, 1992). In clinical education, mentoring focuses on building skills, influencing attitudes, and cultivating aspirations. Mentors model, advise, tutor, and instill a professional identity in the student clinician.
Some aspects of mentoring are involved in all supervisory relationships and, to varying degrees, at all stages of clinical education, depending on the supervisor's style and the student clinician's experience and skill level. Mentoring is less likely to be addressed when performance growth is the focus (i.e., "direct-active" style of supervision) and is more likely to be addressed in later stages of learning, when "collaborative" or "consultative" styles of supervision are used. Mentoring is most appropriate in the advanced transitional stage and the self-supervision stage of the continuum (Anderson, 1988).
The clinical educator holds the power of grading, signing off on clinical hours, and conducting performance evaluations. Awareness and understanding of the influence of power can help avoid intimidation and a reluctance by the student clinician to participate actively in the supervisory relationship.
Cultural or linguistic background may influence a student's response to the power dynamic and may result in behaviors that can be interpreted as inappropriate (Coleman, 2000). Seek advice regarding effective strategies for culturally appropriate interactions.
"The goals of the supervisory process are the professional growth and development of [both] the supervisee and the supervisor, which it is assumed will result ultimately in optimal service to clients" (Anderson, 1988, p. 12).
To that end, the clinical education process incorporates self-assessment on the part of the student clinician and the clinical educator. Self-assessment enhances professional growth and development and provides an opportunity for each person to identify goals and determine whether these goals are being met.
The clinical education process also incorporates reciprocal evaluations—this encompasses the clinical educator's evaluation of the student clinician and the student clinician's evaluation of the clinical educator. Reciprocal evaluations are critical to the process and help both individuals improve their skills.
Deliberate practice is a highly structured activity directed at improving performance on a particular task or set of tasks (Ericsson, Krampe, & Tesch-Römer, 1993). It incorporates immediate, specific, and informative feedback, problem-solving and evaluation, and opportunities for repeated performance to improve and refine skills.
Training that utilizes deliberate practice can facilitate acquisition and maintenance of expert performance in a wide variety of fields (e.g., De Bruin, Smits, Rikers, & Schmidt, 2008; Krampe & Ericsson, 1996; Unger, Keith, Hilling, Gielnik, & Frese, 2009), including acquisition of clinical skills (Duvivier et al., 2011; Ericsson, 2004).
Duvivier et al. (2011) identified a number of study habits related to deliberate practice in the behavior of clinical (medical) students at various stages of skill development:
As students progressed through the curriculum, their use of these study habits increased, particularly in the areas of planning and organization of work.
Deliberate practice can facilitate acquisition of a broad range of clinical skills in audiology and speech-language pathology, including administering tests and interpreting results; conducting oral motor exams; using technology and equipment; and completing audiologic assessments.
Reflective practice involves critical self-analysis, self-evaluation, problem solving, and the ability to modify one's behavior. It is an important tool in practice-based professional learning where clinical skills are acquired through experience rather than from formal classroom teaching.
Reflection-on-action is the process of reflecting on what has been done. It allows the individual to reflect on a prior experience, evaluate how he or she contributed to the outcome, and determine what to do when a similar situation arises (Schön, 1983).
Tools that provide opportunities to reflect on performance include self-evaluation checklists, journals, diaries, portfolios, reviews of video recorded sessions, and clinical educator observations and evaluations.
Reflection-in-action is the process of "thinking on your feet" that allows an individual to make changes in his or her behavior while engaged in a task. It requires critical, in-the-moment evaluation and the ability to identify what is not going well or what needs to be changed and to modify behaviors accordingly (Schön, 1983).
Examples include modifying task instructions or cuing strategies during a therapy session or deciding to forego otoacoustic emissions testing in favor of multifrequency tympanometry to investigate possible causes of a conductive hearing loss.
For more information about reflective practice in clinical education, see Aronson (2011); Geller and Foley (2009); Mann, Gordon, and MacLeod (2009); and Ng (2012).
The Supervision, Questioning and Feedback (SQF) model of clinical teaching integrates supervision, questioning and feedback into clinical learning experiences. It is designed to help the student clinician become an autonomous clinician with sound clinical reasoning (Barnum et al., 2009).
The SQF model incorporates
Strategic questioning consists of consciously adapting the timing, order, and phrasing of questions to help the student process information at increasingly more complex levels. In order of complexity, questions require recall of facts; comparison, analysis, synthesis, and application of knowledge; and the ability to evaluate information, formulate plans, infer meaning, and defend decisions (Barnum 2008).
Three types of feedback can be utilized—confirming lets students know when knowledge and skills are being applied correctly; corrective lets them know when these skills are not on target; and guiding reinforces and advances current levels of knowledge and skills (Barnum & Guyer, 2015).
Specific questioning and feedback techniques depend on the clinical situation—the student clinician, the task he or she is trying to complete, the urgency with which the task must be completed, and the consequences for the patient/student/client and for the student clinician (Barnum & Guyer, 2015).
Cognitive apprenticeship was introduced by Collins, Brown, and Newman (1989) as an instructional model for situated learning, in which students learn to apply skills by performing tasks and solving problems in a variety of authentic contexts.
The cognitive apprenticeship model applies the following teaching methods to promote situated learning:
Using these methods, the clinical educator makes tacit elements of expert practice explicit so that students gain a deeper understanding of the cognitive processes underlying clinical decision making (Dennen & Burner, 2008).
Simulation is a method that replaces or amplifies real client/patient experiences with scenarios designed to replicate real health encounters (Passiment, Sacks, & Huang, 2011). Simulation affords an opportunity to build knowledge and experience by rehearsing in a safe environment (e.g., clinical skills lab), where potential harm to the client/patient is minimized.
The standardized patient (SP) is a well-accepted and frequently used simulation tool. The SP is a layperson hired and trained to portray an actual patient within a clinical setting. He or she presents with faculty-defined patient history and physical symptoms and provides a consistent, controlled clinical experience for teaching and assessment purposes. Academic programs in CSD are beginning to employ SPs for clinical education purposes (e.g., Zraick & Allen, 2002; Zraick, Allen, & Johnson, 2003). Other simulation tools include computer avatars and lifelike mannequins (Zraick, n.d.).
Grand rounds are formal meetings at which cases are presented to student clinicians, clinical educators, and other medical and allied health professionals, followed by a discussion of each case. Students may review current literature to provide support for test protocols, test interpretation, and treatment options. Grand rounds originated as part of medical residency training but can be used in any clinical education setting to enhance clinical reasoning and decision-making skills.
Problem-based learning scenarios are experiences in which groups of students—with guidance from an instructor—learn through solving an open-ended problem by identifying what they know, what they need to know, and where they can access the necessary information to solve the problem.
Case-based learning scenarios are similar but use discussion of case studies and real-life scenarios to help students put their learning into practice in a clinical setting. Students work collaboratively to examine, analyze, and discuss problems related to the case.
Assessment is an essential component of any clinical education process. It involves
Setting objectives is fundamental to subsequent evaluation; progress can be measured adequately only if clear objectives have been established and if behaviors relating to those objectives have been quantified (McCrea & Brasseur, 2003).
It is critical that the clinical educator and the student clinician be jointly involved in the evaluation process (Anderson, 1988; McCrea & Brasseur, 2003). Expectations for performance and evaluation tools need to be clarified at the beginning of the supervisory experience (Brasseur, 1989).
A variety of assessment mechanisms and techniques are used to evaluate progress in acquiring the necessary knowledge and skills. Assessments are conducted on an ongoing basis throughout training and at the conclusion of a defined instructional period.
Formative assessment is ongoing measurement and feedback yielding critical information for monitoring acquisition of knowledge and skill during the learning process for the purpose of improving learning.
Formative assessment in clinical education evaluates the individual's critical thinking, decision-making, and problem-solving skills; it typically includes oral and written components as well as demonstrations of clinical proficiency in actual or simulated settings.
Examples of Formative Assessment
Summative assessment is the comprehensive evaluation of learning outcomes at the conclusion of a defined instructional period (e.g., end of semester, academic year, or program of study).
Summative assessment in clinical education yields critical information for determining an individual's acquisition of knowledge and achievement of clinical skills, including the ability to integrate academic knowledge with clinical practice.
Summative assessments can serve as gateway measures prior to embarking on a more advanced clinical process stage. They often result in a score or grade that is incorporated into the individual's overall performance.
Examples of Summative Assessment
It is important for the clinical educator to avoid the following common pitfalls when assessing student performance.
Clinical educators can use one or more of the following strategies to avoid these pitfalls and ensure objectivity, fairness, and accuracy when assessing student performance:
Difficult conversations frequently pertain to the student's clinical performance but may also be related to other behaviors such as keeping commitments, being punctual, or demonstrating professionalism. These conversations often involve differing perspectives, opposing opinions, strong emotions, and potentially high-stakes outcomes (Patterson, Grenny, McMillan, & Switzler, 2012; Whitelaw, 2012).
One approach for initiating and resolving difficult conversations is the learning conversation. It involves
The learning conversation requires willingness on the part of the clinical educator to put aside his or her views and listen to the student, with the goal of understanding and acknowledging the student's perspective. This nonjudgmental listening can provide a safe emotional environment and facilitate the problem-solving process (Luterman, 2006).
A performance improvement plan—also referred to a remediation plan—is a formal process used to help the student clinician improve performance or modify behavior. The need for remediation can stem from performance on clinical examinations that identifies the student's areas of need.
As part of the process, the clinical educator and student clinician identify specific performance and/or behavioral concerns and develop a written plan of action to address these concerns. The following specific steps in developing and implementing performance improvement plans are adapted from the Society for Human Resource Management (2013).
I. Document areas of performance and/or behavior in need of improvement by
II. Develop action plan for improvement that includes
III. Meet with student clinician to review plan. Be sure to
IV. Gather data
V. Meet regularly with the student clinician (e.g., weekly, biweekly) to
VI. Conclude plan when student clinician
The rights of students with disabilities are protected by the Americans With Disabilities Act (ADA; 1990) and Section 504 of the Rehabilitation Act of 1973. The ADA and Section 504 of the Rehabilitation Act of 1973 define individuals with disabilities as
Major life activities include caring for oneself, walking, seeing, hearing, speaking, breathing, working, performing manual tasks, and learning.
The ADA (1990) is comprehensive civil rights legislation that prohibits discrimination and guarantees that people with disabilities have the same opportunities as everyone else to participate in mainstream American life. This includes the opportunity to participate in higher education. Title II of the ADA covers state-funded schools such as universities, community colleges, and vocational schools. Title III of the ADA covers private colleges and vocational schools.
Section 504 of the Rehabilitation Act of 1973 (hereafter, "the Rehabilitation Act") protects qualified individuals from discrimination based on their disability. The nondiscrimination requirements of the law apply to employers and organizations that receive financial assistance from any federal department or agency and include many institutions of higher learning, hospitals, nursing homes, mental health centers, and human service programs.
Section 504 of the Rehabilitation Act covers any school that receives federal dollars, regardless of whether it is private or public. A recipient of federal financial assistance may not, on the basis of disability,
To be protected by Section 504, a student must be a qualified individual with a disability. In addition to meeting the above definition of individuals with disabilities—and for purposes of receiving services, education, or training—the term qualified means that the student meets essential eligibility requirements, with or without use of a reasonable accommodation.
Examples of discriminatory conduct by a college or university include
Institutions are required by law to provide reasonable accommodations. Specifically, they are required to make reasonable modifications in their practices, policies, and procedures and to provide auxiliary aids and services for individuals with disabilities—unless doing so would (a) fundamentally alter the nature of the goods, services, facilities, privileges, advantages, and accommodations that they offer or (b) result in an undue financial or administrative burden on the institution.
Colleges and universities are not required to provide personal attendants, individually prescribed devices, readers for personal use or study, or other devices or services of a personal nature, such as tutoring and typing.
A reasonable accommodation for a student with a disability may include appropriate academic adjustments (e.g., modifications to academic requirements) that are necessary to ensure equal educational opportunity.
The college or university is not required to lower or substantially modify essential requirements. For example, although the college or university may modify elements of the clinical practicum to meet the student's disability-related needs, it is not required to change the substantive requirements of the clinical experience in ways that can potentially interfere with quality of client care.
All students are held to the same standards and expectations. The presence of a disability may help explain how the student performs but does not excuse inadequate performance. All students deserve equal access to realistic performance assessment.
See Jarrow (2012) for a discussion of students with disabilities and information about maintaining essential requirements for all students.
On occasion, a bilingual student clinician shares the language of the client/patient and/or family. When the clinical educator does not also share the language, a unique set of knowledge and skills is needed to understand, monitor, and evaluate the work of the bilingual student clinician. When this situation arises, it is important to consider the following:
Accents are defined as English pronunciation that is not the result of pathology and that is perceived to be different from the listener's—whether the English was learned as a first, second, or other language. Accents include aspects of speech sound production, prosody, rate, and fluency (Celce-Murcia, Brinton, & Goodwin, 1996), all of which can affect intelligibility. A dialect is any variety of a language that is shared by a group of speakers (Wolfram, 1991).
All individuals speak with an accent and/or dialect, whether it is regional or influenced by another native language. Variation is the norm, and no single standard can be appropriately applied in every clinical interaction. Audiologists and speech-language pathologists (SLPs) manage cases across linguistic variation as a matter of routine.
Student clinicians who speak with accents and/or dialects can effectively provide speech, language, and audiological services as long as they have
Universities impose the same requirements on all student clinicians and consider the potential means by which students can successfully provide clinical services with the varied tools and resources now available. According to ASHA (1998), "the nonacceptance of individuals into higher education programs or into the professions solely on the basis of the presence of an accent or dialect is discriminatory" (p. 1).
When there are concerns about the impact of a student clinician's accent on the delivery of clinical services, the following strategies (ASHA, 2011) are offered to increase the likelihood of success:
Both the service provider and the client/patient bring a unique combination of cultural variables to the clinical interaction, including ability, age, sex, beliefs, ethnicity, experience, gender, gender identity, linguistic background, national origin, race, religion, sexual orientation, and socioeconomic status.
Just as audiologists and SLPs are required to consider each client's/patient's or caregiver's cultural and linguistic characteristics and values in order to provide the most effective services (ASHA, 2004), the clinical educator also considers those of the student clinician (Herd & Moore, 2012). Clinical educators and student clinicians demonstrate cultural competence as they relate to each other and to the diverse populations they serve (ASHA, 2013d).
Culturally competent clinical educators successfully perform the following tasks:
Generational differences can present unique challenges in clinical education. Four distinct generations (traditionalists, baby boomers, generation Xers, and millennials) are currently working together in potentially stressful, competitive environments (Lancaster & Stillman, 2002). Each generation is defined by people, places, events, and symbols that profoundly influence expectations and values.
Different expectations and values between and among generations can result in misinterpretations and misunderstandings between clinical educator and student clinician in a clinical setting. McCready (2007) describes a number of ways to bridge the generation gap and facilitate improved communication, including
Student clinicians typically gain practical experience in the field by "interning" at one or more external practicum sites (e.g., schools, rehabilitation centers, skilled nursing facilities, private practices, hospitals). Academic programs work together with external practicum sites to help provide these experiences.
The clinical affiliation agreement is a formal contract between an academic institution (college or university) and an external practicum site. Most academic programs require a clinical affiliation agreement before sending students to external practicum sites.
The clinical affiliation agreement identifies the responsibilities and liabilities of each party and ensures an appropriate learning experience for the student clinician. Agreements typically include the responsibilities listed in the boxed information below:
Mutual responsibilities of the academic institution and practicum site
Responsibilities of the academic institution
Responsibilities of the practicum site
The practicum site needs to complete a number of tasks prior to student clinician placement, including those listed below:
There is no official ASHA policy regarding payment of students for clinical practicum. However, because it is acceptable to charge for supervised services provided by students, it follows that it is acceptable to pay students in practicum settings. See Issues in Ethics: Ethical Issues Related to Clinical Services Provided by Audiology and Speech-Language Pathology Students (ASHA, 2013e) for more details.
Students work with their academic program and practicum site to determine whether a stipend is available and/or appropriate. Important considerations include
Even if a student is being paid a stipend, he or she requires the appropriate level of supervision and teaching necessary for training. Make clients, patients, and families aware that services are being rendered by a student clinician under the supervision of a credentialed and/or licensed practitioner.
It is not uncommon for clinicians serving as external practicum site clinical educators to be offered incentives or compensation for the additional work involved in being a clinical educator. ASHA does not have a policy on payment of externship clinical educators. Some academic institutions may offer compensation in the form of a stipend or in-kind services (e.g., continuing education opportunities) or, for example, a "thank you" lunch at the end of the semester.
In some cases, the employer (practicum site) might offer compensation or incentives to the employee for working with student clinicians. For example, when practical, the employee may be given a temporarily reduced caseload while working with a student clinician.
If the audiologist or SLP receives payment from the university for serving as an externship clinical educator, he or she will need to disclose this to the employer. As the direct beneficiary of this payment, the individual will also need to declare the income when filing his or her personal income taxes.
Clinical educators who are members of ASHA are expected to abide by the Code of Ethics (ASHA, 2010r) and have the unique opportunity to reinforce and model the importance of the Code of Ethics to their student clinicians.
There are also a number of Issues in Ethics Statements published by ASHA's Board of Ethics that provide guidance in addressing some of the challenges inherent in clinical education. See Ethical Issues Related to Clinical Services Provided by Audiology and Speech-Language Pathology Students (ASHA, 2013e) and Issues in Ethics: Supervision of Student Clinicians (ASHA, 2010) for more details.
Clinical educators and mentors working with speech-language pathology clinical fellows can also review Issues in Ethics: Responsibilities of Individuals Who Mentor Clinical Fellows in Speech-Language Pathology (2013a) for guidance.
The standards for certification for audiology and speech-language pathology are established by audiologists and SLPs, respectively, who are members of ASHA's Council for Clinical Certification in Audiology and Speech-Language Pathology (CFCC). It is important for clinical educators to be familiar with the Standards and Implementation Procedures for the Certificate of Clinical Competence in Audiology (CCC-A) and the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) when working with students interested in seeking ASHA certification.
To embark on a career as an ASHA-certified audiologist or SLP, students must complete the necessary entry-level graduate degree from a program accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA; ASHA, 2014).
Clinical educators must comply with Medicare guidelines related to coverage of student and clinical fellowship services. ASHA has compiled information about these regulations in the following sources:
Audiology and speech-language pathology are recognized as covered services under the Medicaid program. The federal government establishes broad guidelines, and each state then administers its own program. Review and approval is conducted by the federal Centers for Medicare & Medicaid Services (CMS).
Medicaid coverage of services provided "under the direction of" a qualified professional varies by state. See Medicaid Coverage of Speech-Language Pathologists and Audiologists for professional and state-specific information.
HIPAA is a law designed to improve the efficiency and effectiveness of the nation's health care system and health care operations. HIPAA
See the Health Insurance Portability and Accountability Act (1996) for additional information and resources.
HIPAA regulations apply to all covered entities [PDF]. These include health care operations or systems "conducting training programs in which students, trainees, or practitioners in areas of health care learn under supervision to practice or improve their skills as health care providers."
Student clinicians providing services in such health care settings will need to learn about HIPAA regulations and should be introduced to the facility's HIPAA policies and procedures. Facilities may require that student clinicians receive HIPAA training as part of their orientation. Just as any employee in the facility, student clinicians are expected to abide by HIPAA's Privacy Rule which applies to all forms of protected health information (PHI) whether oral, paper, or electronic.
FERPA (1973) protects the privacy of student education records and applies to all schools that receive funds under an applicable program of the U.S. Department of Education. FERPA gives parents certain rights with respect to their children's education records. These rights transfer to the student when he or she reaches the age of 18 years or attends an institution beyond the high school level.
Rights of students receiving services in the practicum setting. In education practicum settings (i.e., schools), student clinicians under the supervision of a qualified professional may generally be considered a "school official" with a "legitimate educational interest" and, as such, may have access to an individual's education records under this legislation. FERPA requires that schools specify the criteria for determining which parties are school officials and what the school considers to be a legitimate educational interest. Student clinicians should be made aware of their responsibilities under FERPA not to disclose personally identifiable information from education records unless authorized to do so, either with parental consent or under one of the conditions in FERPA permitting disclosure without consent. For more information, see FERPA General Guidance for Students.
Rights of the student clinician. The education records of student clinicians are also protected under FERPA; the student clinician has the right to access his or her own education records, seek to have those records amended, control the disclosure of personally identifiable information from the records, and file a complaint with the school or department if he or she feels that these rights have been violated.
Although there are some exceptions, the university generally may not disclose personal identifiable information from the student clinician's educational records without the student's written consent. One exception is when the information is of legitimate educational interest. A clinical practicum site might be allowed access to a student clinician's personal identifiable information and must protect the confidentiality of this information, along with any other educational records generated during the practicum experience (e.g., performance evaluations and grades). For more information, see FERPA General Guidance for Students.
Telesupervision of student clinicians occurs when a qualified professional observes, from a distance, the delivery of services by the student and provides feedback or assistance as needed. Telesupervision offers the potential to expand students' access to clinical placements and to reduce travel and scheduling conflicts for clinical educators. Although telesupervision and telepractice are related due to their use of technology, ASHA's definition of telepractice does not include supervision.
See ASHA's resource on telepractice for information on technology, security, licensure, and other tips.
The use of telesupervision as an alternative to in-person supervision may depend on the policies, regulations, and/or laws of various stakeholders such as universities, clinical settings, ASHA, state licensure boards, and state and federal laws and regulations.
Increasingly, state licensure laws include a definition of telepractice and regulations related to it, which may or may not include guidance regarding telesupervision. States may vary in terms of whether they specifically address the issue of supervising students from a distance.
The clinical educator has an ethical responsibility for the welfare of the individual receiving clinical services and must determine if telesupervision is an appropriate means to supervise a particular student clinician in view of the type of setting, client population, and level of independence of the individual delivering the service.
When implementing telesupervision practice and policies, consider the security of the telesupervision transmission in light of relevant state and federal laws such as HIPAA and FERPA. Policies about safety, liability, and whether a certified and/or licensed professional needs to be on site are also important and relevant considerations.
Like telepractice, delivering supervision services from a distance requires additional knowledge and skills for issues such as managing technology, complying with licensure and security requirements, providing feedback, and so forth. Training may be necessary for clinical educators regarding how to provide telesupervision so that quality and effectiveness of the supervision is equivalent to in-person supervision.
ASHA offers several guidelines for the implementation of telesupervision:
According to the World Health Organization (WHO; 2010), "Interprofessional education (IPE) occurs when two or more professions learn about, from, and with each other to enable effective collaboration and improve . . . outcomes" (p. 7). IPE is an essential first step in preparing professionals to work collaboratively in response to client/student/patient needs.
Interprofessional practice (IPP) allows workers from a variety of professional backgrounds to work together with clients/students/patients, families, caregivers, and communities to provide the highest quality and most comprehensive services possible (WHO, 2010).
Interprofessional education and collaborative practice align with national efforts toward a more interprofessional and collaborative service delivery model that centers on the individual and family with the aim of educating populations, improving health and safety, and enhancing the overall cost effectiveness of educational and health care services.
Clinical educators have the opportunity to engage In IPE/IPP and can reinforce best practices in this area. ASHA has compiled a number of interprofessional education/interprofessional practice (IPE/IPP) resources. Clinical educators and CF mentors may want to familiarize themselves with Core Competencies for Interprofessional Collaborative Practice [PDF], a report published by an expert panel of the Interprofessional Education Collaborative (IPEC, 2011), as well as ASHA's Interprofessional Education (IPE): Final Report, Ad Hoc Committee on Interprofessional Education [PDF] (ASHA, 2013f).
This list of resources is not exhaustive and the inclusion of any specific resource does not imply endorsement from ASHA.
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American Speech-Language-Hearing Association. (2013f). Interprofessional education: Final report, Ad Hoc Committee on Interprofessional Education. Available from www.asha.org/siteassets/uploadedfiles/Report-Ad-Hoc-Committee-on-Interprofessional-Education.pdf [PDF]
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Content for ASHA's Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Clinical Education and Supervision page:
In addition, ASHA thanks the members of the Ad Hoc Committee on Supervision in Speech-Language Pathology, whose work was foundational to the development of this content. Members of the committee were Lisa O'Connor (chair), Christine Baron, Thalia Coleman, Barbara Conrad, Wren Newman, Kathy Panther, and Janet E. Brown (ex officio). Brian B. Shulman, vice president for professional practices in speech-language pathology (2006–2008), served as the monitoring officer.
The recommended citation for this Practice Portal page is:
American Speech-Language-Hearing Association. (n.d.). Clinical Education and Supervision. (Practice Portal). Retrieved month, day, year, from www.asha.org/Practice-Portal/Professional-Issues/Clinical-Education-and-Supervision/.