Issues in Ethics: Supervision of Student Clinicians
About This Document
Published 2025. This Issues in Ethics statement was originally published in 2003 and was last revised in 2017. It has been updated to make any references to the Code of Ethics consistent with the Code of Ethics (2023) (hereinafter, "Code of Ethics"). The Board of Ethics (hereinafter, the "BOE") reviews Issues in Ethics statements periodically to ensure that they reflect current practices and the current Code of Ethics.
Issues in Ethics Statements: Definition
From time to time, the BOE determines that members and certificate holders can benefit from additional analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to heighten sensitivity and increase awareness. They are illustrative of the Code of Ethics and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders in engaging in self-guided, ethical decision making. These statements do not absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine whether the activity is ethical.
Introduction
This Issues in Ethics statement is presented for the guidance of ASHA members and certificate holders in matters relating to supervision of students engaged in the provision of clinical services during all practicum experiences (on campus and off campus), internships, and externships. ASHA members and certificate holders are employed in a variety of work settings and are required by their employers, by their states, and by governmental agencies—as well as by ASHA—to comply with prescribed personnel standards related to certification and licensure. The term clinical educator often is used to describe individuals engaged in supervision of student clinicians (audiology students and speech-language pathology students) in any clinical setting. The term preceptor applies to audiologists who supervise audiology students in their final externship.
Although the standards and requirements can and do differ, under the Code of Ethics, ASHA members and certificate holders delivering or supervising clinical services must hold ASHA certification—the Certificate of Clinical Competence in Audiology (CCC-A) or the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP)—in the area of their clinical or supervisory work regardless of the work setting, state, or jurisdiction in which they are employed. As indicated in the Issues in Ethics statement Clinical Practice by Certificate Holders in the Profession in Which They Are Not Certified, "When audiologists and speech-language pathologists are engaged in any aspect of professional practice, it is essential that they function within the scope of practice of their respective professions (i.e., audiology or speech-language pathology) and only within the scope of their competence, as determined by their certification status, education, training, and experience."
Further, ASHA-certified individuals who supervise student clinicians are bound to honor their responsibility to hold paramount the welfare of persons they serve professionally and to ensure that students under their supervision provide services competently. Whether the term used is supervisor, clinical educator, or preceptor, all of these individuals exercise professional authority or power over students. With that professional authority or power over students also comes an expectation of trust.
Discussion
The BOE cites and interprets the following sections of the Code of Ethics that pertain to the supervision of student clinicians:
- Principle I, Rule A: "Individuals shall provide all clinical services and scientific activities competently."
- Principle I, Rule D: "Individuals shall not misrepresent the credentials of aides, assistants, technicians, students, research assistants, Clinical Fellows, or any others under their supervision, and they shall inform those they serve professionally of the name, role, and professional credentials of persons providing services."
- Principle I, Rule G: "Individuals who hold the Certificate of Clinical Competence may delegate to students tasks related to the provision of clinical services that require the unique skills, knowledge, and judgment that are within the scope of practice of their profession only if those students are adequately prepared and are appropriately supervised. The responsibility for the welfare of those being served remains with the certified audiologist or speech-language pathologist."
- Principle II, Rule A: "Individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience."
- Principle IV, Rule F: "Individuals who mentor Clinical Fellows, act as a preceptor to audiology externs, or supervise undergraduate student, assistants, or other staff shall provide appropriate supervision and shall comply—fully and in a timely manner—with all ASHA certification and supervisory requirements."
- Principle IV, Rule I: "Individuals shall not engage in sexual activities with persons over whom they exercise professional authority or power, including persons receiving services, other than those with whom an ongoing consensual relationship existed prior to the date on which the professional relationship began."
- Principle IV, Rule J: "Individuals shall not knowingly allow anyone under their supervision to engage in any practice that violates the Code of Ethics."
- Principle IV, Rule M: "Individuals shall not discriminate in their relationships with colleagues, members of other professions, or individuals under their supervision on the basis of age; citizenship; disability; ethnicity; gender; gender expression, gender identity; genetic information; nation origin, including culture, language, dialect, and accent; race; religion; sex; sexual orientation; socioeconomic status; or veteran status."
ASHA-certified individuals who supervise students cannot delegate the responsibility for clinical decision making and management to the student. The legal and ethical responsibility for persons served remains with the certified audiologist or speech-language pathologist (SLP). However, the student can, as part of the educational process, make client/patient management recommendations and decisions pending review and approval by the supervisor. Further, the supervisor must inform the client/patient or their legally authorized/appointed representative (i.e., legal guardian) of the qualifications and credentials of the student involved in the provision of clinical services.
All supervised clinical activities provided by the student must fall within the scope of practice for the specific profession to count toward the student's certification. The supervisor or preceptor must achieve and maintain competency in supervisory practice as well as in the disability areas for which supervision is provided. The amount of supervision provided by the ASHA-certified supervisor must be commensurate with the student’s knowledge, experience, and competence to ensure that the welfare of the client/patient is protected. The supervisor must also ensure that the student maintains confidentiality of client/patient information and documents all client records and billing information, if applicable, in an accurate and timely manner.
Differences may exist in the type and amount of supervision of students that is required for teacher certification, state licensure, and ASHA certification. In states where credential requirements or state licensure requirements differ from ASHA certification standards, supervised clinical experiences will count toward or may be applied toward ASHA certification requirements only if those clinical experience hours have been supervised by ASHA-certified personnel.
Guidance
ASHA-certified individuals who supervise students should possess or seek training in supervisory practice and provide supervision only in practice areas for which they possess the appropriate knowledge and skills. The supervisor must oversee the clinical activities and make or approve all clinical decisions to ensure that the welfare of the client/patient is protected.
ASHA-certified individuals who supervise students or Clinical Fellows must complete a minimum of 9 months of practice experience post-certification and must have earned at least 2 hours of professional development post-certification in the area of supervision and/or clinical instruction. Failure of supervisors to meet these standards may result in students and Clinical Fellows failing to meet their ASHA certification requirements. Additionally, such supervisors may be in violation of Principle IV, Rule F. For additional resources, see the CFCC 2020 Supervision Requirements and information regarding supervision of graduate students.
The supervisor must provide no less than the level of supervision that is outlined in the current certification standards and increase supervision if needed based on the student’s knowledge, experience, and competence. In addition, third-party payers are often very specific about the supervision required in order to receive reimbursement for services provided by students; therefore, it is imperative that supervisors be knowledgeable regarding these specific requirements—and meet them. Because the rules and regulations regarding reimbursement by federal, state, and private health plans are constantly changing, supervisors must keep abreast of all reimbursement policies, rules, and regulations. As a general rule, when more than one supervision requirement applies, the most stringent requirement should be followed.
ASHA members and certificate holders who are engaged in the preparation, placement, and supervision of student clinicians must make reasonable efforts to ensure that direct supervision is provided by professionals holding the CCC-A or CCC-SLP. They must inform students who engage in clinical experiences under a non-ASHA-certified supervisor that these experiences cannot be applied toward ASHA certification. ASHA-certified personnel cannot approve clinical hours that were actually supervised by non-ASHA-certified individuals. It is unethical for certificate holders to approve clinical hours for which they did not provide supervision.
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