The terms clinical supervisor, clinical educator, and clinical instructor may all be used to refer to professionals who provide supervision as part of the training and education of student clinicians.
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To meet ASHA's Standards for the Certificate of Clinical Competence in Audiology (CCC-A), student clinicians must be supervised by an individual who
Note for CCC-A applicants: Any portion of the applicant's supervised clinical practicum that was not completed under an audiologist meeting the requirements above can be completed post-graduation. The applicant's post-graduation clinical instructor/supervisor, who must also meet the above requirements, will verify that the applicant has demonstrated and acquired the knowledge and skills for ASHA certification following completion of the required supervised clinical experience. The post-graduate supervised clinical practicum may be telesupervised.
Applicants who apply for certification without completing a full, supervised clinical practicum under a clinical instructor/supervisor who meets the requirements above within their degree program will have 24 months from their application-received date to initiate the remainder of their experience and will have 48 months from the initiation date of their post-graduation supervised clinical practicum to complete the experience.
In addition to the CFCC standards, supervisors of graduate students need to consider requirements and regulations, including
The 2020 Audiology Certification Standards and the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) Standards for Accreditation of Graduate Education Programs in Audiology and Speech-Language Pathology (updated August 2020) do not specify the amount of direct supervision that must be provided in the clinical doctoral program. The relevant sections from the Council for Clinical Certification in Audiology (CFCC) 2020 Standards for Audiology and the Council on Academic Accreditation (CAA) Standards for Accreditation of Graduate Programs are listed below.
The 2020 Audiology Certification Standard III states that the applicant's clinical experiences must meet CAA standards for duration and be sufficient to demonstrate the acquisition of the knowledge and skills identified in Standard II.
The applicant's doctoral program director or designated signatory must verify that the applicant has acquired and demonstrated all of the knowledge and skills identified in Standard II.
CAA Standard 3.1A includes the statement that the clinical doctorate program in audiology must include a minimum of 12 months' full-time equivalent of supervised clinical experience. These include short-term rotations and longer-term externships and should be distributed throughout the program of study.
Clinical educators who are members of ASHA are expected to abide by the Code of Ethics (ASHA, 2016; hereafter, “the Code”) and have the unique opportunity to reinforce and model the importance of the Code of Ethics to their student clinicians. ASHA's documents, Ethical Issues Related to Clinical Services Provided by Audiology and Speech-Language Pathology Students (ASHA, 2017) and Issues in Ethics: Supervision of Student Clinicians (ASHA, 2017), provide additional guidance for addressing challenges in clinical supervision.
The Code provides guidance regarding the ethical issues that may arise when students are providing professional service. Although the Board does not have jurisdiction over students, the Code does apply to their supervisors, clinic directors, and mentors. Specifically, Principle of Ethics I, Rule G recognizes the professional acceptability of appropriately supervised clinical practice by students by stating, “Individuals who hold the Certificate of Clinical Competence may delegate tasks to students related to 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 individual."
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 receives payment from the university for serving as an externship clinical educator, then they will need to disclose this to the employer. As the direct beneficiary of this payment, they will also need to declare the income when filing their personal income taxes.
Supervision requirements of graduate students and audiology externs can vary by payer and setting. It is important to consider all applicable requirements to ensure that you are billing for services provided by graduate students and audiology externs appropriately. The final authority on billing and payment requirements is the patient's insurance plan (payer), in compliance with state law. For more information on supervision requirements across payers, see Supervision of Graduate Students: Billing and Payment Compliance and Supervision of Clinical Fellows and Audiology Externs: Billing and Payment Compliance.
Telesupervision occurs when a qualified professional observes, from a distance, the delivery of services—and provides feedback or assistance as needed. With telesupervision, the audiologist can view and communicate with the patient, student, and/or audiology assistant in real time via telecommunication software (e.g., virtual platforms), webcam, telephone, and similar devices. This enables the professional to give immediate feedback. Telesupervision does not include reviewing a recorded session later. See ASHA's Practice Portal on Telepractice and Teleassessment webpage for information on licensure and teacher certification, international considerations, and reimbursement and other topics. The page also includes a comprehensive list of resources—including checklists and videos to inform practice.
Laws and Regulations for Telesupervision
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, the CFCC, state licensure boards, and state and federal laws and regulations. According to the 2020 Audiology Certification Standards, telesupervision is separate from telepractice and is accepted only in limited circumstances.
Increasingly, state licensure laws may or may not include guidance or regulation regarding telesupervision. States may vary in terms of whether they specifically address the issue of supervising students from a distance. See practice policy for your state. In some cases, the two parties may not reside in the same state or country (e.g., provider and client live in two different states). Serving Students in Other States and Countries Through Telepractice provides information and guidance when this occurs.
Supervisors should refer directly to the following resources to find the most recent information about whether telesupervision is allowed and under what circumstances.
For certification standards, refer to the 2020 Certification Standards for Audiology. See ASHA's State by State resource for state regulations on telepractice and telesupervision along with state contact information.
Ethical Responsibilities for Telesupervision
According to ASHA's Clinical Education and Supervision Practice Portal, the supervisor has an ethical responsibility to determine if telesupervision is appropriate in view of the type of setting, client population, and level of competence of the individual delivering the service.
When implementing telesupervision practice and policies, consider the security of the telesupervision transmission, keeping in mind relevant state and federal laws such as the Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA). Policies about safety, liability, and whether a certified and/or licensed professional needs to be on site are important considerations.
Knowledge and Skills for Telesupervision
Delivering supervision services from a distance requires knowledge and skills for managing technology, complying with licensure and security requirements, providing feedback, and so forth. Training may be necessary to ensure that the quality and effectiveness of the telesupervision is equivalent to in-person supervision.