Student Supervision and Ethics Andrea Vaughan, MS, CCC-SLP Assistant Clinical Professor Saint Louis University MACDG Presentation March 6, 2019

Supervision in Medical Setting 10 years as acute care therapist Multiple students from various institutions 2 students at a time Student unprepared for medical internships Anatomy/Physiology Bedside Swallow Evaluations FEES/MBS

Solution? New role at SLU Developed clinical labs for 1st years 4 labs – 2 weeks each for 8 hours Hearing Social Communication AAC Swallow/Voice Students rotated through each lab every 2 weeks 10 students in each lab

Swallow and Voice Lab Focus on normal through the lifespan Anatomy and physiology Cranial nerves Bedside swallow evaluation (MASA) Hands on experience FEES and Videostroboscopy Observation (Flexible and Rigid) Anatomy identification Procedure protocol Evaluation Report

Lab Requirements Complete bedside swallow evaluations on 5 normal “patients” Anatomy identification on endoscopy/MBS Identify differences between FEES/MBS When to recommend FEES vs MBS Simucase patient Journal article review Evaluation

Lab Feedback Overwhelmingly positive Some review, some new information Most wanted more “Made the idea of having an adult client less terrifying.” “I feel prepared to complete a swallowing evaluation.” “Great review of anatomy, but I loved the charts/handouts.”

Future of Clinical Labs 12 hours instead of 8 per week All students rotate through each lab every 2 weeks Lecture to all 40 students at once and break up into small groups for hands on activities Prevent presenting the same lecture 4 times! Add observation component Acute care hospital Rehab hospital SNF Reinforce those who want to intern at intense medical placements Confirm those who do not

Graduate Student Supervision Speech-Language-Hearing Clinic Initial Preparation Anderson Model Evaluation-Feedback Stage Supervisor takes lead and supervisee takes direction Answer questions and provide thorough detail Transitional Stage Supervisee takes lead and evaluation/treatment is joint project Ask questions with questions Self-supervision stage Supervisor serves as consultant You tell me

Feedback Debrief after each session (at least initially) 4 Quadrant Feedback Form Continue Begin/Do More Consider Stop or Do Less

References Anderson, J. L. (1988) The supervisory process in speech language pathology and audiology. Austin, TX: Pro-Ed Butler, S., et al, “Penetration and aspiration in healthy older adults as assessed during endoscopic evaluation of swallowing”, Annals of Otology Rhinology and Laryngology,118(3), 190-98, 2009. Mann, G. (2002) The Mann assessment of swallowing ability. Albany, New York: Delmar Thomason Learning. Murray, J., Langmore, S.E., Ginsberg, S., & Dostie, A. (1996). The Significance of Accumulated Oropharyngeal Secretions and Swallowing Frequency in Predicting Aspiration. Dysphagia (11):99-103. Neubauer, P.D., Hersey, D.P., & Leder, S.B. (2016). Pharyngeal Residue Severity Rating Scales Based on Fiberoptic Endoscopic Evaluation of Swallowing: A systematic review. Dysphagia (3)352-359. Poburka, B.J., Patel, R.R., & Bless, D.M. (2017). Voice-Vibratory Assessment with laryngeal Imaging (VALI) Form: Reliability of Rating Stroboscopy and High-speed Videoendoscopy. Journal of Voice, 31(4); 513.e1-513.e14. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL (1996) A penetration-aspiration scale. Dysphagia 11(4):225–233.