Back to the Basics

BY: Karlene Stefanakos, M.A., CCC-SLP on Sunday, 19 December 2010. Posted in All, Dementia, Dysphagia, Speech Evaluation, Speech Pathology

As I travel and lecture across this country, the question continuously surfacing in each workshop is "What did I spend my money on for my master's?" This question is usually generated by a feeling that somewhere in their graduate studies, the workshop attendees should have had instruction on the workshop topic areas, since these topics have such basic implications on their SLP practices. Quite frankly, as I look at the catalog curriculums of some of our schools, it is difficult to discern curriculum differences since the time when I went to school - twenty years ago.

Medically based clinical field supervisors in my area of the country still find it irritating that universities still provide externs who have inconsistent academic backgrounds in dysphagia. That is to say, dysphagia is still not a consistently offered course across many Master's level programs. Worse yet, a Master's level clinical fellow can come fresh from their academic endeavors and be staggered when faced with a case mix of dementia and dysphagic patients - two disorders the clinician may never have had any coursework on at all!

The nature of academic accreditation is to guarantee program quality. The ASHA accreditation process is a system of accreditation that should (1) assure that graduates of an accredited program are adequately prepared to enter and continue the practice of speech language pathology (2) stimulate the improvement of speech language pathology education (3) encourage new and innovative approaches to speech language pathology education; and, (4) identify these programs to the public.

Each speech language pathology program for which an institution seeks accreditation, or reaccreditation, should have in place detailed published educational objectives that are consistent with the mission of the institution and additional criteria of: (a) a process based on the needs of the programs' various constituencies in which the objectives are determined and periodically evaluated; (b) a curriculum and process that ensures the achievement of these objectives; and, (c) a system of ongoing evaluation that demonstrates achievement of these objectives and uses the results to improve the effectiveness of the program.

In the end, we are only as strong as our education. Our educational level is the foundation we stand on as we deal with an ever changing reimbursement and clinical landscape. A "standardized curriculum program" would go a long way to empower our medical/school based speech language pathologists. Here are some suggestions gleaned from workshop attendees.

The Speech Pathologist and MBS Radiation: This course would tell us what we presently know very little about - radiation. It should discuss 1) the nature of radiation, 2) radiation and health hazards, 3) radiation and technologies, 4) protective measures to be utilized in the presence of radiation, 5) the effects of radiation in treatment, 6) and monitoring of radiation.

Dementia and OBRA: This course would tell us our legal responsibilities in shepherding the dementia patient throughout the most devastating stages of this disease. Too many times I still hear speech pathologists considering evaluation and development of a functional maintenance program for a demented patient akin to fraud. This tells me, immediately, that she is unaware of her responsibilities under the OBRA law. This course should educate us in 1) dementia and OBRA, 2) the nature and stages of dementia, 3) how to evaluate dementia, (communication and dysphagia), 4) care planning for the dementia patient, 5) staff training contracts for dementia, 6) quality assurance programs used in dementia, 7) family counseling for dementia, 8) recreational therapy for the dementia patient, and 9) the current medical treatment and future medical hopes of dementia.

The Law and the Speech Pathologist: This course would make us experts in the laws under which we provide services. This includes 1) Medicare and Medicaid Law, 2) the IDEA law, 3) OBRA law, 4) public school structure in the implementation of the IDEA law, 5) state Public Law governing public schools, 6) HCFA/CMS infrastructure in the implementation and reimbursement for services, 7) Paper systems germaine to each legal tract of service, and 8) why malpractice insurance?

Esophageal Dysfunctions and Disorders (upper 1/3): This course would enable us in the area we are legally charged to have knowledge of under the Medicare law. This course should cover 1) the structure and physiology of the upper esophagus, 2) disease patterns of the esophagus, 3) diagnostics of the upper 1/3 of the esophagus, 4) treatments (medical) utilized in the upper 1/3 of the esophagus, 5) SLP/radiologist team approach.

Chronic Diseases and their Impact upon Communication and Dysphagia: This course would identify the importance of a "differential diagnosis" as our communal symptoms in communication and dysphagia intersect with exacerbations of chronic diseases such as 1) renal insufficiency, 2) congestive heart failure, 3) COPD and the apneic reflex and dysphagia, 4) cardiac precautions and the cardiac patient in treatment, 5) cancer surgeries and their impact upon the swallow and communication, 6) Dehydration indicators and tests, 7) Critical and Normal Lab Levels and the chronic disease, 8) Ascites and the use of the NG-tube, etc.

The Speech Pathologist and Alternative Communication Systems: This course would cover evaluation and treatment modalities in 1) speech generating devices, 2) voice prosthetics, 3) AAC devices, 4) hearing aid types, 5) pediatric/geriatric FM technology, 6) cochlear implants and communication, and 7) legal funding issues regarding acquisition of all communication devices.

The Speech Pathologist and the Trach Ventilator Patient: This course would cover 1) trach/ventilator patient case mix, 2) how to assess and treat the trach/ventilator patient (communication and dysphagia), 3) trach/ventilator systems, 4) trach/ventilator weaning techniques, 5) trach/ventilator medical treatments, 6) trach/ventilator support/speech patterns, and 7) the trach/ventilator treatment team.

These are just seven courses that come quickly to mind from listening to speech pathologists as I travel around the country. These courses would greatly empower our new graduates and our clinicians in the field who would benefit from their "state-of -the-art" knowledge. Presently , our medical clinical field supervisors are trying to "train" graduates quickly to minimize unpaid time away from treatment. Standardizing strong curriculums which address "real workplace needs" would cut a broad strong swath across weaknesses and strengthen us as a profession and as individual clinicians. ASHA is our accreditation agency for our universities. ASHA's #1 goal should always be state-of-the-art accreditation so that our universities can bring us into a competent professionalism.

Comments (2)

  • Constantine Elias

    29 August 2013 at 11:25 |
    To think that students are walking out of graduate school not knowing what an MBS is!
  • Jill Bona-Garcia, M.A., CCC-SLP

    29 August 2013 at 11:20 |
    I would find this information extremely helpful in my role. I too find that I did not learn much about dysphagia in my master's program, and am continuously looking for more opportunities to expand my knowledge.

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