[Dysphagia] Can we ever train newbies to be ready for the medical world?

[pleslie at pitt.edu (Leslie, Paula)]

Hello All
 
I agree whole heartedly with maintaining our professional training and often it's not the stuff that was taught formally in a class or up on the lecture platform that makes the difference to how I practice, it's what I discussed with more (and less) experienced people during the coffee breaks or at the end of the day.  I've never yet been to a workshop/conference/meeting where I didn't learn something - even when I'm the one giving the talk.  But the learning takes years and luck (or good management).  Can we give students a head start?
 
We have a slightly different education system for SLPs in Britain, 4 years of intensive training where, mostly, SLTs come out with school based and medical ward based knowledge and experience.  We don't have the school vs medical divide so much.  Programmes vary a lot here in the US and so does the output babySLP at the end.  I think it's more difficult here to get "ward ready" in a masters programme and that's why the Clinical Doctorate, if done properly will make a big difference.  You just can't cram all the knowledge required into a couple of years.
 
The CScD programme here at Pitt, the reason I've come to the US, is 2 years of masters and a further 3 years where 50% of the time the students will be in paid CFY type positions, mentored by a member of the CScD team at Pitt. Students will also, during the three years, spend time studying research methods (because you can't apply the evidence unless you can understand it), spend time in medical rotations (not being SLPs but learning all the nonSLP parts to the world of PM&R, neuroscience, progressive neurological disorders, child syndromes, whatever), leadership, law, more anatomy and physiology, case based learning, cognitive neuroscience, bioethics......
 
And at the end of five years of this, our newbie SLPs will still not be independent & ward savvy, but they'll be a good way down the line to learning the role of the medical SLP and having the confidence, skills and knowledge to contribute health care.  Phew, I may even sign up myself.
 
Paula
 
Dr Paula Leslie
CertMRCSLT
Associate Professor, Communication Science and Disorders
Program Co-ordinator Clinical Science Doctorate SLP
Specialist Advisor (Swallowing Disorders) RCSLT
University of Pittsburgh
4033 Forbes Tower
Pittsburgh, PA  15260
tel: (+1) 412- 383-6748     fax: (+1) 412-383-6555
pleslie at pitt.edu <mailto:pleslie at pitt.edu> 
http://www.shrs.pitt.edu <http://www.shrs.pitt.edu/> 
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________________________________

From: dysphagia-bounces at b9.com on behalf of Thompson, Elana
Sent: Thu 08/03/2007 10:43
To: lobsterpam at aol.com; dysphagia at b9.com
Subject: Re: [Dysphagia] I am fed up



That is very well said, Pam, and is the culmination of many things I was considering writing in my own response.  (Now, I don't need to!!)
I will say this, though....
Last fall I had a graduate student, supposedly a semester away from graduation, who came to do a 12-week internship with me in an adult acute care hospital.  She had had NO practical adult eval or therapy experience at her school and was expecting to spend just 12 weeks with me and gain independence in the skills required of an acute care SLP.  Her grade was based on the level of independence she achieved during the internship.  She failed. 
In ALL health care settings, the SLP really should be proficient in ALL areas Pam mentioned prior to independently seeing patients and grad schools should be teaching it to us just like it is taught to an RN, PA-C, or CRNP.  We are involved with patients on that level.  You cannot understand swallowing, cognition, and general recovery processes without understanding those lab values, etc.  I never really understood all of that until the past 5 years, but since then I have been trying very hard to gain proficiency in all those areas.   
SLP's might not like to hear it, but in health care settings, we are medical professionals, not just rehab professionals.  That is probably why it is alarming to some people that an SLP already in those settings would need an introductory level course.  However, if you need them, take them and I hope they are great!  

In Pam's words:  Here's to getting the knowledge base, using your inquisitive open mind, accessing information, and thickening your skin!!

Sincerely,

Elana Thompson, MS,CCC-SLP

See you at PSHA, Pam?

-----Original Message-----
From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com]On
Behalf Of lobsterpam at aol.com
Sent: Thursday, March 08, 2007 7:33 AM
To: dysphagia at b9.com
Subject: Re: [Dysphagia] I am fed up


  This isn't directed at the 'introductory course' topic specifically, but is a more global comment simply offered for consideration. My thoughts on the introductory course is that if someone needs the training, go get it. But recognize the larger less personal point that dysphagia education in our profession in general needs work. Those of us in universities know that and are we working hard to improve it. The ASHA Knowledge and Skills documents speak for themselves, and Division 13 has many excellent resources available for members.

 That said, I think it's very unhealthy for professionals - or members of a professional discussion lists - to stop questioning the practices of the profession. NO profession improves unless it is constantly examining itself. The whole concept of evidence based practice requires continual objective evaluation of the evidence supposedly supporting what we do. If list serve participants only wish to support each other with "atta boy!" comments, no one grows as a professional. Would we rather have an attorney ask some of the questions that are asked here? How do you feel when a smart and savvy family member questions what you are doing? Or when a physician won't order your services? In the litigious society in which we find ourselves, it's best we get used to people asking us the "why" questions about our field, and be prepared to state objectively and from an evidence base - not defensively - why we are doing what we are doing.

 The management of patients with dysphagia is a multidisciplinary field, and any SLP who believes he or she can do it himself/herself has a lot of reading to do and additional academic degrees to obtain. A discussion list that welcomes the contributions of other professionals only helps us to appreciate what these other professionals know. If we are intimidated by that, nothing is gained by telling these people to get out of our sandbox. Have the people who find themselves angry ever located and read the information Irene has posted? A number of years ago I argued openly on this list with Irene, and her tone was directed right at me, and of course I didn't appreciate it. Then I finally read the literature that was posted (Irene was the first one who I had ever heard of mentioning the contribution of reflux or oral secretions to pneumonia, and I'd been practicing for close to 10 years at that point.)

 Individuals have their own manner of conveying their thoughts; some people just don't sugarcoat things. The written word doesn't provide the complete pragmatic. That's a limitation of email communication and it needs to be accepted if one is going to use this medium. Sure, people could be nicer, but I remember a colleague who could be nicer, too. It's a shame if people choose not to interact because of personality differences. Wasn't it Eleanor Roosevelt who said no one can make you feel inferior without your consent? Anyway, eventually I realized that my angst wasn't really about Irene. It was easy to blame this person who was faceless and only showed up in my email inbox with abstracts that showed she had a lot of information at her fingertips that I didn't have, and who wrote things in a way that made me realize that I was missing some very basic information that I SHOULD know. There are and were choices here - to get angry and defensive, or to suck it up and learn thing!
 s. My issues were that I knew practically nothing about lab values, dietary requirements, respiratory physiology or infectious diseases, and yet here I was working with patients with these very problems. My issues were coming to terms with the fact that some of the interventions I had been doing for years had the potential to do as much harm as the underlying problem I was trying to help.

 Whenever students ask me about why practices are so inconsistent, and why they must continue to read research and understand evidence when they are finished with school, I tell them that not so many hundred years ago, doctors used to bleed people to cure them of disease, and that's what killed George Washington. Someone questioned the practice, and someone had to be the first to suggest that maybe bloodletting wasn't the best way to go.

 Working in health care requires a knowledge base, an inquisitive open mind, access to information, and a thick skin.

 Pam Smith, Ph.D.
 Bloomsburg University
 Bloomsburg, PA