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JCPSLP
Volume 14, Number 1 2012
Journal of Clinical Practice in Speech-Language Pathology
greater component of on-line activities to improve flexibility
in learning as well as activities to maintain competency.
Future training models may incorporate the use of
simulation as has been used by colleagues in the USA
(Benadom & Potter, 2010).
Conclusion
FEES is an instrumental tool that provides unique and
complementary visual information about swallowing
function compared to VFSS. It has the capacity to improve
patient access to an instrumental swallowing assessment,
and may also contribute to more timely and comprehensive
diagnosis and management of dysphagia. In many cases
where the underlying pathophysiology of a presenting
dysphagia remains unclear, and it is difficult to establish a
set of recommendations to maximise swallowing safety and
efficiency, it may be very useful to undertake both VFSS
and FEES in order to develop a more comprehensive
representation of swallowing. Health services with
established FEES services and those intending to introduce
FEES into clinical practice should continue to work towards
maximising patient access to this procedure by developing
and implementing cost-effective service delivery models
where SPs are competent to perform all components of the
procedure. Supporting these service delivery models with a
consistent and rigorous approach to training will assist in
developing and promoting standards of practice that
optimise the safety and effectiveness of the procedure. The
transition towards more speech pathologists undertaking
FEES independently should not be seen as a threat to an
interdisciplinary approach to the management of dysphagia.
Speech pathologists, whether they use VFSS and/or FEES
as part of their management of dysphagia, need to ensure
that their clinical decisions are based on the needs of an
individual patient, and where possible, informed by scientific
evidence.
Acknowledgements
The authors would like to acknowledge Dr Jennifer Oates,
School of Human Communication Sciences, and Ms
Rhonda Holmes, Speech Pathology, Austin Health, as
co-developers of the La Trobe University/Austin Health
FEES Competency Short Course. The Department of
Health Victoria (formerly Department of Human Services) is
also acknowledged for its support to enable the
development La Trobe University/Austin Health FEES
Competency Short Course.
References
American Speech-Language-Hearing Association. (2000).
Clinical Indicators for Instrumental Assessment of
Dysphagia
[Guidelines]. Retrieved from
http://www.asha.
org/docs/pdf/GL2000-00047.pdf
Aviv, J. E., Kaplan, S. T., Thomson, J. E., Spitzer, J.,
Diamond, B., & Close, L. G. (2000). The safety of flexible
evaluation of swallowing with sensory testing (FEESST): An
analysis of 500 consecutive evaluations.
Dysphagia
,
15
,
39–44.
Aviv, J. E., Murry, T., Zschommler, A., Cohen, M., &
Gartner, C. (2005). Flexible endoscopic evaluation of
swallowing with sensory testing: patient characteristics
and analysis of safety in 1,340 consecutive examinations.
Annals of Otology, Rhinology, and Laryngology
,
114
,
173–176.
and may provide some evidence to an employer in
procedures to verify an individual’s competency to perform
FEES. However, these courses and workshops do not
usually assess participants’ competency in performing the
procedure. Employers are therefore obliged to devise their
own means of assessing competency in FEES. This may
be difficult in situations where there are no other individuals
who are competent to perform FEES at that workplace. In
these instances, there are issues regarding
who
is suitably
qualified to conduct the assessment, and
what
do they
assess?
Better Skills Best Care (BSBC) was a Victorian project
funded by Department of Health Victoria (formerly
Department of Human Services [DHS]) that aimed to
address the issue of access, availability, and quality
of training in areas of workforce redesign and role
advancement and extension (DHS, 2007). The project
provided a framework for developing and assessing of
competency of new and extended work roles. As an area of
advanced practice, the use of FEES by SPs was identified
as a work role that could enhance patient care in the
area of dysphagia. At the time, opportunities for a training
program with a strong pedagogical basis were limited.
Department of Health Victoria commissioned La Trobe
University School of Human Communication Sciences and
Austin Health Speech Pathology Department to develop
and deliver a training program to teach and examine the
competencies required to perform FEES. A number of
Melbourne metropolitan hospitals were involved in the
project as pilot sites and funded by DHS to nominate SP
staff to participate in the FEES training course.
The pilot course funded by Department of Health
Victoria was run from June to December 2007. It was then
delivered by La Trobe University in conjunction with Austin
Health. A problem-based learning approach supported the
adult learning educational framework of the course, with
mastery learning activities (e.g., self-study and workplace
training) incorporated to ensure a solid link was made
between the learning outcomes achieved in coursework
and participants’ abilities to undertake the procedure in
their local workplaces. The coursework component of
the course amounted to approximately 30 hours, with
participants required to complete approximately 8 hours
of self-study using pre-recorded FEES images, interactive
multimedia programs, texts and journal articles, and
approximately 20 hours of local workplace training.
The La Trobe University/Austin Health short course takes
some positive steps towards training SPs to competency
in the use of FEES, with 21 SPs successfully completing
all the requirements of the course. However, the 2007 and
2008 versions of the course were unable to include training
in the
technical
competencies required to perform FEES.
The course was also limited to individuals who had access
to the relevant equipment and supervision for training.
Continued progress is required to develop professional
development opportunities with a standardised approach
to training that support a model of service delivery in which
SPs are independent in all components of the procedure,
including inserting and manipulating the endoscope. This
model of service delivery will work towards improving
patient access to instrumental assessment of swallowing
function, and will ultimately be more cost-effective than the
other models of service delivery previously discussed. The
course is currently under review, with the vision to include a