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Clinical education
80
JCPSLP
Volume 15, Number 2 2013
Journal of Clinical Practice in Speech-Language Pathology
Keywords
clinical
competence
SWALLOWING
disorders
dysphagia
new graduate
speech-
language
pathology
This article
has been
peer-
reviewed
Trudy Olwen
Smith (top),
Nicola Bessell
(centre), and
Ingrid Scholten
Are new graduate speech
and language therapists
ready to work with
swallowing disorders?
Trudy Olwen Smith, Nicola Bessell and Ingrid Scholten
Irish speech-language pathology (SLP)
graduates were recently required to have
dysphagia competency. Five experienced
dysphagia clinicians from a variety of settings
were interviewed using semi-structured
interviews regarding their expectations of
new graduates and the best ways to prepare
them for practice. Significant issues identified
by the clinicians included the perceived fear
associated with dysphagia management, new
graduate competency, requisite personal
qualities, taking a holistic client view,
assessment of competence, and the need for
support systems in the workplace. Continued
collaboration between universities,
professional bodies and working
environments could facilitate successful
fostering of professional confidence and
optimum client care.
S
peech-language pathologists (SLPs) are expected to
be proficient in dealing with feeding, eating, drinking
and swallowing disorders across the lifespan in
addition to having expertise in communication disorders
(Broniatowski et al., 1999). A rise in demand for dysphagia
services in all settings has resulted in higher percentages of
SLPs routinely providing services for individuals with feeding
and swallowing disorders (American Speech-Language-
Hearing Association [ASHA], 2001; Pettigrew & O’Toole,
2007; Pownall, 2004; Rossiter & Marks, 2004). University
programs in Australia, the USA, Canada, the UK and more
recently the Republic of Ireland, have therefore responded
to the education and training demands implicit in this
addition to the scope of practice by providing students with
“knowledge and skills required to effectively evaluate and
treat dysphagia across a variety of populations and practice
settings” (ASHA, 2001, p. 1). Likewise, systems and
procedures have been established to provide workplace
dysphagia programs (Hutchins & Giancarlo, 1991; Johnson,
2004; Miller & Krawczyk, 2001), ideas for quality
improvement (Halper & Cherney, 1991; Musson, 1994),
staff development programs (Arsenault & Atwood, 1991;
Davis & Copeland, 2005; Harding, Smith, Harrison, Cocks,
& Vyas, 2011; O’Loughlin & Shanley, 1998) and ways to
support students on placement (Cocks & Harding, 2011,
2012; Gasgcoine & Marks, 2001). There is some evidence
to show that where dysphagia services have a longer history,
clinicians are more confident of their skills in dysphagia
management, but where SLP education and services are
less well developed (as in Malaysia) “significantly lower
levels of knowledge, skills, and confidence” are observed
(Kamal, Ward, & Cornwell, 2012, p. 569).
Workforce shortages, fiscal restraint, complex health
care organisations, increasing patient acuity, an increasing
emphasis on knowledge and technology, and the
ever-expanding role of health care professionals have
reinforced the importance of new graduates arriving in
the workplace with the ability to move seamlessly into all
areas of SLP practice (Wolff, Pesut, & Regan, 2010). New
SLP graduates are expected to take responsibility for a
caseload, and to work in a variety of contexts, many of
which are complex and frequently changing. Therefore,
they need not only professional skills, but also the
capacity to function successfully in the workplace, to work
effectively within interprofessional teams, deal with ever-
increasing administrative and organisational aspects of the
professional role and provide a comfortable “fit” into the job
(Brumfitt & Hoben, 2004).
As noted, SLP education aims to produce graduates
who not only achieve basic competence, but who also have
the tools for lifelong learning and who can regulate practice
throughout their professional life (Stansfield, 2004). The
recent introduction of compulsory dysphagia competence
for SLP graduates in Ireland (Irish Association of Speech
and Language Therapists; IASLT, 2012) provided a unique
opportunity to investigate the nature of these “tools” and
examine what knowledge, skills and attitudes experienced
SLP clinicians expected of new graduates working in the
challenging field of dysphagia, considered to be one of the
most contentious conditions managed by SLPs (Anderson,
2005; Dawson, 1996; Parr & Dobinson, 1991).
This study considered the opinions of specialist SLPs
in the area of dysphagia regarding what they expect
from new graduates, how their practice setting facilitated
the involvement of graduate SLPs and the best ways to
prepare a new graduate for the complexities and challenges
of working in this field.
Method
Participants
Participants were required to be SLPs with more than 5
years of experience working with dysphagia or currently in a