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JCPSLP
Volume 15, Number 2 2013
Journal of Clinical Practice in Speech-Language Pathology
The excellent affiliation between the professional
body and Irish universities regarding curriculum content,
standards of education and clinical competencies could
extend to further specification of opportunities for team
work and interprofessional experiences and guidelines for
SLP managers and senior clinicians to follow with regards
to the type and amount of ongoing support, guidance
and supervision required for new graduates. This level of
accord would help new graduates evolve from student to
practising clinician in a structured and supported way. The
process of becoming a clinician is ongoing with developing
skills being honed in practice (Brumfitt, Hoben, Enderby,
& Goddard, 2001; Toal-Sullivan, 2006; Wolff, et al., 2010).
It is only through a robust supervisory system that new
clinicians can be assisted in dealing with risk management
for more uncertain cases and become more adept in the
administration of the ambiguous elements of practice
(Krawczyk, 2005), thus empowering new graduates to take
a proactive role in swallowing disorders.
Conclusion
The findings of this study are particularly relevant as the
subject of dysphagia practice is integrated into current
university programs in accordance with professional body
guidelines (IASLT, 2012). The results may also help reveal
the importance of structure, support and mentoring in
practicum opportunities for students and new graduates
working with dysphagia in countries other than Ireland. In
addition, these findings could provide insight for educators,
students and clinicians alike into how best to develop
professional education programs in order to produce new
graduates who meet the standards expected by
departmental guidelines and service management in
regards to swallowing disorders across the lifespan. At the
time of interview, participants felt that new graduates
possessed unequal skills, education and clinical experience;
however, the inclusion of swallowing as part of university
curricula, with associated well-defined competencies,
should lead to a greater standardisation of ability in new
graduates in this area. As recommended by participants,
and advocated by Meredith (2010), there is a need for
further improvement in education provided to professionals
at entry level and the provision of continuing education for
clinicians already employed in the field to increase support
and enhance confidence. The SLP profession has rapidly
evolved in response to societal needs and development of
therapeutic practice in dysphagia and is likely to continue to
do so; how graduates are prepared to meet these changes
is pivotal for client satisfaction and overall professional
perception.
Acknowledgments
The authors wish to extend their gratitude to all those who
assisted in the gathering of information for this research
project, especially the clinicians who took the time to
participate in this study, sharing their opinions and
experiences. The authors are grateful to the reviewers of an
earlier draft of this paper.
References
American Speech-Language-Hearing Association (ASHA).
(2001).
Roles of speech language pathologists in
swallowing and feeding disorders. Technical report
.
A reduction on the reliance on the “rules of therapy”
is expected in the new graduate with the development
of competence, as their focus turns to the integration of
knowledge and skills (Stansfield, 2004). All participants
agreed that knowing what was expected of them led to
greater confidence levels among new graduates. Equally,
interviewees felt that when graduates became more
familiar with clinical policies and procedural guidelines, their
clinical reasoning and self-reflections improved, leading to
increased clinical effectiveness.
Interviewees felt that being comfortable with specific
clinical frameworks could enhance decision-making in
terms of understanding their duty of care, minimising risk
and meeting clinical needs. The most successful way
to maintain the integrity of such guidelines is to teach
senior clinicians, who then impart this knowledge through
networking within their own departments (Malcomess,
2005). As mentioned,
support
was seen as a key element
in the transition for new graduates from student to base-
grade clinician, particularly in the complex field of dysphagia
practice. High expectations of SLPs in the assessment and
management of swallowing disorders commonly resulted in
feelings of inadequacy, especially amongst newly-qualified
clinicians; reasons for this suggested by the participants
were lack of education, sufficient time and adequate
support as well as a deficit in policy structure. The Irish
Association of Speech & Language Therapists is clear in
its guidelines regarding clinical education for dysphagia,
underlining the need for consultation with senior team
members and onward referral when experience is limited,
ensuring protection for all concerned and guaranteeing
optimum service delivery and team support (IASLT,
2012). Interviewees were well aware that supporting a
new clinician increased clinical competence in practice;
this confidence should aid in dispelling the apprehension
surrounding dysphagia practice and allow new clinicians to
work more self-assuredly, knowing that they have adequate
support when needed (Brumfitt & Hoben, 2004).
Limitations and future directions
While five participants represent a very small sample size,
and data saturation was improbable, all participant opinions
were coherent, albeit reflecting differences between the
various clinical settings in which they worked. Participants
in this study recognised the difficulties faced by new
graduates entering the field of dysphagia across the
lifespan. It was felt that while new graduates can be
prepared to an entry-level competence in their university
programs, some skills could only be mastered with
increasing clinical practice. Similarly, all interviewees
championed the importance of intra- and interdisciplinary
team work. Team intervention is central to dysphagia
practice; it should increase the confidence of newly
qualified clinicians and ultimately reduce fear associated
with swallowing management as they can learn from more
experienced professionals. In addition, all participants
mentioned the necessity of new graduates receiving a form
of support (e.g., mentoring, meetings with managers,
observational opportunities, etc.). While these measures
were informally introduced within the departments, to date
there do not appear to be standardised support systems in
Ireland, unlike in other countries where this is more
formalised.