JCPSLP Vol 15 No 2 2013

Clinical education

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 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, collaboration between universities, professional bodies and working

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

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

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JCPSLP Volume 15, Number 2 2013

Journal of Clinical Practice in Speech-Language Pathology