[Dysphagia] Qualifications

[lobsterpam at aol.com (lobsterpam@aol.com)]

LLORTEAU@sbgh.mb.ca wrote:

[[ I'm sure there are a
number of clinicians out there working with dysphagia who have not had 
the
benefit of Masters' level coursework in swallowing.  I did and it did 
cover many
of those areas listed within the ASHA document.  I had just as much 
education
related to dysphagia in my degree as I did in dysarthria, aphasia, etc. 
 I'm not
suggesting that no one should practice with dysphagia without a formal 
course in
their degree (many have gone to school where it was and is not 
offered).  I
would hope that those clinicians have sought out educational 
opportunities since
their Masters coursework to enable them to work with dysphagia. ]]

One can take a course, but that doesn't mean one necessarily utilizes 
the information in a way that is appropriate.  Mathers-Schmidt and 
Kurlinski found that although clinicians provided some degree of 
comparable TASKS during evaluations, they made different DECISIONS 
about hypothetical cases.  Doing a certain evaluative task doesn't mean 
that a clinician has the knowledge to make USE of the information 
clinically, in a way that integrates what is known about human 
physiology.  Martino et al. and McCullough et al. reported on clinician 
use of evaluation tasks and importance ratings, but that still doesn't 
tell how one utilized that information clinically.  What one does 
bedside with a patient must be applied to what is known about anatomy 
and physiology of the swallow, respiratory system, and digestive tract. 
  That integration of information occurs inside the clinician's head and 
is difficult to quantify.   Has the clinician read anything by Marik? 
Or Langmore et al. 1998?   Does s/he add that to his/her knowledge base 
or simply disregard it?

CEU courses are widely available, but there are NO criteria for courses 
seeking ASHA CEU approval that any content need be evidence based.  See 
the guidelines for providers at 
http://www.asha.org/about/continuing-ed/for-providers/step2.htm

The other piece of all this is that dysphagia is an interdisciplinary 
issue.  SLPs cannot manage it alone; SLP literature alone should not 
inform our practice patterns.  We can't ignore the pulmonary and 
gastroenterology literature.  We can't disregard it because we might 
not necessarily like what it says.  Just because we might not have time 
to read it doesn't mean that it isn't vital to good practice!

We are in the process of revising our curriculum so that our graduate 
students will have two courses in swallowing.  Aside from the fact that 
training in pediatric swallowing issues is woefully inadequate, it's 
unacceptable to me that ONE COURSE is supposed to prepare these 
students for 90+% of what they will do on their medical placement, and 
prepare them in a way that will allow them to actually think and 
understand the reasons behind what they are doing, and not just go 
through the motions.   The KASA that students complete is hardly 
comprehensive.  SID 13 has developed a task force to make 
recommendations on academic preparation.  I don't know that a Ph.D. in 
dysphagia is practical, but I do agree that current academic training 
can't possibly prepare competent clinicians.  Our students review the 
ASHA K&S document at midterm and quake in their shoes.   One hopes that 
we are preparing inquisitive clinicians who will continue to read the 
literature, but when Grandma has a stroke, there is no assurance that 
her SLP knows how to clinically reason through a bedside evaluation, is 
aware of the relationship between oral bacteria, reflux, host 
resistance, etc. and respiratory compromise, is aware of the known 
risks of dehydration, will not thicken her liquids solely based on a 
VFSS result, and so forth.  People who read list serves are NOT typical 
practicing SLPs.  The percentage of clinicians who actually have/take 
the time to do so are in the minority.

Off my soapbox... and shields up, Mr. Sulu.

Pam Smith