[Dysphagia] Basic Training vs. Professional Education of SLPs

[sydhoward at cox.net (Sydney Howard)]

I have been a speech-language clinician with CCCs and licensure since 
1978.  I have been in and out of the clinical field during that time 
and do not feel inferior to any other rehabilitation professional in my 
education or performance of therapy.  Assuredly I was not taught 
dysphagia techniques in my basic training.  What I was taught, as are 
most professionals in training (MDs, Lawyers, dentists), was a sound 
understanding of the basics of the field and a way of 
thinking--anatomy, neuroanatomy, development and level of functions 
associated with speech, language and hearing, and, most importantly 
sound ways of logical and scientific thinking with emphasis on 
interpreting and engaging in research!  I would imagine that both Irene 
and HAL 9600, etc. have been in the field long enough that several 
developments in our field were not covered in their basic or any 
college-level course they took.  Yet, they appear to be very 
knowledgeable of the field and believe they are capable to give advice 
to the field.

And, as any good professional (MDs, Lawyers,etc) I have kept up with 
new information and methods of addressing clinicial challenges.  That 
is the key to a professional, not some basic training in which the 
Ph.D. is a part .  Do we want only specialist in the field?  Let's hope 
that trend is not accepted or more O/Ts and other therapy professionals 
will be attempting to do our job.  Just recently in the sub-acute 
system I have noted O/Ts being trained to do dysphagia evaluations and 
training.  Please don't even suggest that their basic training 
background gives them the basis for such interventions.  A speech 
therapist, on the other hand, has the basics for learning, 
understanding and treating dysphagia without some 16-week university 
course.  The information and training is out there for any professional 
SLP to gain new theories and practices and make much better decisions 
on the merits of these and much better clinical decisions and 
interventions.

We do ourselves no service demeaning our training or ability to keep 
abreast of best practices in the field.  A Ph.D. does not give one the 
necessary skills across areas or even, necessarily, the therapeutic 
skills in one area that are being asked by these writers.  What a Ph.D. 
as basic training will do is leave us with fewer good clinicians for 
which other professionals will "take up the slack."  As O/Ts did with 
the cognitive area without a good understanding of language, they may 
well be the dysphagia clincians of the near future without  the basic 
skills in the neurology of swallowing, mechanics of oropharyngeal or 
esophageal function.  It that better?  Uhm, let me think?  NO!

As to the quality of our basic education as speech-language clinicians, 
it really does depend on the program and the quality of the students, 
doesn't it?  Was this poor education found in an ASHA certified 
program? Did it focus on deeper understandings and problem-solving?  
Or, did this program have a poor, limited cookbook curriculum?  Let's 
be honest a good program that teaches hands-on problem-solving with 
high standards to thoughtful, intelligent students can give a solid 
education at the master's level.  A Ph.D. is for people teaching 
clinicians and for preparation of more pure researchers, not for 
practitioners.  The master practitioner finds the information and 
learning opportunities to keep up with our field.  Let's not shoot 
ourselves in the foot as I believe P/Ts are on the way to doing.

Syd Howard, Ph.D., MA-CCC/SLP