[Dysphagia] I am fed up

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

 I expect that the example of the graduate student who was woefully prepared for a medically based internship is repeated in many settings across the country. It is a situation we do our best to avoid. I'd be willing to bet that it's a big reason some SLPs don't want to take students. Although in our idealism we like to think that "someone did this for you, so you should be willing to do it for them," the reality is that a less-than-prepared student can be more work than benefit. They can require SO much time and energy that your own productivity suffers more than the department is able to absorb. After all, health care is a business. 
 
 Our second years (they'll graduate in May) started their second half placements this week, a week which always makes me a bit nervous, because it is their medical assignment. I hope I did my job well enough so that our SLP supervisors, whom we need and value SO much, can still do theirs. We want the experience with our students to be a benefit, not a burden. That's the goal... time always will be the best judge of how we did.
 
 And yes, Elana, I'll be at PSHA. Come to "Scary Videos" on Friday!
 
 Pam Smith
 Bloomsburg University
 Bloomsburg, PA
    
 -----Original Message-----
 From: EThompson at mountnittany.org
 To: lobsterpam at aol.com; dysphagia at b9.com
 Sent: Thu, 8 Mar 2007 10:43 AM
 Subject: RE: [Dysphagia] I am fed up
 
  That is very well said, Pam, and is the culmination of many things I was 
considering writing in my own response.  (Now, I don't need to!!)
I will say this, though....
Last fall I had a graduate student, supposedly a semester away from graduation, 
who came to do a 12-week internship with me in an adult acute care hospital.  
She had had NO practical adult eval or therapy experience at her school and was 
expecting to spend just 12 weeks with me and gain independence in the skills 
required of an acute care SLP.  Her grade was based on the level of independence 
she achieved during the internship.  She failed.  
In ALL health care settings, the SLP really should be proficient in ALL areas 
Pam mentioned prior to independently seeing patients and grad schools should be 
teaching it to us just like it is taught to an RN, PA-C, or CRNP.  We are 
involved with patients on that level.  You cannot understand swallowing, 
cognition, and general recovery processes without understanding those lab 
values, etc.  I never really understood all of that until the past 5 years, but 
since then I have been trying very hard to gain proficiency in all those areas.    

SLP's might not like to hear it, but in health care settings, we are medical 
professionals, not just rehab professionals.  That is probably why it is 
alarming to some people that an SLP already in those settings would need an 
introductory level course.  However, if you need them, take them and I hope they 
are great!   

In Pam's words:  Here's to getting the knowledge base, using your inquisitive 
open mind, accessing information, and thickening your skin!!

Sincerely,

Elana Thompson, MS,CCC-SLP

See you at PSHA, Pam?

-----Original Message-----
From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com]On
Behalf Of lobsterpam at aol.com
Sent: Thursday, March 08, 2007 7:33 AM
To: dysphagia at b9.com
Subject: Re: [Dysphagia] I am fed up


  This isn't directed at the 'introductory course' topic specifically, but is a 
more global comment simply offered for consideration. My thoughts on the 
introductory course is that if someone needs the training, go get it. But 
recognize the larger less personal point that dysphagia education in our 
profession in general needs work. Those of us in universities know that and are 
we working hard to improve it. The ASHA Knowledge and Skills documents speak for 
themselves, and Division 13 has many excellent resources available for members. 
 
 That said, I think it's very unhealthy for professionals - or members of a 
professional discussion lists - to stop questioning the practices of the 
profession. NO profession improves unless it is constantly examining itself. The 
whole concept of evidence based practice requires continual objective evaluation 
of the evidence supposedly supporting what we do. If list serve participants 
only wish to support each other with "atta boy!" comments, no one grows as a 
professional. Would we rather have an attorney ask some of the questions that 
are asked here? How do you feel when a smart and savvy family member questions 
what you are doing? Or when a physician won't order your services? In the 
litigious society in which we find ourselves, it's best we get used to people 
asking us the "why" questions about our field, and be prepared to state 
objectively and from an evidence base - not defensively - why we are doing what 
we are doing. 
 
 The management of patients with dysphagia is a multidisciplinary field, and any 
SLP who believes he or she can do it himself/herself has a lot of reading to do 
and additional academic degrees to obtain. A discussion list that welcomes the 
contributions of other professionals only helps us to appreciate what these 
other professionals know. If we are intimidated by that, nothing is gained by 
telling these people to get out of our sandbox. Have the people who find 
themselves angry ever located and read the information Irene has posted? A 
number of years ago I argued openly on this list with Irene, and her tone was 
directed right at me, and of course I didn't appreciate it. Then I finally read 
the literature that was posted (Irene was the first one who I had ever heard of 
mentioning the contribution of reflux or oral secretions to pneumonia, and I'd 
been practicing for close to 10 years at that point.) 
 
 Individuals have their own manner of conveying their thoughts; some people just 
don't sugarcoat things. The written word doesn't provide the complete pragmatic. 
That's a limitation of email communication and it needs to be accepted if one is 
going to use this medium. Sure, people could be nicer, but I remember a 
colleague who could be nicer, too. It's a shame if people choose not to interact 
because of personality differences. Wasn't it Eleanor Roosevelt who said no one 
can make you feel inferior without your consent? Anyway, eventually I realized 
that my angst wasn't really about Irene. It was easy to blame this person who 
was faceless and only showed up in my email inbox with abstracts that showed she 
had a lot of information at her fingertips that I didn't have, and who wrote 
things in a way that made me realize that I was missing some very basic 
information that I SHOULD know. There are and were choices here - to get angry 
and defensive, or to suck it up and learn thing!
 s. My issues were that I knew practically nothing about lab values, dietary 
requirements, respiratory physiology or infectious diseases, and yet here I was 
working with patients with these very problems. My issues were coming to terms 
with the fact that some of the interventions I had been doing for years had the 
potential to do as much harm as the underlying problem I was trying to help. 
 
 Whenever students ask me about why practices are so inconsistent, and why they 
must continue to read research and understand evidence when they are finished 
with school, I tell them that not so many hundred years ago, doctors used to 
bleed people to cure them of disease, and that's what killed George Washington. 
Someone questioned the practice, and someone had to be the first to suggest that 
maybe bloodletting wasn't the best way to go. 
 
 Working in health care requires a knowledge base, an inquisitive open mind, 
access to information, and a thick skin.
 
 Pam Smith, Ph.D.
 Bloomsburg University
 Bloomsburg, PA
 
    
 -----Original Message-----
 From: cohoe at uci.net
 To: vickycox at yahoo.ca; dysphagia at b9.com
 Sent: Wed, 7 Mar 2007 11:52 PM
 Subject: Re: [Dysphagia] I am fed up
 
  I vote for a kindler, gentler listserve as well.  Can we stop wit the
questioning of others and simply be supportive?  If we fear posting for the
ridicule of one member we allow her to win.  Let's ask those beginner
questions and let's advertise those courses.  This listserve is for SLP's;
let's take it back.

-----Original Message-----
From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com] On Behalf
Of Vicky Cox
Sent: Wednesday, March 07, 2007 7:42 PM
To: dysphagia at b9.com
Subject: [Dysphagia] I am fed up

Hello all,

  I am an SLP and proud to say that I am attending "beginner" workshops even
though I have been practising for a long time. I suppose I never think I am
a perfect SLP, and guess what, I may even learn something from the new
grads, who as someone put it, should already know everything form their
masters program.

  I posted a question a few years back when I was a new grad, and a
particular person posted a reply and made me look like a total idiot (the
same person who normally does this). I feel saddened to say that I have been
afraid of posting since then. But reading all of these replies, I am glad
that others can see how toxic this list serve can be.

  Its a shame really, because there are some really great SLPs who post here
(all in fact), and I am sorry I had such a bad experience in the past.

  Thanks,
  Vicky


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