Issue II Managing the Impact of Market-Driven Changes in Communication Sciences and Disorders

This session examined some of the market-driven changes occurring in the work place and how they have, will, or  should influence admission policies, curriculum design and implementation, qualifications and composition of faculty, and the type, level, and content of academic and clinical instruction.  The following represents a few of the questions raised and points considered regarding the challenges of challenges of change in our professional employment settings.

-  How can professional education programs better prepare students to work with an increasingly culturally and linguistically diverse population?

• Increase efforts to recruit and retain students and faculty of color.
• Increase funding and other support for students and faculty of color.
• Identify or create a networking system for all students and faculty, and in particular, for students and faculty of color.
• Create an atmosphere of inclusion through research, program focus, curriculum design and course content.
• Develop cultural competence and sensitivity in all students and faculty.

• Consider the appropriateness of justifying, regulating and/or restricting the number of students admitted to undergraduate and graduate programs in communication sciences and disorders.
• Examine validity and value of the Vector study and implications for graduate education.
• Challenge states and school districts where personnel shortages exist to provide monetary or credit incentives to students for promise of employment.
• Focus on need as well as demand for services increase advocacy activities at state and national levels.
• Work with state agencies to determine and maintain high salaries comparable to those in similar professions (e.g., OT and PT).
• Educate public and third party payers about the  consequences of not having services and the benefits of having them;  seek cost effectiveness and treatment outcome data as well as information on effectiveness of short-term versus long-term treatment.

• Need to adapt to the culture of the work environment.
• Need to be reflective thinkers and problem-solvers.
• Need to demonstrate excellent interpersonal (“people”) skills.
• Need to understand the supervisory process and both  accept and provide supervision.
• Need to recognize what they do not know and when to seek help.
• Need for exposure to billing, paperwork, ethics and other “business” aspects of clinical practice.
• Need for exposure to early intervention.
• Need for more course work in dysphagia, professional  issues, and ethics.
• Need for exposure to a variety of service delivery models including but not limited to the pull-out approach.
• Need to recognize the importance of teamwork and  interactions with students and professionals from other disciplines.
• Need for training in the use of the Internet and web-based instructional models.
• Need for more focus on accent reduction.

-  What are some of the challenges and opportunities created by the introduction of the SLP assistant?

• Concern regarding saturation of market.
• Concern regarding the negative impact on salaries for speech-language pathologists.
• Concern regarding the negative impact on undergraduate enrollment.

• Recognize that incentive to pursue advanced degrees is low as reimbursement for services is the same regardless of clinician’s educational background.
• Recognize the need to examine and promote job satisfaction of university faculty.
• Recognize that doctoral programs in CSD continue to emphasize research and provide little or no clinical education, while masters programs provide minimal, if any, research experience.
• Promote the scholarship of teaching and learning.
• Encourage clinic-based empirical research studies.
• Increase opportunities for master’s level clinicians to return for advanced degrees by employing flexible scheduling of classes and accepting administrative, clinical, and research projects.

Practicum Issues

• It is difficult to negotiate contracts for practicum placements in medical settings and to provide students with sufficient experiences in adult care.
• Supervision at rehabilitation and skilled nursing facilities is limited due to high turnover and part time schedules.
• Some sites require students to commit to longer blocks of time.
• Some clinics run year round and others are on academic calendars.
• In some geographic areas, it is difficult to provide  students with sufficient exposure to clients from diverse backgrounds.
• University clinics are pressured to function more like for-profit clinics.
• It may be time to revisit the need and expense of  initiating clinical practicum on the undergraduate level.
• Some practicum settings demand monetary compensation for supervisory time.

• Examine the impact of new certification standards on curricular flexibility(e.g., distance education,  Internet classes).
• Examine predictors of graduate success (e.g., undergraduate GPA, GRE, letters of recommendation, writing sample) and whether these differ for students of color.
• Examine factors (e.g., personal, academic, clinical, experiential) that may influence whether or not students make good researchers.
• Examine effectiveness of different methods of faculty evaluation(e.g., classroom observation, evaluation of peers, review of syllabi, student evaluations).
• Educate audiologists and speech-language pathologists to function in business environments.

Suggestions for future CAPCSD Programs.

• Examine different administrative models or tracks.
• Pool data regarding validity of predictors of academic performance in graduate school.
• Consider creating a journal devoted to teaching in SLP/AUD pedagogy.
• Compare and contrast the education of generalists versus specialists in CSD.
• Develop a plan to heighten awareness of the value of speech, language, and hearing evaluation and treatment.
• Explore different models of doctoral education.

This session examined outcome strategies and how CSD programs might use them.  Summative assessments were reviewed, and various formative assessment techniques were presented for audiology and speech-language pathology.  The following summarizes the discussions and questions raised about assessment strategies and their application to the new CCC-A standards and the proposed CCC-SLP standards.

General Issues Related to Assessment

• As our standards become less prescriptive, our  assessments become more prescriptive.
• The proposed standards need to be clear relative to  formative and summative assessment, including  operational definitions of each.
• We need to be clear whether we are assessing student  performance or program performance and quality.
• The proposed standards are outcome oriented and will require systems of documentation.
• Educational programs will need to allow adequate  administrative time for the development and monitoring of assessment programs.
• From the outset, Program directors will need to create a culture of assessment and involve faculty.
• Educational programs might consider completing  assessment in cycles, rather than all at once.
• Both academic and clinical faculty need to be involved  in establishing competencies and outcomes for students.
• It may be helpful to enlist support from Centers for  Teaching Excellence or similar resources available on campuses.
• Formative assessments may be more commonly used in  academic courses.
• Are there outcome measures on the outcome process?

-  What Strategies are being used by CSD programs for student and program assessment and what issues of problems are associated with these strategies?

 Exit Assessments Strategies

• Exit interviews with graduating students.
• Capstone requirement (e.g., course, portfolio, project).
• Portfolio and portfolio assessment in lieu of comprehensive exam.
• Demonstration of increased student learning, such as reflection through journals and portfolios.
• Competency-based evaluation.
• Number of undergraduates who applied to graduate school and were accepted.
• Performance in undergraduate clinic.

Comprehensive Examinations Strategies

• Various combinations of oral and written examinations.
• PRAXIS II examination.
• Clinical project.
• Thesis.

 Issues/Problems

• The PRAXIS II examination assesses content knowledge, but not clinical skills.
• There are students who pass classes, but fail the  comprehensive examination; some even pass the PRAXIS II.
• Do faculty have unrealistic expectations?
• Programs must  be able to defend the comprehensive examination process.
• Some faculty believe the comprehensive examination  assists students in integrating and applying information, particularly if the examination is case study based.

• Proprietary issues at some Universities make it unclear  whether the course evaluation is faculty or University  property?
• The raw dada may be summarized before it is shared with  anyone else.
• Faculty may use the course evaluations to set goals for  the next year.
• If a doctoral student seminar on academic and clinical  teaching and learning is available, faculty may be invited to attend.
• The course evaluation may be done at several points during the semester, using open-ended questions, to get on-going feedback during the course rather than waiting until the end of the course.

 Evaluation of Supervisors:  Issues/Problems

• Promotion processes for academic and clinical faculty differ.
• Students are hesitant to give honest feedback about supervisors, because the supervisors will know who wrote  it (confidentiality issue).
• Evaluation of off-site supervisors may meet with some resistance.
• Programs need to address the preparation and monitoring of supervisors to enhance the effectiveness of their  supervision?

 Alumni and Employer Surveys:  Issues/Problems

• There are problems with these surveys such as confidentiality, cooperation, and compliance.
• Administering and tracking this program of assessment is time-consuming, although the ASHA on-line directory may be helpful.
• Employer surveys may not provide useful feedback, since not all employers have good assessments and evaluation skills.
• Other tools, beyond mail-in surveys, include phone interviews and receptions.

-  How can programs obtain on-going feedback from students about their progress in the program?

1. Brown bag lunch meetings with students.
2. Questionnaire dedicated to attitudes and atmosphere in the program.
3. Student advisory board that gives students representation but avoids confrontation.

-  How are formative evaluations being used in  academic courses?  Is “formative assessment” different from good teaching?

 Strategies

• Examination on first day of class to determine what content needs to be addressed.
• Pre- and post-class survey of students relative to course content, learning, etc.
• Debriefing students at midterm using someone outside the program to get valid evaluation of the course.
• Competency-based examinations of content in phonetics, anatomy, and language development that students must pass before they may enroll in specific graduate courses (e.g., articulation and phonology, neuroanatomy, language disorders).

• Good teachers do continuous formative evaluation.
• It is easier to assess knowledge and comprehension than to assess higher order thinking skills.
• Evaluation must address students’ ability to synthesize  and apply knowledge to professional practice.
• Instructors may need to change teaching methods to achieve better outcomes (e.g., problem-based learning, cooperative learning groups, etc.).
• Faculty struggle to find time to cover course content and include practice-based learning, problem solving  activities, etc.
• Because students have difficulty linking information from one class to another, it might be helpful to use combined activities and/or case studies from two classes  that are being taught the same semester.
• ASHA SIDs could develop case studies and post them on the web for use by students and faculty.

-  How are formative evaluations being used in  clinical experiences?

 Strategies

• Rating scales to assess on-going clinical performance during the semester.
• Clinical/academic advising teams to assess clinical and  academic development throughout the program.
• Competency exam (oral and written) before externship placement.

• The continuum nature of the old W-PACC has been lost in many recent adaptations.
• To the extent that we average all items on rating scales and use summary numbers for grading students, we’re not really using formative evaluations in a formative manner.
• Off-campus supervisors don’t always give enough feedback; we need to teach our externship supervisors how to do formative assessments.
• It is difficult to assess areas such as writing, problem-solving, and cultural sensitivity.
• We must be able to identify exactly what a student needs to know and how to provide that knowledge or skill, so that it can be assessed.
• If we provide extra time for examinations and other academic projects for students with disabilities, perhaps we also need to provide extra time for clinical assignments.

-  How can formative evaluations be used to help weak clinicians?

• Need to develop, specify, and inform students about the essential knowledge and skills necessary to be admitted to and complete a CSD program.
• Need to provide well-documented and systematic evaluation.
• Need to discuss the progress of all students at faculty meetings.
• Need for on- and off-campus supervisors to meet to discuss clinical issues and problem students.
• Need for academic and clinical faculty to work together to identify problems early and to address them.
• Need for academic and clinical faculty, including off-campus supervisors, to be honest and to give appropriate grades regardless of how hard students have worked.
• Need to develop a clinical skills remediation plan or a clinical growth plan for students who are having problems.
• Need to address more than knowledge and skills--attitude problems, affective skills, etc.
• Need to have contingencies for students such as counseling or a pragmatic group.
• Need to divorce clinical practicum from degree requirements to allow students to pursue CSD degree  without going for ASHA certification (ESL, research).

-  What are some admission strategies that may be used to avoid admitting students who are likely to be poor clinicians?

• Explanation of academic and clinic expectations at time  of admission.
• Interviews with faculty team, clinic director, or alumni.
• Group interviews and orientation.
• Discussion of scholarly articles as a part of group interviews.
• Greater emphasis on interpersonal skills in requested letters of recommendation.
• Collection of an on-site writing sample during interviews process.
• Inclusion of written portion of GRE.
• Greater emphasis on CSD undergraduate course grades rather than overall GPA.
• Oral and written language screening after admission, but before classes start to be used prescriptively as a formative measure.

-  How can we link what’s being learned in the classroom with what’s being learned in the clinic?

• Use curriculum review to close the academic-clinical gap.
• Have teams of clinical and academic faculty review curriculum to identify key content areas and what students need to know.
• Engage in curriculum audits - at the start of the year, have faculty present course syllabi in faculty/supervisor meetings.
• Have lunches with clinical and academic faculty where syllabi and texts are shared.
• Require clinical supervision or clinical involvement of all faculty.
• Provide opportunities for clinical supervisors to present in classes (e.g., periodic case  review presentations).
• Use clinical terms--clinical supervisors and academic faculty working together in clinic.
• Bring in professionals from the community to present case studies.
• Orient students to program outcome goals.
• Use problem-based learning in classes.Link academic courses with specific clinics-course  assignments involve clinic clients. Have a professional growth plan for students each  semester to integrate clinic and  classroom;  plan to address student strengths, needs, and growth.

• Explore the status of clinical supervisors as primary agents of change in clinical education.
• Examine the evaluation and promotion process for clinical supervisors relative to job security and continued appointment status.
• Explore strategies to promote the improvement of classroom instruction.
• Explore techniques to enhance effective clinical supervision.
• Explore the facilitation of long-term assessment and provide access to assessment materials from various programs.