Teaching CSD Students is a Public Health Issue

As CSD faculty, we spend long days teaching our students “how.” We help them take a better case history, notice a clinical detail, or more quickly meet a client’s need. As we’re doing that, though, we’re also teaching our students “who.” Who is an SLP or an audiologist? How do they act? What do they prioritize and value? We help our students learn who they are as a clinician, which is an identity they likely haven’t experienced before. Yet, we don’t often consider how we’re conveying these expectations or whether the expectations are an appropriate fit for each of our students.

Public health research considers a client’s ability to access culturally-concordant care (care from a clinician who shares their cultural background) to be one of many social determinants of health. A client’s ability to receive services from clinicians who understand their language, culture, community context, communication practices, and lived experiences can shape trust, diagnosis, treatment engagement, follow-through, and ultimately health equity. In medicine, culturally-concordant care has been linked to improved health outcomes, like reduced morbidity, increased patient decision-making in their own care, and enhanced follow-through with care plans.

In this sense, diversifying and equitably socializing the CSD workforce is not just about representation. It is part of addressing the social determinants of health that affect whether individuals and communities can access effective and responsive care. It is no secret that, in the United States, SLP and audiology are racially and culturally homogenous fields. Both fields have also been making strides towards increasing diversity, which must include diversifying our entry-level degree programs. As we do this, are we also being thoughtful about how we are enculturating our students into the programs and fields? Or are we inadvertently teaching them that who they are as a clinician must mirror the majority culture they are surrounded by? Research into the hidden curriculum of rehabilitation sciences fields (PT, OT, and SLP) indicates that it may be the latter (Wolford et al., 2025).  

Addressing Programmatic Cultural Expectations

So – what do we do? A critical part of this work is recognizing that students are learning more than course content and clinical skills. They are also learning the often-unspoken norms, values, expectations, and power structures of our professions through the hidden curriculum. We socialize students every time we define professionalism, provide feedback, open doors to mentorship, explain unwritten expectations, or model how to respond to inequity. If we do this work passively, the hidden curriculum remains intact. If we do it intentionally, we can build professions that are more inclusive, more accountable, and better prepared to advance communication and hearing health equity.

This requires us to make the hidden curriculum visible. We can explain the “unwritten rules” of graduate education and clinical training, including how to seek mentorship, prepare for supervision, respond to feedback, access leadership opportunities, and navigate professional networks. We can talk directly about professionalism and ask whether our expectations unintentionally privilege white, middle-class, neurotypical, monolingual, or able-bodied norms. We can normalize help-seeking, make clinical reasoning transparent, and name bias, racism, ableism, linguistic discrimination, and structural inequities as central issues in clinical education rather than peripheral topics.

For students from minoritized backgrounds, these implicit messages can deeply influence their sense of belonging, professional identity, and persistence in the field. Socializing minoritized students into CSD should not mean asking them to assimilate or leave parts of themselves behind. Rather, it should mean explicitly valuing the perspectives, languages, lived experiences, cultural knowledge, and community commitments they bring to clinical practice, research, and advocacy.

Reference Wolford, L. L., Lugo-Neris, M. J., Watkins Liu, C., Nieves, L. E., Rodriguez, C. L., Patel, S. S., Lee, S. Y., & Naidoo, K. (2025). Uncovering the Hidden Curriculum in Health Professions Education. Education Sciences, 15(7), 791. https://doi.org/10.3390/educsci15070791

Laura Wolford, PhD, MS CCC-SLP

CAPCSD DEIB Committee Member