Translation of content to a practice that specializes in human connection is simultaneously our most powerful clinical training endeavor and our biggest challenge. The content-based orientation in our clinical coursework, while crucial, is insufficient for acquiring the practices of the profession. In clinical training, the clinical mentor takes a student through an experience that will shape and affect any subsequent clinical experiences that the student might have. Despite the power of this teacher-student relationship, the ways in which we teach and learn in the field of speech-language pathology have been little studied, even while often being passionately discussed.
A search of the literature yielded a total of 19 journal articles on clinical supervision in the field of speech-language pathology since 1982. In contrast, a total of 316 journal articles were found on the topic of clinical supervision and teaching in fields such as social work, education, clinical psychology, and counseling. A search of the Web site of the American Speech-Language-Hearing Association (ASHA) for the years 2004-2008 suggested that the topic is certainly under consideration in a variety of ASHA publications. Articles on supervision appeared four times in the ASHA Leader, and 10 times in Perspectives on Administration and Supervision (the newsletter of the same named ASHA Special Interest Division). Unfortunately, the impact of these articles is limited by restricted dissemination. The ASHA Leader is not a peer-reviewed journal. The division newsletter is peer reviewed, but circulation is restricted to the members of the Special Interest Division. Most recently, a 2005 issue of Advances in Speech-Language Pathology brings an international perspective to the need for evidence-based practices in supervision.
In this issue, our goal is to uncover, describe, and analyze the ways in which we transmit our clinical practices and how students come to know and understand the clinical enterprise. The articles present a framework for a research agenda, and many of them report some pilot data or qualitative data on supervision practices, raising questions that should be further addressed through empirical studies. How can the methods that guide teaching practices in clinical supervision be made explicit? Can we look to our field as a source for originating teaching and learning practices that resonate both clinically and academically? This set of articles we believe is a starting point to discuss some of these issues.
The series begins with Goldstein introducing the notion of development of scientific thinking in student clinicians, a thread that continues through all the articles. Gillam and Gillam describe ways to teach students to learn to use evidence-based practices in the clinical setting. They provide vignettes of the supervisor and the student engaged in discourse about evidence that illustrate processes of thinking which students undergo, as well as ways to scaffold those processes in order to consider and integrate evidence-based practice into clinical training. Leahy and Walsh then focus on discourse between the student and the client as a teaching tool. It is through vignettes of students and clients interacting that students gain a deeper understanding of how they interact with their clients. Students acquire the skills of discourse analysis through learning to empower their clients' participation in discourse.
Pena and Kiran propose a scripted approach for teaching novice clinicians new clinical skills. They argue that novice clinicians may have difficulty generating clinical plans not because they do not have the knowledge to do so, but because they do not have a mental script for how to translate their theoretical knowledge into clinical practices. A script-based approach allows students to learn evidence-based procedures while gaining multiple experiences that will lead to their ability to self-monitor their implementation and adaptation of the procedures, and also acquiring an understanding of the role of clinicians in contributing to the evidence base. Bedore, Mendez-Perez, and White apply a script-based approach for training bilingual clinicians. Bilingual clinicians face a dual challenge because they may need to learn assessment and intervention practices in a language in which they have only conversational facility. That does not necessarily translate to assessment and intervention discourse in that language. Scripts help students not only build their clinical repertoire but allow expose them to the vocabulary and cultural interactions that they will need to provide services in another language. Epstein focuses on the student struggle, which is a counterpart to the scripted approach. By focusing on an aspect of student learning we often take for granted, she contributes to an understanding of how students come to construct, understand, and finally "see" clinical data. Finally, Baharav provides a tutorial of how to incorporate video as part of clinical teaching. Not only do students learn from the video, they contribute to the archive by making clips of particular cases as well. In this way, students are involved in developing new knowledge.
The speech-language mentor plays a pivotal role in scaffolding this universally fragile point in student learning and thus needs to employ a variety of approaches to ensure a truly successful student experience. In this set of articles we see many of the specific approaches used that enhance clinical learning. We also see the struggle that both students and supervisors go through. Students tend to seek top-down direction from mentors, while mentors attempt to lead students to their own solutions to clinical questions. Central to these practices are the need for students to build frameworks of speech and language theory and to see those frameworks in action in the clinical setting. At the core of all our questions lies a connective thread, our concern that our students succeed in bringing together clinical expertise with clinical evidence when engaged in the practice of speech-language pathology.
-Laura Epstein, PhD, CCC-SLP
-Elizabeth D. Pena, PhD, CCC-SLP
Issue Editors