Bridging the Divide Between EBP and Practice

becky blog

How well does your program integrate clinical practice and research education? It’s a question definitely worth asking. Today, clinicians are expected to use evidence-based practice in all of their clinical encounters, but does it ever seem as though research evidence is pulling clinicians in one direction while clinical experience is pulling the other way?

EBP requires you to consider current best research evidence, clinical expertise, and patient perspectives in your clinical decision-making. Clinicians who did not receive a proper balance and integration of research and clinical practice in their graduate classes may be feeling thinly stretched to meet these demands. In an ASHA survey fielded in 2011, 24 percent of respondents indicated that EBP created unrealistic demands on clinicians.  CSD programs need to provide students with the knowledge and tools to evaluate and apply research. Additionally, faculty members need to think about how well they model a fusion of research and clinical practice in their own teaching.

Some help

To help, ASHA has updated a tool, the Academic Program Self-Assessment: Quality Indicators for Integrating Research and Clinical Practice in Communication Sciences and Disorders (CSD) Programs. The Quality Indicators (QIs) were developed originally in 2007 and were updated in 2014. They can act as a tool to stimulate discussion among academic and clinical faculty members and students about the program’s strengths and needs in integrating clinical practice and research education. The QIs are divided into five sections:

1) Curriculum and Department Goals

2) Course Work

3) Faculty

4) Students

5) Clinical Practica

They are designed to be flexible in their application–some programs may choose to formally survey a broad group of faculty and students using the tool, while others may choose to use the QIs to guide discussion during a faculty meeting.

A test drive, if you will

Beginning in November of 2013, ASHA asked several academic programs to try out the updated QIs and report back on how they used the tool. Here’s what they said…

It took most responders about one hour to complete the QIs, and most programs judged the length, appropriateness, and comprehensiveness of the tool to be “good.” Most of the programs (82 percent, 9/11) had academic faculty, clinical faculty, and the program director/administrator complete the QIs individually and then discussed the results in a meeting. Alternatively, one program provided time for faculty members to complete the QIs during a faculty meeting rather than asking that the QIs be completed on their own time. A few programs (27 percent, 3/11) also included students in the process.

A handful of challenges also were reported. Some faculty members did not have time to complete the QIs, and some students and faculty were not familiar enough with certain aspects of the department to respond to all items. ASHA is currently working to address these challenges; for example, revising the QIs to include a “Don’t know” response option and providing additional online resources.

The QIs did reveal areas of need and areas of poor knowledge exchange between clinical and academic faculty for some pilot programs. Roughly half of the pilot programs used the QIs to develop department goals for further integration of research and clinical practice. Southern Connecticut State University developed and shared with us three of their goals:

  1. To provide opportunities for discussion of contemporary research and clinical topics, faculty will rotate presenting their research and related topics to faculty/staff/students each semester.
  2. The department curriculum committee (DCC) will conduct annual reviews to ensure that EBP concepts are included in syllabi in accordance with the department mission and vision.
  3. NSSLHA will host monthly meetings to discuss research topics of interest.

Jayne Brandel of Fort Hays State University stated that following completion of the QIs, “We are reviewing our curriculum at the undergraduate and graduate level. In addition, we are exploring new clinical opportunities and having clinical instructors participate in courses.”

ASHA plans to follow up with several of the participating CSD programs after 6 to8 months to gain more insight into the longer-term role of the QIs for these programs.

Whether you are a program director, faculty member, or student, the QIs are a great resource to check out to get your program thinking about and talking about the integration of research and clinical practice. It is imperative that new clinicians are adequately prepared for the changing healthcare landscape with knowledge and application of EBP as soon as they enter the workforce. Thus, Academic programs need to be focused on both providing and modeling the foundations of EBP consistently throughout CSD education. The QIs are freely available for download.

 

Rebecca Venediktov, MS, CCC-SLP, is a Clinical Research Associate for ASHA. 

 

On Becoming an Interprofessional

teamwork

According the authors of “The Interprofessional Healthcare Team: Leadership and Development,” interprofessionalism refers to the active participation of different professionals, which may include persons with professional licensure or certification in nursing, occupational therapy, physical therapy, speech-language pathology, social work, and other health-related professions who are collaborating to provide quality services to the patients they serve. Through a steadfast commitment to collaboration, interprofessional practice among healthcare professionals seeks to enhance the quality of health and medical services, which lead to improved patient outcomes. Developing synergy between through shared knowledge and decision-making promotes positive change in work settings and builds meaningful relationships with patients and their families. But, say the authors, shaping efficacious teams depends upon fundamental knowledge of the represented field, the use of evidence-based practice, interprofessional leadership, and members who are prepared to collaborate effectively in a team, which we believe can be accomplished through interprofessional education (IPE).

 
The Institute of Medicine Committee on Health Professions Education provides recommendations for developing a strong team: “health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.” Because of ongoing changes to the U.S. healthcare system, including insurance policy initiatives, technological advances, and innovative service delivery models, it is imperative for all professionals, including speech-language pathologists and audiologists, to embrace a new spirit of interprofessional collaboration and cooperation. Leading health organizations, such as the Pew Health Professions Commission, the Institutes of Medicine, and the World Health Organization, support the concept that health professionals have received adequate education to work in healthcare settings only if it includes experience participating in interdisciplinary teams to collaboratively solve complex problems.

 
Due to changes in service delivery models that have resulted in an increase of members within healthcare teams, interprofessional practice is rapidly becoming an expectation in most healthcare settings. Universities and training programs in speech-language pathology and audiology are only recently beginning to embrace models of IPE. In some universities, students from several disciplines are enrolled in the same courses, teamed for practicum experiences, participate in field-based experiences, and ultimately learn to work as effective, interprofessional teams. A unique way for IPE to be learned has recently occurred though simulation-based education in the College of Health Professions at The University of Akron.

 
Simulation-based education is an innovative process for creating authentic situations in which groups of IPE students learn to collaborate. Specifically, this technique can assist in overcoming some of the challenges that exist in healthcare: inadequate communication among professionals, focusing on specific needs rather than the whole patient, lack of knowledge of other professionals’ roles, the inability to work as an effective team member, and a lack of conflict-resolution skills. IPE conducted as a simulation activity may supplement traditional classroom strategies to enhance the performance of healthcare providers, ultimately resulting in reduction of errors in the workplace and an increase in the quality of care provided to patients. Although this strategy has been recognized by various international professional societies, including the World Health Organization and Institute of Medicine, as foundational to achieving safe, high-quality, accessible patient-centered care, not many healthcare training programs are on board.

Fortunately, as graduate students in speech-language pathology at The University of Akron, we were given the opportunity to participate in an IPE simulation activity. It included more than 90 students studying in the fields of nursing, nutrition/dietetics, social work, medicine, and pharmacy. Groups of five or six students from each discipline worked together to treat a specific, simulated patient. This particular simulation portrayed a young female combat veteran primarily diagnosed with a traumatic brain injury, with secondary diagnoses of depression, binge eating, insomnia, post-traumatic stress-syndrome, and cognitive deficits. Working as a team, our goal was to assess, diagnose and create a treatment plan for this patient to help alleviate her daily struggles, such as her inability to maintain a healthy diet, pay attention during class, and communicate effectively with loved ones. To develop an effective treatment plan, these challenges needed the knowledge and skills of each of the disciplines that participated in the simulation activity.

As the simulation began, we quickly recognized the need for strong interpersonal skills. It was a challenge figuring out when to speak, when to listen, and how to deliver opinions appropriately. Common observations of group dynamics included students promptly stating their opinions on how the patient should be treated before discussing a rationale or their role; students aggressively prioritizing needs of the patient without consultation; and many students reported they were unaware or had misconceived ideas about the roles of other professionals, especially speech-language pathologists. From these experiences, the need for this type of training was even more apparent. We learned that professional roles, especially speech-language pathologists, may be unclear to others, and we found ourselves advocating for our field and its importance in making treatment decisions. We also found that many students were very knowledgeable about their discipline but lacked good communication skills. This challenge resulted in a struggle to connect constructively with other students in other courses of study. We now recognize how vital  interpersonal skills are to delivering optimum patient-centered care.

 
From this exercise we now believe an IPE approach to teaching and training can have a tremendous impact on the preparation of speech-language pathologists and audiologists. With this training, students will enter the workforce with experience collaborating with other professionals and will understand the power of teamwork to accomplish a task. When students practice interprofessionalism and see the power in collaborating with other professionals, greater progress can be achieved in the workplace. Participating in the IPE simulation has boosted our confidence by showing us how to apply our clinical knowledge and skills in a safe but functional learning environment, but most importantly, it has given us a sense of how to work as a team to improve the life of our patient, which is the essence of patient-centered care. We have definitely taken our first critical steps toward becoming truly interprofessional!

Crystal Sirl, BA, is a graduate student in the School of Speech-Language Pathology and Audiology at The University of Akron.
Grace Bosze, BA, is a graduate student in the School of Speech-Language Pathology and Audiology at The University of Akron.

 

 

Election Year, Taxes and the HES CSD Education Survey

Tax Day

Photo by MoneyBlogNewz

This has been an election year and one could not help but hear the debate over taxes. As I listen, it occurs to me that there are some interesting parallels between taxes and the Higher Education System (HES) CSD Education Survey.

This may seem like an odd comparison but think about the following:

  • Tax time comes around the same time every year, April.  The HES CSD Education Survey opens every September (although slightly delayed this year because of enhancements including pre-population of certain data).
  • The government “collects” money. ASHA and CAPCSD “collect” data on CSD undergraduate through PhD education.
  • The government uses the money for defense, public works, schools, Medicaid, etc. ASHA and CAPCSD use the data to showcase academic programs in EDFIND, an online search engine, as well as publish national aggregate and state aggregate reports on undergraduate through PhD education in CSD. The data, in turn, is used to inform the personnel pipeline, assess potential academic capacity building, gauge student diversity plus much more!
  • Taxes are a source of debate. Differences of opinion abound. The challenge is how much tax to collect and how to use it. Well, so too, ASHA, CAPCSD, faculty and other stakeholders grapple with which questions to ask and strive to ask the lowest number of questions that will provide the greatest value and benefit for the discipline.

Emotions about taxes and the CSD Education Survey are somewhat analogous:

  • First, there is an initial sense of hesitation about the magnitude of the task. Academic programs must gather their data on applications, admissions, enrollment, graduation, first employment and more for all CSD degree programs offered at the institution. Likewise, tax payers must gather up a year’s worth of receipts and forms before sitting down in front of Turbo Tax or sending it all off to the CPA.
  • Once the initial feeling has passed, acceptance prevails.  We recognize taxes are necessary for the common good. So too, faculty recognize the need to inform the pipeline of the professions and advocate on its behalf. Getting the academic program profile in EDFIND is a plus too.
  • Once tax forms are completed and documents and checks signed, a sense of relief and triumph takes over.   For the CSD Education Survey, the final review of the data by the program director or chair and the subsequent click of the submission button also provide a feeling of accomplishment.   Edfind will showcase the program’s academic profile and related information and the academic program’s data will be part of the National Aggregate and State aggregate reports, thus contributing to greater efforts in support of the professions.

Collection mechanisms are complex and require systems that mitigate burden.  Imagine trying to collect money from millions and millions of U.S citizens and residents and organizations?  While ASHA’s and CAPCSD’s data collection endeavors are not of the same magnitude, they are, nonetheless, challenging and require the collaboration of many stakeholders.  The CSD Education Survey goes out to 300 institutions with multiple undergraduate through PhD programs in audiology, speech language pathology and speech language and hearing sciences. This translates into 700 plus degree programs for which data is compiled!  As a result, ASHA and CAPCSD are forever striving to streamline the process.  Academic programs now use a convenient and easy-to-use platform to report data  To that end, ASHA and CAPCSD employ some similar tools used by the IRS:

  • The IRS has a Website with instructions and forms; ASHA has a website with instructions and forms too.
  • Tax payers use nifty electronic platforms that allow for online submission and payment. The HES is housed on a platform that allows for online submission of data.
  • The IRS has an email and phone numbers for folks with questions.  ASHA has an HES Manager who answers questions too; simply email hes@asha.org.
  • In both cases, finishing early has its rewards.  Early refunds for the taxpayer or the satisfaction of completing the task as part of one’s civic duty.  For academic programs, completing and submitting their HES CSD Education Survey results in immediate update of their CSD program’s profile in EDFIND. The satisfaction of knowing the data is part of the larger aggregate national and state reports should not be overlooked.

Let’s face it, taxes are necessary. We all benefit from roads, schools, healthcare etc… The CSD Education Survey is also necessary and valuable. Without it, there would be no coordinated mechanism for systematically collecting CSD education data and there would be no data reports to inform the personnel pipeline.   For the past two years the CSD Education Survey completion and submission rate has been over 80%.  This leads to robust data for use by all. Additional benefits of having the national aggregate and state  data reports include their use in strategic planning, grant proposals, federal and state advocacy,  first employment trends, and  data based decisions for the professions.

The CSD Education Survey is currently open and will close December 17th.

 

Silvia Quevedo, Associate Director, Academic Affairs and Research Education at ASHA, can be reached at squevedo@asha.org.