What if a graduate student doing their speech-language pathology clinical placement—or audiology externship—was asked by their supervisor to perform a procedure on their own. And they are unsure about their readiness to do such a procedure flying solo.
The short answer? As a student, you aren’t yet obligated to abide by ASHA’s Code of Ethics. However, your ASHA-certified supervisor is so obliged. The answer to the questions below raises some ethical considerations a supervisor should consider.
I’m a graduate student, and my clinical placement is in a hospital.
SLP graduate student clinician: After performing the bedside clinical swallow examination twice to patients with dysphagia under my supervisor’s oversight, she has asked me to complete future assessments by myself.
Audiology graduate student clinician: After performing and interpreting one OAE (otoacoustic emissions) test on a patient with my supervisor, she has asked that in the future I handle all OAE testing and interpretation.
I really need a good rating from her at the end of the semester, but I’m not sure I’m ready to do this solo. How should I handle?
In hospitals, supervisors often shadow students 100% because of patients’ medical fragility and for hospitals to receive reimbursement for services. But you aren’t alone in asking this question. While a good relationship with your supervisor is important, raising a difficult issue doesn’t pose the same risks as performing services for which you’re not yet qualified. Doing so can put your supervisor, you, and—most importantly—your patients at risk.
Trust your gut.
Don’t perform tests for which you don’t feel properly trained or appropriately supervised. Under the Code, your supervisor may delegate to you only those clinical duties for which you are “adequately prepared and appropriately supervised.” (Principle I, Rule G).
Bottom line: Your clinical supervisor is responsible for the welfare of the clients/patients you treat.
Under the Code, the primary obligation of a practitioner is protecting the people they serve. As a student, your ASHA-certified supervisor is ultimately ethically responsible for patient welfare. Therefore, your supervisor must make sure you provide clinical services competently. They violate the Code by not being available to quickly intervene if there are concerns about the quality of care you are providing.
Your ASHA-certified clinical supervisor must also maintain other requirements.
The Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) as well as the Council for Certification in Audiology and Speech-Language Pathology (CFCC) both have supervision requirements. For example, ASHA-certified audiologists who provide clinical instruction and supervision of students in a doctoral program must provide oversight of clinical and administrative duties directly related to patient/client care across settings, life span, and scope of practice of audiology.
ASHA-certified SLPs must oversee, in person, at least 25% of a student’s total contact with each client/patient. In determining the level of supervision for a student, supervising clinicians should consider ASHA guidelines, state law requirements, and conditions of payer coverage. While the CFCC 25% supervision requirement sets the floor, a supervisor should determine the level of oversight based on their confidence in patient/client outcomes. The supervisor also should remain ready and available to intervene for a student if the need occurs.
Speak with your clinical supervisor about your concerns.
As a clinician in training, you need to learn from your supervising clinician. Their responsibility includes helping you gain confidence to perform clinical services and working with you to deliver the highest quality of care.
Your supervisor should foster a culture of open dialogue from the outset of the fellowship. If this isn’t the case, consider taking the following steps:
- Consult with your faculty adviser or liaison as soon as possible about how best to proceed in raising the topic with your supervisor.
- Discuss with your clinical supervisor—if you haven’t already—their expectations of the Code’s “properly trained and appropriately supervised” as applied to your work.
- Ask your clinical supervisor for additional practice before administering the test alone on a patient.
- Ask for additional opportunities to observe the test being given to patients by others.
As a soon-to-be licensed and certified audiologists and SLPs, you will often navigate tricky ethical waters. As a soon-to-be licensed and certified audiologists and SLPs, you will often navigate tricky ethical waters. More practice navigating these waters now equals more confidence later—both in your clinical work and understanding of ethical responsibilities to patients and clients.
Donna R. Euben, Esq., is ASHA ethics director. email@example.com
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