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The Future of Supervision: ASHA Requirements, Best Practice and Tools for Success

´ Caitlin Fitzgerald, MS, CCC-SLPcaitlinf@pacificu.edu

´ Elise Peltier, MS, CCC-SLPelisep@uoregon.edu

´ Cassie Quinn, MS, CCC-SLP, BCS-Scquinn@pdx.edu

Collaborating in Support of Clinical Supervisors

´ INTRODUCTIONS:

´ University of Oregon

´ Elise Peltier

´ Pacific University

´ Caitlin Fitzgerald

´ Portland State University

´ Cassie Quinn

Let’s Reflect

´What are your strengths as a supervisor?´What is your biggest challenge?

´What do you hope to learn from today’s talk? Supervision RequirementsCaitlin Fitzgerald, MS, CCC-SLP

Historical Perspective on Clinical Education in CSD

´ 1978

´ Establishment of ASHA’s Committee on Supervision in Speech-Language Pathology

´1985´ Position statement delineated 13 basic tasks and 81 competencies for clinical

teaching

´2008´ New focus on importance of interpersonal elements and the need for more

research

ASHA Clinical Supervision Documents 2008

Position Statement on Clinical Supervision in SLP

´ Clinical Supervision in SLP Technical Report

´ Knowledge and Skills Needed by SLPs Providing Clinical Supervision

´ 11 core areas outlined

´ ASHA Position Statement 2008:´ “The highly complex nature of supervision makes it critically important that supervisors obtain

education in the supervisory process.”

American Speech-Language-Hearing Association. (2008). Clinical supervision in speech-language pathology [Position Statement]. Available from www.asha.org/policy.

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Ad Hoc Committee on Supervision´ December 2013 Report

Knowledge, skills and training consideration for individuals serving as supervisors: http://www.asha.org/uploadedfiles/report-ad-hoc-committee-on-supervision.pdf

´ May 2016 Report

A Plan for Developing Resources and Training Opportunities in Clinical Supervision: https://www.asha.org/uploadedFiles/AHC-on-Supervision-Training.pdf

Ad Hoc Committee on Supervision

´ Development of a systematic, well-coordinated plan to establish resources and training opportunities in clinical supervision

´ Minimum of 2 (and up to a maximum of 30) hours of professional development training in supervision required in an ASHA certification cycle in the area of supervision training.

Speech-Language Pathology Certification Standards 2020

´ Clinical supervisors and Clinical Fellowship mentors will have to have a minimum of nine months practice experience post-certification before serving as a supervisor

´ Must have two hours of professional development in the area of supervision post-certification

ASHA Supervision CE Course (free)

´ https://www.asha.org/professional- development/supervision-courses/

Council on Academic Programs in Communication Sciences & Disorders Course

(free)´ Available for ASHA and AAA CEUs

´ Graduate program faculty can provide course access to supervisors

´ Handout provided during this presentation for all attendees

´ 4 Courses available:

´ Foundations- Roles & responsibilities, Knowledge & skills, Methods

´ Relationships- Communication, Learning/Teaching styles

´ Feedback- Feedback vs evaluation, Creating receptive environment

´ Assessing Student Performance- Purpose, Methods, Quality

PSU Supervision CE Courses (free)- Each module provides 1 hour of CE in Supervision- Free to supervisorsModule #1: Understanding Roles & ExpectationsModule #2: Implementing appropriate level and style of supervisionModule #3: Communication & Interpersonal SkillsModule #4: Giving Feedback & ConferencesModule #5: Critical Thinking & Problem-solvingModule #6: Observation & Data CollectionModule #7: Supervisor & Supervisee AccountabilityModule #8: Supervising Students with DisabilitiesModule #9: Supervision across SettingsModule #10: Supervisor Case Studies

Contact Cassie Quinn @ cquinn@pdx.edu if interested.

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References´

Bray, L., Nettleton, P. Assessor or mentor? Role confusion in professional education. Nurse Education Today. Nov. 2007;27(8):848-55.

´ Corbin, J.R. The first clinical supervisory experience: implications for clinical supervision. www.socialworker.com. 1 Oct. 2009;22-25.

´ Crommelinck, M., Anseel, F. (2013). Understanding and encouraging feedback-seeking behaviour: a literature review. https://doi.org/10.1111/medu.12075

´ Dowling, S., & Witkopp, J., (1982) Students’ perceived supervisory needs. J. Comm Disorders 14, 319 -328.

´ Dudding, Carol C., McCready, Vicki, Nunez, Loretta, Procaccini, Samantha J. (2017) Clinical supervision on speech-language pathology and audiology in the United States. Development of a professional specialty, The Clinical Supervisor, 36:2, 161-181, DOI:10.1080/07325223.2017.1377663

´ Ende, J., (1983). Feedback in clinical medical education. Journal of the American Medical Association (JAMA). 1983:250(6):777-781. doi:10.1001/jama.1983.03340060055026

´ Gurley, Janet Michelle, "Supervisory Feedback in Speech-Language Pathology: Preferences and Practices." (2000). Electronic Theses and Dissertations. Paper 8. https://dc.etsu.edu/etd/8

´ Hendry, G. Communication and power in the student-supervisor relationship. Institute for Teaching and Learning, The University of Sydney.

´ Hoffman, M.A., Hill, C.E., Holmes, S.E., & Freitas, G.F., (2005). Supervisor perspective on the process and outcome of giving easy, difficult, or no feedback to supervisees. J. of Counseling Psychology 52(2) 3 – 13.

´ Stone, D., Heen, S. (2014) . Thanks for the feedback: The science and art of receiving feedback. Penguin Books., New York, NY

´ Stone, D., Patton, B., and Heen, S. (1999) Difficult conversations: How to discuss what matters most. Penguin Books. New York, NY.

´ van de Ridder, J.M.M., Stokking, K.M., McGaghhie, W.C., & ten Cate, OT.J., (2008). What is feedback in clinical education? Medical Education 43 189-197

´ Victor, Shelley (2016). Conflict Management and Supervision. Downloaded from http://sig11perspectives.pubs.asha.org

SupervisionCassie Quinn, MS, CCC-SLP, BCS-S

Process ~ Stages ~ Styles

is defined as “that interaction that takes place between the clinician and the client”

(Committee on Supervision, ASHA, 1978a – p. 479)

CLINICAL PROCESS

SUPERVISORY PROCESS´is defined as the “interaction that takes place

between the supervisor and the clinician and may be related to the behavior of the clinician or the client or to the program in which the supervisor and clinician are employed” (ASHA, 1978a, p.479)

´Ward and Webster defined this process as “an interactive process between student and supervisor in which both are working together to find the most productive ways of effecting the diagnostic or therapeutic relationship” (1965b, p. 104)

SUPERVISION

´ �Supervision� – “the act of one person watching over the work of another who is less skilled, usually in a work, professional, or educational context.” Wikipedia

´ “Supervision is a process that consists of a variety of patterns of behavior, the appropriateness of which depends upon the needs, competencies, expectations and philosophies of the supervisor and the supervisee and the specifics of the situation (task, client, setting, and other variables).”--McCrea, Elizabeth S. and Brasseur, Judith A., The Supervisory Process in Speech-Language Pathology and Audiology, Allyn & Bacon, 2003, p. 8

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ILLUSTRATIVE MODEL OF SCAFFOLDING

What students can now do on their own as a result of the scaffold.Scaffold fades or is removed

Knew Knowledge

Provided from the instructorScaffolding

That students cannot do on their ownNew Task

What the students can already doFoundational Knowledge

HOW IS IT DONE?´At first the supervisor controls the learning

situation, provides ample input, and models.´The student’s role may be quite minimal.´Over time, the supervisor gradually yields

control; guides the student to successfully complete the pieces of the task, providing support when needed.

´As the student gains skill and independence, the supervisor provides less and less support

PLOT TWIST……

´Don’t think like a supervisor….. Think like a clinician!!!

SOUND FAMILIAR?´This is a description of scaffolding (van Kleeck,

1994; Vigil & van Kleeck, 1996).´Just replace the word “student” with the word

“child/adult/client” and the word “supervisor” withthe word “clinician”

´In other words, we know how to do this!

STAGES OF SUPERVISIONEvaluation Feedback Stage

1. Evaluation Feedback StageuSupervisor dominant uNeeded when student is new or

dealing with new disorder category, new intervention or assessment

uStrategies/Behaviors:u Modeling and demonstration

from supervisoru Supervisor is dominant in

discussionsu Feedback is specificu Student self evaluatesu Marginal students will stay here

longer

STAGES OF SUPERVISIONTransitional Stage

2. Transitional StageuSupervisee has reached a level of

competence in knowledge and skill and can operate independently to some extent.

uSupervisee can analyze their clinic behavior to some extent and make some modifications on their own.

Strategies/Behaviors:uSupervisor engages supervisee in

joint problem solving and peer interaction (not assuming the lead).

uThis stage is a shared processuStudent self evaluates

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STAGES OF SUPERVISIONSelf Supervision Stage

3. Self-Supervision StageuStudent becomes more of an

independent problem solver, analyzes behavior and makes appropriate changes based on self analysis

uRelationship shifts to more of a collegial interaction rather than teacher/student

Strategies/Behaviors:uSupervisor gives more

collaborative feedbackuStudent takes on the caseloaduNot everyone will get here in a

10 week termuStudent self evaluates

STYLES OF SUPERVISION´ Direct-Active (Evaluation of Feedback Stage)

´ Directing, suggesting and modeling´ Collaborative (Transitional Stage)

´ Assist the student’s problem solving and critical thinking´ Involve the student in decision making´ Supervisor provides feedback, but also encourages input

´ Consultative (Self-Supervision Stage)´ Student seeks assistance when appropriate´ Cooperative interaction between supervisor and student´ Student can identify strengths and weaknesses and make modifications

ADAPT YOUR APPROACH´ What style do you associate most closely with?

´ Know your style and know when to adapt based on the student’s learning stage

´ Know what stage your student is at´ Adjust your approach depending on the level, experience and personality of your student

´ Communicate expectations with the supervisee

´ Informal or formal conferences

´ Balance targets for improvement with positive feedback

ASHA POSITION STATEMENTS

An effective working relationship between supervisors and supervisees is

essential to the success of student learning

American Speech-Language-Hearing Association. (2008a). Clinical Supervision in Speech-

Language Pathology[Position Statement]. Available from wwww.asha.org/policy.

American Speech-Language-Hearing Association (2008b). Knowledge and Skills Needed by

Speech-Language Pathologists Providing Clinical Supervision [Knowledge and Skills]. Available

from www.asha.org/policy.

WHAT DO WE KNOW?

Supervisory relationship depends on…

´Alignment of student-supervisor expectations´Negotiating the balance of power´Open communication

Hendry, G. Communication and power in the student-supervisor relationship. Institute for Teaching and Learning, The University of Sydney.

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COMMUNICATIONCassie Quinn, MS, CCC-SLP, BCS-S

TYPES ~ STYLES ~ DIFFERENCES

EFFECTIVE COMMUNICATION

´As communication specialists, we should know how to communicate effectively with supervisees

´“I know you believe you understood what you think I said but, I am not sure you realize that what you heard is not what I meant”

~Your Mother

COMMUNICATIONGENERATIONAL DIFFERENCES

´WRITE ME, CALL ME, TEXT ME´GENERATIONAL DIFFERENCES IN THE

WORKPLACE ARE A DIFFERENCE, NOT A DISORDER

COMMUNICATION STYLE DIFFERENCES

Analytical Driver

Amiable Expressive

What style are you? …….Let’s find out!

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- How would you communicate this message?A colleague is always ready to jump in and help, but lacks follow through. Your boss views your colleague as a “team player”, but the fact that she continues to drop the ball, which you are usually picking up, makes this difficult for you to hear.

- How would you communicate to your colleague that she needs to follow through on her commitments?

- What if this were a student?

EXERCISE

REFERENCESSupervisory Styles

Anderson, J.L. (1988). The Supervisory Process in Speech-Language Pathology and Audiology. Boston, MA: College-Hill Press/Little Brown & Co.

American Speech-Language Hearing Association. (2015). Highlights and trends: Member and affiliate counts, year-end 2015. Rockville, MD: ASHA’s Surveys and Analysis Unit.

Bartlett, S. (2001). Supervisory Action Plan. Presented in Supervision 102: Short Course conducted with Brasseur, J., McCrea, E., Newmann, W., Rassi, J., Solomon, B., & Weinrich, B. at annual convention of the American Speech-Language-Hearing Association, Washington, D.C.

Hersey, P. & Blanchard, K. (1982). Management of Organizational Behavior (4th ed.). Englewood Cliffs, NJ: Prentice-Hall.

McCrea, E.S., & Brasseur, J.A. (2003). The Supervisory Process in Speech-Language Pathology and Audiology. Boston, MA: Pearson Education, Inc.

O’Sullivan, J., Peaper-Fillyaw, R., Plante, A., & Gottwald, S. (2014). On the road to self-supervision. Perspectives on Administration and Supervision, 24 (2), 44-50.Quinn, C. (2015). Supervision and mentorship: The future of our profession [Powerpoint Slides]. Oregon Speech and Hearing Association Conference.

Solomon-Rice, P., & Robinson, N. (2015). Clinical supervision and the use of a three-tiered hierarchical approach to evaluate student clinician performance. Perspectives on Administration and Supervision, 25 (1), 31-41. Doi: 10.1044/aas25.1.31

Vigil, A., & van Kleeck, A. (1996). Clinical language teaching: Theories and principles to guide our responses when children miss our language targets. In M. Smith & J. Damico (Eds.), Childhood language disorders (pp. 64-96). New York: Thieme

REFERENCESCommunication

´ Anderson, J. L. (1981). Training of supervisors in speech-language pathology and audiology. American Speech and Hearing Association, 23, 77-82.

´Anderson, J. L. (1988). The Supervisory Process in Speech-Language Pathology and Audiology. Boston, MA: College-Hill Press/Little Brown & Co.

´Andrews, J. & Andrews, M. (n.d.). Section 1: Introduction to supportive listening. Counseling Techniques for Speech-Language Pathologists. Podcast retrieved from http://web.pdx.edu/~cgfl/Session1.html

´Andrews, J. & Andrews, M. (2000). Chapter 8: Counseling techniques. Family-based treatment in communicative disorders: a systemic approach (2nd Ed.), 77-100. DeKalb, IL: Janelle.

´Barnum, C., & Wolnianksy, N. (1989). Taking cues from body language. Management Review, 78(6), 59-60.

´Bartlett, S. (2001). Supervisory Action Plan. Presented in Supervision 102: Short Course conducted with Brasseur, J., McCrea, E., Newman, W., Rassi, J. Solomon, B., at the annual convention of the American Speech-Language-Hearing Association, Washington DC, November 16, 2001.

´Bayes, M.A. (1972). Behavioral cues of interpersonal warmth. Journal of Consulting and Clinical Psychology, 39(2), 333-339.

´Beebe, S.A. (1980). The role of nonverbal communication in education: Research and theoretical perspectives. Paper presented at 66th

annual meeting, Speech Communication Association. New York, NY, November 13-16.

´Behrens, S. J., Jablon, A. D., & Neeman, A. R. (2007). A linguistic examination of student-teacher talk: Implications for communication across dyads. Research and Teaching in Developmental Education, 23(2), 3-14.

´Behrens, S. J., & Jablon, A. D. (2008). Speaker perceptions of communicative effectiveness: Conversational analysis of student-teacher talk. Journal of College Science Teaching 37(3), 40-44.

´

´ Birdwhistell, R.L. (1952).Introduction to Kinesics: An Annotation System for Analysis of Body Motion and Gestures. Louisville, KY: University of Louisville.

´Blau, P. M. (1964). Exchange and power in social life. New York: John Wiley.

´Burgoon, J.K., Schuetzler, R., & Wilson, D.W. (2014). Kinesic patterning in deceptive and truthful interactions. Journal of Nonverbal Behavior, 39(1), 1-24.

´Burke, C.S., Sims, D.E., Lazzara, E.H., & Salas, E. (2007). Trust in leadership: A multi-level review and integration. The Leadership Quarterly, 18(6), 606-632.

´Carozza, L. S. (2015). Chapter 1: Introduction. In Science of Successful Supervision and Mentorship (pp. 23-30). San Diego: Plural Publishing, Inc.

´Cropanzano, R., & Mitchell, M. S. (2003). Social exchange theory: An interdisciplinary review. Journal of Management, 31(6), p. 874-900. Retrieved from http://dx.doi.org/10.1177/0149206305279602

´de Vries, R. E., & Bakker-Pieper, A., Alting Siberg, R., Van Gameren, K., & Vlug, M. (2009). The content and dimensionality of communication styles. Communication Research, 36(2), 178-206. doi: 10.1177/0093650208330250

´de Vries, R. E., Bakker-Pieper, A., Konings, F. E., & Schouten, B. (2011). The communication styles inventory (CSI): A six-dimensional behavioral model of communication styles and its relation with personality. Communication Research, 40(4), 506-532. Doi: 10.1177/0093650211413571

´Emerson, R. M. (1976). Social exchange theory. Annual Review of Sociology, 2: 335-362.

´Gkorezis, P., Bellou, V., & Skemperis, N. (2015). Nonverbal communication and relational identification with the supervisor: Evidence from two countries. Management Decision, 53(5), 1005-1022. Retrieved from https://doi.org/10.1108/MD-11-2014-0630

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Jandt, F.E. (2001). Intercultural Communication: An Introduction, 3rd ed. Thousand Oaks, CA: Sage Publications Inc.

Karanges, E., Johnston, K., Beatson, A., & Lings, I. (2015). The influence of internal communication on employee engagement: A pilot study. Public Relations Review, 41, 129-131. Retrieved from http://dx.doi.org/10.1016/j.pubrev.2014.12.003

Keltner, D., & Kring, A.M. (1998). Emotion, social function, and psychopathology. Review of General Psychology, 2(3), 320-342.

Masterson, S. S., Lewis, K., Goldman, B. M., & Taylor, S. (2000). Integrating justice and social exchange: The differing effects of fair procedures and treatment on work relationships. The Academy of Management Journal, 43(4), 738-748. doi: 10.2307/1556364

Mehrabian, A., & Wiener, M. (1967). Decoding of inconsistent communications. Journal of Personality and Social Psychology, 6(1), 109-114.

Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2002). Crucial Conversations: Tools for Talking when Stakes are High. McGraw Hill.

Pratt, M.G. (1998). To be or not to be: Central questions in organizational identification. In Whetten, D.A. and Godfrey, P.C. (Edgs). Identity in Organizations: Building Theory Through Conversations, 171-207 Thousand Oaks, CA: Sage Publications Inc.

Sluss, D. M., Klimchak, M., & Holmes, J. J. (2008). Perceived organizational support as a mediator between relational exchange and organizational identification. Journal of Vocational Behavior, 73(3), p. 71-92. Retrieved from http://dx.doi.org/10.1023/A:1015630930326

Sundaram, D. & Webster, C. (2000). The role of nonverbal communication in service encounters. Journal of Services Marketing, 14(5), p. 378-391.

Elise Peltier, MS, CCC-SLP

Fostering Critical Thinking

Critical Thinking Defined

“Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and or evaluating information gathered by observation, experience, reflection, reasoning, or communication, as a guide to belief and action”

(Scriven, M. and Paul, R : National Council for Excellence in Critical Thinking)

Why should we think about critical thinking as a professional competency?

´ Helping professionals face evolving and expanding knowledge base

´ Increasingly complex systems´ Simply providing more knowledge would not be as

beneficial without also fostering the ability to think about why one believes what they believe

Critical Thinking as a professional competency

´ “Teaching and fostering their ability to think critically is an approach that is best-placed to give them an understanding that it is not just what they think that matters, but how they think” (Finn 2018)

Critical thinking either identified in accreditation standards or recognized as a valued outcome

´ - Accreditation Council for Pharmacy Education (2007)

´ - American Association of Colleges of Nursing (2006, 2008, 2011)

´ - Commission on Dental Accreditation (2018)

´ - APA Guidelines for Undergraduate Psychology Major (2013)

´ - Medical College Admissions Test (2018)

´ - CVTEA American Veterinary Medical Association (2018)

´ - Accreditation Standards for Nutrition & Dietetics Programs (2017)

´ - Council on Social Work Education (2015)*

´ - Association of American Medical Colleges (2008)*

´ - Accreditation Council for Occupational Therapy Education (2011)*

´ - Commission on Accreditation in Physical Therapy Education (2016)*

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Critical thinking identified in policy documents within our profession including:

´ Clinical Doctorate in Audiology (ACAE, 2005, 2016)

´ ASHA (2015). Guidelines for the Clinical Doctorate in

´ Speech-Language Pathology

´ ASHA (2015). The Role of Undergraduate Education in Communication Sciences and Disorders

´ Revised 2016 version of 2014 Standards for CCC in SLP

´ ASHA (2015). Strategic Pathway to Excellence

´ Interprofessional Education Collaborative Expert Panel (2011). Core competencies for interprofessional collaborative practice

Critical Thinking

´ SKILLS

´ Inference

´ Explanation

´ Analysis

´ Interpretation

´ Evaluation

´ Self-regulation

´ DISPOSITION

´ Inquisitive

´ Systematic

´ Judicious

´ Analytical

´ Truth Seeking

´ Open Minded

´ Confident in reasoning

How do we increase critical thinking?(Procaccini 2016)

• Inquiry- based instruction methods• Problem-based learning methods• Case-based learning methods• Concept mapping methods• Guided discovery methods

• Feedback and strategic questioning methods• Evidence-based practice methods• Metacognitive models of self-reflection

How can we teach critical thinking?(Finn 2018)

´Case-based learning´Socratic Seminar ´Reflective Practice

How can educators help develop critical thinking skills in students?

´ “ The quality of our thinking is given in the quality of our questions” Elder and Paul (2006)

´ Educators frequently acknowledge that good students ask good questions

´ Quality thinking and questions are linked

´ We can actively and and purposely promote critical thinking by deliberately incorporating structured question asking into instructional practices

Bloom’s Taxonomy

´ Supervisors can use Bloom taxonomy as a framework to consider the complexity of the questions you are asking and understand the associated assumptions

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Bloom’s Taxonomy

´ Six levels of cognitive complexity:

1. Knowledge

2. Comprehension

3. Application

4. Analysis

5. Synthesis

6. Evaluation

Bloom Taxonomy

´ Knowledge, comprehension, and application are lower level skills that build a foundation for the the higher level thinking skills of analysis, synthesis, evaluation.

´ Clearly a student cannot optimally analyze, synthesize, or evaluate a clinical session if there are gaps in knowledge, comprehension, or application in disorder content or understanding the clinical process.

• Explicit teaching about question asking ( purpose, use, barriers and levels) can significantly improve scores on measurements of inferencing and deductive reasoning. Loy, G., Gelula, M and Vontver, L (2004)

• Clinical educators may more likely facilitate critical thinking within the clinical context if feedback and questioning methods are intentionally strategic and situational to the context and level of the learner ( Barnum et al, 2009)

Asking Questions

• Questions that require factual information (e.g. what is apraxia of speech? ) may be posed initially

• As the student gains more experience, more complex questions requiring synthesis and application of knowledge are posed (e.g. tell me reason for and a reason against implementing melodic intonation therapy with apraxia of speech) (Proccaccini

Good News! As clinicians scaffolding is something we are already good at!

List adapted from CDS NeuroRounds

Critical Thinking Template The following question frames will provide you with a scaffolding to ask critical questions. Use these question frames to think critically about all of your coursework and clinical applications. Question Frames:

• Knowledge Questions: • What is (diagnosis)? How does it affect speech-language-cognition? • What is the difference between (disorder) and (related disorder)? • What is the underlying neurological process that is impaired for (client)? • Why is (client) experiencing problems with (processes)? • What are possible tx approaches for this type of client/type of disorder?

Application Questions: • How could (disorder) affect (client)’s daily life? • How should (approach) be used to help (client) achieve (goal)? • How can you adjust level of difficulty? • How will you know if your treatment approach is working? What are you

measuring? • How does this information compare with what you learned in class?

Rationale Questions:

• Please explain why you selected (approach) to treat (disorder)? • Please explain why you selected (method) to assess (disorder)? • Are there other treatment approaches / assessment methods that might be

better for this client? Why or why not? Analysis Questions:

• What are the strengths and weaknesses of (treatment approach / assessment method)?

• What are the differences between (approach) and (other approach)? • Explain why (outcome/observed behavior) occurred? • Why is (observation/data) important?

Evaluation/Synthesis Questions:

• What would happen to (outcomes/data) if . . . ? • What are some possible solutions to this problem? • What is another way to look at this problem? • Do you agree or disagree? What would you do the same or differently? Why? • How could this be applied to other clients?

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Reflective Practice´ Self-regulated process by actively engaging in prudent and conscious analysis

of one’s actions (Geller, 2002)

´ Incorporate deliberate self- evaluation to bring conscious awareness to what would otherwise be unconscious practices (Geller, 2002)

Reflective Practice

´ Rationale/Link to Critical Thinking Skills

´ - Considered to be fundamental in preparing evidence-based healthcare professionals (Aronson, 2011; Mann, Gordon, & Macleod, 2009)

´ - Touted as a vehicle for reducing diagnostic and treatment error, improving professionalism and clinical reasoning, and encouraging professional autonomy (Aronson, 2011; Graber et al., 2012)

Reflective Practice – Faculty Tasks and Roles

´ Studies have indicated that reflective practice requires mentorship and time to develop

´ Faculty should be prepared to take on the role of mentor and facilitator

´ Model your own reflective practice

Reflective Practice- Student Tasks and Roles

´ Students should be prepared to engage in a variety of tasks that foster development of reflective practice at all levels of education

´ Students should understand that reflective practice is life- long skill, not isolated to specific course or clinical rotation

References´ Teaching reflexive ability in year 3 medical students. Medical Education, 46(8), 807-814.

´ Barnum, M., Guyer, S. Levy, L., and Graham, C. ( 2009) Supervision, questioning, feedback model of clinical teaching: A practical approach. The athletic trainer’s guide to clinical teaching. Thoroughfare, N.J.: Slack Inc.

´ Bloom, B.S. (Ed). (1956)Taxonomy of educational objectives: The classification of of educational goals: Handbook I, cognitive domain. New York, Toronto: Longman’s, Green.

´ Finn, Patrick. (2018) Critical thinking as professional competency: task force update. CAPSD Annual Conference.

´ Gavett, E. and Peaper, R. (2007) Critical thinking: The role of questions. ASHA Division 10 Perspectives, 10, 3-5.

´ Geller, E. (2002) A reflective model of supervision in in speech-language pathology: Process and practice. Clinical Supervisor, 20(2) 191-200

´ Loy, G., Gelula, M., and Vontver, L. (2004). Teaching Students to question. Am J of Obstetrics and Gynecology, 191, 1752-6.

´ Procaccini, S., Carlino, N., and Joseph, D. (2016) Perspectives of the ASHA special interest groups. SIG 11, Vol 1(Part 1)

´ Reuler, E., Messick,C. ,Gavett, E., McCready,V., and Raleigh,L.(2011) EBP for Clinical Education: What do we know& what can we do? CAPCSD Annual Conference.

Caitlin Fitzgerald, MS, CCC-SLP

Feedback

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Specific information about the comparison between a trainee’s observed performance and a standard, given with the intent to improve the trainee’s performance

Types of Feedback´ Appreciation

´ Purpose is to motivate, encourage and acknowledge actions

´ Should be specific (vs “great job today”)

´ Can have positive effect on relationship and lead to more effective coaching

´ Coaching

´ Purpose is to increase knowledge and improve supervisee’s skills

´ Evaluation

´ Purpose is to provide a ranking or rating based on a set of expectations

´

Consider the purpose of feedback

´ Is goal to improve, assess or be supportive?

´ Check in to see if it was what student expected and ask what is helpful/needed?

Receiving & Inviting Feedback

´ Feedback is colored by the relationship between giver & receiver

´ Important for students and supervisors to learn to both receive and invite feedback

´ Feedback seeking behaviors have been correlated with higher performance ratings, greater creativity and enhanced learning

Crommelinck & Ansel, 2013; Stone & Heen, 2014

Framing the Issue

´ Feedback may focus on...

´ Translation of academic content into clinical practice

´ Aspects of professionalism

´ Promoting/refining skill development

´ “Attitude” towards learning

Feedback Variables´ Timing (when provided)

´ Modality (verbal, written; both)

´ Specificity & Quality

´ Balance (positive & negative)

´ Relation to defined goals

• Improvements occur when immediate verbal feedback provided

Effective Feedback is balancedDescribes positive/effective behaviors Describes ineffective/negative behaviorsDefines how to modify the ineffective behaviors

Ho & Whitehill, (2009); Kelly, (2007); Salerno, et al. (2002); Dowling & Witkopp,( 1982); Hoffman, Hill, Holmes & Freitas, (2005); Kelly, (2007); Steelman & Rutkowski, (2004)

CSD & other Health Professionals

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Effective Feedback

´ Informed

´ Objective

´ Non-evaluative

Feedback vs. Evaluation

FEEDBACK EVALUATION

•Integral part of learning process •Provides information •Not judgmental •Neutral•Uses nouns & verbs•Formative

•Presents judgment •How well or poorly a given goal is met •Comes after the fact •Uses adjectives and adverbs•Summative

More Feedback Qualities

´ Well-timed

´ Based on first hand data

´ Limited to remedial behaviors

´ Descriptive & non-evaluative

´ Deals with specific performance

As a Supervisor, you may wonder:

´ Whether to give feedback

´ What to say´ How and when to give feedback

´ How to handle supervisee’s response

Tips for Delivering Feedback

´ Focus on observed behaviors

´ Be limited to behaviors that can be modified

´ Be mindful of quantity of feedback

´ Be specific

´ Be timely, frequent and expected

´ Use non judgmental terms

´ Allow opportunity for self-assessment

•Check that communication was clear • Teach back

• Devise plan of action with supervisee • Encourage student participation in conversation regarding areas

for growth and next steps

•Document that feedback has occurred • Provide written copy of feedback to student• Maintain a copy for reference

•Provide opportunity for follow-up • Schedule a time to meet

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Resources for Delivering Feedback

• Supervisor Action Plan• Supervisory Conference Plan

“Easier feedback” is generally related to clinical issues

Perceived as less personal

“Difficult feedback” is related to the supervisory relationship, supervisee’s personality, or professional behavior”

Supervisor Perspective on Feedback

• Most barriers lie within the receiver• Past experience with negative feedback • Overly positive or negative feelings between supervisor and supervisee

• Remember, quality of relationship colors feedback • Marked age/generational differences • Feedback too gentle• Lack of time• Concern about popularity• Desire to keep relationship comfortable • Fear that feedback will have effects beyond it’s intent

Stone & Heen, 2014

Barriers to Effective Feedback

•Wanting only positive feedback

•Perceiving feedback as statement about personal worth •Perception that feedback is unfair if goal has not been stated

•Embarrassment•Feelings that feedback is irrelevant

•Lack of respect for supervisor

Supervisee Barriers

Don’t be afraid to fail. Don’t waste energy trying to cover up failure. Learn from our failures and go on to the next challenge. It’s ok to fail. If you’re not failing,

you’re not growing

-H. Stanley Judd

´I hope that in this year to come, you make mistakes. Because if you are making mistakes,

then you are making new things, trying new things, learning, living, pushing yourself, changing

yourself, changing your world. You’re doing things that you’ve never done before, and more

importantly, you’re doing something. Don’t freeze, don’t stop, don’t worry that it isn’t perfect.

Whatever it is you’re scared of doing, do it. Make your mistakes, next year and forever.

´-Neil Gaiman

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• Bray, L., Nettleton, P. Assessor or mentor? Role confusionin professional education. Nurse Education Today. Nov. 2007;27(8):848-55.

• Corbin, J.R. The first clinical supervisory experience: implications for clinical supervision. www.socialworker.com. 1 Oct. 2009;22-25.

• Crommelinck, M., Anseel, F. (2013). Understanding and encouraging feedback-seeking behaviour: a literature review. https://doi.org/10.1111/medu.12075

• Dowling, S., & Witkopp, J., (1982) Students’ perceived supervisory needs. J. Comm Disorders 14, 319 -328.

• Dudding, Carol C., McCready, Vicki, Nunez, Loretta, Procaccini, Samantha J. (2017) Clinical supervision on speech-language pathology and audiology in the United States. Development of a professional specialty, The Clinical Supervisor, 36:2, 161-181, DOI:10.1080/07325223.2017.1377663

• Ende, J., (1983). Feedback in clinical medical education. Journal of the American Medical Association (JAMA). 1983:250(6):777-781. doi:10.1001/jama.1983.03340060055026

Resources • Gurley, Janet Michelle, "Supervisory Feedback in Speech-Language Pathology: Preferences and Practices." (2000). Electronic Theses and Dissertations. Paper 8. https://dc.etsu.edu/etd/8

• Hendry, G. Communication and power in the student-supervisor relationship. Institute for Teaching and Learning, The University of Sydney.

• Hoffman, M.A., Hill, C.E., Holmes, S.E., & Freitas, G.F., (2005). Supervisor perspective on the process and outcome of giving easy, difficult, or no feedback to supervisees. J. of Counseling Psychology 52(2) 3 – 13.

• Stone, D., Heen, S. (2014) . Thanks for the feedback: The science and art of receiving feedback. Penguin Books., New York, NY

• Stone, D., Patton, B., and Heen, S. (1999) Difficult conversations: How to discuss what matters most. Penguin Books. New York, NY.

• van de Ridder, J.M.M., Stokking, K.M., McGaghhie, W.C., & ten Cate, OT.J., (2008). What is feedback in clinical education? Medical Education 43 189-197

• Victor, Shelley (2016). Conflict Management and Supervision. Downloaded from http://sig11perspectives.pubs.asha.org

Case Application

Bringing It All Together

CommunicationScenario

´ A: Clinical Scenario´ "Robert turned to his client's family as soon as the test was finished. He decided this

was his case and that he did not need to consult his supervisor, Ms. McGraw. 'Ms. Valdes, your husband passed the test! He is not aspirating on any of the barium we gave him. He should be free to eat anything at home, given necessary feeding precautions.'

´ Ms. McGraw was surprised by Robert's misinterpretation of the videoflouroscopystudy. She was more stunned by his quickness to respond without consulting her. How would Ms. McGraw inform the clients of Robert's mistake without putting him to shame?"

´ Source:´ Carozza, Linda S. (2015). Augmentative and Alternative Communication:

Engagement and Participation. Plural Publishing, inc.

CommunicationPrompt

´ B. Specific Question/Prompt

´ If you were Robert's supervisor, Ms. McGraw, how would you respond to this situation? Using your knowledge of effective communication strategies and your knowledge of the Communication Styles Inventory, how would you communicate with Robert?

CommunicationGuided Framework

´ First, consider what you will do in the situation. How will you use effective communication strategies to mediate the communication between Robert and the client's family? How will you provide clarification for the family but still allow collaboration in the conversation?

´ By asking questions of Robert during the session, you can provide opportunity for open communication between you and him without taking over the situation. This can provide a moment of teaching, but still allow Robert to participate as he thinks through his answers and has a chance to revise the feedback he gives the client's family. Consider asking Robert how he came to the conclusion that aspiration is not occurring and how he knows this is the case. You may also ask him to identify other steps of the swallow, giving him a chance to look more closely at areas that may be impaired. Finally, you can ask him about the process of diagnosis to help him understand why it is inappropriate to give advice without reporting the data to a physician or writing an official report. This conversation between you and Robert can remain focused on the client, rather than on Robert's mistakes, and it can allow Robert to continue participating in the situation. But ultimately, it allows you to guide him to a more appropriate action in the situation.

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´ Next, consider the conversation you'll have with Robert after the situation is over. Think about the four important aspects of effective communication: How will you begin your conversation with Robert? How will you make use of backchanneling or other strategies during the conversation? How will you facilitate effective turn taking strategies and appropriate overlap so that both Robert and you have opportunities to share and listen? Finally, how will you end the conversation with Robert?

´ It is important to allow Robert a chance to reflect back on the situation and provide feedback from his perspective. Find out what questions he has, or what areas he's feeling unsure about. Did he think he handled the situation appropriately? Did he realize his mistakes? How will he change his course of action next time? Continue to restate what he tells you, so that you can be confident you understand him. Provide open-ended questions rather than narrow ones, and allow space between interchanges for him to continue speaking if he wishes. When it's your turn to speak, you can provide feedback from your perspective and answer his questions. Finally, remember to provide guidance for the mistakes he made but also encouragement for what he did well.

´ As you anticipate these aspects of your communication with Robert, think about the strategies we discussed in the module. Consider how you will use listening and joining skills, and how you will restate or clarify what Robert is saying to ensure you understand his points. How will you provide conversational feedback that acknowledges Robert's thoughts but still asserts your expertise as a supervisor?

´ Phrases like "It sounds like you're saying…" or "I understand you think…" can be great ways to restate Robert's comments and clarify his thoughts. Using backchanneling cues like "umm hmm" can encourage him to continue his thoughts without feeling rushed.

´ Finally, consider the Communication Styles Inventory to reflect on your own communication styles. From this scenario with Robert, what do you anticipate his style to be? How might your styles clash or complement each other? How can you approach your conversation with Robert in a way that facilitates cohesion of communication styles?

´ From the situation, Robert seems to be very expressive and eager to share his opinion. He may have a tendency for verbal aggressiveness, shown by his rush to diagnose the client prematurely. Robert shows a lack of questioningness, since he did not appropriately reflect on the results or consult with the supervisor before reporting to the client's family. These are all aspects of Robert's communication style to consider. He may need some firm guidance that redirects his process and lets him improve his skills by talking them through with his supervisor. Think about questions you can ask that will force him to reflect on his actions and explain ways he can improve next time.

Critical Thinking Scenario´ An externship level graduate clinician administers a standardized assessment

to one of your clients. The graduate clinician watched you administer the same test earlier in the week, reported experience with the assessment and practiced at home. The administration of the test was well done and the student is performing strongly all around. After the client has left, you are called out of the office as the student is finishing scoring and interpreting the results of the test. When you return you read the first draft of the assessment report and decide to ask the student some critical thinking questions to clarify some questions you have about the results and recommendations they are suggesting.

You ask a synthesis level questions , “How would you create/design a new home program for this client? “ The student struggles to answer. You realize they are having some challenges with interpreting the assessment results and recommending the immediate next steps. You have jumped ahead in your questioning.

Critical Thinking Scenario Continued Critical ThinkingPrompt

´ What do you do next?

´ What are some ways to determine where the student may need support ?

´ How can you ask questions to help guide them but ultimately let them discover the answer on their own?

´ Are you accurately determining their knowledge and then scaffolding appropriately?

´ Are you asking the student about their own questions and areas of strengths and challenges?

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Critical ThinkingGuided Framework

´ Allowing the student a chance to ask questions.

´ This might help you determine about the depth of knowledge they have in a certain area.

´ Recognize that strengths in some areas (administering standardized assessment) may not always mean experience or strengths in other areas ( interpretation and/or treatment selection).

´ Start with a knowledge or application question in new circumstances and move up the complexity from there.

´ Keep the lines of communication open

FeedbackScenario

´ Judy, a second year graduate student, enters her practicum each day with great confidence. Her supervisor becomes uncomfortable with the initiative with which Judy approaches all clients and families, as she is noted to share her personal opinion with clients and jump in without warning. Further, Judy tends to strike up too much conversation with clients and families and shares much personal information. Maggie finds this all incredibly unprofessional and has given feedback, but in a subtle and gentle manner. She doesn’t want to jeopardize the relationship or make things awkward. She also thinks about how terrible she’d feel to be responsible for destroying Judy’s confidence by giving too harsh of feedback.

Feedback Prompt

´ How would you handle this situation?´ What tools/strategies for delivering feedback should Maggie employ?

´ How might you balance the desire to maintain a positive relationship and the need to deliver feedback on these sensitive personal/professionalism issues?

´ What would you say/do if this was your student?

FeedbackGuided Framework

´ Focus on observed behaviors´ Be specific´ Use non judgmental terms

• Check that communication was clear • Teach back

• Devise plan of action with supervisee (Encourage student participation in conversation regarding areas for growth and next steps)

• Document that feedback has occurred • Provide written copy of feedback to student

• Maintain a copy for reference

• Provide opportunity for follow-up

• Schedule a time to meet

Than you for attending! We look forward to working with you to shape the future

of our profession.

~ Elise, Cassie & Caitlin