The Pulse

Clinical Competence

Posted by Ed M. Bice, M.Ed., CCC-SLP on Jul 23, 2019 1:31:08 PM

As speech language pathologists, we are all familiar with the word “competence.” After a good deal of time invested in educational pursuits followed by a nine-month period of supervision, we are awarded our Certificate of Clinical Competence (CCC) from the American Speech Language and Hearing Association (ASHA). The reality is, when I received my CCC, I could hardly consider myself competent in any area of practice.

Competence can be an esoteric concept. In 2002, Defining and Assessing Professional Competence was published in the Journal of American Medical Association.¹ The content suggests competence is comprised of many skills and attributes including core knowledge, abstract problem solving, utilizing resources (e.g. published evidence), incorporating scientific judgement, critical curiosity, recognition of and response to cognitive emotional biases, and willingness to acknowledge and correct errors. The article is quite extensive and discussing it in detail is beyond the scope of this commentary. It is an open access article so easily accessible and a recommended read.

In recent years, the skills and knowledge of speech language pathologists to evaluate and treat swallowing disorders have been examined. Several studies have questioned if the profession possesses necessary core knowledge and encouraged a systematic evidence-based approach.1-6 To assist in the evaluation of competency, ASHA has recently published a document to guide individuals and organizations in clinical swallow assessment and dysphagia treatments.7 The 11-page document covers topics from basic anatomy and physiology to clinical assessment, instrumental assessment and therapy. A recommended first step is to download the document and perform a self-assessment. Such a task would provide a time of reflection of areas of strength and weakness and allow the development of a plan that would fill in identified gaps.

1. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA, 287(2):226-235, 2002
2. Carnaby G D, Harenberg L. What is “usual care” in dysphagia rehabilitation: a survey of USA dysphagia practice patterns. Dysphagia. 28(4):567-574, 2013
3. Lee J W, Randall DR, Evangelista LM, Kuhn MA, Belafsky PC. Subjective Assessment of Videofluoroscopic Swallow Studies. Otolaryngol Head Neck Surg. 156(5):901-905, 2017
4. McCurtin A, Healy C. Why do clinicians choose the therapies and techniques they do? Exploring clinical decision-making via treatment selections in dysphagia practice. Int J Speech Lang Pathol. 19(1):69-76, 2017
5. Plowman EK, Humbert IA. Elucidating inconsistencies in dysphagia diagnostics: Redefining normal. Int J Speech Lang Pathol. 20(3):310-317, 2018
6. Vose AK, Kesneck S, Sunday K, Plowman E, Humbert I. A Survey of Clinician Decision Making When Identifying Swallowing Impairments and Determining Treatment. J Speech Lang Hear Res. 61(11):2735-2756, 2018
7. American Board of Swallowing and Swallowing Disorders. Dysphagia Competency Verification Tool (DCVT). ASHA. Accessed 7/10/2019

Topics: Dysphagia