Tag Archives: planning clinical practicum instruction

11.20.14 Update — Supervisory Notes, “Trust the Process” Reflection

Notes on clinical supervision, ,

A couple of thoughts were brewing in my head all at about the same time right before Thanksgiving in 2013.  This was also updated in November 2014.

Event 1:  Dr. McNaughton made a comment at an AAC Faculty meeting that in the SPED department, they use a “CONE” approach — trying to be mindful of the Content of the Next Environment — to review whether or not students are prepared to move forward.  “Prepared” is something of a trigger word for me.  Students have either told me directly or provided in written feedback that they very much appreciate our discussions, my guidance, resources I share, etc.; however, that they worry that they are not prepared for the Real World, for how things actually go in the schools.  I work very hard to align what I teach them through clinical practicum experiences to what they learn in their courses, I hope to model EBP with my supervision just as I hope they will apply it in their clinical careers (and, over time, as they have opportunities to mentor or provide supervision themselves).  So I have struggled with how to reconcile the idea that some students suggest they feel more ‘principled’ than ‘prepared’ when we’re done.  At present, I’ve come to the notion in my own mind that my role is not to prepare them how to DO the work — it’s a mistake to think that’s even possible — but how to THINK THROUGH the work.  Uncertainty is part of the gig:  there will always be an unfamiliar diagnosis, or an unusual presentation of skills/needs, an unexpected confluence of personal and work events.  My goal isn’t to share with them every possible scenario, it’s to hopefully put a foundation of problem solving skills and coping strategies that will support their efforts.

Event 2:  A surprising number of second year grad students have expressed the notion, “I just want to know what you know.”  I have had a surprisingly emotional reaction to that idea — that’s simply not fair.  I didn’t know what I know now when I was where where they are — I’ve worked hard to know what I know now.  I’ve earned it.  Further, I am certain I don’t know everything:  I’m very much committed to being a learner yet myself.

So given these thoughts, I wanted to present an activity to the students I am working with to engage them in an experience.  In a general sense, my goal was oriented around the notion of “Trust the Process.”  To not get to caught up or rushed in knowing it all, to not feel like that is the goal, to not consider uncertainty and the disquiet that comes with it as indicators of failure/weakness.  In addition, since it was in front of the Thanksgiving holiday and at a stressful point of the semester (the stampede to the end), I also wanted it to be very different than the assignments they get in their courses.  The following is the email I sent.

“We are at an interesting place in the semester, and I would expect everyone is feeling a degree of tension about getting from here to the next point.

For everyone I am working with through the clinic, I would like for you to please set aside 15 minutes to BRIEFLY review the following, choose one, and email me a 1-paragraph response.  There are no right/wrong answers.  I want to repeat that:  There is no specific answer I am looking for other than authentic consideration.  Due to me by November 30th.

(1).  In 2011, Alan Kamhi established a Clinical Forum on “Balancing Certainty and Uncertainty in Clinical Practice,” and posed the question, “How certain are you that your clinical decisions and practices are the most optimal ones for your patients?” Although I found the whole forum to be excellent and thought-provoking, attached is a three-page response (also in hard copy in your box):  Finn, P. (2011).  Critical Thinking:  Knowledge and Skills for Evidence Based Practice.  Language Speech, and Hearing Services in the Schools, 42: 69-72.

((2).  This 5:22 minute clip from Between the Folds on https://www.youtube.com/watch?v=OlbneFIcXyU.  I highly recommend the entire documentary if you have access, but for now I’m especially interested in this segment.

(3).  A diagram on OODA.  (Note:  The link here includes text and discussion but I just send the diagram itself as an attachment to the email.)

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I chose these because they do speak to the value of critical review, of being systematic and engaged in learning/questioning/evaluating specifically as an SLP (the Finn article); because the origami sequence is amazing in Between the Folds and he specifically talks about the process and the tension that exists within it; and the diagram comes from a business website but actually illustrates a flowchart of how to engage EBP.  I chose these because they inspire me, and I was interested in reaching the students in different ways (clinical/research-based; artful; graphic).

The responses have been truly great — I have loved the reflections and conversations we’ve had, and this lent itself very well as a lead into a discussion on actively Engaging in Learning (Lesson Plan available in Resources).

So it’s been a wonderful and exciting learning experience for me, too.   I’ve so enjoyed their perspectives into all of this, and how different it is from the other things they do while in the graduate program or that we have done together with their clinical practicum.   Some of them haven’t gone exactly down the path of “Trust the Process” but that’s okay — there were no right or wrong answers.

End blip.

11.1.13 — Supervisory Notes, Lesson Plans for Clinical Practicum Experiences

Notes on clinical supervision

I started preparing more formal lesson plans primarily for two reasons:  (1) If I said that it was important (indeed, required!),  for the graduate student clinicians to have thought through their instruction, I felt I had to seriously reflect on what messages I conveyed if I then didn’t; and (2) If I wanted to complete the grading rubric with integrity, I needed to know for certain that they had been taught the targeted skills at some point.  Otherwise, it just felt like I was judging/critiquing them on things unfairly.  So that lead to the third point:  (3) it was a chance to model what features of a lesson plan I would be looking for from them — an opportunity to discuss the process.

When we have the first conversation and review my initial lesson plan, I do talk about how being a clinical practicum instructor doesn’t precisely map onto the kinds of teaching involved with being a clinician, so it isn’t a 1:1 example.  I also disclose that I rarely did these kinds of plans when I worked in the schools — it was partially more intuitive at that point, but also a matter of basic survival given the time I had for planning.  I did do a fair amount of thinking about teaching-learning as part of developing or preparing my materials of instruction though.  Regardless, I say to the students that the argument that the lesson plans required by our clinic are not “real world” may be true but is, in any case, irrelevant to me insofar as it serves an entirely different purpose/function which is fundamentally critical to our experience here and now.  The lesson plan (and other required documentation procedures), are a platform for the dialogue we share about the client, about SLP generally, learning approaches, research foundations, etc.  It is my window into their thought process.

With more experienced clinicians, I typically fade out the requirement of written lesson plans being submitted to me over the course of the semester (unless I have concerns).   I feel like it’s in the same vein as Shapiro’s 1985 research around contracts between supervisors and supervisees — with findings of an inverse relationship between the level of experience and completing commitments when written documentation was involved.  Two, I want to be conscientious and responsive to their stress level at that point in their academic programs; if I already have a sense of their process, and they can verbally discuss their plan, I do not want lesson plans to be “busy work.”

To again reference McCrea & Brasseur, The Supervisory Process in Speech-Language Pathology and Audiology (2003), goes into specific details about the nature of planning in Chapter 5, and highlight:  “Professional growth for all participants comes as a result of careful, systematic, fourfold planning:  for the client, for the clinician, the supervise, and the supervisor.  In other words, it is not enough to plan the clinical process, the process through which the client learns; the supervisory process, through which the supervisee and supervisor learn, must also be planned if maximum growth is to be achieved.” (p. 106).

So far, I have specific lesson plans for the Clinical Practicum Instruction around the  following topics:

– getting started (first meeting, review of what a lesson plan looks like, expectations),

– documentation (word choice, structure),

– writing goals (word choice, structure, design of instruction, prognosis),

– session structure (transition, introduction, instruction, directions, guided practice, wrap-up), and

– engaging in learning (the rationale for why it is important  and how to invest in continued learning after the University setting with conferences, web resources, text-learning, etc).

These are all available under Resources (password = “m4ter14ls”), and should be easily accessed by searching under Lesson Plans.

End blip.