Supervision of Clinical Fellows: A Mentoring Process

Introduction and Overview:

In today's workplace environments, responsibility for supervising others is increasingly becoming a part of our job responsibilities. These responsibilities may involve oversight of individuals with varying levels of expertise. Distinguishing who the individual(s) are is very important in determining how we approach supervision.

For example, after completing the required academic coursework, clinical practicum experiences, and after receiving a graduate degree, individuals enter the profession as "clinical fellows." An experienced professional is assigned to the clinical fellow to facilitate continued growth and integration of knowledge, skills and tasks of clinical practice in speech-language pathology. Although ongoing evaluation of skills and knowledge are components of the fellowship experience, so too, is the establishment of a "mentoring relationship."

Before beginning a clinical fellowship, the clinical fellow and the supervisor should review and determine the American Speech Language Hearing Association (ASHA) requirements, as well as their state licensing requirements. However, it is important to note that some states use different designations to describe the fellowship experience. In California, the experience is referred to as the "Required Professional Experience" (RPE). Upon approval of an application for licensure filed by a qualified individual, the licensing board may issue an RPE temporary license for a period to be determined by the board. Other states require the individual to register with the licensing agency and obtain a provisional or temporary license prior to embarking on the fellowship experience. Some states may also require filing a fellowship plan. Therefore, because documentation and licensure requirements may vary with respect to ASHA's requirements, the fellowship candidate and the supervisor should review and plan accordingly. Address and telephone numbers of state regulatory agencies are available on the ASHA web site www.asha.org.

The supervisor and the clinical fellow must also be very familiar with the Membership and Certification Handbook published by ASHA. This Handbook lists supervisory requirements and functions, and provides an evaluation tool that must be used to determine whether the clinical fellow can satisfactorily perform the skills necessary for independent practice. Supervisors also have ethical obligations to the clinical fellow. Thus, it is important to be familiar with the Clinical Fellowship Supervisor's Responsibilities (ASHA Supplement, 24, 36-38), an "Issues in Ethics" document, along with the ASHA Code of Ethics. As these documents are updated on occasion, it is important to review the information on the ASHA website, to be certain the most recent rules are being followed.

Once national (ASHA) and state requirements are clearly understood, it is time to consider the process of supervision. In the 1980s, Jean Anderson published the first book in our profession which addressed supervision. She noted in the preface of this book (Anderson, 1988) that the study of the supervisory process had largely been ignored. In her book, Dr. Anderson offered a framework she called the "continuum of supervision," and suggested the continuum, along with the accompanying material in her book, be used to encourage members of the professions to view the supervisory process as an important and appropriate area for self-study. Having become an "overnight supervisor" in 1978, only three short years after completing my graduate program, I read Dr. Anderson's book from cover to cover. The book provided answers to a multitude of questions I had about my responsibilities as a supervisor, and clarified how important this process is to the training of future professionals. The same excellent book also provided for me, what was to become my professional focus. I have spent the majority of the last twenty years engaged in the practice of supervision to help train future professionals. For the last ten years I have given many workshops to facilitate the development of supervisory skills in others, while (hopefully) helping them become better supervisors.

In the first position statement on supervision (ASHA, 1978), it was acknowledged that we had little or no knowledge of critical factors in supervision methodology. Since that time, the combined efforts of many people have contributed to our knowledge of supervision methodology. For example, Anderson (1988), Brasseur and McCrea (2003) and Dowling, (2001) have made significant contributions to our knowledge in this area. As a consumer of this literature, I have adapted some of their ideas and developed a methodology which I believe is the foundation upon which one can build an effective supervisory environment. Some of my methodology is based on Dr.Anderson's earlier "basic components of supervision," and for those familiar with her work the similarities will be apparent.

Therefore, the following framework and its five components have been developed to ensure that the supervisee (the clinical fellow) will be able to participate meaningfully in the supervisory process. Importantly, the framework also ensures that the supervisor and supervisee effectively communicate throughout the entire fellowship experience. Each of the five components consists of activities which consider the possible roles of the participants, the importance of knowing and understanding each other's expectations and the importance of encouraging self-knowledge and self-evaluation.

The Five Components:

I. Setting the Stage.

Think of this stage as the assessment stage of supervision. In our clinical work, we would not think of planning treatment without thorough assessment. The same should be true of our work as supervisors. At the beginning of the supervisory experience we need to obtain information from the supervisee about prior clinical and supervisory experiences. This will provide information as to the supervisee's experience with certain populations, and help to determine how much clinical instruction is needed Anderson (1988) suggested a way to gather this information and what follows is an adaptation of that outline.

Clinical Information

1. General clinical experience


2. Academic background


3. Specific clinical experience with particular types of clients.


4. Clinical Fellow's perception of his or her own strengths and weaknesses


5. Anxieties about working with clients who have _(fill in name of disorder)_____

Supervisee Information
 

1. Type(s) of supervisory interaction experienced previously


2. Perception of self in terms of dependence/independence in general and with clients


3. Prior experience with data collection and analysis of client behavior


4. Experience with data collection and analysis of own clinical behavior


5. Perceptions of responsibility for bringing data and questions to the supervisory conference.


6. Perceptions of assisting in problem solving, and decision making


7. Expectations for learning or modification of clinical skills from the current situation.


8. Perception of need for feedback (amount and type)

In this component it is most important for the participants to be aware of the role perceptions they have for themselves and each other. Each participant will bring expectations to the supervisory experience and it is important for each party to be aware of what these expectations are. Roles and expectations need to be clearly defined by the supervisor, giving the supervisee an opportunity to share his or her perceptions and seek clarification if necessary.

During this first component, expectations, goals, needs, re-evaluation and analysis throughout the fellowship experience, are defined, discussed and clarified. The Clinical Fellowship Skills Inventory (see component 5, below) should be reviewed. If there are discrepancies between the supervisee's expectations and the supervisor's actual behavior, the performance and satisfaction which the supervisee derives from the process may be negatively affected (Anderson, 1988). In other words, without clarification of roles, expectations and needs, the supervisory experience may be characterized by confusion, lack of direction, frustration, and stress. Ideally, there should be a defined process for identifying and addressing discrepancies throughout the supervisory process.

II. Training.

This component may also be referred to as the "teaching" component. The supervisor needs to analyze the needs of the program and the clients served, as well as the knowledge and skills of the supervisee. Supervisors will encounter experienced and less experienced clinical fellows, therefore, the amount of training required will vary from one fellow to another. Supervisors need to determine how much demonstration (or modeling) is necessary, how much practice is needed and the best protocol to provide feedback. During this component, the supervisor often takes the lead, primarily due to the supervisor's role as the person responsible for clinical instruction and client management. Nonetheless, clinical fellows should be allowed to state their own needs in relation to how much instruction is needed.

Supervisors often make assumptions based on preconceived attitudes toward people (i.e., fellows) and their perceived worth. Instead, it is important for the supervisor to believe in the individual's ability to think and learn, and to recognize when these abilities are present. Johann Von Goethe once wrote, "Since we have gifts that differ according to the grace given to us, let each exercise them accordingly."

III. Planning.

This component involves planning for the client and planning for the supervisory process. In terms of planning for the supervisory process, I am referring to interactions that will take place between the supervisor and the supervisee. The literature indicates that often, the supervisee is not an active participant in planning for these interactions, which limits the amount of growth experienced and shown by the supervisee. Anderson (1988), and Brasseur and McCrea (2003) note that all activities for all participants should be planned. These include clinical activities, observation, data collection, supervisory conferences, self-analysis and evaluation. It is a continuous process and should occur on a regular basis. All professionals tend to agree on how important it is to plan for the client but, as supervisors, professionals often neglect the importance of planning interactions between the supervisor and the supervisee. The supervisor is responsible for "operationalizing" the planning process and involving the supervisee (i.e., fellow) at whatever level he or she is able to participate, commensurate with the supervisee's capabilities. The supervisee will be more committed to the process if he or she is given an opportunity to be involved in planning. Otherwise, it is the supervisor's program nd not the supervisees. This is particularly important for clinical fellows because the fellowship is a time to foster their sense of responsibility;helping to ensure professional growth.

IV. Managing Schedules.

Managing and coordinating schedules is an essential component of the process. For example, if there are "team" meetings and schedules, the tasks, locations and expectations need to be clearly defined in advance. In school settings, this might include class or activity schedules, and how the caseload is viewed. Some supervisors and mentors believe this will happen incidentally as the supervisee learns more about the program and/or the clinical setting. However, it is much better to be very clear about the schedule for each facility and, if possible, to provide the clinical fellow with a written schedule to avoid misunderstandings. Electronic time management tools such as "Outlook" and the use of personal computers (PCs) and personal digital assistants (PDAs) and other Internet-based tools and services (if available) are particularly useful in managing and amending busy and variable schedules.

V. Evaluation.
 

A. Formal Evaluation - During supervisory experiences, one of the supervisor's roles is to be accountable for evaluating the performance of the supervisee with regard to clinician effectiveness and ongoing development. The clinical fellowship experience is no exception. In all supervisory experiences, it is important for the supervisor to establish and evaluate performance standards. The Clinical Fellowship Skills Inventory (CFSI-SLP) is provided in the Membership and Certification Handbook of the American Speech-Language Hearing Association. Supervisees should be aware of the criteria that will be used to evaluate them, and supervisors should meet with their fellows early in the fellowship process (see component 1, above) to review the competencies outlined in the CFSI.

B. Informal Evaluations- The supervisee and the supervisor should consider and facilitate periodic "informal" observations and opportunities to provide feedback to the clinical fellow. There should be agreement regarding the frequency with which these will occur (e.g. weekly, monthly), and how the behaviors observed will be documented. It is also important to think about the purpose of each observation. The supervisor and the supervisee should determine if the purpose of the informal evaluation is to:

1. to collect data for teaching purposes,


2. to monitor to assure quality services,


3. to collect baseline data to determine future intervention goals, or


4. to collect data regarding behaviors for formal evaluation purposes.

The supervisor should also consider sharing the format and techniques that will be used for observation For example, will evaluative statements be included? Will a rating scale with specifically defined supervisee behaviors outlined be used? Will verbatim or selective recordings be made? When planning observations, it is very important to involve the clinical fellow in the decision making process.

As a follow-up to these informal observations, there should be an opportunity for analysis of the data gathered. This is a chance to distill the raw data so it becomes coherent, manageable and useful. This process of analysis may be one of the most important steps in supervision, and yet it is often a neglected part of the process.

Supervisees need insight about what the problem(s) might be and how their behaviors impact the clinical process. They need to be able to look at what is happening, draw inferences, construct hypotheses, and determine what was effective and what was not. The objective here should be increased responsibility on the part of the supervisee for self-analysis. In this way, he or she can plan for the future, based on findings and guidance from their supervisor/mentor.

The language used by the supervisor can facilitate self-analysis on the part of the supervisee. For example, consider the supervisee who expresses frustration in not being able to effectively change a client behavior. In response, the supervisor says, "I am sure I can think of some strategies that would help you." This promotes dependence on the supervisor to problem solve. However, if that same supervisor replies, "What kind of strategies have you tried?" this puts the responsibility on the supervisee for thinking through the situation and then he or she can begin the problem solving process through self-analysis:

The evaluation process is useful in facilitating the growth of the fellow as a clinician. Thus, both parties need to plan for activities that will influence the assessment process. These should include:

1. observing,


2. collecting data,


3. analyzing the data, and


4. integrating information for growth.

Summary and Discussion:

Supervisor/mentors and clinical fellows are a "team" with dual responsibilities. On the one hand they are collaborating for the best interest of the client, while on the other hand they are working together to facilitate the professional growth of both the mentor and the clinical fellow as a clinician. Not only is the mentoring process an opportunity for the mentee to further develop his/her clinical skills, it is an opportunity for the mentor to undergo professional growth from providing the guidance and instruction. In essence, the team is composed of two individuals committed to a shared purpose, to each other, and to working together to achieve common goals (Team Definition, Briggs, 1997).

However, each member's individual style must be considered when making decisions, dealing with conflict and when planning future goals. If we view this relationship as a team, it becomes important to note behaviors which exemplify successful teams.

Successful teams are characterized by the following qualities:

• Using time effectively.


• Making a commitment to skill development.


• Building morale by showing respect and recognition of one another.


• Giving one another feedback.


• Maintaining positive attitudes towards each other's ideas.


• Communicating openly.


• Learning from one another.


• Resolving conflicts effectively.


• Accepting challenges.

A closer look at these qualities assumes there is interdependence among team members. A good supervisor/mentor allows the supervisee the freedom to be him/herself. Perhaps some unknown sage has offered the best advice for supervisors who are guiding mentees: "Our job as supervisors is not to mold them;it is to unfold them. God has already given them their shape."

References:

American Speech-Language Hearing Association (1978) Committee on Supervision in Speech-Language Pathlogy and Audiology. Current status of supervision of speech-language pathology [Special Report]. Asha, 20, 478-486.

American Speech-Language Hearing Association (1985) Clincal Supervisoin in Speech-Language Pathology and Audiology. Rockville, MD: ASHA.

American Speech-Language Hearing Association (2003) Code of Ethics (revised). Asha, Supplement 23.

American Speech-Language Hearing Association (2004) Clinical Fellowship Supervisor Responsibilities. Asha Supplement, 24, 36-38.

Anderson, Jean L. (1988) The Supervisory Process in Speech-Language Pathology and Audiology. Boston, MA: Little Brown and Company

Briggs, M. H. (1997) Building Early Intervention Teams: Working together for children and families. Gaithersburg, MD: Aspen.

Cripps-Ludlum, J. (2006) A Glimpse into the CFY. Perspectives on Administration and Supervision. ASHA, Division 11, Vol. 16, No. 1, March 2006.

Dowling, S. (2001) Supervision: Strategies for Successful Outcomes and Productivity. Allyn and Bacon

McCrea, E. and Brasseur, J.A. (2003) The Supervisory Process in Speech-Language Pathology and Audiology. Allyn and Bacon

Membership and Certification Handbook of the American Speech-Language-Hearing Association. www.asha.org/about/membership-certification/handbooks/slp

Mosheim, J. (2005) Mentoring: A key factor in professional success. Advance for Speech-Language Pathologists and Audiologists. Merion Publications, Inc.