What’s in a name? Preceptor,

Mentor, Coach,

Supervisor in Clinical EducationSusan M Moore, Clinical ProfessorUniversity of Colorado, Boulder

Goals for SessionParticipants will increase knowledge of and discuss:

• Current ASHA & CAPSD issues and initiatives impacting clinical educators

• Design and content of current models of clinical education in personnel preparation

Participants will have an opportunity to share perspectives regarding their roles and responsibilities as clinical educators at each level of personnel preparation in SLP Perspectives

Clinical Education is a process…

• Goal: “… guide and support the learner through hands-on clinical training with the goal of developing clinical and professional knowledge and skills.” (Newman, 2005)

What’s New?

• Knowledge, Skills and Training Consideration for Individuals Serving as Supervisors ~ ASHA 2013…Ad Hoc Committee on Supervision

• White Paper: CAPCSD ~ Preparation of Clinical Educators …”to develop a white paper on evidence-based guidelines for individual's to acquire the knowledge and skills necessary for effective clinical supervision and education” 2012

Questions to guide our Discussion

• What is the emerging content addressing the increasing roles and responsibilities of clinical educators preparing the future professionals in our disciplines serving individuals with communication challenges?

• What are issues and questions that guide our review, including: • what knowledge is needed specific to each level of

personnel preparation? • What are the necessary skills and competencies of

clinical educators? • What amount and type of preparation is necessary to

achieve competence as a clinical educator • Why would you want to do this?

ASHA Ad-Hoc Committee& CAPCSD

White Paper• We used to think if you were an

effective master clinician, you could easily fulfill the role of preparing future professionals.

• We now know a wider knowledge base and refined skill set, specific to each level of personnel preparation, is necessary to fulfill a role as clinical educator.

Consider the Knowledge Base

• Supervisory Process and Clinical Education—Supervisor will possess:

• Knowledge of collaborative models of supervision

• Knowledge of adult learning styles

• Knowledge of teaching techniques (e.g., reflective practice, questioning techniques)

• Ability to define supervisor/supervisee roles and responsibilities appropriate to the setting

What specific skills are needed?

• Relationship Development—Supervisor will:

• Develop supportive and trusting relationship with supervisee

• Create an environment that fosters learning and exploration of personal strengths and needs

• Work within the relationship to transfer decision making and social power to the supervisee, as appropriate

• Educate supervisee about the supervisory process

Communication Skills

• Communication Skills—Supervisor will define/demonstrate:

• Expectations, goal setting, and requirements of the supervisor/supervisee relationship

• Expectations for interpersonal and modes of communication, including written/oral messages with supervisor, families, clients, referral sources, or colleagues

• Appropriate responses to differences in communication styles and evidence of cultural competence

Other considerations

• Recognition of and access to appropriate accommodations for supervisees with disabilities

• Engagement in difficult conversations, when appropriate, regarding supervisee performance

• Access to and use of technology, when appropriate, for remote supervision

Guiding and modeling the Way

• Establishing and Implementing Goals—Supervisor will:

• Develop goals/objectives—collaboratively with the supervisee—that allow for the supervisee’s clinical and professional growth in critical thinking, problem solving, etc.

• Set personal goals to enhance supervisory skills

• Observe sessions, collect and interpret data, and share data with the supervisee

Feedback

• Give the supervisee objective feedback designed to motivate and improve performance…Side point on type and method…

• Understand the levels and use of questions to facilitate clinical learning

• Adjust supervisory style based on level and needs of the supervisee

• Review relevant paperwork and documentation

Analytical Skills and Function

• Analysis—Supervisor will:

• Examine collected data and observation notes to identify patterns of behavior and target areas for improvement

• Assist the supervisee in conducting self-reflections until independence is achieved

• Reflective practice is key towards independence and autonomy of future professionals

Clinical Decisions

• Clinical Decisions—Supervisor will model and guide supervisee to:

• Respond appropriately to ethical dilemmas

• Apply regulatory guidance in service delivery

• Access payment/reimbursement for services rendered

Evaluation as a Function

• Evaluation—Supervisor will collaborate with the supervisee and continually:

• Assess performance of the supervisee

• Determine if progress is being made toward achieving the supervisee’s goals

• Modify current goals or establish new goals if needed

Performance Decisions

• Performance Decisions—Supervisor will:

• Guide supervisee in using reflective practice techniques to modify his/her own performance

• Assess supervisee performance and provide guidance regarding both effective and ineffective performance

• Determine if progress is being made toward achieving the supervisee’s goals

What happens when its not working?

• Performance Decisions—Supervisor will:

• Identify issues of concern in regard to supervisee performance

• Create and implement plans for improvement that encourage supervisee engagement

• Assess response to plans for improvement and determine next steps, including possibility of failure, remediation, or dismissal

Research/EB Practice

• Supervisor will adhere to principles of evidence-based practice and effectively convey applicable research information/analysis to the supervisee and will:

• Refer to research and outcomes data and their application in clinical practice

• Encourage the supervisee to seek applicable research and outcomes data

• Utilize methods for measuring treatment outcomes

Look Around…What works?

• Clinical education literature across all allied health fields should be employed for the development of training materials—notably the information related to the scholarship of teaching and learning, adult learning, and successful models for training clinical educators in related disciplines.

• Inter-professional… Team-Based…

Additional Considerations

• Clarifying Expectations : A Sample Teaching Technique Definition and discussion of terms…variations on a theme and parallel process

• “Giving Back” to the professions: The why…• Career Ladder: Framework for Roles and

Responsibilities at Each Level of Professional Preparation

• Models to guide your development and practice

• Strategies for Learning

Expectations

• Think about your expectations for your time here in this presentation today…

• What do you expect of me as a presenter and what do you expect of yourself in terms of:• Content• Participation

• See a handout

Sample Strategy

• Clarifying Expectations: This strategy is appropriate at any level of professional development…

• Saves time as can avoids misunderstandings and/or miscommunication down the line

• Opens doors to discussion and resolution of discrepancies that can interfere with relationship building and satisfaction

Clarifying Expectations

• “as the relationship begins, it is critically important to “set the stage” for participation by resolving expectation discrepancies. This will prove beneficial in the long run as communication about expectations “up front” alleviate the problems of backtracking later with “but I thought…” and also documents what is expected reciprocally . This exercise is critical to the establishment of realistic expectations for both the prospective employee/ student and the mentor and clarifies goals and objectives for a mentoring process.” Moore et al, 1998

Terms Can Be Confusing…

• What do we mean by… Preceptor

Collaboration COACHING Mentorship

SupervisionConsultation Performanc

e-BasedCompetency

-Based

Working Definitions

Do you do all of the these…mentor, supervise, coach, complete performance-based assessments, promote and evaluate competency development etc…?

Focus of each may pull in another perspective that facilitates meeting the individual personal preparation needs or career goals of a student at any given point in time …

Supervision & Supervisory Process

• Purposes: Sergionanni (1991)

• Quality control through monitoring of performance

• Competency development in a particular skill set

• Promoting commitment to the position or work focus…alignment of goals

Supervision is a process…

• “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

Key Components of Supervisory process

• Defining and communicating the position activities and scope of responsibilities

• Coaching for improved performance

• Provision of job-related instruction

• Providing formative feedback

• Evaluating performance

• Providing consequences for poor performance

Additional Aspects• “ Organizational acculturation” Dowling

(2001) : Includes introduction to workplace culture and people; orientation to roles & responsibilities of others etc.

• Determination of training and supervisory needs including pathways to competence with appropriate levels of supervision

• “Guidance of development” modeling of professional behavior, confidentiality, appearance, ethics, quality services

• Documentation of performance with feedback ( journals, portfolio development, written evaluations, formal written appraisals, individual growth planning processes)

Is Mentorship part of the role?

• Mentorship is a term that implies more than supervisory management and evaluation of assigned tasks and responsibilities. It is often described as a “caring and supportive relationship between an experienced more knowledgeable practitioner (mentor) and less experienced, less knowledgeable practitioner (mentee) in which the mentee receives career-related and personal benefits” (Henry, Stockdale, Hall, & Deniston, 1994).

Reciprocal Relationship

• Mentorship relationships are relationship based and not entirely one-sided, with only the mentor providing time, advice, expertise and support of the mentee. More recent descriptions of the relationship point out benefits for both the mentee and the mentor (Moore & Pearson, 2003).

• “Mentoring is a tool that organizations can use to nurture and grow their people. It can be an informal practice or a formal program. Protégés observe, question, self-reflect and explore. Mentors demonstrate, explain, model and use inquiry to promote self awareness and problem solving.

The act of mentoring…

• “Deliberate learning is the cornerstone of mentorship. The mentor's job is to promote intentional learning, which includes capacity building through methods such as instructing, coaching, providing experiences, modeling and advising.

• “Benefits may include career satisfaction, job retention, opportunities to actualize and optimize skill development and abilities, expansion of knowledge base, opportunity to grow and learn and working effectively with others.”

A Matter of Focus ?

• The terms mentoring and supervision are not synonymous but are often used interchangeably (Urish, 2004). Mentoring is typically defined as a relationship between two people in which one person (the mentor) is dedicated to the personal and professional growth of the other (the mentee) (Robertson, 1992). While this definition may sound similar to the relationship of the supervisor and the supervisee, the primary focus of supervision is accountability for the supervisee's performance (e.g., providing grades or conducting performance evaluations; documenting professional behavior and clinical performance).

In contrast…

• In contrast, mentoring focuses on creating effective ways to build skills, influence attitudes, and cultivate aspirations. Mentors advise, tutor, sponsor, and instill a professional identity in mentees.

• Mentoring is an intense interaction between two people, where the mentor has authority and power based on experience. To highlight the importance of the mentoring role, the 2005 ASHA Standards for Clinical Certification references mentoring.

Coaching

• Crane, T., (2002) The art of assisting people enhance their effectiveness, in a way they feel helped”

• Current research from business, education, etc. indicates training alone is necessary but not sufficient to promote sustained performance changes…without coaching old behaviors quickly resurface, sustained performance improvements do not materialize

Coaching Process

• “Coaching is a comprehensive communication process in which the coach provides performance feedback to coachee in all work-related dimensions…the coach acts as a guide by challenging and supporting individuals as they strive to achieve their personal and organizational objectives”

• “An adult learning strategy in which the coach promotes the learner’s ability to reflect on his or her actions as a means to determine the effectiveness of an action or practice and develop a plan for refinement and use of the action in immediate and future situations. Rush & Shelden, 2005

Coaching vs. Training

Category 1 Category 2 Category 3 Category 40

1

2

3

4

5

6

TrainingCoaching

Consultation

• Intention is to share vital information about policies, procedures, content and effective practices…Lipton & Wellman, 2003

• Buysse & Wesley ,2005 …it is an indirect method…triadic in nature, ..a joint , systematic problem solving process

Consultant Consultee

Client

Collaboration

• “Involving two or more professionals providing direct service to the client” Buyesse & Wesley, 2005

• Often difficult to distinguish …especially when consultant is internal… is a valuable goal in consultation to foster collaboration to optimize resources, commitment and satisfaction in the process.

How do these constructs fit

together?

Key Components to Consider in your role as a clinical educator•Relationship-Based

•Competency & Performance Based

•Involves Reflective Practice

Relationship-Based

• “The supervisory relationship should be based on a foundation of mutual respect and effective interpersonal communication”. ASHA, 2008

• Development of trust… “a sense of investment in the other person, earned confidence and trust, use of empathy to understand the other person’s emotional reality and mutually developed goals” (p. �26).

Competency/ Performance-Based

Assessments• Competency and/or performance based

assessments are integral to the process

• Tools utilized may be informal or formal, based upon standards of practice, and provide data to promote improvement in practices specific to a setting or role or discipline.

• Internal … Self –administered checklists, inventories, use of video tape to promote reflection.

• External… PRAXIS, CLASS, Annual Performance Review etc.

Reflective Practice• Reflective practice is defined by Schon

(1996) as “thoughtful consideration of one’s own experiences in applying knowledge to practice while being coached by professionals in the discipline.” The ability to learn from one’s actions is necessary for continuous learning and crucial to quality clinical education.

Self-Reflection is Key!

• Effective supervisors are able to foster, model, and facilitate reflective activities that teach self- awareness and the ability to assess one’s strengths and weaknesses leading to changes in practice.

• Goal: “Simultaneously enhance clinician performance and develop a relationship that supports the clinicians’ ability to effectively convey concerns, strengths, and new ideas to the supervisor.”

Reflective Practice involves…

Reflective Practice - a process by which educators actively engage in thinking critically about our own:

• Reactions…

• Judgments…

• Behaviors…

• Emotions… and Intentions

Models & Process

• Anderson, 1988 A continuum…

A Developmental Continuum

Variables

• Novice ………………………… Proficient

• Direct ……….………………… Indirect

• Inexperience…………………..Experienced

• Intensive………………………..Less Intensive

• Active Support…Collaborative…Consultative

Expanded Definition

• ASHA's position statement (1985b) noted that “effective clinical teaching” involves the development of self-analysis, self-evaluation, and problem-solving skills on the part of the individual being supervised. Self-analysis and self-evaluation are important activities for the supervisor as well.”

• the shared core principles of supervision regardless of the discipline and/or service delivery setting (Dowling, 2001).

Mentorship Model

• Mentoring Matters ( Lipton & Wellman, 2003

• “Learning focused mentoring relationships frame the learning journey from novice to expert…” Mentees are more likely to…

• Increase efficacy as problem-solvers and decision-makers

• Engage in collaborative professional exchanges

• Remain in the profession

What mentors do…

• Mentors offer support, create challenges and facilitates professional vision through maintaining a learning focus within the relationship Daloz, 1998

Model for Learning Focused Interactions • Lipton & Wellman

CONSULT COLLABORATE COACH

Information and analysis

Information and analysis

A Continuum of Interaction

• Consulting …share information, advice and technical assistance about policies and procedures, content, learning competencies, effective practices to establish standards for professional practice

• Collaborating ….to co-develop information, ideas, and approaches to challenges. Model a collegial relationship as a standard of practice

• Coaching…skilled coaches provide guidance in accessing internal resources and developing capacities for self-directed learning

Moving Back & Forth Across the Continuum

• Consultation Strategies : Sharing Information Think Aloud…Offer a Menu…Idea Bank …Model…Review Video tape

• Collaboration Strategies: Co-develop or Co-construct the information pool through brainstorming, co-planning, co-teaching, conduct action research, explore research and case studies

• Coach: Support thinking, problem solving and goal through nonjudgmental inquiry …probing , paraphrasing, or inquire about successes, concerns, self- reflection is key

Coaching Model by Crane

This transformational model is built upon…

• 1. Foundations (Connect, Set Expectations, Observe and Prepare)

• 2. The Learning Loop (“Asking the L earning Questions” with permission and positive intention, share perceptions, and explore through listening

• 3. Forwarding the Action (Identify options and specific changes, clarify commitment with support and follow-up)

Transformational Coaching

Activity… Characteristics

• Think about your favorite advisor, mentor, supervisor when you were in training…

• Pair & Share with the person sitting in front or behind you…

• What about the relationship worked for you?

• How did this professional support your professional development and career?

• Think of an “opposite” person if one in your life…what did not work?

Consultation Framework

• Buyesse & Wesley, 2005

• Stage 1: Gaining Entry ~ Establish purpose and assess disposition

• Stage 2: Building the Relationship~ Open and trusting relationship with parameters and roles and goals

• Stage 3: Gathering Information / Assessment ~Identify factors for change

• Stage 4: Setting Goals~ Agree on concrete goals for change

Buyesse & Wesley, 2005

• Stage 5: Selecting Strategies ~ Develop agreed upon plan for change

• Stage 6: Implementing the Plan ~ Support and assistance from consultant

• Stage 7: Evaluating the Plan ~ What is match between desired goals and outcomes? Document

• Stage 8 Summary Conference~ Transfer of responsibility for maintenance and consider new goals

Career Ladder

• All professions ( OT, PT, SLP, Education, Other) have a career ladder of personnel preparation

• Mentorship, supervision, coaching and consultation must be seated in context of level of personnel being prepared and scope of practice at each level

Comparison of Levels of

Preparation• SLP

SLPP24 creditsIn SLHS

BA

SLPA0-100 hrs

AuthorizationCDE

MA-SLP400 + hrs

CCCCDE-SLP

Clinical Felloe

PhDResearch

+ Teaching

Specialty Recognition

How do models address each level

of personnel preparation across

disciplines?• Supervision ?

• Mentorship ?

• Coaching ?

• Collaboration ?

Standards : Consider standards at each level

Time to talk…

• Think Pair Share…Complete survey…

• Do you need more information? Knowledge and skill development? Are recommendations from ASHA and CAPSCD applicable?

• How do these models inform your practice as a mentor, supervisor, coach, consultant or collaborator in your present role?

• How does context of level of personnel preparation impact your practice as a mentor, supervisor, coach, consultant or collaborator?

Refining your Skills

A “5” step program ( A proposed framework for your engagement in online learning class)

1. Develop skills to support learning and competency development at each level of preparation

2. Develop skills as a mentor: relationship -based

3. Develop skills and tools as a supervisor

4. Learn skills and strategies that facilitate adult learning and reflective practice

5. Use the level of support appropriate to level of preparation

Step 1

Step 1…Develop skills to support learning and competency development at each levelKnow level of preparation as this dictates

specific roles, responsibilities, and limitations as well as supervisory requirements for performance.

e.g.. Can an SLPA take your place on a team-based assessment? No!!!

SLPAs are not prepared, nor qualified to plan, implement, or interpret diagnostic assessments

Step 2

Step 2 …Develop skills as a mentor

• Mentor: “Deliberate learning is the cornerstone”

• The mentor's job is to promote intentional learning at each level of expected performance, which includes capacity building through methods such as instructing, coaching, providing experiences, modeling and advising.

Step 3

Step 3…Develop skills as a supervisor

• The terms mentoring and supervision are not synonymous but are often used interchangeably (Urish, 2004).

• Mentoring is typically defined as a relationship between two people in which one person (the mentor) is dedicated to the personal and professional growth of the other (the mentee) (Robertson, 1992).

Mentorship…Supervision or Both

• While this definition may sound similar to the relationship of the supervisor and the supervisee, the primary focus of supervision is accountability for the supervisee's performance (e.g.., providing grades or conducting performance evaluations; documenting professional behavior and clinical performance)

• In contrast, mentoring focuses on creating effective ways to build skills, influence attitudes, and cultivate aspirations. Mentors advise, tutor, sponsor, and instill a professional identity in mentees. Mentoring is an intense interaction between two people, where the mentor has authority and power based on experience.

Step 4

Step 4… Learn skills and strategies that facilitate adult learning and self –reflection

Examine how you learn…ask how others learn…

Reflect on how you reactions, judgments/biases, behaviors, feelings and intentions impact what you do.

“Adult learning refers to a collection of theories and methods for describing the conditions under which the process of learning is optimized” Trivette et al, 2009

Adult Learner characteristics…

• Readiness to learn

• Self-directedness

• Active learner participation

• Solution-centered Knowles ,1995

Research about Adult Learners

New material and information is more easily learned when it relates to existing learner knowledge and it’s relevant to the learner

Mastery of new material and information requires application in contextual framework

Ongoing monitoring of learning and self-assessment of progress facilitates deeper understanding and continued application of new knowledge

Adult learners benefit from…

Planning

Introduce/preview new information

Illustrate or demonstrate applicabilityApplication

Practice

EvaluateDeeper Understanding

Reflection Mastery

Research… Trivette et al, 2009

A review of 79 research studies evaluating learner outcomes showed all 6 characteristics listed above were associated with more positive learner outcomes

Adult learning methods that more actively involved learners in using, processing, and evaluating their knowledge and skills were most effective

Implications

Engage learners in a process of self-assessment through a relationship-based building of trust

Use instructor “guided” learning and feedback in reference to competencies

Active learner participation throughout all three phases of planning, application and deeper understanding promotes sustained learning

Multiple learner opportunities and practice are necessary

Step 5

Step 5…Use the level of support appropriate to the level of preparation

Development matures over time. Mentoring -- when it works -- taps into continuous learning that is not an event, or even a string of discrete events. Rather, it is the synthesis of ongoing event, experiences, observation, studies, and thoughtful analyses.

Tools

• Pre- post learner surveys

• Expectation Clarification exercise

• Professional Growth Planning … written and discussed…based upon data

• Self Reflection within scope of practice… tools ( check lists, videotape, inventories or objective measures such as CLASS etc.) must be adapted to context of practice

• Performance –based assessments

Strategies that work …

• Focus on the learning conversation… respect boundaries

• Tap into conflict resolution strategies as needed when having the “difficult conversation”.

• Use inquiry respectfully but frequently to promote self reflection and independent problem solving …ask the learning questions.

Selected References

• American Speech-Language-Hearing Association. (2008). Clinical Supervision in Speech-Language Pathology [Technical Report]. Available from www.asha.org/policy.

• Anderson, J. L. (1988). The supervisory process in speech language pathology and audiology. Austin, TX: Pro-Ed.

• Buyesse & Wesley, (2005) Consultation in Early childhood Settings, Baltimore: Paul H. Brookes

References

• Crane, T.G., (2002) The Heart of Coaching: Using Transformational Coaching to Create a High-Performance Culture .San Diego, CA: FTA Press.

• Fenichel, E., (1992) Learning through Supervision and Mentorship. Washington, DC: Zero to Three Press

• Lipton , L., & Wellman, (2003) Mentoring Matters, Sherman CT: MiraVia Publications

• Moore, S. & Pearson, L (2003). Competencies and Strategies for the Speech, Language Pathology Assistant. Delmar Learning Solutions. Delmarlearning.com

• Urish, C. (2004). Ongoing competence through mentoring. Bethesda, MD: American Occupational Therapy Association.

Thank You

• It was a pleasure to be here…Thank you for your participation and engagement

Human Resource ~

• Susan M. Moore, JD MA CCC-SLP, Clinical Professor Emeritus

• Susan.moore@colorado.edu

• University of Colorado, Boulder