Educating the Speech Therapist
by Jan Lewin, Ph.D
I attended my first Annual Meeting of the International Association of Laryngectomees in 1983 as a speech pathologist trainee. Since that time I have had the good fortune to return as a member of the faculty to teach, train, and share my experiences working and interacting with people who have undergone laryngectomy to help restore communication and facilitate recovery. Having recently been elected to the Board of Directors, I also had the privilege of attending my first Interim Board of Directors Meeting this past February in Atlanta Georgia. Needless to say that enthusiasm, dedication, and commitment to continuing education abounded. However, there was an overriding topic of conversation which seemed to arise during committee meetings as well as private conversations and remains a major concern and frustration to me in my hospital practice. The topic continues to revolve around the limited amount of education and experience with laryngectomy that speech pathologists receive as part of their graduate training. Many laryngectomees provide lectures to graduate students as part of a general class in voice disorders . For many practicing speech pathologists, this remains their only exposure to alaryngeal voice restoration. Yet many will find themselves in hospital practices expected to provide expert service to patients undergoing laryngectomy.
I am surprised that more clinical placements are not sought in hospital departments which offer specific opportunity for clinical experience with patients who have undergone laryngectomy and/or other types of head and neck cancer surgery. It is my feeling that competency in alaryngeal voice restoration does not become a real concern until the time when the first referral for preoperative counseling or alaryngeal voice consultation comes across the speech pathologists desk. To better understand this dilemma in relation to the education requirements for speech pathologists I called the American Speech-Language? Hearing Association for further clarification. Since so many laryngectomees have expressed similar concerns and asked me for suggestions as to what can be done, I will share the information I have learned.
Speech pathologists must obtain approximately 350 hours directly providing evaluation and treatment to individuals with various types of communication problems. Some of the hours must be completed with children, some with adults who have language disturbances and some with individuals who have hearing loss. When you subtract all of the specific requirements, there are approximately 195 hours which can be filled with any type of communicative problem whether it be in adults or children. There are no specific requirements that mandate part of the graduate student's clinical experience be with individuals who have undergone laryngectomy. In fact, many speech pathologists receive only one to two lectures in alaryngeal voice restoration as part of a single class in the evaluation and treatment of voice disorders.
The problem of limited student placements and contact seems to one of availability and the prevalence of the disorder itself. In other words, students are placed in hospital or community programs by and large determined by what is available to them. secondly, when you compare the prevalence of stroke and childhood development delay, for example, laryngectomy is by far less common. Therefore, when students are placed in local community hospitals the majority of their experience, if not entirely, is with children and/or adults who have the more commonly occurring speech and language problems.
I have taken the concern of many of the laryngectomees who have asked "What can I do?" along with the concerns of many of the speech pathologist like me, who are discouraged by the limited preparation of students in the area of alaryngeal voice restoration to the past president of the American-Speech-Language-Hearing Association, Dr. Jeri Logemann, for her advice. She has suggested that letters be sent to two individuals who have strong input into the committees who regulate and mandate the educational standards for graduate students in speech pathology. Laryngectomee clubs might draft a single letter suggesting a need for more education and training and send it in with the signatures of the club members to the individuals listed below. another method may be to copy a single letter with the individual signatures and mailings. The choices are many. Anyone who is interested in sending a letter of concern should mail to:
Donald Counihan, Ph.D
Chair, Educational Standards Board
lO7Ol E. Lake Circle
Oklahoma City, OK 73l62
John Ferraro, Ph.D
President, Council of Graduate Programs
in Communication Sciences & Disorders
Department of Hearing and Speech
University of Kansas Medical Center
Kansas City, KS 66160-7605
Finally, not enough can be said about the need for the continued support and promotion of postgraduate training courses and educational seminars like the IAL Voice Institute and other courses and workshops which are put on across the country to facilitate laryngectomee rehabilitation. These are the types of educational activities I hope we as members of the International Association of Laryngectomees will continue to support.