Fostering Clinical and Academic Faculty Collaborations to Improve Graduate Education

Recommended Citation Etter, Nicole M.; Madhavan, Aarthi; Lindquist, Elise M.; Byrd, Amanda J.; and Kubat, Anne Marie (2021) "Fostering Clinical and Academic Faculty Collaborations to Improve Graduate Education," Teaching and Learning in Communication Sciences & Disorders: Vol. 5 : Iss. 2 , Article 5. DOI: https://doi.org/10.30707/TLCSD5.2.1624983591.697369 Available at: https://ir.library.illinoisstate.edu/tlcsd/vol5/iss2/5


Introduction
High quality graduate education depends on excellence in academic coursework, strong clinical practicum, and an overarching capstone experience that provides a summative assessment of the student's ability to integrate their knowledge and skills (Council on Academic Accreditation in Audiology and Speech-Language Pathology, [CAA], 2017). Often these three elements exist in silos, with clinical faculty focusing on clinical practicum and academic faculty focusing on coursework and the capstone research experience. However, collaborations between research, coursework, and clinical practice are critically important to ensure future speech-language pathologists are able to connect multiple streams of evidence-based practice and prepared to provide high quality care (Dalton et al., 2017;Dincher et al., 2020). In fact, in the revised 2017 Standards for Accreditation of Graduate Education Programs in Audiology and Speech-Language Pathology by the CAA, collaborative practice is emphasized as part of the curriculum in both Audiology and Speech-Language Pathology graduate programs (CAA, 2017). Although collaboration between academic and clinical faculty members is vital, establishing and maintaining collaboration between professionals is not easily achieved (Apel, 2006). However, university programs employ both academic and clinical faculty providing a unique opportunity for integrating research principles with clinical practice. The purpose of this reflection paper is to present a model of clinical and academic collaborations in graduate education to connect academic, clinical, and research experiences. Additionally, we briefly describe some of the challenges and facilitators to successful collaborations.

Model for Collaborations in Graduate Education
Recently, the Communication Sciences and Disorders (CSD) department at The Pennsylvania State University has been in transition with retirements amongst longstanding faculty members and the hiring of several new clinical and academic faculty members. Faculty departures changed existing collaborations within the department, and new faculty brought novel clinical foci, research specialties, and experiences. This time of transition provided an opportunity to develop new collaborative efforts. Since new Speech-Language Pathology graduates are expected to incorporate their knowledge from academic coursework and research into their clinical practice, we endeavored to design new collaborations that take place at the intersection of academic coursework, clinical practicum, and the capstone research experience our program requires. An outline of our model of collaboration and newly implemented collaborative projects can be seen in Figure 1. Activities at each intersection will be described.

Figure 1
Collaborative model for graduate education in CSD

Collaborative Activities in Graduate Education
Academic Coursework -Clinical Practicum. A simple first method of collaboration between academic coursework and clinical practice was to begin to incorporate simulated clinical cases in coursework. The department purchased access to Simucase ® ("Simucase," 2020) and began using these cases in multiple graduate courses; including: Voice, Motor Speech Disorders, Dysphagia, Adult and Child Language Disorders, Augmentative and Alternative Communication (AAC), Fluency, and Clinical Practicum. To integrate the best practice skills they are learning in courses, graduate students benefit from exposure to clinical simulations when direct client interactions are not possible (Towson et al., 2018). Following simulation activities, a period of "debriefing time" is essential to provide students an opportunity to reflect, review, and ask questions regarding their experience. Debriefing activities have been led by clinical faculty or academic faculty with their Certificate of Clinical Competence (CCC). In addition to traditional debriefing activities, we have also had students design treatment plans with appropriate goals, write a case history or clinical evaluation report, or develop intervention stimuli following a Simucase ® evaluation. Following these activities, students receive individual feedback and are provided an opportunity to discuss their work as a group.
A second example of this collaboration is a new project developed for the Voice Disorders course. At the beginning of the assessment section of the course, clinical faculty teach the students about the current voice screening protocols in the clinic. Students then complete a voice screening on a pseudo-client as part of their course requirements and can earn a clinical clock hour in voice if the session is observed by either academic or clinical faculty with their CCC. Students are encouraged to recruit pseudo-clients who will be naïve to the testing protocol to provide the best opportunity to practice giving clear instructions. They may ask friends, family, or other students on campus, but are instructed to select someone outside of the CSD major. This project helps students make connections between academic coursework and clinical practice, gives them the opportunity to earn clinical hours, and orients them to typical voice screening procedures, documentation, and equipment in the clinic. A similar project was created in the Motor Speech Disorders course to provide students an opportunity to practice oral mechanism examinations on a pseudo-client.
A third method of clinical and academic collaboration came in the development of preliminary Interprofessional Education (IPE) between the CSD and Nutrition departments. IPE is essential in advancing health education, to prepare students to provide excellent patient care in a collaborative manner (Buring et al., 2009), and aligns with the 2017 Accreditation standards (CAA, 2017). CSD students attend a collaborative guest lecture from academic and clinical faculty in the Nutrition department, during which they work systematically through a case study involving a patient with dysphagia who has nutritional needs. In the last two years, we have collected preliminary data on student perception of comfort and knowledge on collaboration between SLPs and dietitians as it relates to dysphagia. Using a Likert rating ranging from 1 (minimal or no information comfort) to 5 (know very well/very comfortable), students self-evaluation increased from a median of 3 to 4 after the activity. Additionally, while students are in the Dysphagia course, academic and clinical faculty collaborate to provide a number of hands-on clinical experiences such as completing oral care on each other and practicing modifying liquids using the newly established International Dysphagia Diet Standardisation Initiative (IDDSI;, 2019) standards.
Clinical Practicum -Capstone Research Experience. As a summative program activity, all graduate students in our program complete a research paper for a capstone research experience. Traditionally this project has been subsidiary to the advisor's research or data collection facilitated by that faculty member. A missed opportunity for clinical integration was realized here. It was noted that students could earn clinical hours for portions of their research projects involving direct assessment and intervention of clients with supervising faculty who have their CCCs. Three students' research projects have led to the creation and development of a cognitive stimulation group for individuals with mild cognitive impairment, under the co-advisement and supervision of an academic faculty member and a clinical faculty member. This project has led to a regular clinical placement opportunity for students offering clinical hours in adult cognitive group therapy. Additionally, this collaboration resulted in poster presentations at state and national level conferences, and nine graduate students have now completed this clinical placement. This successful model led to similar research-clinical collaborations in a group vocal fitness class for older adults with plans to extend programming in other adult living communities, as well as a project in literacy and visual scene displays in AAC.
Another collaboration between clinical practicum and research was the addition of grand rounds. During the clinical practicum course, students have the opportunity to discuss and defend their clinical decision making skills with the use of evidence-based practice (EBP) in case studies (Namazi et al., 2019). Academic faculty also attend these presentations.

Capstone Research Experience -Academic Coursework.
To scaffold the graduate students' introduction to completing their research project, students take a graduate course in research methodology in their first semester. Required class projects in this course help students develop research questions, locate and evaluate quality research articles, and begin to outline their literature review. Students work closely with their academic advisors to help determine appropriate questions and guide their literature reviews. The collaboration between academic coursework and research continues throughout their graduate education as students are required to read current research in each of their academic classes.

Academic Coursework -Clinical Practicum -Capstone Research Experience.
In an effort to combine all three elements of graduate education, students complete a Critically Appraised Topic (CAT) as a final assignment in their Motor Speech Disorders course. In the CAT assignment, students learn to ask focused clinical questions and then search, locate, and critically evaluate the evidence base, in short, a critically appraised topic is a guided means of conducting a rapid review of literature (White et al., 2017). First, students develop a focused clinical question related to the course topic at hand. They are encouraged to consider any population of interest to them or to reflect on a recent clinical case they have observed. Next, they use EBP to locate and evaluate the best evidence to respond to their clinical scenario. Finally, students present their findings to the class and also provide a single page summary of their findings. These summaries of a clinical scenario with the best evidence for clinical practice are collected and disseminated to all students in the class to help the students develop a resource binder for treating motor speech disorders. Although no formal evaluation has been conducted at this time, students have anecdotally reported referring back to these materials in clinical practice.

Challenges and Barriers to Success
The process of forming and fostering academic and clinical collaboration does not occur without challenges; the most obvious of these being limitations on time, resources, and incentives. Time and resources are required to attend courses, co-plan events, review documents and procedures, and communicate with other faculty members. Establishing these opportunities for academic and clinical faculty to work together has opened the lines of communication to promote additional collaborations. Another ongoing challenge is evaluating the effectiveness of these collaborations. Current student assessments of the success of these collaborations has been assessed by reviewing course grades, asking students to complete self-reflections, observing the carry-over into clinical work, and using pre/post evaluations for lab experiences. While formal evaluations and reviews of these collaborations are in process, preliminary results indicate students find them engaging, practical, and helpful in developing their clinical application skills.
A recent challenge has been the rapid adaptation of these programs for remote learning due to the COVID-19 pandemic. To meet this challenge, academic and clinical faculty have increased the use of Simucase ® (2020) to allow students to earn up to 75 hours of simulated clinical experience before they graduate. Additionally, students have used technology to conduct voice and oral mechanism screenings through Zoom using phone applications to assess frequency and volume. These adaptions help to ensure our students are ready to enter clinical practice with the additional skill of using teletherapy.

Facilitators to Success
While challenges to academic and clinical collaborations certainly exist, there are numerous means of facilitating these collaborations with mutually beneficial results. At times in graduate education, academic or clinical work appear to take precedence and priority over the other. The use of these collaborative projects provides an opportunity for a win-win situation, one in which academic and clinical concerns are equally important. Most importantly, students appreciate the culmination of academic, research, and clinical work in their roles as future SLPs.
Throughout this process, it is important for both groups to feel as if their time and energy is respected. This may mean one person is developing lectures or materials, while another completes the grading and provides feedback, or maybe all collaborators work together to develop an evaluative rubric. One of the quickest means to ensure this process is fair and equitable is through open dialogue. Upfront communication helps identify the purpose of each project and clearly define the roles and responsibility of each collaborator. At all times, each collaborator must feel that their time, skills, and efforts are respected.

Conclusion and Future Directions
While gains towards more frequent and efficient collaboration have been made, this process is far from complete. Future directions in collaboration may include additional coursework with academic and clinical components, colloquia for students and local professionals to discuss clinical and academic perspectives on various topics, partnerships between clinical and academic faculty in grant-writing and clinically-driven research, and similar collaborations with scholars from other academic departments. One of the best means for preparing future clinicians to integrate their knowledge and skills is to provide numerous opportunities for high quality educational experiences at the intersection of the academic, clinic, and capstone experiences.

Financial Disclosures:
The authors have no financial or nonfinancial conflicts to disclose.