#096: How We Approach Clinical Expertise

Marisha: Hello there, and welcome to the SLP Now podcast where we share practical therapy tips and ideas for busy speech language pathologists.

Marisha: Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hello there, and welcome to the SLP Now podcast. I'm your host, Marisha, and this month, we have Monica Lynn joining us to talk about all things evidence-based practice. So in Episode 95, we did a review of the EBP Triangle, just some of our initial thoughts. And then for the rest of the month, we are going to be diving into the different parts of the Triangle.

Marisha: So without further ado, let's dive in into this week's episode.

Marisha: So Monica, what does clinical expertise look like for you?

Monica Lynn: I think that because I take interns and I supervise CS, I get to see kind of how it looks like for them and some of the difficulties that they have transitioning into learning all of this and trying to balance all of this and kind of comparing brand new SLPs to people who are a little bit more experienced or super seasoned, I think, SLPs, so I think brand new SLPs that don't have a lot of clinical expertise to rely on, they have a lot of that external evidence and internal that they can rely on, but it's just analyzing your data and being able to do what we were talking about.

Monica Lynn: And then to then take that and look at where the kids aren't making as much progress and honing that part of your clinical expertise to know where to make those adjustments, I think, is really kind of what becomes difficult because when you have an entire new caseload, it's like you don't know what type of progress those kids should be making because they're really new to you. So I think that can be hard.

Monica Lynn: And then I think for experienced SLPs, you might use your clinical expertise as a way to look at how can you level up the progress that your students are making? You might have someone who's making awesome progress already, but you just kind of know, you have that clinical expertise and judgment to know that, "You know what? I know that they could be making faster progress" and then it's just pulling all of the different things together to try something. And a lot of times, it's overwhelming to add something new. So a lot of times, I'll just start with maybe a couple students. And then if that new type of thing goes well, and you're just using your clinical judgment to know if this is going well and using some of that internal data too, then I'll do it with my entire caseload rather than changing everything at once.

Monica Lynn: This is also kind of where it's hard too because you're just making a really honest assessment for if your students are making progress or not. And sometimes that's really hard to think, "You know what? I don't feel great about this student because so and so and so," so that can be really hard to kind of look inward and know that you need to do a little bit more legwork, especially during a really busy IEP season.

Monica Lynn: I think it's just made easier by some of the resources that we have nowadays though because even a couple years ago when we didn't have a lot of this stuff, when you really did have to go find one article and figure it out and then kind of have trial and error. I feel like now with some of the things that we talked about or even social media, there's new ideas popping up all the time. It's a lot easier now, but your clinical judgment and expertise is also filtering all of that out which can be really overwhelming as well.

Marisha: I love what you said. If you're a really experienced SLP and your students are consistently making progress, it's worth asking that question, "So they're making progress, but could they be making more rapid progress, or could they be progressing more quickly?" And I love what you said about how that our clinical expertise can be a filter.

Marisha: It gets really interesting to think about how we can turn that off and maybe... I don't know. I wonder what that would look like. Maybe not attending certain courses or not reading certain articles because it doesn't fit with our view?

Monica Lynn: That's so interesting.

Marisha: And it is.

Marisha: I bet we all do a little bit of that. It's like, "How do I do it," right?

Monica Lynn: I sound like clinical fellows. Try not to look at too much social media your first year because you're just trying to tread water, and there's so many new things coming in at you that sometimes it's just... you just need to get that progress going with your students and get to know them and build relationships that sometimes it is. It's really hard to know what to look at.

Marisha: And I bet having students and interns is a great way... if they're asking questions, that's probably a great way to check our filters.

Monica Lynn: For sure. And I know because I tend to talk way too much. If any of them are listening, they're like, "I know." But it's like if you have to explain something, if you can't explain it in a simple way, then you don't have a good grasp on it because you are then kind of not able to put it simply. So I think that's also a great measure of where I might need to look into things a little bit more.

Marisha: No, that's so good.

Marisha: Is there anything else that you wanted to point out when it comes to clinical expertise?

Monica Lynn: Maybe asking teachers and parents. So I tend to do goals that are really functional and will generalize, but I think that you kind of have to know what that generalizing will look like and where you should start that student. And so making goals really is a lot of clinical judgment because you're looking at the student where they are now and where you think that they'll be in a year. And then my district has benchmarks, where you think they'll be in a couple months.

Monica Lynn: And that's pretty daunting to be that portion telling, crystal ball type of situation. But I think that by asking teachers and asking parents what do they look like in different areas and putting that together and making that a part of your clinical judgment can also help, I think, so it's like if in the speech room looks different than the classroom because it's a different setting, making that a part of how you make your goals or what you do with your treatment.

Monica Lynn: I think that starting small, kind of we talked about, and then celebrating how much your students are improving along the way is great, just not being too critical. We're constantly learning. We have so many areas to cover. And I think a lot of us tend to be that Type A perfectionist thing where you want everything to go just right. But it's like our case loads are so varied. We have so much to do. You just need to give yourself a little bit of grace with that.

Monica Lynn: And coming back to you have your activity and your materials, but being critical of it. Just because it says it's EBP does not mean it's EBP because your caseload is different. So that person who made it has a certain thing in mind, but it's really using yourself as that tool to modify it for your students. So it's knowing that you can't just take a product that's out there and do it just the way that it's given. You're going to have to modify it with visuals or the way it's presented or the explicit teaching that you have to do before to really make it EBP, I think, sometimes can be the hardest part, especially when you're new and you're starting out. And if you go to a site and you're new, there are no materials.

Monica Lynn: To then have to get all the materials for your caseload can be really overwhelming which is why SLP Now is great because you just have access to everything, and you're not having to get individual things for everything. That really helps. I always suggest that for new SLPs. It just makes that a little bit less overwhelming, but then being able to look that up and use it in a way that's EBP can be a balance. It can be a struggle, for sure, I think.

Marisha: Absolutely.

Marisha: I just think that's a huge takeaway that a given resource isn't EDP. It's just how we use it, how we implement it, and how we as clinicians incorporate all three parts of the Triangle is what makes that evidence-based which it's a big task. It can be really exciting and fun to tackle.

Marisha: So we've got this. We have the skills that we need, and we'll just going to continue growing and building over time.

Monica Lynn: For sure.

Monica Lynn: Actually, ASHA has a practice portal, so if you get a new kid on your caseload or you have something and you're just like, "I don't even know where to start. Where do I start?" A lot of grad students don't necessarily get a lot of experience with students with apraxia. That's a big one that's very specialized. There is a practice portal that has everything from prevalence to roles and responsibilities, assessment, treatment resources, and you can start there for your external evidence and has a little bit of a guide too for where you might need to use your clinical judgment.

Marisha: Thanks for listening to the SLP Now podcast. This podcast is part of a course offered for continuing education through speech therapy PD. So yes, you can earn ASHA CEUs for listening to this podcast.

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Marisha: See you next time.