Clinical Education

The National Competency Profiles specifying clinical competencies required of each clinician upon entry-to-practice in Canada, with the goal of safe and effective practice were created in 2018. These competencies form the foundation for accredited audiology and speech-language pathology curriculum in Canada. Other regulated professions, such as medicine, occupational therapy, and physiotherapy, also utilize similar assessment frameworks.

The ACC was developed using these professional competencies and adapting them to allow for assessment of students across various stages of clinical learning. The ACC tool assesses seven roles required of an entry-to-practice speech-language pathologist or audiologist: Expert (Knowledge and Clinical), Communicator, Collaborator, Advocate, Scholar, Manager, and Professional. Each role contains one or more essential competencies (with several sub-competencies) that the student clinician must demonstrate by the time they complete their studies.  

A rating scale accompanies the tool and describes the expected performance of a student along a continuum from “Early Novice” to “Entry-to-Practice”. with “Unsatisfactory” as an option to reflect students with significant difficulties. Over the course of a master’s program, students are expected to progress from Early Novice (early stages of first placement) to Entry-to-Practice (when they finish their final placement). Individual university programs will identify required achievement levels along this continuum. Please refer to your university program’s communication to determine the achievement level requirements for the student’s placement.

In the traditional education approach, emphasis is placed on what knowledge students’ need and how clinical educators will teach them that knowledge. In the competency-based education approach, the focus is on the abilities of the student and the competencies they are expected to demonstrate. Assessing student performance using the traditional method focuses on the assessment of learning and knowledge. Competency-based assessment involves assessment for student learning and their application of that learning.

The ACC requires a change in thinking for clinical educators to a competency-based educational approach. This involves a shift in focus from disorder or population-specific knowledge and skills to abilities that transfer across disorders/placement, such as clear communication and applying academic knowledge.

Using ACC Essential Competencies, Sub-Competencies, Milestones, & Rating Scale
Using the accompanying rating scale, you will assign the student a rating for each essential competency. In doing so, consider the applicable sub-competencies listed below each essential competency and make an overall determination on how to rate the student on that competency. When needed, you may use the milestones to inform this rating. The milestones are stages in the development of specific competencies along the continuum from Novice to Intermediate to Entry-to-Practice. They form a road map and provide explicit performance expectations for each competency. Milestones enable better assessment, as well as a pathway to support, learning for the clinical educator and the student. 

The rating scale is designed to be flexible enough to assess performance on all the essential competencies. Level descriptors vary along three parameters:

● Amount of assistance required,

● Amount of time required and

● Complexity of clients/situations managed.

Choose how to weigh the relative importance of the three parameters of the rating scale and of the sub-competencies within your own context when choosing a final rating of the essential competency. After assigning a rating for each essential competency within a role, provide comments on the student’s strengths and areas for development within that role.

Using the Not Applicable (N/A) Rating
In cases where an essential competency is not applicable to a particular setting or there has been no opportunity to assess a competency, Not Applicable (N/A) should be selected. Clinical educators are strongly encouraged to review both sub-competencies and milestones before selecting N/A to ensure that there has not been an opportunity for the student to demonstrate the competency within the practice setting.

Using the Unsatisfactory Rating
A rating of Unsatisfactory is available for the rare instances where a student experiences significant difficulty during familiar/routine cases, even when provided with specific direction from the clinical educator. These students may demonstrate little to no evidence of self-reflection or insight over time into their strengths and weaknesses, fail to seek knowledge or support, struggle with basic reasoning and/or demonstrate difficulty applying prior learning. This rating differs from Early Novice in that students who are demonstrating Unsatisfactory performance continually struggle to improve their skill set, whereas students in the Early Novice level are new to clinical practice, but demonstrate the ability to begin to change their performance in response to feedback.

Rating Inconsistent Student Performance Within an Essential Competency
There may be instances where students demonstrate inconsistent performance and perform poorly on a particular sub-competency that impacts the overall rating of the entire essential competency. It is reasonable for clinical educators to emphasize this area for improvement when rating the essential competency. For example, in the role of professional, if a student maintains client confidentiality, but does not maintain professional boundaries with clients, it would be reasonable to rate the student lower on the overall essential competency. In these cases, please add specific comments regarding your rationale to the Comments section.

Amie is an audiology student on her third clinical placement; she is over half-way through her master’s program. She has planned and completed several assessments in the first half of her placement with growing responsibility. She requires specific cueing (i.e., modelling) to complete new and unfamiliar assessments with complex cases or when there are behaviour difficulties, but performs familiar assessments with only general guidance from the clinical educator (CE). Her assessment plans show consideration of appropriate deviations during formal and informal assessment and she is able to make online changes. She struggles with writing accurate assessment reports. She recognizes appropriate information for documentation, has challenges utilizing structured templates and examples of written reports from the CE, is unable to explain complex assessment results and takes extra time to write all reports. Reports usually require three revisions before they meet requirements to release to the client.

Amie’s CE completed her midterm assessment with the following ratings for essential competencies 1.2.b (Plans, conducts, and adjusts an assessment) and 2.b (Completes documentation thoroughly and accurately, in a timely manner):  

1.2.b Plans, conducts, and adjusts an assessment.

• In partnership with the client, substitute decision-maker, and family, as appropriate, collects and analyzes pertinent personal information about the client (e.g., case history, client goals, expectations, motivations, needs, activity limitations, participation restrictions)
• Plans a valid, accurate and reliable assessment, selecting the tools, equipment and techniques that will address the unique needs of the client
• Conducts the assessment, modifying as necessary**

Milestone Example:

1.2.b.iii **Conducts the assessment, modifying as necessary

2.b Completes documentation thoroughly and accurately, in a timely manner.

• Accurately documents informed consent, services provided and outcomes**
• Ensures reports clearly integrate results, client input, analysis, recommendations, goals and outcomes, in a manner understandable to the target audience(s)
• Documents in all professional contexts in a clear, concise, organized and grammatically acceptable manner
• Completes and disseminates documentation in a timely manner
• Complies with regulatory, legislative and facility requirements related to documentation

Milestone Example:

2.b.i. **Accurately documents informed consent, services provided and outcomes

Stefan is finishing his first placement. He has been a pleasure to have on placement. Stefan demonstrated an excellent work ethic and professional behaviour at all times. He hasn’t had an opportunity to manage conflict, but he did observe a significant difference of opinion between a physician and physiotherapist on the team and demonstrated insight into how this could have been better managed in a later discussion with the CE. This included resources he had learned about in the interprofessional conflict learning activity. The CE had previously completed a large number of assessments and Stefan has been participating in providing a mix of 1:1 and group intervention for adults with acquired brain injuries. The CE had summarized the patterns of strengths and challenges for each client and then they worked together to translate the assessment results into goals, approaches and likely activities. Stefan could choose holistic goals from relevant information, however, needed frequent support to select and word short -vs long-term goals, but he was then able to identify good ideas for how to target the goals in 1:1 sessions. Stefan required assistance to determine how to approach group intervention. He also was unsure of how outcomes might be measured, but once given one to two examples, he was usually able to generate one to two additional measures.

The CE completed the final assessment with the following ratings for essential competencies 7.a (Maintains professional demeanour in all clinical interactions and settings) and 1.3.a (Develops a realistic, evidence-informed and measurable intervention plan):

7.a Maintains professional demeanour in all clinical interactions and settings.

• Maintains confidentiality (e.g., follows consent procedures to share information with other parties).
• Demonstrates professionalism in managing conflict**
• Maintains personal and professional boundaries in relationships with clients, colleagues and other professionals
• Displays a positive, professional image (e.g., follows dress code
• Demonstrates professionalism in all communications, including those involving electronic platform
• Demonstrates responsible, reliable behaviour and accountability for actions and decisions
• Recognizes and responds appropriately to the inherent power differential in the relationship between the client and the student-clinician

Milestone Example:

• 7.a.ii **Demonstrates professionalism in managing conflict

1.3.a Develops a realistic, evidence-informed and measurable intervention plan.

• Establishes and prioritizes long-term intervention goals that reflect the client’s strengths, needs, values, expectations and constraints**
• Develops specific, measurable, realistic, time-limited, short-term goals to reach the functional long-term intervention goals
• Selects direct and/or indirect service delivery model(s), as appropriate
• Determines the resources and timelines required for the intervention
• Develops activities and outcome measures that align with the client’s goals

Milestone Example:

• 1.3.a.i **Establishes and prioritizes long-term intervention goals that reflect the client’s strengths, needs, values, expectations and constraints.