Issues in Ethics: Supervision of Student Clinicians
About This Document
Published 2017. This Issues in Ethics statement is a revision of Supervision of Student Clinicians (originally published in 2003 and revised in 2010). It has been updated to make any references to the Code of Ethics consistent with the Code of Ethics (2016). The Board of Ethics reviews Issues in Ethics statements periodically to ensure that they meet the needs of the professions and are consistent with ASHA policies.
Issues in Ethics Statements: Definition
From time to time, the Board of Ethics (hereinafter, the "Board") determines that members and certificate holders can benefit from additional analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to heighten sensitivity and increase awareness. They are illustrative of the Code of Ethics (2016) (hereinafter, the "Code") and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders in engaging in self-guided ethical decision making. These statements do not absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine whether the activity is ethical.
Introduction
This Issues in Ethics statement is presented for the guidance of ASHA members and certificate holders in matters relating to supervision of students engaged in the provision of clinical services during all practicum experiences (on campus and off campus) and externships. ASHA members and certificate holders are employed in a variety of work settings and are required by their employers, by their states, and by governmental agencies—as well as by ASHA—to comply with prescribed personnel standards related to certification and licensure. The term clinical educator often is used to describe individuals engaged in supervision of student clinicians (audiology students and speech-language pathology students) in any clinical setting. The term preceptor applies to audiologists who supervise audiology students in their final externship.
Although the standards and requirements can and do differ, under the Code, members and certificate holders delivering or supervising clinical services must hold ASHA certification—the Certificate of Clinical Competence in Audiology (CCC-A) or the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP)—in the area of their clinical or supervisory work regardless of the work setting, state, or jurisdiction in which they are employed. As the Issues in Ethics statement Clinical Practice by Certificate Holders in the Profession in Which They Are Not Certified (ASHA, 2017) states, "When audiologists and speech-language pathologists are engaged in any aspect of professional practice, it is essential that they function within the scope of practice of their respective professions (i.e., audiology or speech-language pathology) and only within the scope of their competence, as determined by their certification status, education, training, and experience."
Further, ASHA-certified individuals who are engaged in supervision of student clinicians are bound to honor their responsibility to hold paramount the welfare of persons they serve professionally and to ensure that services are provided competently by students under their supervision. Whether the term used is supervisor, clinical educator, or preceptor, all of these individuals exercise professional authority or power over students. With that professional authority or power over students also comes an expectation of trust.
Discussion
The Board of Ethics cites and interprets the following sections of the Code that pertain to the supervision of student clinicians:
- Principle I: Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or who are participants in research and scholarly activities, and they shall treat animals involved in research in a humane manner.
- Principle I, Rule A: Individuals shall provide all clinical services and scientific activities competently.
- Principle I, Rule D: Individuals shall not misrepresent the credentials of aides, assistants, technicians, support personnel, students, research interns, Clinical Fellows, or any others under their supervision, and they shall inform those they serve professionally of the name, role, and professional credentials of persons providing services.
- Principle I, Rule G: Individuals who hold the Certificate of Clinical Competence may delegate to students tasks related to the provision of clinical services that require the unique skills, knowledge, and judgment that are within the scope of practice of their profession only if those students are adequately prepared and are appropriately supervised. The responsibility for the welfare of those being served remains with the certified individual.
- Principle II, Rule A: Individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience.
- Principle IV, Rule H: Individuals shall not engage in sexual activities with individuals (other than a spouse or other individual with whom a prior consensual relationship exists) over whom they exercise professional authority or power, including persons receiving services, assistants, students, or research participants.
- Principle IV, Rule I: Individuals shall not knowingly allow anyone under their supervision to engage in any practice that violates the Code of Ethics.
- Principle IV, Rule L: Individuals shall not discriminate in their relationships with colleagues, assistants, students, support personnel, and members of other professions and disciplines on the basis of race, ethnicity, sex, gender identity/gender expression, sexual orientation, age, religion, national origin, disability, culture, language, dialect, or socioeconomic status.
ASHA-certified individuals who supervise students cannot delegate the responsibility for clinical decision making and management to the student. The legal and ethical responsibility for persons served remains with the certified individual. However, the student can, as part of the educational process, make client management recommendations and decisions pending review and approval by the supervisor. Further, the supervisor must inform the client or client’s family of the qualifications and credentials of the student supervisee involved in the provision of clinical services.
All supervised clinical activities provided by the student must fall within the scope of practice for the specific profession to count toward the student's certification. The supervisor or preceptor must achieve and maintain competency in supervisory practice as well as in the disability areas for which supervision is provided. The amount of supervision provided by the ASHA-certified supervisor must be commensurate with the student’s knowledge, experience, and competence to ensure that the welfare of the client is protected. The supervisor must also ensure that the student supervisee maintains confidentiality of client information and documents all client records and billing information, if applicable, in an accurate and timely manner.
Differences may exist in the type and amount of supervision of student supervisees that is required for teacher certification in audiology and speech-language pathology, state licensure in the professions of audiology and speech-language pathology, and ASHA certification in audiology and speech-language pathology. In states where credential requirements or state licensure requirements differ from ASHA certification standards, supervised clinical experiences (including student practica for teacher licensing) will count toward or may be applied toward ASHA certification requirements only if those clinical experience hours have been supervised by ASHA-certified personnel.
Guidance
ASHA-certified individuals who supervise students should possess or seek training in supervisory practice and provide supervision only in practice areas for which they possess the appropriate knowledge and skills. The supervisor must oversee the clinical activities and make or approve all clinical decisions to ensure that the welfare of the client is protected. The supervisor should inform the client or the client’s family about the supervisory relationship and the qualifications of the student supervisee.
The supervisor must provide no less than the level of supervision that is outlined in the current certification standards and increase supervision if needed based on the student’s knowledge, experience, and competence. The supervisor should document the amount of direct and indirect supervision provided and should design and implement procedures that will protect client confidentiality for services provided by students under supervision.
ASHA members and certificate holders who are engaged in the preparation, placement, and supervision of student clinicians must make reasonable efforts to ensure that direct practicum supervision is provided by professionals holding the CCC-A or CCC-SLP. They must inform students who engage in student practica for teacher licensing or who engage in other clinical experiences under a non-ASHA-certified supervisor that these experiences cannot be applied to ASHA certification. ASHA-certified personnel cannot sign for clinical practicum experiences that were actually supervised by non-ASHA-certified individuals. It is unethical for certificate holders to approve or sign for clinical hours for which they did not provide supervision.
