Participating in a post-graduate clinical fellowship is a fundamental part of becoming a speech-language pathologist, serving as a basic qualification for professional certification and for becoming licensed in virtually every jurisdiction:
- All but eight states require clinical fellowship experience to meet SLP licensing requirements
- The American Speech Language Hearing Association (ASHA) requires a 36-week, 1260-hour clinical fellowship as part of its strict requirements for the Certificate of Clinical Competence in Speech Language Pathology (CCC-SLP)
Finding the right fellowship opportunity can set the tone for a speech-language pathologist’s entire career path. During a fellowship, SLPs make contacts and learn about the industry from the inside out, creating a pathway for further career progression in the years ahead. This makes it extremely important to select a fellowship position that aligns with career goals, whether with a school system, hospital, independent practice, long-term care facility or rehabilitation clinic.
The clinical fellowship, or CF, typically comes at the end of an SLP’s formal schooling. According to ASHA, the purpose behind post-graduate supervised clinical practice is fourfold:
- Integrating and applying theoretical knowledge gained in academic training to real world cases
- Evaluating strengths and identifying limitations in the fellow’s practice
- Developing and refining clinical skills consistent with the defined scope of practice
- Advancing from requiring constant supervision to an ability to practice independently
The fellowship is viewed as the final transition from student to well-qualified SLP practitioner. New graduates in the field of speech-language pathology and the authorities responsible for certifying and licensing them take this segment of pre-professional experience very seriously.
A Clinical Fellowship is the First Step Into the World of Professional Speech Language Pathology
Most master’s programs already include an extensive clinical practicum that involves working with actual patients during the course of the graduate program, but the carefully supervised setting does not provide the student with the necessary independence to truly learn all the skills critical to becoming a full-fledged SLP. Further experience and on-the-job training is necessary, and the clinical fellowship provides the ideal circumstances and environment for this to take place.
At the same time, a CF is similar to school in the sense that the candidate will be evaluated, graded, and will pass or fail according to specific requirements. ASHA’s clinical fellowship requirements involve:
- 1,260 hours of post-graduate clinical practice: 36 weeks of full-time work at a minimum of 35 hours a week OR part-time with a minimum of 5 hours per week to be completed over a course of no more than 4 years
- 80 percent of the fellow’s time must be spent in direct clinical contact with patients
- A score of 3 or better must be awarded to the fellow on the core skills section of their final evaluation
- Supervision and mentoring must be delivered by a CCC-SLP holder
Although minimum licensing requirements may vary from state to state, most closely resemble ASHA standards. In fact, in many states, the CCC-SLP is either an accepted path to licensure or is otherwise the primary path to licensure.
Scaling Back Supervision
SLP fellows spend a significant amount of time under the supervision of a competent SLP who has already undergone their own fellowship. The supervisor will offer direct supervision while fellows work with patients, supervising their work more frequently at the beginning of the fellowship, and less and less frequently as the fellowship progresses and the fellow becomes more adept and confident.
Toward the end of the fellowship, supervision may be limited to the fellow’s case notes and discussions about diagnoses and treatment plans.
A Mentor is a Critical Part of the Clinical Fellowship Experience
The candidate might work under the supervision of any number of SLPs depending on the nature of the fellowship practice, but usually one of them will serve as the fellow’s designated mentor. This mentor will provide most of the guidance during the fellowship and will serve as a resource for the candidate when, inevitably, questions arise about diagnosis or treatment in complex cases.
The role is not merely informative, however, but evaluative as well. The mentor is expected to turn in a report certifying that the clinical fellow has met all the expected requirements. This report would then be submitted to the state licensing board, and to ASHA in the event that the fellow is pursuing CCC-SLP certification.
The standard ASHA report form includes 18 different skill categories on which the candidate will be rated during three different segments of the fellowship. In general, those categories cover:
- Evaluation skills
- Treatment skills
- Management skills
- Interaction skills
The ratings take into account the accuracy, consistency, independence, and supervisory guidance required in each category.
Generally, the mentor, state licensing boards and ASHA will be looking to see performance in each category improving incrementally over the course of the fellowship.
The mentor is also responsible for tracking and affirming that the clock-hour and experience components required of the fellowship were met.
Finding the Right Mentor and Fellowship Opportunity
A fellowship is a paying job in an actual, working therapy practice. Because many SLPs are employed in school systems, naturally, many SLP fellowships are in education, but they can also be found in acute care hospitals, clinics, and long-term rehabilitation facilities.
Students are expected to line up their own fellowship opportunities, but schools and state SLP associations typically have lists of likely employers. ASHA also maintains a list of employment resources on their website that includes CF opportunities.
Perhaps surprisingly, the SLP is expected to exercise a considerable amount of discretion in their search for a fellowship position. Unlike some other medical fields where post-graduate work is luck of the draw, students in speech language pathology are encouraged to find an opportunity that is a good fit for their ambitions.
Prospective SLP fellows often consider factors that include:
- Availability of a mentor and their strengths and weaknesses in the field
- Ability of the position to fulfill requirements either for state licensure or CCC-SLP certification
- How clinical fellows fit into the operations and authority of the practice
- Whether or not the fellowship would lead to permanent employment
- Whether or not the practice or setting has a particular specialty that the candidate is interested in
At the end of a clinical fellowship, SLPs would be expected to be able to take on any entry-level SLP role and be able to work successfully and independently without close supervision. Although consulting with other SLPs and resources will be an ongoing part of any SLP’s career, the fellowship serves to impart the skills and experience required to confidently serve the needs of patients and clients.