External Clinical Practicum

Introduction

Clinical practica are an essential component of graduate education in speech-language pathology. Clinical practice is not only the opportunity to apply theoretical knowledge acquired in academic courses; it is the training ground for mastering the full skill set required for clinical practice, including interpersonal communication, writing skills, professional conduct, behavior management, evidence-based practice, as well as business-related aspects of speech-language pathology such as billing and reimbursement.

Basic Tenets of Professionalism

• Taken from: Chial, M. R., 1998. Conveying expectations about professional behavior Audiology Today, 10, 25. 

• This article has stood the test of time because every professional was once a novice, starting right where you are now, and had to learn these exact things (University of Virginia, Speech-Language Pathology): 
  • You show up. 
  • You show up on time. 
  • You show up prepared. 
  • You show up in a frame of mind appropriate to the professional task. 
  • You show up properly attired. 
  • You accept the idea that “on time,” “prepared,” “appropriate,” and “properly” are defined by the situations, by the nature of the task, or by another person. 
  • You accept that your first duty is to the ultimate welfare of the persons served by your profession, and that “ultimate welfare” is a complex mix of desires, wants, needs, abilities, and capacities. 
  • You recognize that professional duties and situations are about completing tasks and about solving problems in ways that benefit others, either immediately or in the long term. They are not about you. When you are called upon to behave as a professional, you are not the patient, the customer, the star, or the victim. 
  • You place the importance of professional duties, tasks and problem-solving above your own convenience.
  •  You strive to work effectively with others for the benefit of the person served. This means you pursue professional duties, tasks, and problem-solving in ways that make it easier (not harder) for others to accomplish their work. 
  • You properly credit others for their work. 
  • You sign your work.
  • You take responsibility for your actions, your reactions, and your inaction. This means you do not avoid responsibility by offering excuses, by blaming others, by emotional displays, or by helplessness. 
  • You do what you say you will do. By the time you said you would do it. To the extent you said you would do it. And to the degree of quality you said you would do it. 
  • You take active responsibility for expanding the limits of our knowledge, understanding, and skill. 
  • You vigorously seek and tell the truth, including those truths that may be less than flattering to you. 
  • You accept direction (including correction) from those who are more knowledgeable or more experienced. You provide direction (including correction) to those who are less knowledgeable or less experienced. 
  • You value the resources required to perform professional duties, tasks, and problem-solving, including your time and that of others. 
  • You accord respect to the values, interests, and opinions of others that may differ from your own, as long as they are not objectively harmful to the persons served. 
  • You accept the fact that others may establish objectives for you. While you may not always agree with those goals, or may not fully understand them, you will pursue them as long they are not objectively harmful to the persons served. 
  • When you attempt a task for the second time, you seek to do it better than you did it the first time. You revise the ways you approach professional duties, tasks, and problem-solving in consideration of peer judgments of best practices. 
  • You accept the imperfections of the world in ways that do not compromise the interests of those you serve or your own pursuit of excellence. 
  • You base your opinions, actions, and relations with others upon sound empirical evidence, and upon examined personal values consistent with the above. 
  • You expect all of the above from other professionals.

Placement Procedures

Each student will complete an Externship Interest form during their first fall in the program, in addition to an interview with one or more externship coordinators. This form will be provided to students through an online survey web app. During the student’s second year of studies, they will be placed in an externship at two off-site facilities and may be given the opportunity to gain some clinical hours via telepractice or clinical simulation. Please note there are caps on the number of telepractice and simulation hours that may count toward clinical certification in speech-language pathology.

In order to arrange an externship, the University must have a contract established with the site. All clinical practicum assignments will be made by the Externship Coordinator based as closely as possible on student interest, the student’s demonstrated competence, the student’s identified areas of clinical need, and site availability; however, there is no guarantee that the student’s preferred choice(s) will be offered. Please note, healthcare sites are highly competitive. Each clinical practicum will provide the student with a range of clients across the lifespan with varied disorders. The goal of the program is to provide each student with three significantly different experiences, with Monmouth University’s Center for Speech and Language Disorders serving as one experience. Most sites require interviews and resume reviews. A site interview does not guarantee acceptance. Final externship assignments are at the sole discretion of the Externship Coordinator in conjunction with the facility. Students are not permitted to turn down an externship interview offer or site assignment. In the event a student refuses a site assignment, the student will be placed at the end of the placement queue and there will be no effort to place the student elsewhere prior to all other students receiving their placement assignments. This will likely result in a delay in graduation.

Students must complete all externship prerequisites prior to their placement date (i.e. coursework, clinical benchmarks, background check, physical, etc.) Students must schedule necessary appointments to complete prerequisites outside of their course schedule or academic requirements. Absences due to completion of prerequisites for externship will NOT be excused. Please contact your professor in advance if there is a schedule conflict and alternate dates are unavailable to complete prerequisites or orientation.

Students will be required to comply with all specific requirements of their clinical placement facility. These requirements may include, but are not limited to: fingerprinting, drug screens, proof of flu shot, proof of a variety of vaccinations, proof of tuberculosis testing, wearing a mask, smoking guidelines, documentation deadlines, site-specific hours of operation, etc. The program does not assume any responsibility for these items other than informing the student of the obligation to follow site requirements. Students are responsible for any additional fees incurred for requirements, as well as transportation to/from the site. If a student fails to obtain all necessary requirements and clearance by the start date, the student forfeits his/her clinical experience at the assigned site for the semester.

COVID-19 Guidance

Effective with the start of the Summer 2023 semester, which begins on May 15, we will no longer require that all members of the community get the COVID-19 vaccine primary series or bivalent booster. Students and faculty engaged in clinical/fieldwork or other experiential learning are required to follow each clinical or field site’s policies, which may include proof of full vaccination.

We continue to highly recommend that all members of the community get the COVID-19 vaccine primary series as well as the bivalent booster as recommended by the CDC. We also encourage all students and employees to continue to inform the University of their COVID-19 vaccination status on the health portal to ensure that the University can respond appropriately to any outbreak situation on campus, consistent with prevailing CDC guidelines. Some external sites may require proof of COVID-19 vaccination, and we must respect the rules and regulations of each site. Therefore, a student that has not or will not receive the COVID-19 vaccination may not be eligible to participate in clinical practicum at sites where vaccination is required. COVID-19 exposure guidelines and positive test guidelines will be followed according to each site’s respective rules and regulations.

Please note, if the CDC and/or New Jersey Department of Health guidelines change, the University will revisit this policy and may change its requirements. Please check the university website for the latest information on COVID-19 policy: https://www.monmouth.edu/covid-19/

Thank you for your continued cooperation as we work to keep our campus healthy and safe. If you have specific questions about our COVID-19 protocols, please contact Health Services at health@monmouth.edu.

Schedule

Each student’s start and end date will vary based upon the externship site, not necessarily Monmouth University’s academic calendar. Each student is expected to complete a 14-week clinical rotation, however, some sites may require more than 14 weeks of clinical practice. The external site will dictate the number of days per week that the student is expected to attend, which ranges from three days to five days per week. The following guidelines will be adhered to by all students:

• Students will begin externship within 7 days of the University semester start date, and will end no earlier than Reading Day as per the University calendar, which will be provided to each supervisor.
• Schedules are created by the supervising clinician and may range from 3 days per week to 5 days per week according to specific site needs and requests.
• Students are required to be on campus one to two late afternoons and/or evenings each week for their coursework. The student is not to manipulate his or her schedule beyond what is required to return to campus for coursework.

• Changes to the schedule must be discussed with the external site supervisor and the Externship Coordinator. Violation of this policy will impact your grade. The expectation is that the student’s externship schedule will be created according to the externship site’s needs and required coursework scheduled for that semester.
• The program understands that some students choose to maintain some form of employment. Under no circumstances will externship site schedules or assignments be tailored to meet employment schedules.

*** If exceptions are needed, the supervising clinician must contact the Externship Coordinator to inform the University of the change.***

Attendance, Tardiness, Illness

The Monmouth University Academic Calendar will likely differ from the externship site schedule. All Monmouth University course meeting times shall be observed regardless of an externship site calendar (e.g., spring break). In exactly the same way, all scheduled externship activities shall be observed regardless of Monmouth University’s Academic Calendar (e.g., spring break). Every attempt should be made for the student to attend his or her externship each day. Students are not to schedule vacation time during clinical practica. If for some reason, the student is unable to attend their externship, they must notify their immediate supervisor as well as the Monmouth University Externship Coordinator. Absences will be excused with a doctor’s note which specifies the day of service. Session plans are to be made available to a covering therapist, and plans are to be sent to the external supervisor along with the Externship Coordinator. Any sessions or days that are to be made up in lieu of an absence are solely at the discretion of the clinical supervisor.

If the student anticipates being late or needs to leave the external site early, the student must notify the Monmouth University Externship Coordinator and their external site supervisor via email or telephone of an estimated arrival time and/or departure time. Additionally, all students must notify the Monmouth University Externship Coordinator via email of any changes in their clinical schedule which relate to external site supervisor illness, change in hours or days, days off for inclement weather, etc.

A student who fails to notify the externship supervisor and Monmouth University Externship Coordinator of an absence or tardiness will be subject to disciplinary action by the Monmouth University Speech-Language Pathology Program.

A student who accumulates more than ONE unexcused absence will have their grade reduced by one letter grade (A –> B). However, a site supervisor may choose to dismiss the students for any unexcused absence.

Travel and Expenses

Students may be required to travel up to 60 miles from their home in order to complete an externship. As each externship site and travel time will vary, you may incur expenses and fees such as tolls, cost of gas, payment for subway, etc. Students may incur additional expenses and fees for background checks, fingerprinting, medical testing and/or application costs associated with their external placements.

Students are responsible for their own transportation to and from external sites. Arrangements for use of a personal automobile or public transportation are the student’s responsibility. Lack of transportation will not be considered a reason to cancel a confirmed day at the placement. Lack of reliable transportation must be made known to the site and the externship coordinator immediately. Inability to be physically present at the externship site will likely delay graduation.

Student Dress Code/Cell Phones

Dress code and grooming standards are imperative in presenting a professional appearance. All faculty, staff, and students are expected to dress in attire that presents a clean, professional appearance at all times when in the clinical spaces. Personal hygiene and grooming must also reflect professionalism in clinical spaces. Clothing and grooming styles dictated by religion or ethnicity are exempt from this policy. It is the supervisor’s decision whether to allow a student to proceed with a scheduled session/meeting when the dress code has been violated. Students should also be aware that many offsite facilities have dress codes that are more stringent/specific. It is the student’s responsibility to ask the off-site supervisor to review the code with them.

• ID badge (either site-specific or name tag from Clinical Practicum) must be worn in clear sight at all times
• Clothes must be neat and clean with the proper fit and length. This includes dresses and skirts that when measured from a seated position, are no shorter than four (4) inches from the front of the knee to the bottom hem of the dress or skirt. Clothing must be free of rips and must not be sheer or revealing in nature (e.g. no torn jeans, spaghetti straps, halters, or midriff tops).
• No t-shirts with advertisements, sayings, or logos
• No denim blue jeans or shorts
• No sports attire (including exercise clothing, hats, and sports sandals).
• Tattoos that are perceived as offensive, hostile, or that diminish the effectiveness of professionalism must be covered, and not visible to staff, clients or visitors.
• Scented personal products (fragrances, cologne, and lotions) should be minimally noticeable and not a distraction to others.
• Hair, including facial hair, must not be wet and should be styled in a professional manner.

Scrubs/Lab Coats

Students may be required to wear scrubs or lab coats at certain external sites. Lab coats will be purchased for all students at the start of the Fall semester. These lab coats can be used for external sites that may require them.

Cell Phones

Students should abide by each individual site’s cell phone policy. Overall it is good clinical practice to eliminate any cell phone use during patient care, professional meetings and activities, and meetings with supervisors/mentors unless prior consent is granted. Students must also gain consent prior to using personal laptops and other electronic devices at each site, unless authorized as an accommodation by the Department of Disability Services. This accommodation must be discussed with the Externship Coordinator and external supervisor prior to use. Failure to follow these guidelines will result in disciplinary action.

Required Paperwork/Therapy

Each facility will require report writing and record keeping for every patient/client on caseload. These records may include lesson/treatment plans, progress notes, goal writing, discharge report, IEP requirements, and a variety of other record-keeping—either paper or electronic. Students should be aware of all due dates that the facility has in place for the completion of records.

Each facility will require students to design, conduct, and evaluate their own therapy sessions for each patient/client. Students will be required to choose materials, select therapy techniques, and carry out appropriate therapy sessions. Evidence-based practice, HIPPA guidelines, FERPA guidelines, ethical conduct, and professionalism will be considered. Therapy sessions will be conducted under direct supervision per ASHA requirements.

Tracking of Clinical Hours

It is the student’s responsibility to track and maintain a log of all clinical hours over the course of the externship. Students should record their hours on the Calipso tracking system at least once weekly. Clinical supervisors will receive an email from Calipso whenever a student posts hours and these postings can be approved each time or held for weekly or monthly approvals. Clinical hours may only be recognized as approved by a signature/online approval from their direct external clinical supervisor. Supervisor instructions for Calipso will be emailed to supervisors with a PIN number for registration along with a call-in number and email address for direct assistance, as needed. If external supervisors have any issues with Calipso, they can contact the Externship Coordinator via phone or email.

See Calipso Student Instructions.

Safety Requirements

Safety requirements mandate that bloodborne pathogen training be completed online with the accompanying certificate of completion printed and provided to the Director of the Center for Speech and Language Disorders for inclusion in the clinical student chart. CPR training is required prior to beginning the external placement. Additional safety training may be required by individual sites.

Evaluations

A midterm and final evaluation will be completed in Calipso by your direct supervisor. Additionally, the student will complete a self-rating in Calipso.

Supervisors will conduct ongoing, formative evaluations of student clinicians on a daily basis, and while these evaluations may not be formal in nature, they are of equal importance. Supervisors may provide feedback in varying forms including verbal or written feedback. This feedback may also be given before, during, or after clinical sessions. Students are responsible for incorporating feedback into the next scheduled session and showing progress in clinical skills over the course of the semester, along with progress in any other areas delineated by the clinical supervisor. Daily performance is equally as important in externship success as midterm and final evaluation scores.

Remediation

Clinical performance below expectation in any area must be remediated to meet minimal competency requirements. If an external supervisor contacts the externship coordinator with concerns regarding clinical performance, a meeting will be held and a remediation plan will be put into place in order to help the student succeed in the placement. The external supervisor, in concert with the Program Director and Externship Coordinator, will determine the need for clinical remediation. Remediations may occur at any point in the semester and must be completed within the designated timeframe.  Please note: due dates for all remediation assignments are at the discretion of your clinical supervisor. It is the student’s responsibility to adhere to the due date associated with a remediation assignment, failure to comply may result in the need for further remediation and/or failure of clinical practicum. Please keep in mind, a remediation assignment will not change the original grade earned. Failure in clinical performance may result in dismissal from the site. Clinical hours obtained during an unsuccessful clinical experience will not count toward the minimum required clock hours for graduation.

Dismissal from Site

On the rare occasion that a student is dismissed from a clinical site, the student will earn an “incomplete” or a “fail”. Students who are dismissed due to poor performance (clinical, professional, or both) may receive a grade of “incomplete” or “fail”, based on circumstances, for the semester and will be required to complete one-on-one remediation with the externship coordinator before repeating the clinical practicum experience the following semester. The determination of an “incomplete” or “fail” grade will be determined by three parties: Monmouth University’s Externship Coordinator, the external site supervisor, and the Program Director. Additionally, if a student leaves a site at their own discretion, they may receive an “incomplete” for the semester, and will complete remediation before repeating the clinical experience the following semester. This will result in a delay in graduation. If a student is dismissed from a site due to site or staffing issues (for example, site closure or supervisor resignation), the externship coordinator will make all attempts to assist the student in completing the semester at an alternate site and/or via clinical simulation. The department will take all necessary steps to avoid a delay in graduation in this case, but that cannot be guaranteed. In order to prevent these issues, it is of the utmost importance for students and/or site supervisors to contact the externship coordinator with any issues or concerns early on in the semester so the problem might be resolved. All site dismissals are handled on a case-by-case basis, as each scenario requires individualized attention.

Dismissal from Program

In addition to Monmouth University’s general policies outlined in the Graduate Catalog, three additional policy areas may lead to dismissal from Monmouth University’s M.S.Ed. in Speech-Language Pathology (SLP) Program: (1) poor academic/clinical performance, (2) inability to demonstrate the essential skills for a career in SLP, and (3) unprofessional or unethical conduct.

Poor Academic or Clinical Performance:

Satisfactory progress through the SLP program requires a minimum passing grade of ‘C’ (73%) in each course and a minimum 3.0 cumulative GPA. Failing to receive a grade of ‘C’ or better in any course will automatically result in dismissal from the program. Failing to achieve a 3.0 semester GPA for the first time will automatically result in a student being placed on Academic Warning. Failing to achieve a 3.0 semester GPA for the second time, will automatically result in a student being placed on Academic Probation. Failing to achieve a 3.0 semester GPA for the third time will automatically result in a student being dismissed. Students cannot continue in clinical training if on Academic Warning or Probation, potentially changing the program completion date (i.e., students must have a cumulative 3.0 GPA to continue with their clinical phase of training). Students can have a maximum of one academic probation during the program (i.e., a second academic probation will result in automatic dismissal from the program).

Inability to Demonstrate the Essential Skills for a Career in SLP:

A student who cannot successfully demonstrate the essential functions, or essential skills, for clinical practice, cannot be endorsed for American Speech-Language-Hearing Association (ASHA) clinical certification. Upon application to the M.S.Ed. Program in speech-language pathology, students provide endorsement of their own ability to fulfill the essential skills and functions for clinical practice via signature.

For each student, the faculty, clinical supervisors, and Program Director will monitor for signs of poor demonstration of essential skills beginning immediately upon enrollment in the Program and will continue throughout the completion of the Program. The faculty/supervisor identifying a sign of struggle, the Program Director, and the student in question will meet to explore any concerns with demonstration of essential skills. As indicated by circumstances, the team will (a) counsel the student, (b) prescribe a remediation plan, (c) implement the plan, and (d) monitor the outcome. The intent of the first and follow-up meetings will be (1) to support and facilitate growth/progress in developing the student’s skills and functions (2) apprise the student of his/her status as determined by the faculty, supervisor, and/or Program Director, and (3) counsel the student regarding possible and likely dispositions. When the outcomes of the remediation plan do not indicate demonstrable growth in essential skills and functions, the Program must fulfill the ethical responsibility of recommending to the School of Education’s Academic and Professional Dispositions Review Committee (APDRC) terminating a matriculation plan (dismissing the student) that is not leading to clinical competence sufficient for meeting the American Speech-Language-Hearing Association’s Council for Clinical Certification (CFCC) certification standards. With APDRC’s recommendation, a student is dismissed from the Program and counseled regarding career alternatives. No more than two formal clinical remediations are permitted across the entire program. Any student requiring a third formal clinical remediation will be dismissed per this Inability to Demonstrate Essential Skills policy.

Unprofessional or Unethical Conduct:

When signs of unprofessional or unethical conduct are detected, faculty members/clinical supervisors intervene for the purposes of (a) educating/counseling a student, (b) identifying and invoking appropriate student support services, (c) formulating a remediation plan, (d) setting explicit expectations on outcomes, and (e) monitoring progress. The faculty/supervisor identifying a sign of struggle, the Program Director, and the student in question will meet as necessary to review progress and likely dispositions. Once a student is determined to be at risk based upon a demonstrated deficiency in professionalism and/or ethics, the student’s standing is moved from ‘good standing’ to ‘probation.’ If the remediation plan is successful, a student’s standing in the Program is returned to ‘good standing.’ When the outcomes of counseling interventions and the remediation plan do not indicate acceptable growth, as determined by the Program’s leadership, in professionalism and/or ethics, the Program must fulfill the ethical responsibility of recommending to the School of Education’s Academic and Professional Dispositions Review Committee (APDRC) terminating a matriculation plan (dismissing the student) that is not leading to clinical competence sufficient for meeting the American Speech-Language-Hearing Association’s Council for Clinical Certification (CFCC) certification standards. With APDRC’s recommendation, a student is dismissed from the Program and counseled regarding career alternatives. Please note that any violation that places a client/patient/coworker/peer student/supervisor/instructor in any level of physical, psychological, or emotional danger is grounds for immediate dismissal without remediation. All Federal, State, and local laws must be followed at all times when participating in any aspect of the M.S.Ed. in Speech-Language Pathology Program. Failure to uphold applicable laws will result in immediate dismissal from the Program without intervention.

Site Visits and Call Backs

The Externship Coordinator may conduct in-person or virtual site visits at the student’s designated externship site. This time will be used to observe a portion of the student’s session with a client, to meet individually with the clinical supervisor, and to meet with the student individually to discuss progress as well as current clinical level.

Additionally, students are required to attend all call-back sessions for SLP 683: External Clinical Practicum I and SLP 684: External Clinical Practicum II throughout the semester at the Monmouth Graduate Center as a forum for reviewing professional issues and case presentations. These call-back sessions are held in the late afternoons/evenings on coursework days and/or online synchronously in order to minimize interference with externship schedules. Travel time from external site to Monmouth University should be taken into account by the student and supervisor when planning schedules on days of call-back sessions and academic coursework.

Confidentiality/HIPAA

It is imperative to maintain client confidentiality. The Health Insurance Portability and Accountability Act of 1996 (PL 104-191), also known as HIPAA, is a law designed to improve the efficiency and effectiveness of the nation’s healthcare system and to ensure patient privacy. The student must follow all HIPAA procedures at their placement, including regulations for discussing clients/students, following confidentiality guidelines, not taking documents, not exchanging information with other agencies or family members unless directed by their supervisor, submitting electronic work on a non-secure network, etc. Failure to comply with HIPAA procedures at a clinical placement may result in disciplinary action by both the University as well as the externship site, including but not limited to grade reduction, dismissal from the externship site resulting in course failure, and dismissal from the program.

Formal HIPAA training will be completed during the student’s first summer session in SLP 604 Clinical Methods in Speech-Language Pathology.

Incidents

Any incident that may occur at the site involving a student clinician and/or client must be reported to the student’s supervisor and to the Monmouth University Externship Coordinator, with an incident report completed for the site and for the student’s clinical record at the Monmouth University Center for Speech and Language Disorders.