JCPSLP Vol 14 No 1 2012

and may provide some evidence to an employer in procedures to verify an individual’s competency to perform FEES. However, these courses and workshops do not usually assess participants’ competency in performing the procedure. Employers are therefore obliged to devise their own means of assessing competency in FEES. This may be difficult in situations where there are no other individuals who are competent to perform FEES at that workplace. In these instances, there are issues regarding who is suitably qualified to conduct the assessment, and what do they assess? Better Skills Best Care (BSBC) was a Victorian project funded by Department of Health Victoria (formerly Department of Human Services [DHS]) that aimed to address the issue of access, availability, and quality of training in areas of workforce redesign and role advancement and extension (DHS, 2007). The project provided a framework for developing and assessing of competency of new and extended work roles. As an area of advanced practice, the use of FEES by SPs was identified as a work role that could enhance patient care in the area of dysphagia. At the time, opportunities for a training program with a strong pedagogical basis were limited. Department of Health Victoria commissioned La Trobe University School of Human Communication Sciences and Austin Health Speech Pathology Department to develop and deliver a training program to teach and examine the competencies required to perform FEES. A number of Melbourne metropolitan hospitals were involved in the project as pilot sites and funded by DHS to nominate SP staff to participate in the FEES training course. The pilot course funded by Department of Health Victoria was run from June to December 2007. It was then delivered by La Trobe University in conjunction with Austin Health. A problem-based learning approach supported the adult learning educational framework of the course, with mastery learning activities (e.g., self-study and workplace training) incorporated to ensure a solid link was made between the learning outcomes achieved in coursework and participants’ abilities to undertake the procedure in their local workplaces. The coursework component of the course amounted to approximately 30 hours, with participants required to complete approximately 8 hours of self-study using pre-recorded FEES images, interactive multimedia programs, texts and journal articles, and approximately 20 hours of local workplace training. The La Trobe University/Austin Health short course takes some positive steps towards training SPs to competency in the use of FEES, with 21 SPs successfully completing all the requirements of the course. However, the 2007 and 2008 versions of the course were unable to include training in the technical competencies required to perform FEES. The course was also limited to individuals who had access to the relevant equipment and supervision for training. Continued progress is required to develop professional development opportunities with a standardised approach to training that support a model of service delivery in which SPs are independent in all components of the procedure, including inserting and manipulating the endoscope. This model of service delivery will work towards improving patient access to instrumental assessment of swallowing function, and will ultimately be more cost-effective than the other models of service delivery previously discussed. The course is currently under review, with the vision to include a

greater component of on-line activities to improve flexibility in learning as well as activities to maintain competency. Future training models may incorporate the use of simulation as has been used by colleagues in the USA (Benadom & Potter, 2010). Conclusion FEES is an instrumental tool that provides unique and complementary visual information about swallowing function compared to VFSS. It has the capacity to improve patient access to an instrumental swallowing assessment, and may also contribute to more timely and comprehensive diagnosis and management of dysphagia. In many cases where the underlying pathophysiology of a presenting dysphagia remains unclear, and it is difficult to establish a set of recommendations to maximise swallowing safety and efficiency, it may be very useful to undertake both VFSS and FEES in order to develop a more comprehensive representation of swallowing. Health services with established FEES services and those intending to introduce FEES into clinical practice should continue to work towards maximising patient access to this procedure by developing and implementing cost-effective service delivery models where SPs are competent to perform all components of the procedure. Supporting these service delivery models with a consistent and rigorous approach to training will assist in developing and promoting standards of practice that optimise the safety and effectiveness of the procedure. The transition towards more speech pathologists undertaking FEES independently should not be seen as a threat to an interdisciplinary approach to the management of dysphagia. Speech pathologists, whether they use VFSS and/or FEES as part of their management of dysphagia, need to ensure that their clinical decisions are based on the needs of an individual patient, and where possible, informed by scientific evidence. Acknowledgements The authors would like to acknowledge Dr Jennifer Oates, School of Human Communication Sciences, and Ms Rhonda Holmes, Speech Pathology, Austin Health, as co-developers of the La Trobe University/Austin Health FEES Competency Short Course. The Department of Health Victoria (formerly Department of Human Services) is also acknowledged for its support to enable the development La Trobe University/Austin Health FEES Competency Short Course. References American Speech-Language-Hearing Association. (2000). Clinical Indicators for Instrumental Assessment of Dysphagia [Guidelines]. Retrieved from http://www.asha. org/docs/pdf/GL2000-00047.pdf Aviv, J. E., Kaplan, S. T., Thomson, J. E., Spitzer, J., Diamond, B., & Close, L. G. (2000). The safety of flexible evaluation of swallowing with sensory testing (FEESST): An analysis of 500 consecutive evaluations. Dysphagia , 15 , 39–44. Aviv, J. E., Murry, T., Zschommler, A., Cohen, M., & Gartner, C. (2005). Flexible endoscopic evaluation of swallowing with sensory testing: patient characteristics and analysis of safety in 1,340 consecutive examinations. Annals of Otology, Rhinology, and Laryngology , 114 , 173–176.

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JCPSLP Volume 14, Number 1 2012

Journal of Clinical Practice in Speech-Language Pathology