JCPSLP Vol 17 Supplement 1 2015_lores

order to receive a service and be provided with support, this also applies to the student – who attends the clinic to receive support and guidance from the clinical educator. Ethical planning is a practical strategy that can support a balanced approach. A key component to this is the need for transparency. Ensuring clarity among all parties underlies the success of almost every aspect of clinical education. There is a need for clinical educators, students and clients to take an objective step back and discuss the processes, relationships, responsibilities and expectations. Examples of focus questions are provided in Table 1. This will be facilitated by reflection on past experiences and drawing on successes. Such a pro-ethical step could be embedded by providing this level of detail within orientation packages and materials placed in waiting rooms in an effort to prevent potential ethical dilemmas from arising. Duties aligning to key ethical principles This layer of the grid aligns closely with that of the SPA Code of Ethics (Speech Pathology Australia, 2012), specifically addressing the principles of truth, fidelity, beneficence and non-maleficence. Beneficence in the clinical education context extends beyond the common understanding of ensuring the “most positive good” (Seedhouse, 1998) for our clients. It also encompasses responsibility towards the student, and is dependent on understanding the role clinical educators play in student learning. It is suggested that clinical educators spend time discussing the code with their students and reflecting on its application to clients and clinical experiences (see Table 1). The key component in this relationship is education . As a clinical educator, the speech-language pathologist is responsible for teaching, nurturing and providing feedback. This involves taking responsibility for imparting, rather than only expecting knowledge. Herein lies the difference between clinical education and supervision – those who teach and develop skills and those who monitor and assess skills (McAllister & Lincoln, 2004). McAllister and Lincoln’s (2004) discussion of clinical educators creating learning contracts for themselves (in addition to using these with their students) is a valid suggestion which emphasises that they too need to be constantly reflecting on their performance and experiences. The past experiences of a clinical educator provide significant support for decision-making if these situations arise again. For example, when supervising a marginal student, the clinical educator needs to take responsibility for their role as a “gatekeeper” for future professionals, and be honest with the student in giving them the required feedback. These difficult decisions and discussions align with the concept of truthfulness and loyalty, and reflecting on previous experiences and drawing on past successful outcomes can assist in supporting the clinical educator with their current decision-making. Consequences The next layer of the grid considers a broader perspective of ethical issues, and the potential consequences for society, students, clients and clinical educators themselves. For example, when considering the most beneficial outcome for the student, the clinical educator may wish to select clients taking into account the requirements of a student to develop specific competencies, the level of skill of that student and the limitations and opportunities of the workplace. However, this may come into conflict with the

Responsibility

Clinical educator

Student

Client

University

Profession

Figure 2. The clinical education balance

Student

Clinical educator

Responsibility

Client

University

Profession

Figure 3. The client focused clinical education balance

Client

Clinical educator

Responsibility

Student

University

Profession

Figure 4. The student focused clinical education balance

This paper will now explore some of the recurring ethical issues that arise in clinical education, in particular those related to balancing the needs of the client and student, drawing on the casuistry approach and the ethical grid as a tool (Seedhouse, 1998). The grid is presented in four layers to highlight the need to consider these four aspects in a comprehensive ethical analysis of a situation. It can be used in many ways, and in this context we have chosen to start in the innermost layer and work outwards. Basis or rationale for health care The core of the ethical grid addresses the key concept of autonomy – specifically, the need to both respect and create the opportunity for all parties to be actively involved (Kummer & Turner, 2011). This concept underpins the delicate balance depicted in Figure 2, in that clinical educators are attempting to balance the opportunity for students to develop independence, while ensuring the clients are actively involved in the therapy and decision- making process. The clinical educator also needs to respect the autonomy of the client and their family to provide and withdraw consent for working with a student at any time, while respecting the autonomy of the student in acknowledging and encouraging perspectives and opinions different to their own. Although the client is attending in

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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology

Journal of Clinical Practice in Speech-Language Pathology