Wait…Is That Okay?: Student Voices on Ethics in Clinical Placements

Entering off-campus clinical placements marks a pivotal transition for graduate students in speech-language pathology and audiology. These placements offer students the chance to showcase their academic preparation and further increase and refine their clinical skills. However, along with the excitement of working directly with clients comes a host of ethical responsibilities and dilemmas that many students feel unprepared to navigate.  

Graduate students placed in off-campus clinical placements serve in the dual role of both learner and service provider. The responsibility of their clinical supervisor is to uphold and model ethical professional practice at all times, yet students witness practices that may conflict with the ASHA Code of Ethics or are asked to perform tasks that stretch the limits of their competence. Unlike licensed professionals, students often feel they have a reduced ability to question authority or advocate for clients without jeopardizing their evaluations or relationships with clinical supervisors. 

To highlight how graduate students in speech-language pathology and audiology respond to ethical challenges, three students were presented with fictional scenarios that could be encountered during various clinical placements. The students were asked to identify the ethical issues involved, reference relevant principles from the ASHA Code of Ethics, and explain how they would approach each situation. Their responses offer insight into how emerging professionals interpret and apply ethical standards.  

Scenario: You and a classmate are both working in pediatric medical placements this semester and have students with similar profiles. Your classmate is using the student’s first name when discussing their recent evaluation report while you are waiting for class to start. How do you respond to your classmate? 

Student Response: In this situation, I would consider this to be a violation of HIPAA because my classmate is sharing their client’s first name in conjunction with their profile, which likely includes other protected health information such as their age or diagnosis. I would politely inform my classmate that the information they are sharing is protected health information so that they do not continue to share sensitive information in front of myself and other individuals who may be waiting for class to begin. In this situation, I feel that it would be my responsibility to reach out to my university’s designated HIPAA officer to report this incident so that it may be handled the appropriate way.  

Relevant Ethical Principle: Principle of Ethics I P: “Individuals shall protect the confidentiality of information about persons served professionally or participants involved in research and scholarly activities. Disclosure of confidential information shall be allowed only when doing so is legally authorized or required by law.”  (American Speech-Language-Hearing Association, 2023) 

Scenario: You interviewed with a private practice company that specializes in a therapy approach you are unfamiliar with. They offer to train you in this method as it will be an expected therapeutic approach used in your role, but something feels off about it. What might you do? 

Student Response: In this case, as with many situations, I would apply the “gut check,” meaning I would lean into my uneasy feeling to uncover more information. I would search for evidence-based research on this therapy approach and see if ASHA has any information on it as well. I would also reach out to trusted mentors (e.g., current or past supervisors) in the field to see if they have heard of this therapy approach and of the private practice. Depending on what I learn about this therapy approach, I may decide to politely decline future interview opportunities in order to uphold my duty to provide best, evidence-based care for those I serve.  

Relevant Ethical Principle: Principle of Ethics I L:“Individuals who hold the Certificate of Clinical Competence shall use independent and evidence-based clinical judgment, keeping paramount the best interests of those being served.” (American Speech-Language-Hearing Association, 2023) 

Scenario: You are completing an off-campus clinical placement in a SNF. Your supervisor is new to supervision and you are her first student. After three weeks, she tells you that she feels confident you can start seeing your own patients, while she sees other ones. You are concerned that she will not be able to observe you at least 25% of the time with each patient. Is this an ethical practice? What are your next steps? 

Student Response: This would be an unethical practice. I would directly tell my supervisor that her supervision is needed for at least 25% of the time. 

“Individuals who mentor Clinical Fellows, act as a preceptor to audiology externs, or supervise undergraduate or graduate students, assistants, or other staff shall provide appropriate supervision and shall comply—fully and in a timely manner—with all ASHA certification and supervisory requirements.” (American Speech-Language-Hearing Association, 2023) 

Scenario: You are in your first off-campus clinical placement in a school setting. At your first IEP meeting, your supervisor introduces you to the parents and they seem confused. They mention that they didn’t know you were working with their student. What is the issue here? 

Student Response: This would be a tough and awkward situation as a student. A supervisor has a duty to inform their students’ parents/guardians that a student clinician will be working with their child for the next couple weeks/months, and specifically for this case, the parents should have been informed of all who will be present at an IEP meeting in advance. Since the supervisor did not inform or obtain consent about my presence at this IEP meeting, I would directly ask the parents for their consent to attend the meeting for learning purposes. After the meeting, I would respectfully ask my supervisor what the protocol is for providing informed consent to families when the SLP has a graduate student working with them and confirm that has been done for the remainder of the caseload. 

Relevant Ethical Principle: Principle of Ethics I D: “Individuals shall not misrepresent the credentials of aides, assistants, technicians, students, research assistants, 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.” (American Speech-Language-Hearing Association, 2023) 

Scenario: Your school placement supervisor has expressed frustration with having to complete so many evaluations. Many of these students end up qualifying for services and their caseload keeps growing. After seeing some of the students, you suspect that many of them are exhibiting language differences rather than language delays, secondary to their status as multilingual learners. Your supervisor doesn’t often stray from strictly giving the CELF-5 and GFTA-3 as assessment measures. What is the concern with using only standardized tests with this population that they might be overlooking? 

Student Response: My concern is that, by only giving standardized tests and not accounting for multilingual language development and skill acquisition, my supervisor is not capturing an accurate representation of these students’ language skills. In doing so, my supervisor is likely over diagnosing language differences as language disorders. This can be emotionally harmful as it sends a negative message about the students’ multilingual status in the school environment, as well as academically harmful, as it can result in pulling students out of class time for services that they do not actually require. If my supervisor were to use bilingual assessments, informal assessments, and seek guidance from a bilingual SLP in addition to administering standardized assessments, they would likely gather a more well-rounded understanding of the child’s language abilities, be able to make better-informed clinical decisions about service delivery, and create a more welcoming, inclusive space for multilingual learners.  

Relevant Ethical Principle: Principle of Ethics II C:“Individuals shall enhance and refine their professional competence and expertise through engagement in lifelong learning applicable to their professional activities and skills.” (American Speech-Language-Hearing Association, 2023) 

Scenario: You have to submit a final presentation regarding your clinical placement. Your supervisor mentions that her student last year had a great presentation that she could showyou for inspiration. You are utilizing many of the same therapy techniques for the same population and joke that you wish you could just submit theirs. Your supervisor winks and says I won’t tell if you don’t and sends you their presentation. What are the ethical issues at play here? 

Student Response: The ethical concern here is that if you don’t cite the work, you are plagiarizing. While you can look at what the student has done, your work should be entirely your own and should include appropriate citationsand give credit where it’s due. 

Relevant Ethical Principle: Principle of Ethics IV L: “Individuals shall reference the source when using other persons’ ideas, research, presentations, results, or products in written, oral, or any other media presentation or summary. To do otherwise constitutes plagiarism.” (American Speech-Language-Hearing Association, 2023) 

While these scenarios are fictional in nature, similar situations are a reality for both students and professionals in speech-language pathology and audiology. Current graduate students have the following recommendations to help strengthen knowledge and confidence for using ethically sound practices in both clinical placements and future clinical practice: 

• Become familiar with and refer to the ASHA Code of Ethics throughout your time as a student and your career as a future clinician
• Trust your gut instinct when a situation does not feel right  
• Have open discussions with student peers, clinical supervisors, trusted mentors in the field, and university personnel when you are unsure about a situation 
• Don’t be afraid to advocate for yourself, individuals you serve, colleagues, etc. if you are involved in a situation that does not align with ethical practice standards  
• Encourage others to uphold the ASHA Code of Ethics by being a role model to advocate when necessary 
• Keep current with evidence-based information and engage in ongoing continuing education to ensure best practices as you continue in this field 
• Familiarize yourself with what constitutes an ethical violation and the appropriate channels in which to report a violation