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Conversations about re-imagining SLP clinical education. Hosted by Megan Berg, SLP.
Megan Berg 00:01
Hi everyone, my name is Megan Berg and I'm an SLP in Missoula, Montana, and this is the Reimagining SLP Podcast, a space to reimagine SLP clinical training. About a year ago, I started doing research into the CCC, including its history, purpose, intended benefits, and fumbling flaws.
Megan Berg 00:30
Some of you hearing this probably saw or heard my research, which became the FixSLP platform. I am no longer associated with FixSLP, and I am here for a different kind of conversation. My goal has always been to share information in a way that allows space for critical thinking, open debate, and collaborative solutions.
Megan Berg 00:51
And one of the things I've learned over the last year is that often, while social media can be a fantastic place to have these conversations because we can get so many people talking to each other, and we can get so many different perspectives all in one place, I think the challenge is that we can get locked into binary thinking, which is often what social media feeds kind of force us into.
Megan Berg 01:19
And so we start thinking this is right, and this is wrong, and we create sides that are kind of fighting against each other, rather than holding multiple perspectives, which is what we really need to create that sort of innovative tension that ultimately allows us to creatively and collaboratively solve problems.
Megan Berg 01:42
So you can find me on this podcast and on Instagram @re.imagining.slp. You can also email me at reimaginingslp@gmail.com. And with anything I say or write, you may disagree with me, and that's okay, because again, it's the tension of our disagreements that innovation is energized.
Megan Berg 02:06
I hope that you can learn from my research and I can learn from you and your experiences. Again, reach out to me anytime. You can send me a DM on Instagram at re .imagining .slp or email me at reimaginingslp at gmail .com.
Megan Berg 02:23
And the conversations I'm going to have on this podcast are all about reimagining clinical training for speech language pathology. And my first guest is Dr. Ian Windmill. And I hope you enjoy our conversation as much as I did.
Megan Berg 02:36
So first, I just want to introduce you a little bit. And so I know that Currently, you're the clinical director of audiology at Cincinnati Children's Hospital. And you have been the past president of the American Academy of Audiology and the chair of the board of Accreditation Commission for Audiology or the ACAE, which we will talk a lot about.
Megan Berg 02:58
But is there anything else that you want SLPs to know about you?
Dr. Ian Windmill 03:02
So I don't, I'm no longer at Cincinnati Children's. I'm semi -retired. I'm kind of working on my own out of my house now. So, but so I do think the one thing that I've been interested in is education, the education of audiologists and speech pathologists over the years.
Dr. Ian Windmill 03:24
And so I've always looked at this and it comes from a very personal place. And my own education, I didn't think was adequate. And I challenged my own university on my education. And that program doesn't exist anymore, which isn't a bad thing.
Dr. Ian Windmill 03:45
But so I've always been interested in education. So as I've worked in various centers and particularly medical type centers, the education of audiologists and speech pathologists to be able to work in those types of centers has been of interest to me.
Dr. Ian Windmill 04:02
So a lot of academic and clinical work, but education is a very high interest of mine.
Megan Berg 04:15
Excellent. And when you say that you challenged your education, how did you do that?
Dr. Ian Windmill 04:21
So when I finished my master's degree at the time, which was in 1979, I went on to get my PhD.
Dr. Ian Windmill 04:30
And of course, I have an ego like everybody else and thought I was big stuff when I finished with my degree. And I went to the University of Louisville School of- medicine was my first position and I got there in December and and I was the new guy on the block and they said okay part of your job is to go cover the clinics and patients at University Hospital.
Dr. Ian Windmill 04:56
No problem in my mind. Well in those that first week I saw more things that I'd never seen before and was asked to do things that I had never done and yet the people who were asking it just thought it was something every audiologist knew how to do.
Dr. Ian Windmill 05:15
So I remember going into a patient room and you'd been in a motor vehicle accident and of course was in not very good shape and they wanted to know the status of the facial nerve and I didn't let anyone know where do you get the chart to write in much less what to write in the chart or where to write in the chart.
Dr. Ian Windmill 05:33
So I wrote a letter back to my my program and my dean at the time, and I said, you know, you didn't really train me to do this. I don't know what I'm doing here in this environment. And it's scaring me, and it should scare the patients and physicians that are relying on what I do.
Dr. Ian Windmill 05:50
So that started kind of a journey of kind of self -reflection and understanding what my own limitations were. And then that transformed into what were the limitations of audiology training at the time.
Dr. Ian Windmill 06:04
Because I thought I went to an average program, a very typical program, I don't think it was, you know, really great or not so good. So it was just, you know, middle of the road program. I thought, boy, if I went to an average program and I'm not trained, what are people that went to lesser programs doing?
Dr. Ian Windmill 06:22
So that was kind of the genesis of my interest in how we train audiologists in particular, but because we were linked to speech pathology, it was how all of our training is developed, is regulated, is manifest, etc.
Dr. Ian Windmill 06:39
So that's how I got into it.
Megan Berg 06:41
Yeah. Yeah, I think I have a similar story and I bet a lot of people listening have a similar story. Like I was, I got really great grades throughout my program. And then when it came time for the comprehensive oral and written exam, I was spectacularly failed along with, like, it felt like half the cohort.
Megan Berg 07:06
I don't know what the number was, but they failed a lot of us. And I remember thinking like, is this a failure on my part or is this a failure of them to teach me what I need to know? Like it was just a very confusing experience.
Megan Berg 07:19
And I was older, I had had a different career before going back to grad school. And so it just felt very dehumanizing to be treated that way. And then the things that were said to me by the faculty was just very humiliating and degrading.
Megan Berg 07:35
And then when, yeah, like when I went and got a job, especially in the medical field, I had no idea what I was doing. And I think a lot of SLPs feel the same way. And especially in areas like dysphagia, and all of the practice areas that were added onto the scope, but not really built into the curriculum standards, or they kind of have been added on, but not really like comprehensively thought through, it doesn't feel like.
Dr. Ian Windmill 08:05
I really agree with that. When I was in one position, I had both audiology and speech pathology as my charge. And it was very difficult to find speech pathologists who could work in a medical setting who had any experience with dysphagia, or any of the things.
Dr. Ian Windmill 08:35
So it was, it was very difficult to find. And those that we did find had very limited knowledge. And so we spent a good deal of time sending them the training programs. And that so that's, you know, one of the kind of issues and I agree with you completely.
Dr. Ian Windmill 08:50
There's a lot of things been added on and layered on to speak to the logic over my 45-50 years, it's grown substantially in terms of its scope. But the academic programs haven't grown at all. They're essentially unchanged in the last 50 years.
Dr. Ian Windmill 09:07
And it just doesn't make sense to me why that hasn't changed and hasn't evolved.
Megan Berg 09:13
Yeah. And ASHA is not here to defend itself, but I know as an organization, they will consistently say that, you know, they send out this survey, it's all this evidence based thing is how they develop all this curriculum for this or not curriculum, but standards for the CAA.
Megan Berg 09:30
And just so we can kind of get listeners oriented to what we're talking about, I'm going to kind of walk us through what the, what the current setup is for SLP. And then could you kind of tell us how that has evolved for audiology and how it could evolve for speech pathology.
Megan Berg 09:48
So right now there's one accrediting body for speech pathology, and that is the CAA. What does that stand for? Council for Academic Accreditation. And they are an arm of ASHA. And ASHA developed that branch in the 90s, is that right?
Megan Berg 10:10
Early 2000, something like that. And it was sort of like they were combining a bunch of different committees and subcommittees and whatever. And so there's one body that credits masters level speech pathology programs in the United States, and they're tied with ASHA.
Megan Berg 10:28
And ASHA currently has a model where they sell this certification product, the certificate. of clinical competency or the CCC. And the idea behind this is that you're not getting any clinical training in your master's level program.
Megan Berg 10:47
You are getting 375 hours plus 25 observation hours, but those are only required if you eventually wanna pay for the CCC. Technically, you could get a master's degree without any clinical training. And some programs do offer that track.
Megan Berg 11:02
So the idea is that unlike every other allied health profession except for dietitians, we are expected to get our master's degree and then go off on our own and get our clinical training through this clinical fellow year and then pay for the CCC.
Megan Berg 11:25
And ASHA has it set up where the CCC is an annual renewal right now of $250 a year. And you cannot be a member of ASHA unless you have this certification. So they're tying membership with certification, which AOTA and APTA does not do.
Megan Berg 11:44
Also, AOTA and APTA do not sell a full scope certification product. Also, in the professions of OT and PT, they get all of their clinical training wrapped into the professional master's or doctorate level degree.
Megan Berg 11:58
So they're not having to go off and do this CFY. Or pay for the CCC eventually. And from my perspective, and you can tell me if I'm wrong, but ASHA does not have an incentive to wrap the clinical training into the degree.
Megan Berg 12:13
Because at this point, they're getting tens of millions of dollars, upwards of close to $60, $70, $80 million a year on these CCC renewal fees. So their entire budget is based on this recurring revenue from CCC renewals.
Megan Berg 12:34
And when we look at membership rates of AOTA and APTA, those are around 25%, 28% of therapists are voluntary members of those associations. Whereas with ASHA, we have over 100% of working SLPs are members of ASHA.
Megan Berg 12:52
And the reason it's over 100% is a lot of people are no longer working in the field, but they're afraid to stop paying for the CCC if they ever want to go back to work. So ASHA has created this situation where they have not provided any clinical training within the degree.
Megan Berg 13:09
And they are expecting people to go out and get their own clinical training and then pay ASHA for a piece of paper that says that they've done that and then renew that every single year. Do I have that correct?
Megan Berg 13:21
Is that the situation?
Dr. Ian Windmill 13:22
Okay. Sounds pretty good. Sounds pretty correct. And then it was the same for audiology, right? Like the exact same setup. And then just... just tell us everything that's happened in the last few decades.
Dr. Ian Windmill 13:37
So I think there's two perspectives here. One's my personal perspective, of course, and one's the profession's perspective. And there were a number of things that had happened over the years and kind of the eighties and nineties that were trigger points for audiology.
Dr. Ian Windmill 13:59
And it didn't start with accreditation or certification, although that was tied in a little bit. But it was just, you know, is ASHA representing audiology in an organization where you have 100 ,000 speech pathologists and 20 ,000 audiologists, and that became part of the question back then.
Dr. Ian Windmill 14:20
And I can remember in the mid nineties, the FDA was trying to do some changes to the hearing aid regulations. And they sent out a series of questions that they asked the various stakeholders, ENTs and consumers and audiologists, etc., to answer.
Dr. Ian Windmill 14:40
And so five audiology organizations got together to answer these questions. And it was the Educational Audiologists, the Academy of Rehabilitative Audiologists, the Academy of Dispensing Audiologists, the American Academy of Audiology, and the American Speech -Language -Hearing Association.
Dr. Ian Windmill 14:57
And we got into a room, and we were discussing a strategy to respond to these questions, and we had to go before a big FDA panel to answer them, etc. And the lobbyist for ASHA kind of made the comment that something to the effect of, well, the people on Capitol Hill, they don't know what audiology is all about.
Dr. Ian Windmill 15:23
And this woman who was kind of head of the VA for audiology and speech at the time kind of stood up and pointed her finger at him and says, but isn't that your job? Well, what we came to understand is that when they were going to Capitol Hill, ASHA was advocating for ASHA, the American Speech -Language -Hearing Association.
Dr. Ian Windmill 15:45
They weren't advocating for audiologists, probably weren't doing it for speech pathologists either. They weren't going and saying, hey, we've got these speech pathologists, and you need to treat them this way.
Dr. Ian Windmill 15:54
They were going saying, we're ASHA, and this is how we think. But they never used the word audiology. And so those were kind of examples of some of the factors that were happening, and we're saying, wait, ASHA, are you representing us or not?
Dr. Ian Windmill 16:06
And so we became a little jaundiced about what was really happening. And that's where the American Academy of Audiology emerged from those discussions. Some of the people who were the big names in audiology began this quest to start a new academy.
Dr. Ian Windmill 16:25
Well, in the same vein, then the question of certification and accreditation came up as well. And And just as you expressed, you know, I think exactly the way we felt back then is, you know, we're paying on this annual basis for this certification.
Dr. Ian Windmill 16:42
And, and especially if you're an academic because for supervision purposes, that you're telling me on December 31st, I'm clinically competent, but on January 1st, I'm not, because I didn't pay the money.
Dr. Ian Windmill 16:56
It became, well, what do we, what's going on here? Why are we paying this money to, for somebody to tell us that the criteria in your 10th year is exactly the same as the criteria in your first year, which at the time, there was no CEUs associated with it.
Dr. Ian Windmill 17:10
So it was, you know, you finish your degree, your CFY and pass your national exam. And every year after that, as long as you paid 250, they'd say, yes, you've done that. It was like, wait, wait, that doesn't make sense to us.
Dr. Ian Windmill 17:21
Why are we still paying that? And again, like you've done, you've been looking into it. And we looked into that and we said, you know, in every other field, this certification is... tends to be, you know, maybe topic specific.
Dr. Ian Windmill 17:32
It's voluntary. There's no reason, you know, you don't have to have it. Licensure isn't because of it. Now, you know, to be honest or fair, before 1980, there were not many states that had licensure, so the CCCs became the de facto way to measure somebody.
Dr. Ian Windmill 17:55
But after licensure came in, we said, well, we don't need that either. So there became...
Megan Berg 17:59
Which, by the way, that's what's happening with SLPAs, is ASHA stepped in and tried to make the certification de facto before licensing has happened.
Megan Berg 18:07
So now they're trying to get the CCC tied into all the licensing regulations for SLPAs. But carry on, sorry.
Dr. Ian Windmill 18:13
But you're absolutely correct. I mean, there's a lot of money involved in that. If it's $250 a year and you have 100 ,000 people, that's $25 million a year, just on that alone before you even get anywhere.
Dr. Ian Windmill 18:24
So we kind of questioned that, and it became this circular argument, well, you've got to have your CCC to supervise so they can get their CCC. And then to be accredited, you have to have your CCC, and you have to produce people who can get their CCCs in order to get accredited.
Dr. Ian Windmill 18:43
And this kind of circular argument of why is all this tied together? So it wasn't a simple thing. And as you expressed that you're spending a number of years studying this, we began to study those types of areas in the CCC and in audiology and the accreditation of audiologists or audiology programs and how it all tied together and how it tied into the organization.
Dr. Ian Windmill 19:09
And there became kind of a group of, I would say, leadership that kind of emerged. We've got to make some changes. And it was also in the context of the scope of audiology is expanding. Can we continue to teach the same amount of stuff in two years that we've traditionally done?
Dr. Ian Windmill 19:29
Or do we need to look at some of these things? something else. Layered on top of that was the clinical fellowship year. So if you do your academic training in your place, you finish your two years, then you do your CFI in a public school system, or if you do your CFI in a medical center, those are two very, very different experiences.
Dr. Ian Windmill 19:51
And it was the same in audiology, so these very different experiences and yet we're declaring them equally competent in all areas, right? Yeah. How can you be equally competent in all areas? And again, that was part of the audiology discussion around this educational position we'd found ourselves in.
Dr. Ian Windmill 20:11
And I think those were the same kind of things like you've been saying, is that you start looking at these things and say, this is tied in an odd way and we were being kind of forced to do this and you can't do this unless you do this and pay your money.
Dr. Ian Windmill 20:24
And that became the only factor that we could figure out was really different was there was money. involved.
Megan Berg 20:31
Yeah, a lot of money.
Dr. Ian Windmill 20:33
Right. And that plus these kind of perspectives that ASHA was advocating for the organization, not its members.
Dr. Ian Windmill 20:44
And in fact, in that same FDA process, we had arranged the speakers that people were going to testify and we had done a good job. I think everybody did a ton of good job. There came a time when the representatives from ASHA, the vice president from ASHA had said, we don't want them to, these particular people to testify who are the experts in the area with hearing aids.
Dr. Ian Windmill 21:13
We would think they should be just average members from the street. So Megan, we want you to come to Washington and testify about swallowing or whatever. Why would they do that? What was their... Well, because the people who were going to testify had dropped their ASHA membership and they were members of other organizations.
Dr. Ian Windmill 21:33
And they said specifically to me, the photo ops won't look good for ASHA if we don't have our people up there. So again, that became more about the ASHA than it became about the members, about audiology, about doing something at the Food and Drug Administration that would benefit just us, but the consumers.
Dr. Ian Windmill 21:54
So those were kind of all being wrapped up in there and became part of our about it. And then the document that I sent you, the Morgan Downey document, kind of also was part of that discussion that the liability of the C's and saying, I'm certifying you as an ASHA as being clinically competent.
Dr. Ian Windmill 22:15
And what's the liability for ASHA if I've declared you clinically competent? And in fact, you're not. And so I've actually had discussions with some attorneys who have looked into, if something happened with an SLP an audiologist, whether they would challenge ASHA.
Dr. Ian Windmill 22:32
So since that time, I've had those discussions. Nothing came of them because there was nothing going on, but just having those discussions in general. So that became part of it. And so we all took a step back and said, all right, let's think about this thing through.
Dr. Ian Windmill 22:46
The Academy came up, the Academy has a certification program, but it's entirely voluntary if you want it. And then accreditation kind of crept into that and how do we look at accreditation as well and make a difference there in our academic programs.
Dr. Ian Windmill 23:02
And of course, then we switched to this four year doctoral degree program. And part of that was pulling that clinical fellowship year back into the academic umbrella. So it's all covered there. And now the academic programs are accountable for it, right, or making sure everybody's trained rather than this university for two years and some random person out there for nine months.
Dr. Ian Windmill 23:29
So now we've got an entity we can hold accountable for. Yeah. I think, do you have any comments on this? Because one of the things when I bring up this idea of reimagining the clinical training program, often it does come back to a doctorate.
Megan Berg 23:50
Because it's like, if you're going to, what I'm seeing is that these faculty members that these university programs are doing a stellar job, they're working so hard to find clinical placements for their students.
Megan Berg 24:03
It takes, that's like almost a full time job in and of itself just to find really high quality placements. But what happens is they're only required to get those 375 hours. But when we look at OT and PT, they're getting 1 ,000, 1 ,200 hours -ish in their degree programs.
Megan Berg 24:23
So why not just expand the number of hours so that it's all wrapped into the training? And then all of these faculty members who are spending so much time doing this, it's actually worth the time to do it because you're getting the students to spend enough time there to make a difference.
Megan Berg 24:40
I do think that ultimately that could add a year on to the program, especially if you were to add more than one dysphagia class or other curriculum that really needs to be in there. But the pushback I get is like, doctorate degrees are too expensive.
Megan Berg 24:59
It's too much time in the program. There's already a shortage of SLPs, especially in the schools. We can't put that burden, that extra barrier in place. And my thought is, are we here to protect the SLP?
Megan Berg 25:14
Are we here to protect people's conveniences and the quickness with which they can get the degree accomplished? Or are we here to protect consumers and SLPs and actually make sure that they have comprehensive trainings?
Megan Berg 25:27
I don't know if you have any thoughts about people.
Dr. Ian Windmill 25:29
people who have that mindset of like, we can't change it because it would be inconvenient and take too much time. Well, I think that it's very, very easy to defend the status quo, especially in academic programs.
Dr. Ian Windmill 25:43
And they have a lot of things they have to deal with, you know, their funding sources and the university and how many students you have and the tuition that's paid, all those are factors that impact how they make their decisions.
Dr. Ian Windmill 25:56
It's not always just about, you know, is it in the best interest of the students kind of thing. And sometimes those funding things can really hamper this people who want to make a difference. So maintaining the status quo is a very easy thing to do.
Dr. Ian Windmill 26:12
And it's very easy to justify it as well. Well, we've always done it this way, it's always worked. We have a shortage, we can't do this, et cetera. And speech pathology programs traditionally have a lot more students, their graduate programs have a lot more students than audiology ever has, right?
Dr. Ian Windmill 26:26
So they have 25, 30, 40, 50. not students per cohort. And so if you've got, you know, somewhere between 60 and 100 students, that's a lot of tuition dollars being generated as well. And they generally have bigger faculty, etc.
Dr. Ian Windmill 26:40
But when you have put 30 or 40 or 50 students, then you've got a lot more clinical placements that you've got to find. And if you know, so that's part of it. The second thing is it's But I don't even know if that's true, because they're finding usually it's two clinical placements, one school and one medical.
Dr. Ian Windmill 26:56
So what I'm saying is you just add on hours instead of finding additional placements. But it could be and it could be that that's how it needs to be, I think the important thing is not being tied to the existing model of education.
Dr. Ian Windmill 27:14
So that those individuals who want to go work in a in a educational setting, maybe they have a whole different program than those that want to work in a medical setting, right? I mean, you don't have to have the same thing for everybody.
Dr. Ian Windmill 27:28
It doesn't have to be that way. You can say, hey, at the University of Montana, we're going to do an educationally based program, right? So when I was at the University of Mississippi Medical Center, that's in Jackson, Mississippi.
Dr. Ian Windmill 27:42
And all the medical things are there. And then the main campus is in Oxford, which is in the north of state about three hours away. But the SLP program was up there. And we were trying at the medical center to start the audiology program there.
Dr. Ian Windmill 28:02
And also an SLP doctorate program there that would be focused strictly on medical. And the other campus was going to kind of have more of an educational focus. I mean, that was kind of the discussion.
Dr. Ian Windmill 28:14
I don't know where it ever got to, people have changed over now. But the model can be different. It doesn't have to be the same model and then add a little bit or just tweak it a little bit, etc. So that's part of what I think.
Dr. Ian Windmill 28:29
challenges. It's also trying to find people who want to champion that within academia, right? Who can acknowledge that from the academic world and say, you know, our program just can't do that. So I know in audiology, when I go to hire people, and I'm at Cincinnati Children's Hospital, there are academic programs that have come from a medical setting, right, or have or involved in North Carolina would be examples at Ohio State.
Dr. Ian Windmill 29:01
And there are others who don't have a medical setting at all. So a Ball State University, not that they don't turn out good audiologists, but they don't turn out ones that are trained in this type of environment, right, have any choice.
Dr. Ian Windmill 29:13
So kind of thinking about the models that are out there, I think is also part of the challenge is, do we keep the same model and modify it? Or do we you know, develop a kind of a unique model, a unique track, a track system.
Dr. Ian Windmill 29:30
How do we do this? And what about the undergraduate program? That's been bantied about for years. Do you have to go through the undergraduate program? What about that biology major that discovers SLP?
Dr. Ian Windmill 29:43
Or you said you were a different background who finds this and wants to come in. Do they have to go back to the undergraduate degree? So all those are factors in there, but maintain the same, then it's or believe that that's the model, the only model that works, then you're not going to change at all.
Dr. Ian Windmill 30:03
That's the hard thing to do. Yeah. It took a long time for people to believe that. Yeah. Yeah. So for anyone who's listening, who's in academia, who's fired up about this, please reach out to me because you are the people that I'm looking for.
Dr. Ian Windmill 30:19
And there's good people out there in academia that would be thinking about these things. And that was part of the part of it is, is finding people who say, you know, it doesn't make any sense the way we're doing things and in academia or that the accreditation model doesn't work or whatever it might be.
Dr. Ian Windmill 30:36
There are people that are very thoughtful about that. They're also people that are there, you know, hell no, we're not changing. This is good. And this is the way I like it. You know, when we tried to start the doctor of audiology programs, the big 10 universities got together and said, no, we are not changing.
Dr. Ian Windmill 30:54
We are not doing this. That's ridiculous. And of course, they all have programs now because everybody else changed around them when they were left behind. So they all have programs now. But but you had to find those programs and actually our movement came out of Purdue University.
Dr. Ian Windmill 31:07
The faculty there started challenging everything.
Megan Berg 31:14
Yeah, and I just something I've got in my brain that I'll say out loud that I'll tack on here is another pushback I get specifically for myself is well, I didn't know if I wanted to do school or medical, or I like being able to switch between the two things.
Megan Berg 31:29
And it's like, that's great. That's wonderful. You should be able to switch between the two things if you have the full competency training to do so. This whole thing right now of like this, this nonsensical thing that the CCC represents total competency across the scope is, is harming people.
Megan Berg 31:48
Like we cannot have people who are medically trained going into schools who have no idea how that system works or how to work with kids appropriately. Likewise, we can't have a school -based SLP coming into a hospital and treating someone with the tracheostomy.
Megan Berg 32:02
Like those two things cannot happen. And it's up to us to protect consumers because ASHA isn't doing it. They're just getting a lot of money with their certification that they think is appropriate. And they're setting up the profession and themselves for huge liability concerns that just haven't come to fruition yet.
Dr. Ian Windmill 32:22
And maybe that's exactly right. I was at a meeting about 10 years ago, and it was audiology and speech pathologist there, and they divided us into a group, and there was a group of about a dozen of us sitting around.
Dr. Ian Windmill 32:34
And I mentioned something about how I wasn't finding people that were trained in dysphagia or working with patients that had head and neck cancer or things like that, that had any experience coming out of school.
Dr. Ian Windmill 32:49
They may have gotten it after they've been out for a while, but I was having a difficult time. And a couple of people there acknowledged, yes, we find it difficult to find those kinds of settings to get our students into, so we're very limited.
Dr. Ian Windmill 33:03
And one SLP faculty member said to me that she teaches that class in dysphagia and actually goes into the hospital there and works there part -time treating those patients. And she said that, which I really appreciate, somebody who's as an instructor is clinically involved, right?
Dr. Ian Windmill 33:27
And they're doing things, and they come back, and they can teach. The reality is not just the book learning, as we always used to say. She said what she did was she said, and I would identify those top third of students in my class, and I'd take them with me, and I would do that.
Dr. Ian Windmill 33:47
And I said, so let me get this right. So you've got about a third of your students who are getting trained in this stuff and who have some hands -on experience. And she said, yes. I said, oh, that's great.
Dr. Ian Windmill 33:56
If we ever have openings, tell them to look. I'd love to talk to them. I said, but you're telling the two -thirds of your students don't get any hands -on training on this? And she says, yeah. I said, but when they graduate, they're still licensed to do it and certified as competent in it.
Dr. Ian Windmill 34:16
That's what you're telling me. Well, we just can't do everything for everybody. So that's just the way it is. I mean, like, oh my God, really.
Megan Berg 34:24
ASHA likes to say too, yeah.
Dr. Ian Windmill 34:26
Right, it's like I'm still certified as competent in it, even though I've never done anything.
Dr. Ian Windmill 34:31
That's how I felt when I graduated.
Megan Berg 34:33
We can't let this happen.
Dr. Ian Windmill 34:34
Right, and we've got to figure out ways to do that. And that became, and so when this idea of switching the audiology to this four -year program came up, I was all on board because, yes, because we can't train everybody to do what they need to do in two years anymore, it's just too much.
Dr. Ian Windmill 34:50
And PTs switched, right? They're moving that way, and OTs, and I am shocked that SLP hasn't had more momentum in that direction, given their expanding scope and what they do these days. I am just shocked that they haven't undertaken that.
Dr. Ian Windmill 35:07
And I would say the biggest reason for that is our own, it's our own mindset. It is. Which is why I want to have this conversation, because it's not like you're saying, it's not about tweaking things, it's about re -imagining.
Megan Berg 35:20
And even things like... with the CAA, they have this, to me, it's a bizarre rule, but maybe somebody in academia could help me understand it as like this, this ratio of PhDs. So you have to have a certain number of PhDs in your program.
Megan Berg 35:36
And so what ends up happening is you have the PhDs, but they're teaching classes on stuff they have never done anything with. And I've heard this so many times from different professors. And they're just assigned to this because nobody else on the team knows how to do it.
Megan Berg 35:53
Versus if the CAA would be more realistic, or any alternative accrediting body would be like, we want a lot more adjunct faculty, we want people who are clinically active teaching these courses that actually know what they're doing.
Dr. Ian Windmill 36:08
So the medical school and dental school models and veterinary school even are good models that you know, we looked at and you just think about the progression through the, you know, medical student does in those first few years, there are a lot of classes that are kind of the basic physiologies and anatomies and pharmacologies.
Dr. Ian Windmill 36:28
And they're taught by people who know anatomy and physiology. But then as they progress, they start working in the clinical setting, and they learn more from the physicians, the people who are actually in the OR doing those things, and in the clinics doing those things and get more and more lectures from that type of person.
Dr. Ian Windmill 36:46
And then when they're done, they go into this, you know, residency program where it's very intense, but they get lots of lectures and heavily involved in that and they're still learning, right? So they're still learning through this whole, so just thinking about that process of, you know, having people who know anatomy teach anatomy, that's great.
Dr. Ian Windmill 37:03
And then having people that, you know, have that on a daily basis are going out there and, and working with patients in a certain environment, teach that class. And then as you get farther into it, you get more and more in, you know, switching from the classroom to the clinic as a student and getting more and more one -on -one tutoring, mentoring kind of thing.
Dr. Ian Windmill 37:24
That kind of process is necessary. That's one of the things that we found that with the CAA in audiology, it was too prescriptive. It was telling you, this is exactly how many things you have to have.
Dr. Ian Windmill 37:42
You have to have this many hours, you have to have that many. And as soon as you got to that many hours, it was like, okay, I'm done. I must be competent. I've never done it. And you started looking at, you've got to have this many and do this and can only have these credentials and this PhD ratio, as you said.
Dr. Ian Windmill 37:59
And it didn't make any sense that that was going on. So that's where... looking at accreditation became important. And the reason is because that's the only way we can get into our fields. The only way we can be in an SLP is to come through an SLP program.
Dr. Ian Windmill 38:16
There's no trade schools out there that trade you, train you as an SLP. It's an accredited university academic program. Same with med schools, same with, you know, audiology or OT. That's the entry point.
Dr. Ian Windmill 38:28
So that's where things have to start is at the entry point into the field. And that's accreditation. If you want people to be better trained and know what they're doing, that's the only place you can start.
Megan Berg 38:41
Yep. Okay, I'm going to pull up the question I sent you because it has a bunch of numbers in it. Okay, so the ACAE, which is the alternative to the CAA for audiology, was founded in 2002. And there are eight graduate programs currently accredited by the ACAE and one's currently applying in contrast to the CAA, which was established in 1994.
Megan Berg 39:07
And like I said, that was that just combining a bunch of committees from ASHA and they currently accredit 75 programs. So can you talk to me about why it's important for audiology to have both accrediting bodies?
Megan Berg 39:25
And then can you talk about like, what does an audiologist get from an ACAE accredited degree versus a CAA accredited degree?
Dr. Ian Windmill 39:33
Sure. So there's, again, this was part of our response, audiology saying, you know, the current accrediting system is too tied into other things like the CCC.
Dr. Ian Windmill 39:47
That it had to be broken. So we said, you know, one of the ways to do that is look at accreditation. We're moving to this doctoral degree that the standards have to reflect that doctoral degree. The standards, however, from CAA were not changing.
Dr. Ian Windmill 40:06
They said, our standards exist. That's what they are. And we said, well, that doesn't make any sense. I mean, we're moving to a four -year program. Those kind of standards and what's embedded in there doesn't make sense.
Dr. Ian Windmill 40:18
So we began this quest to develop the Accrediting Commission for Audiology Education, which we ended up doing and going out there. Well, after you develop it, and again, we had a few programs that said, we're going to do this as soon as you get it up and running, right?
Dr. Ian Windmill 40:38
And as soon as you get recognized as an accrediting body. So you have to be recognized by one of two agencies. One is the US Department of Education. And the US Department of Education recognizes programmatic accreditors, not the big university ones.
Dr. Ian Windmill 40:56
There's an accrediting body, a regional accrediting body that recognizes the whole university. And then you have programmatic accreditors, which is what. the CAA is. So PT has one, law school has one, et cetera.
Dr. Ian Windmill 41:10
Those are programmatic accreditors. So programmatic accreditors have to be recognized by the US Department of Education or the Council of Higher Education Accreditation, CHIA, one of those two. The US Department of Education recognition is only to protect federal financial aid.
Dr. Ian Windmill 41:31
That's its purpose. It's not anything else. So if you have an academic program where they're getting some grant from the US Department of Education, for example, for training, then the programmatic accreditor has to be recognized by the US Department of Education as well.
Dr. Ian Windmill 41:50
They want to get quality for their money. So in audiology, we have like two programs, three programs in the country that are under that umbrella. So the CAA went for CHIA recognition, which we got. And again, it's just like they're an accrediting body.
Dr. Ian Windmill 42:11
They accredited accreditors. So go through the whole, go through all there. The whole pyramid scheme. You go to that and you said, and they said, okay, yes, you're blessed. You're an accreditor. And then we began the accrediting process and we identified two or three that named programs who were willing to do this and did so.
Dr. Ian Windmill 42:34
But the problem was is that most audiology programs in this country are related by marriage to speech pathology, right? And so because we got this relationship and the CAA says, well, we can do both at the same time.
Dr. Ian Windmill 42:54
And if you do, you get a two for, right? A two for one deal, as opposed to speech doing one and audiology doing the other. So again, status quo. was very easy to maintain, and therefore- So when I start the alternative accrediting body for speech pathology, we all get together and do a two -for -one, anyways, sorry, period.
Dr. Ian Windmill 43:16
So you could do that with audiology, right. So that's the deal because, and again, finances are important, so it costs a lot of money to do accreditation, and just the fees that you have to pay and paying for the site visitors, but all the prep work that has to go in ahead of time to become accredited or re -accredited, it's costly.
Dr. Ian Windmill 43:40
And so they're saying, hey, why would we double our costs instead of just doing two -for -ones? So you have many programs out there that won't break that. And that's very common across the country. So the ones that are coming online, the University of California, that's a big, or the California state system, there's a big.
Dr. Ian Windmill 44:05
history about why they're all coming online now with the ACA. University of Mississippi Medical Center isn't tied to a speech pathology program. I'm working with a program who's developing a doctorate of audiology degree program.
Dr. Ian Windmill 44:20
They don't have a speech pathology program, so they're not tied. So they're going ACA. But even though that's gone, it's been, like you said, it's been you know 20 years and you still have a dozen programs perhaps that have done this out of the 75 that exist.
Dr. Ian Windmill 44:42
You know, that's not big, but it's related to factors that don't have anything to do with what's better, what's worse, what's good, what's bad. It has everything to do with the kind of status quo. So getting people to change that, as you said earlier, the models getting them to change the status quo is the very easy thing to do and people don't want to do that.
Dr. Ian Windmill 45:09
Now starting new programs also, if you're just starting from scratch, that's a whole, there's other factors there in there, which is how long it takes to get accredited, you know, if you're starting a new one.
Dr. Ian Windmill 45:21
And right now ASHA'S is out five or six years. You can't even start a program to admit students for five or six years. If you started, you know, today, it's at least six years we've already, whereas ACAE, it can do it in two.
Megan Berg 45:35
So that's a competitive advantage. I mean, I think there are so many ways to innovate an accrediting program that would be so enticing to universities that it could be like such an obvious choice to choose something other than the CAA.
Megan Berg 45:52
For example, including offering like a suite of building blocks of curriculum. So a lot of these professors are having to build all of their slides and all of their curriculum from scratch. What if they had something that they could take and adapt and like had something to start with there?
Megan Berg 46:12
What if the accrediting body also acted as the coordinator and maybe this is a terrible idea and you could tell me it's a terrible idea but the coordinator for clinical experiences kind of like a national residency program where it's like we're not going to so what ash is doing is they're accrediting this person and that person and this person and that person and they're not paying attention to the regional impact.
Megan Berg 46:38
So they're accrediting programs really close together and then there's not enough supervisors to take on those students. So what if an alternative accrediting body was paying attention to that and they're saying we're only going to accredit this one region and then we're going to do the work to coordinate all of the supervisors so that the universities can just plug and play their students into what we're doing.
Dr. Ian Windmill 47:02
Well, so I think, you know, you're on the right track of being innovative and creative and saying, you know, how do we get this to be bigger, better, faster and do that? So so with accreditation, of course, accreditation is like it's about the program and certification is about the individual.
Dr. Ian Windmill 47:19
That's where the argument always kind of goes to, even though it's the same thing. You know, the the the requirements on both are the same. It's like, well, if you have a good accrediting body, why do you need to certify people coming out?
Dr. Ian Windmill 47:33
That doesn't make any sense. If your accreditation is really good, then all the graduates should be good. Right. Like every other profession that doesn't have a certification. Yeah. Or your accreditation is not so good.
Dr. Ian Windmill 47:44
So we better certify people to make sure they got some out of it. Right. So so. But when you look at accreditation of academic programs, there's really two parts to it. Right. One is the standards and the standards are the standards.
Dr. Ian Windmill 47:57
It's really. If you look at an audiology, the ACAE and the CAA standards side by side, they're pretty similar, right, because you we know in audiology what we want people to know when they graduate. All right.
Dr. Ian Windmill 48:16
So so then it's not terribly different. And I bet if you had got 10 people together and said everybody writes standards, a graduating SLP should know you're going to be pretty close. Right. And so that's that's one thing.
Dr. Ian Windmill 48:30
But it depends on how you write it as well as how, you know, locked in. Like you brought up how many PhDs should they have? Well, how about just having the correct faculty? You don't have to say four PhDs for every 10 students.
Dr. Ian Windmill 48:45
You don't have to do that. You can just say you need to have the best faculty and they can be clinicians and they can be PhDs and they can be people that have experience or they can be, you know, from different walks of life.
Dr. Ian Windmill 48:57
Yeah. You know, so you can write it very specifically or be a little bit more. generic in terms of what they need to be able to do. We say, in the CAA, it was written that for vestibular evaluations, you had to do so many of these procedures, so many of those procedures, so many of these procedures.
Dr. Ian Windmill 49:17
And in the ACAE, we say, you have to be able to conduct a vestibular evaluation, not just today, but in anything that comes down the pipe coming up. You can't, if there's new technologies come out, you're expected to be able to teach that as well, not just teach the ones that happened to be on the books from 10 years ago.
Dr. Ian Windmill 49:36
So you've got to be able to do that and be an adaptation. So that's one part. The other part is the process, and that's how an academic program says, I want to become accredited, I contact the accrediting body, then they say, these are the things you've got to do.
Dr. Ian Windmill 49:52
You have to look at these, examine that, check these things out, develop this document, send it to us. We're going to send a couple of people out and check. the site visit that happens. And people get all freaked out about the site visits, like it's the police coming in, you know, oh my god, you know, the police are coming.
Dr. Ian Windmill 50:10
And that's, that's not what it's supposed to be. Accreditation was never supposed to be.
Megan Berg 50:15
It's a partnership.
Dr. Ian Windmill 50:17
Right. So one of the things that we had decided to do, well, first of all, I'll tell you the story that the first experience I went through of accreditation, and it was the CAA, there are a couple of areas that we need improvement on.
Dr. Ian Windmill 50:31
And I asked the question with the site visitors there, well, can you give us some examples of how other programs have addressed this particular topic and how they might do it? And he said, no, we're not allowed to tell you that.
Dr. Ian Windmill 50:44
And I'm like, but what, what do you mean? So when we developed the ACAE as an audio alternative, we said, you were going to be a resource for programs to do better. And so we purposefully made a part of our site visit process, that we are going to tell you at the end exactly what we found on every standard.
Dr. Ian Windmill 51:07
And we're going to tell you, give you ideas about how you can improve on each one of those ones that you did on the standard. And so we're going to be, you know, assist and improve, we're an improvement group, not the police or a regulation group that comes in just to tell you where you stand.
Dr. Ian Windmill 51:27
So, so that's part of the innovation. And you were kind of saying that yourself, how do you become innovative and say, this is what we need? Well, how do we get to that point? If we write the slate claim, we're here, we need to get to here, how do we get there?
Dr. Ian Windmill 51:40
May not be a direct route, but how do we get there? And so with accreditation, you have to, and I think that over the years, the CAA has changed and audiology has changed, because we forced it to change.
Dr. Ian Windmill 51:59
The ACAE forced that change. And so they are definitely better for audiology today. I still don't think they're where they need to be. But I haven't been through it in the last half dozen years anyway.
Dr. Ian Windmill 52:16
So I don't know how they are exactly today. But we did force them to change. In fact, the Council of Academic Programs and Communicative Sciences and Disorders, the CAPSID group, asked that ASHA and our group, this ACAE, why am I have a background like that?
Dr. Ian Windmill 52:40
They asked us to merge together into one. I don't know what's going on there. Anyway, they asked us to merge together. And we said, okay, we'll do it. Under these conditions, we wanted things to evolve and change.
Dr. Ian Windmill 52:56
And the CAA said, no, we don't want to do that stuff. So we're not going to merge. they but there was a there was also a financial end to that that they didn't know that there was gonna be a hit to them financially so but I don't think that was the only reason I just don't think they wanted to to relinquish the um authority that they have in that position so yeah so it became um we said okay you guys do your thing we'll do our thing and we'll go on and but we again tried to be innovative in how we thought about the role of an accrediting body rather than being a regulator let it be a a mechanism for innovation in audiology and to assist programs to get better and to help them out and send them materials and develop like you said a library of materials that you can send to them and and if they say we don't know how to teach this well you know what there's so -and -so is doing it online and he i'm sure he could you could contract with him to do it for your university so you know those are the kind of things that you've got to think about in terms of of the being innovative okay stupid question what is capsid so the council of academic programs and communicative sciences and disorders is the organization that all the academic programs belong to it's the university of colorado's program in audiology and speech pathology is a member of CAPSID and generally they're separate from ASHA yeah they're separate from ASHA a lot of the same people you know let's face it a lot of the people in the hierarchy of ASHA are academics right and same with triple a and the hierarchy of academics so you get a lot of the same people but it's it's focused on the academic programs themselves and it's a kind of the membership where they get together and share what they've done and innovations and create you things in teaching um or in in how they've responded to you know,
Dr. Ian Windmill 55:01
some new things that the U .S. Department of Education is pushing out on on programs. Oh, now you have to do certain things like this. Let's say a DEI initiatives, right, that had come out. CAPSID might have a, at one of their conferences, they'll have a session on how do you implement DEI in audiology and speech pathology academic programs.
Dr. Ian Windmill 55:20
So, and so they meet once a year.
Megan Berg 55:22
Okay, did you go to CAPSID before you started the, like, I guess my question is, was any input taken from CAPSID for the founding of the ACA?
Dr. Ian Windmill 55:22
Yeah, the input was don't do it. They voted against it because they didn't want another accrediting body, because again, status quo, they they thought it was too much. I mean, we went to them say we're thinking about doing this.
Dr. Ian Windmill 55:51
They said, don't do it. because it's gonna disrupt everything out there and we don't want to, and we don't want the controversies with Eshin. So they just didn't want that to happen.
Dr. Ian Windmill 56:00
So, and we said, well, we're doing it anyway, so.
Megan Berg 56:04
Yeah, love it.
Dr. Ian Windmill 56:06
But we persisted and they kind of recognized us. And in the end, they were actually very, I think, as they tried to get, the two groups to work together and it failed, we were willing to do it and they weren't, they were very appreciative of what we had done.
Dr. Ian Windmill 56:25
And this is probably five years ago, I ran into somebody who was kind of involved back there and they said, you know, you really caused CAA to change and that was good. So, you know, pushing that forward might be the best outcome that you've done with your accredited getting that as well.
Dr. Ian Windmill 56:44
So, that can be your goal, right? That can be your goal is to get CAA to change, even if you don't get, aren't successful in it. Yeah, yeah, and to hold the system accountable.
Megan Berg 56:56
So, can you walk us through, with all of these changes, the clinical training was wrapped into the degree and the CCC for audiologists kind of became obsolete -ish?
Dr. Ian Windmill 57:10
So, what we did is, so, you know, the CCC has got the three parts. It's got the degree, it's got the CFY and it's got the exam. So, all we did was pull the CFY back in, it's no longer a clinical fellowship year, it's now an externship year.
Dr. Ian Windmill 57:27
And so, in a four -year program, the fourth year is spent, just like a CFY might be, except that, you know, that there's a lot- There's actual supervision. There's supervision and there's grading that has to happen and there's feedback loops and there's affiliation agreements with the universities and there's vetting of sites that, you know, we vetted to make sure that they, you know, are up to snuff.
Dr. Ian Windmill 57:53
right, that they can provide what they say they do, and if they say we're a pediatric center and they see two kids a month, then that's not it. And so the academic programs vet the sites now for this fourth year.
Dr. Ian Windmill 58:08
So the students end up with about the same amount of clinical hours as they would in what, they end up with more hours than what you would be getting with your CFY. So what's that 40? Yeah, for a whole year.
Dr. Ian Windmill 58:30
It's nine months worth, whatever it is. Our students and audiology end up with about 3 ,000 hours total now, clinical. So that's double what you would get with the CFY at the top of the year. Because they're doing it for three years now on campus and then, or immunity based, and then one full year of full time.
Dr. Ian Windmill 58:50
That's a lot of hours. It's not semesters. It's full time.
Megan Berg 58:52
Wow. So they're going 12 months. That's like, that's, I don't know, I'm just thinking like nursing is 600, OT is 900, PT, if I remember correctly, it's like 1200, so 3 ,000 hours, radiologists.
Dr. Ian Windmill 59:06
So yeah, because that final year, it's about 2 ,000 hours they get, usually not quite, because they got vacations and a few things, it's never quite a year, you know, so it's really 1750 plus the other hours, and some get as little as 300 or 400 in the first three years, others get 1 ,000 hours.
Dr. Ian Windmill 59:24
So it's somewhere, I would say, you know, 2 ,500 is probably a better number than 3 ,000, but even so, that was part of it. And again, it's now it's structured, though, there's a structure to it that didn't exist before.
Dr. Ian Windmill 59:38
So students, when they're done, can apply for the C's if they wish. And they have to pass the national exam. Kind of generally speaking, we've tried to, not everybody's doing this, but I think we're still slowly moving it, we're moving that battleship, you know, turn it into the direction, it takes a long time to do it.
Dr. Ian Windmill 01:00:03
But we've kind of gotten to the point where we said, if you want your C's, you can get your C's, you will qualify for them coming through this program, but we're not telling you to get them or not get them.
Dr. Ian Windmill 01:00:16
The C's still require some degree of supervision, right, with somebody who has their C's, which is bullshit on top of that. Right. That's no good. Like I dropped my C's 25 years ago, and I still supervise students, they just can't count the hours towards getting their C's.
Dr. Ian Windmill 01:00:34
The supervision, yeah. I mean, I'm still a good supervisor, I'm still a good audiologist, but so our students don't qualify for it. Or they can do one of the specialty certifications that's out there, or the AAA has a certification, but it's voluntary, and so they only have maybe 10% of their members that have that certification.
Megan Berg 01:00:58
And do audiologists continue to pay for it because jobs require an in -state licensing board? It's still a little confusing around that, or why do they keep paying for it?
Dr. Ian Windmill 01:01:08
So the two reasons that most people will tell you that they continue to have their Cs is, one is to supervise students. So if they do have students, even if they're on the externship year, they want the hours to count. And so that's not a bad reason to do it, as long as you're doing it because you feel like you owe it to them so that they can have their choices in their future.
Dr. Ian Windmill 01:01:37
That's one. The other one is if they move from state to state, it makes it easier to get your license. Now, only one state requires the Cs. to get your license, and that's Alaska in audiology. Not audiology.
Megan Berg 01:01:54
In only two states for SLP. For anyone who's listening, it's Nevada and Virginia. But only if you're a medical SLP in Virginia. So that's interesting. One state for audiology.
Dr. Ian Windmill 01:02:04
And speaking of that, in Maryland, I know audiologists just got the licensing right to order radiologic tests. They can order MRIs and CTs now, which is completely aside. But it tells you about expanding scopes, right? And knowledge and information's got to be imparted to students. But if you move from state to state, basically, it makes it easier.
Dr. Ian Windmill 01:02:29
You say, I've got my Cs there. Good. So what that has become at the state level is the Cs are the verification program that you've completed those three things, that fellowship year or that clinical experience year.
Dr. Ian Windmill 01:02:45
Because it's not a fellowship year in audiology where it's an experience year. They finished the clinical experience year, passed the exam, and also graduated with a degree. So Ashley is just verifying, yes, in fact, those three things are true.
Dr. Ian Windmill 01:02:59
This person has done that. So the licensing board goes, OK, here's your license. So the Cs are become the verification program for state licensing board. However, I've moved twice in the last 25 years to new states.
Dr. Ian Windmill 01:03:15
And the first one I went to, I made my application. I got a call from them that said, well, you've got to submit your Cs. I said, no, I don't. And they said, well, yeah, you do. And I said, no, I don't.
Dr. Ian Windmill 01:03:29
I'm looking at the state licensing law. And it says, submit your Cs or prove that you've done these three things. And they were like, oh, well, nobody's ever done that before. But I got my license because I proved that I had done those three things.
Dr. Ian Windmill 01:03:43
And you know how I proved it? I called ASHA because I was certified at one time. And they said, no, I don't. sent a letter to the licensing board that said, yes, he's completed those three things. So, and it cost me $35.
Dr. Ian Windmill 01:03:58
$35, I didn't have to pay $200 a year for 20 years. So I was like, okay, this is pretty good. And then when I moved to, you know, now with these state compacts that are going on and reciprocity, it's even easier.
Dr. Ian Windmill 01:04:12
So, but those are the two reasons why my people were getting their C's, but I would say that a substantial number, it's not half, but, you know, 30%, a third of audiologists don't have their C's anymore.
Dr. Ian Windmill 01:04:28
They've dropped those. They may not have any certifications. In fact, they've got license. The drumbeat message has been, you need a license. The other's gravy. If you want to get your C's, great, but it's your license that's the key factor.
Dr. Ian Windmill 01:04:43
Because they take your license where you can't promise. They take your C's away, you can still practice. doesn't matter. Yeah. Right. Yeah. So there's no power authority behind the C's.
Megan Berg 01:04:54
Yeah. I mean, I've spent hundreds of hours at this point. And they made a massive spreadsheet of all 50 states and some other regions of like, of all the licensing rules. And yeah, there's it's the CCC or equivalent. And so you just have to because what's happened is they these applications together.
Megan Berg 01:05:16
And they're these poor people are just like shuffling paper work all day. That's what these boards do. So it's just easier for them to look at a CCC number than it is to look at a practice score and a degree certificate and the what's the third one of the supervision requirements.
Dr. Ian Windmill 01:05:34
Yeah, so so again, the C's are the verification program. Because, in fact, as what was interesting is state license and started to become part of our, you know, part of what we did, or had to do, it was all modeled on the C's.
Dr. Ian Windmill 01:05:51
And ASHA was very purposeful in getting it modeled on the C's, I think, because that's the only thing we had. It's not because they were saying, they're trying to, they were trying to get the C's as the credential to be licensed.
Dr. Ian Windmill 01:06:03
But that didn't work. Everybody kind of recognized that in state licensing boards. No, that's that's really not it. And those that did have it over time dropped it or, you know, said, you know, that's not really, you know, voluntarily paying something to this professional organization doesn't make you licenseable in my state.
Dr. Ian Windmill 01:06:20
So, so they started changing that over time so that so that they kind of dropped that, but it became modeled on the C's, because that's all we had at the time. And I don't think anybody really thought anything different.
Dr. Ian Windmill 01:06:32
So now, all right, ASHA has verified it for us. Now we give you less, not because you've got your C's, but because they verify that you have completed those three things.
Megan Berg 01:06:42
Yeah. Well, and like, in my research, Florida was the first state to enact state licensing in 1969. And that was because there were speech pathology clinics popping up that were not speech... They were people who didn't have a speech pathology degree, and so they were trying to protect their own clinical practices, and ASHA wasn't doing it. And then ASHA fought the concept of licensing. And then they switched tactics, and they're like, okay, we're not gonna fight you, we're gonna help you. Look at us, the benevolent people that we are, and we're gonna give you the language that you can use in your legislation, and it was the language that worked for them.
Dr. Ian Windmill 01:07:22
You're exactly right. I mean, you know, until 76, 77, audiologists couldn't sell hearing aids because ASHA said we couldn't. And somebody, you know, Angela Levenbrueck, who you've talked to before, said, well, I'm not doing that.
Dr. Ian Windmill 01:07:38
As they started doing it, they were getting kicked out of action, they're like, okay, well, you know, it's me. You know, and I don't. I can't, I don't want to, you know, let your listeners believe that I just want to ash a bash because there's some good people at ASHA.
Dr. Ian Windmill 01:07:57
They work really hard to do certain things. You know, they do have some resources that they can, they can be a good lobbyist, you know, and they have certainly the numbers that help them. So as an organization, I think that they could do even more though.
Dr. Ian Windmill 01:08:14
They could do more than they are doing and be more innovative and creative than they have been. So that, that's my issue. Not that they're bad or wrong. It's just that they're not as innovative as they've needed to be over the years to keep pace with what's going on out here.
Megan Berg 01:08:29
And I've received criticism of like, you know, Megan, what you're saying is fine. And like, maybe there's some parts of it that I agree with, but you should really go to ASHA and you should really get involved and you should volunteer and you should be on the boards and you should try to change this from within. And what would you say to that?
Dr. Ian Windmill 01:08:51
Very hard to do. I mean, it's, first of all, your, your tenure on any of those things is very limited, right? So you don't, if you're on the board, you're on the board for two or three years. And, and then boards deal with lots of things, you know, they, it's not just that I, when I was on the board of AAA, we dealt with, you know, like the government agencies who are suddenly doing something and you've got to be able to react and respond to that or a consumer group who's lobbying to get over the counter hearing aids.
Dr. Ian Windmill 01:09:24
And so, you know, you're working in the backgrounds, doing things that have nothing to do with accreditation or certification or those kinds of things, but you are doing some money things as well. You know, some of the finances of the organization that, and you're making sure that the executive director is doing their job. And so there's all kinds of things that go on. So, but it's very hard within three years to make substantive. changes on that kind of area, unless you're on something that you can remain part of over time.
Dr. Ian Windmill 01:09:56
Like the CAA, which you might, I don't know what their tenure is, but some of them you can stay on for a lot longer. Multiple terms, right? So you can do three, three -year terms, or two, four -year terms. It's really hard to go into organization, especially that's got a very large infrastructure, like ASHA does, and as a short -termer on any board or any committee to make substantive changes. It's just very hard and difficult to do that.
Dr. Ian Windmill 01:10:32
Part of it is you've got to find your allies, right? You've got to find the people out there that really support your vision or your concepts or the need for change. at all levels, some in those medical communities, some that are in the academic world, the consumers who understand it, those businesses who can give you some financial support, you know, as well, you're gonna have all those people who and then start doing things like, you know, how can we bring this group together to start forming our strategic plan that, you know, thinking 10 years out, where do we want to be in 10 years and what's the next logical step in the step after that?
Dr. Ian Windmill 01:11:14
It's expensive proposition to kind of go out on your own. It was expensive to start ACAE. And to this day, it doesn't make it doesn't make money, it doesn't even break even. But we had to also in our minds, create the idea that we're not doing this to make money, we're not doing this to break even, we're doing this as a service to our profession. We want our profession standards to be elevated. So we're going to put invest in this to keep our standards up. That's entirely different than, you know, pulling in all the money from the C's and things that Ashes do.
Megan Berg 01:11:50
Right. And so how did you get the money? Was it funded by AAA? Was it funded by grants? Was it you mentioned businesses? So there was two or three things that we did. We got mostly from AAA and what became the Academy of Doctors of Audiology.
Dr. Ian Windmill 01:12:11
The ADA used to be the Academy of Dispensing Audiologist. We're all the ones that were selling hearing aids and making, you know, good money. They always tend to be a little bit innovative, push the boundaries a little bit more than they're a little bit more radical, you know, they tried to do those things.
Dr. Ian Windmill 01:12:29
And so they said, hey, we need an accrediting body, we'll pony up some money. You know, AAA will pony up some money. So the two of the groups ponied up some money and they put about a hundred thousand dollars into it to start with, you know, we had to figure it all out on the fly, but one of the things we did, we had to hire somebody who knew accrediting. We did it part -time so they could guide us through the processes and what we needed to do, but that came out of there.
Dr. Ian Windmill 01:12:56
And then AAA kept doing it, ADA backed out after a while, and AAA kept funding it. They still get, you know, some money from the academic programs to go through the processes, and I don't know what they are anymore, what it is anymore, but it's somewhere, you know, five to eight thousand dollars every time, and they get a thousand or two thousand dollars a year from each program they accredit.
Dr. Ian Windmill 01:13:20
It's not enough to sustain the program at all. And then we got a few gifts that we got. They weren't that big, but we did get a few gifts. When we started the... I was trying to think of what we started, you know, we did... always go to our hearing aid companies and cochlear implant companies, and they're always willing to, you know, pony up some monies. And they did. It wasn't a lot, but they did. We had to keep it low because we didn't want them to say, this is the, you know, sponsored by Starkey hearing aids. We didn't want that. So. We have raise funds. So Foundation holds an annual gala. My Siri came up. But we got some gifts, but mainly that organizations did it. In some of the other ventures that we had done when we were moving to the AUD, for example, that came, we got, they actually started a foundation.
Dr. Ian Windmill 01:14:27
And the foundation then solicited monies from mostly corporate levels. And then a lot of individuals that did it, they collected quite a bit of money enough to get them on a speaking tour around, you know, the dog and pony show and go around and explain what they were trying to do.
Dr. Ian Windmill 01:14:43
So, but I think that the financial component is quite, you know, it can be quite big to get, you know, an accrediting body started. The standards have to be written and that takes some time. And then you've got, you know, somebody to run it and somebody to go to Chia and develop all that stuff.
Dr. Ian Windmill 01:15:03
And there's quite a lot involved in it more than I knew when I started. That's for sure. But, but it was, it was mainly the organizations with some gifts. Okay. All right. I've taken over an hour of your time, which I'm super appreciative of.
Megan Berg 01:15:22
Is there anything that I sent you that we didn't get to talk to you that you really want to talk about?
Dr. Ian Windmill 01:15:29
You know, I think if you're going to talk about accreditation, you've got to find your partners in the, in the academic programs, those who feel strongly about these kinds of things. And part of it is you and and those individuals that you've already got to understand these perspectives, to kind of start doing some visits and seeing how people react and respond, maybe doing some state meetings just to gauge that and present it in a very positive way. And here's what we're thinking we'd like to do this and see what the feedback is. And then you get the feedback and then you revise how you do things just so that you understand, okay, this feedback was pretty good. They said, well, what about this factor? We hadn't thought about that factor. Now we've got to look into this a little bit more. And I think that's what-
Megan Berg 01:16:16
And when you're saying go to state meetings, you're saying which meetings?
Dr. Ian Windmill 01:16:20
So the Kentucky Speech and Hearing Association meeting.
Megan Berg 01:16:25
Okay, so the state association's got it.
Dr. Ian Windmill 01:16:27
Yeah, go to those meetings and we're just asked to present. We want to present on some innovations in the SLP education and certification process. So, you know, we've been thinking about this, we want to do some of these things differently. And then you got to have the money to go there, right? So that's, that's where the money comes in to kind of get those things going. And then, you know, eventually people say, you know, here, here's 25 bucks, you know, or here's 50 bucks or something. Now audiologists are generally cheap people. We don't really contribute that much, but you know, you get enough little ones that it sustains you for a while. And it's a long process. I mean, from the time we started, we said, should we have a new accrediting body? So we said, let's, let's commit to this. That was probably a four or five year period. And then it was another four or five years to get that thing over the finish line. So it was a 10 year process. Didn't know that upfront. I thought we could do it in six months, right? Oh, this is easy. How hard can this be? Well, it is involved many, many years. Yeah. But there's a satisfaction.
Dr. Ian Windmill 01:17:35
I mean, for me, I really learned a lot about education, not just audiology or speech pathology, but just in general education. And you do like you've done, you look into OT education and you look into veterinary medical education, like what's included in their scopes of practice. And how does that fit into all this? And you know, how does the U .S. Department of Education view these fields and things like that that you look into? So you begin to understand it. And it's really for somebody who's interested in education. I thoroughly enjoyed the experience and would have done it again in a heartbeat. So yeah.
Megan Berg 01:18:13
Yeah. I talk about this on Instagram, but I went to high school in a zoo and it was a public school, but it was just done very differently. Like all the teachers went by their first names or four teachers. And we had, we presented portfolios instead of taking final exams. And every Wednesday was a focused day. So we would write or research or travel or have a speaker or learn how to code or learn how to do Photoshop or whatever. Like it was just a very. different structure. So for me, I think because of that experience, it's easier to kind of move away from the status quo, because I've seen how powerful it can be.
Dr. Ian Windmill 01:18:50
Right. But it is challenging when you're working in a profession that hasn't really changed. So I mean, you bring up things like comprehensive exams or, or projects or things like that. I mean, you know, the universities all do it differently. So it's really an odd dynamic. Salas University in Pennsylvania, they have a very unique audiology program. Instead of classes, they have kind of modules. And so they take a class and say, what are the six components in it? Well, the students need to know the first component really at the beginning, the second component in the second year, third component in the third year, and they spread it out, you know, and they so doing these modules throughout the, you know, they may be two weeks or three weeks long. So instead of taking four classes and four classes and four classes, if they're taking parts of 10 classes and, you know, because they're laying, you know, laying the foundation and then building up as opposed to having these odd doing one whole wall and you haven't even got to the back wall yet.
Dr. Ian Windmill 01:19:57
Right. So, so it's very interesting. It looks challenging as hell to manage, but it's really unique and it's innovative and it's creative. And that I really appreciate that they've tried something different and, you know, it sounds like you've got a lot of those ideas and, and, you know, I keep thinking that way status quo might be okay, but there may be some really creative innovative ways that you can do this and approach it and you've got to find your allies and start, you know, getting people excited about it. And I think that's, I do think you're doing a good thing. Having looked at some of the Fix SLP and some of the things that you've done, it's, it's good to do that. As I've challenged SLPs in the past, some of them are like, Oh, that's right. Maybe there's something there. And others are like, yeah, I don't care. So you got to find that, that core group who's got the energy and enthusiasm to do it.
Megan Berg 01:20:56
Yeah. So if you're listening and you have made it this far, I want to talk with you, but thank you so much for everything that you've done. I feel like audiology is just laid a lot of the groundwork and set a model for what speech pathology can follow. So I really appreciate it. So thank you.
Dr. Ian Windmill 01:21:14
You're quite welcome. I enjoyed talking with you, Megan.
Megan Berg 01:21:22
Wow. I love that conversation. And thank you so much to Dr. Windmill for his time. I'm excited for the next episode, which will be a conversation with Dr. Angela Levenbrook, who has a lot of perspective to share as well in her journey as an audiologist. Again, if any of this is resonating with you, if you are hearing this and getting excited and have lots of ideas and you're energized by the thought of innovation and change in our field when it comes to SLP clinical training, I want to connect with you.
Megan Berg 01:21:57
You can find me on Instagram @re.imagining.slp. You can email me at reimaginingslp@gmail.com. I would love to hear from you. And again, you can email me and tell me that you disagree. I would love to hear your perspective because I think as we're trying to reimagine what this could look like, it's going to take a lot of perspectives and experiences coming together to create a really strong solution and that solution is going to have to evolve and change over time and adapt as the world changes.
Megan Berg 01:22:35
So, again, I'm super excited to hear from you if this is something that resonates with you. Hit me up. ReimaginingSLP at gmail .com. Thanks everybody, and I'll see you at the next episode.