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The National Competency Profiles specifying clinical competencies required of each clinician upon entry-to-practice in Canada, with the goal of safe and effective practice were created in 2018. These competencies form the foundation for accredited audiology and speech-language pathology curriculum in Canada. Other regulated professions, such as medicine, occupational therapy, and physiotherapy, also utilize similar assessment frameworks.

The ACC was developed using these professional competencies and adapting them to allow for assessment of students across various stages of clinical learning. The ACC tool assesses seven roles required of an entry-to-practice speech-language pathologist or audiologist: Expert (Knowledge and Clinical), Communicator, Collaborator, Advocate, Scholar, Manager, and Professional. Each role contains one or more essential competencies (with several sub-competencies) that the student clinician must demonstrate by the time they complete their studies.  

A rating scale accompanies the tool and describes the expected performance of a student along a continuum from 鈥淓arly Novice鈥� to 鈥淓ntry-to-Practice鈥�. with 鈥淯nsatisfactory鈥� as an option to reflect students with significant difficulties. Over the course of a master鈥檚 program, students are expected to progress from Early Novice (early stages of first placement) to Entry-to-Practice (when they finish their final placement). Individual university programs will identify required achievement levels along this continuum. Please refer to your university program鈥檚 communication to determine the achievement level requirements for the student鈥檚 placement.

In the traditional education approach, emphasis is placed on what knowledge students鈥� need and how clinical educators will teach them that knowledge. In the competency-based education approach, the focus is on the abilities of the student and the competencies they are expected to demonstrate. Assessing student performance using the traditional method focuses on the assessment of learning and knowledge. Competency-based assessment involves assessment for student learning and their application of that learning.

The ACC requires a change in thinking for clinical educators to a competency-based educational approach. This involves a shift in focus from disorder or population-specific knowledge and skills to abilities that transfer across disorders/placement, such as clear communication and applying academic knowledge.

Using ACC Essential Competencies, Sub-Competencies, Milestones, & Rating Scale
Using the accompanying rating scale, you will assign the student a rating for each essential competency. In doing so, consider the applicable sub-competencies listed below each essential competency and make an overall determination on how to rate the student on that competency. When needed, you may use the milestones to inform this rating. The milestones are stages in the development of specific competencies along the continuum from Novice to Intermediate to Entry-to-Practice. They form a road map and provide explicit performance expectations for each competency. Milestones enable better assessment, as well as a pathway to support, learning for the clinical educator and the student. 

The rating scale is designed to be flexible enough to assess performance on all the essential competencies. Level descriptors vary along three parameters:

鈼� Amount of assistance required,

鈼� Amount of time required and

鈼� Complexity of clients/situations managed.

Choose how to weigh the relative importance of the three parameters of the rating scale and of the sub-competencies within your own context when choosing a final rating of the essential competency. After assigning a rating for each essential competency within a role, provide comments on the student鈥檚 strengths and areas for development within that role.

Using the Not Applicable (N/A) Rating
In cases where an essential competency is not applicable to a particular setting or there has been no opportunity to assess a competency, Not Applicable (N/A) should be selected. Clinical educators are strongly encouraged to review both sub-competencies and milestones before selecting N/A to ensure that there has not been an opportunity for the student to demonstrate the competency within the practice setting.

Using the Unsatisfactory Rating
A rating of Unsatisfactory is available for the rare instances where a student experiences significant difficulty during familiar/routine cases, even when provided with specific direction from the clinical educator. These students may demonstrate little to no evidence of self-reflection or insight over time into their strengths and weaknesses, fail to seek knowledge or support, struggle with basic reasoning and/or demonstrate difficulty applying prior learning. This rating differs from Early Novice in that students who are demonstrating Unsatisfactory performance continually struggle to improve their skill set, whereas students in the Early Novice level are new to clinical practice, but demonstrate the ability to begin to change their performance in response to feedback.

Rating Inconsistent Student Performance Within an Essential Competency
There may be instances where students demonstrate inconsistent performance and perform poorly on a particular sub-competency that impacts the overall rating of the entire essential competency. It is reasonable for clinical educators to emphasize this area for improvement when rating the essential competency. For example, in the role of professional, if a student maintains client confidentiality, but does not maintain professional boundaries with clients, it would be reasonable to rate the student lower on the overall essential competency. In these cases, please add specific comments regarding your rationale to the Comments section.

Amie is an audiology student on her third clinical placement; she is over half-way through her master鈥檚 program. She has planned and completed several assessments in the first half of her placement with growing responsibility. She requires specific cueing (i.e., modelling) to complete new and unfamiliar assessments with complex cases or when there are behaviour difficulties, but performs familiar assessments with only general guidance from the clinical educator (CE). Her assessment plans show consideration of appropriate deviations during formal and informal assessment and she is able to make online changes. She struggles with writing accurate assessment reports. She recognizes appropriate information for documentation, has challenges utilizing structured templates and examples of written reports from the CE, is unable to explain complex assessment results and takes extra time to write all reports. Reports usually require three revisions before they meet requirements to release to the client.

Amie鈥檚 CE completed her midterm assessment with the following ratings for essential competencies 1.2.b (Plans, conducts, and adjusts an assessment) and 2.b (Completes documentation thoroughly and accurately, in a timely manner):  

1.2.b Plans, conducts, and adjusts an assessment.

• In partnership with the client, substitute decision-maker, and family, as appropriate, collects and analyzes pertinent personal information about the client (e.g., case history, client goals, expectations, motivations, needs, activity limitations, participation restrictions)
• Plans a valid, accurate and reliable assessment, selecting the tools, equipment and techniques that will address the unique needs of the client
• Conducts the assessment, modifying as necessary**

Milestone Example:

1.2.b.iii **Conducts the assessment, modifying as necessary

2.b Completes documentation thoroughly and accurately, in a timely manner.

• Accurately documents informed consent, services provided and outcomes**
• Ensures reports clearly integrate results, client input, analysis, recommendations, goals and outcomes, in a manner understandable to the target audience(s)
• Documents in all professional contexts in a clear, concise, organized and grammatically acceptable manner
• Completes and disseminates documentation in a timely manner
• Complies with regulatory, legislative and facility requirements related to documentation

Milestone Example:

2.b.i. **Accurately documents informed consent, services provided and outcomes

Stefan is finishing his first placement. He has been a pleasure to have on placement. Stefan demonstrated an excellent work ethic and professional behaviour at all times. He hasn鈥檛 had an opportunity to manage conflict, but he did observe a significant difference of opinion between a physician and physiotherapist on the team and demonstrated insight into how this could have been better managed in a later discussion with the CE. This included resources he had learned about in the interprofessional conflict learning activity. The CE had previously completed a large number of assessments and Stefan has been participating in providing a mix of 1:1 and group intervention for adults with acquired brain injuries. The CE had summarized the patterns of strengths and challenges for each client and then they worked together to translate the assessment results into goals, approaches and likely activities. Stefan could choose holistic goals from relevant information, however, needed frequent support to select and word short -vs long-term goals, but he was then able to identify good ideas for how to target the goals in 1:1 sessions. Stefan required assistance to determine how to approach group intervention. He also was unsure of how outcomes might be measured, but once given one to two examples, he was usually able to generate one to two additional measures.

The CE completed the final assessment with the following ratings for essential competencies 7.a (Maintains professional demeanour in all clinical interactions and settings) and 1.3.a (Develops a realistic, evidence-informed and measurable intervention plan):

7.a Maintains professional demeanour in all clinical interactions and settings.

• Maintains confidentiality (e.g., follows consent procedures to share information with other parties).
• Demonstrates professionalism in managing conflict**
• Maintains personal and professional boundaries in relationships with clients, colleagues and other professionals
• Displays a positive, professional image (e.g., follows dress code
• Demonstrates professionalism in all communications, including those involving electronic platform
• Demonstrates responsible, reliable behaviour and accountability for actions and decisions
• Recognizes and responds appropriately to the inherent power differential in the relationship between the client and the student-clinician

Milestone Example:

• 7.a.ii **Demonstrates professionalism in managing conflict

1.3.a Develops a realistic, evidence-informed and measurable intervention plan.

• Establishes and prioritizes long-term intervention goals that reflect the client鈥檚 strengths, needs, values, expectations and constraints**
• Develops specific, measurable, realistic, time-limited, short-term goals to reach the functional long-term intervention goals
• Selects direct and/or indirect service delivery model(s), as appropriate
• Determines the resources and timelines required for the intervention
• Develops activities and outcome measures that align with the client鈥檚 goals

Milestone Example:

• 1.3.a.i **Establishes and prioritizes long-term intervention goals that reflect the client鈥檚 strengths, needs, values, expectations and constraints.

The amount of supervision a student will need depends upon the type of task assigned, the client population, and the student鈥檚 competence and level of training (fall practicum, winter practicum, internship, or externship placement). Supervision should include direct observation, feedback, and guidance to allow the student to evaluate and improve his/her performance and ultimately develop clinical competence.

As a general rule, the School of Communication Sciences and Disorders recommends the following guidelines for supervision of speech-language pathology and audiology students completing practicum placements:

• Supervise at least 25% of all treatment sessions
• Supervise at least 50% of each assessment session
• Supervise 100% of interventions that carry significant risk of harm, including, but not limited to, taking an initial case history, communicating results and recommendations to clients and/or caregivers following an initial assessment, tracheoesophageal puncture care/voice prosthesis placement, dysphagia assessment, ear mold impressions, participating in hearing aid prescription procedures, and cerumen management

These are minimum requirements and should be adjusted upward if the student's level of knowledge, experience, and/or competence warrants such modifications. For example, 2nd year speech-language pathology students completing fall and winter practicum placements require more supervision than the minimum standards listed above. They will require direct training and active feedback during these initial practicum experiences.

Clinical educators must be available to consult with the student when he/she is providing clinical services to clients. The clinical educator should typically be on-site or delegate to an on-site alternate clinical educator who meets the requirements for student supervision if he/she plans to be away.

References

• American Speech-Language-Hearing Association. (2008). .
  
• Nova Scotia Regulator of Audiology and Speech-Language Pathology (2025). .

Though faculty in the School of Communication Sciences and Disorders (SCSD) may have few interactions with students in practicum settings, the information they impart in class will have a direct and profound impact upon students鈥� clinical performance. The primary faculty contributions to the clinical education experience are:

• To provide relevant information regarding speech and language development and normal processes of speech, language, and hearing;
  
  
• To provide relevant and up-to-date information regarding the nature, assessment, and treatment of speech, language and hearing disorders;
  
  
• To provide 鈥渂ridges鈥� for the clinical application of the above information;
  
  
• To participate in collaborative efforts to share current information impacting upon assessment and intervention;
  
  
• To encourage students to become independent and life-long learners and problem-solvers;
  
  
• To teach and model fundamental principles involved in professionalism.

Student participation in the clinical education experience can be thought of as a dual role. First, the student is responsible for completing the appropriate administrative and professional duties that are demanded from the practicum and placement process, including completion of all placement requirements such as immunizations and criminal record checks, obtaining a list of recommended readings and/or materials to review prior to commencement of the placement, and ensuring required forms are signed and returned to the school. Second, the student is also responsible for developing the competencies that will allow for successful completion of the program and the beginning of independent practice.

The student plays an active and changing role in the clinical education process. In order for that role to evolve as the student does, the student needs to recognize both his/her strengths and limitations as each practical experience is approached. In addition, students are expected:

• To integrate the information presented in class lectures and readings;
  
  
• To seek to extend that knowledge via additional readings, professional dialogue, etc.;
  
  
• To take responsibility for their own clinical education, in conjunction with clinical educators and faculty, to ensure an experience that is adequate and appropriate to their individual needs;
  
  
• To assist other students in developing clinical abilities by actively mentoring those with less experience;
  
  
• To provide evaluative feedback regarding their clinical education experience so as to improve the training of future students, and foster the development of clinical educators;
  
  
• To develop professionalism.

Given that a student鈥檚 clinical skills evolve over time, the clinical educator鈥檚 role in the practicum process must also change. Initially, the clinical educator provides direct teaching and instruction, with a gradual shift to a more collaborative relationship. The clinical educator offers support as the student becomes more actively involved in the clinical process, while simultaneously facilitating the student鈥檚 growing independence. Ultimately, there is a transition on the clinical educator鈥檚 part to the role of consultant, at which time the clinical educator participates in information-sharing and joint problem-solving with the student.

It is also the clinical educator鈥檚 role within the practicum process to evaluate the students鈥� development of clinical skills. This allows for the identification of clinical strengths and weaknesses, and assists in planning programs that meet the individual needs of students. In summary, the clinical educator is responsible for:

• Discussing and/or demonstrating clinical procedures and participating with the student in the clinical process;
  
  
• Following supervision standards, as determined by the school;
  
  
• Assisting the student in observing and analysing assessment and treatment sessions;
  
  
• Assisting the student in developing and refining assessment skills;
  
  
• Assisting the student in developing clinical goals and developing and refining clinical management skills;
  
  
• Facilitating the student鈥檚 self-evaluation of clinical performance while enhancing the student鈥檚 clinical independence;
  
  
• Assessing the student鈥檚 development of clinical skills and providing ongoing feedback to the student (including completing mid-term and final evaluations with the student);
  
  
• Demonstrating and modelling professionalism to students and assisting them in refining their own professional attitudes and behaviours.

The academic coordinators of clinical education at the School of Communication Sciences and Disorders (SCSD) serve as the link between clinical education sites and the school and act as the liaison between the clinical education site coordinator, clinical educator, and student. They organize, coordinate, and evaluate the clinical education component of the SCSD speech-language pathology and audiology programs. In addition, the clinical coordinators are responsible for:

• Providing an orientation and/or orientation materials to the clinical educator;
  
  
• Providing the student and clinical educator with information about expectations, goals, student competencies, and specific forms;
  
  
• Arranging continuing education certificates for the clinical educator;
  
  
• Offering ongoing support to the clinical educator and student;
  
  
• Assigning a grade of pass/fail to the student at the end of the practicum placement.