Characteristics and challenges of professors in the supervision of probation in speech-language pathology (SLP) and audiology (AUD)

Abstracts

PURPOSE:

The aim of this paper is to investigate the supervisor (professor) profile of the probation in Speech-Language Pathology and how is his practice while the monitoring of the trainees (students).

METHODS:

It treated of a descriptive cross-sectional study based on the application of a questionnaire in 21 supervisors of the probation in a Course of Speech-Language Pathology at a public university in State of Alagoas, Brazil.

RESULTS:

The studied group shows 95.24% of women, predominantly aged between 31 and 40 years. Most is Master, however, few have specific training for teaching in health, always performing their activities mainly with medium complexity and outside the interdisciplinary context.

CONCLUSION:

The results point to the need to the specific training focused on teaching as well as to the redirection of training for the Primary Care and the Interdisciplinarity.

Speech-Language Pathology; Higher Education; Clinical Probation

OBJETIVO:

investigar o perfil do supervisor de estágio em Fonoaudiologia e como se dá sua prática durante o acompanhamento dos estagiários.

MÉTODOS:

trata-se de um estudo descritivo do tipo transversal, baseado na aplicação de um questionário junto aos 21 supervisores do estágio obrigatório do Curso de Fonoaudiologia de uma Universidade Pública de Alagoas.

RESULTADOS:

o grupo estudado apresenta 95,24% de mulheres, com faixa etária predominante entre 31 e 40 anos. A maioria possui titulação de mestre; no entanto, poucos têm formação específica para a docência em saúde. Realizam suas atividades principalmente na média complexidade e fora do contexto interdisciplinar.

CONCLUSÃO:

os resultados apontam para a necessidade de formação específica voltada para a docência, bem como o redirecionamento da formação para a Atenção Básica e Interdisciplinaridade.

Fonoaudiologia; Educação Superior; Estágio Clínico

Introduction

The qualification of human resources in the healthcare has required joint efforts of the Brazilian Ministries of Health and Education, which culminated in the drafting of the new National Curriculum Guidelines (DCN, in Portuguese) of undergraduate courses in healthcare, recommending the training focused on Unified Healthcare System (SUS, in Portuguese), the generalist profile of graduates, as well as the necessary skills for these professionals, respecting the peculiarities of each profession. Therefore, it is recommended to the Higher Education Institutions (IES, in Portuguese) guide the curriculum of their courses for the needs from the System^{1 - 5}.

Since the implementation of the DCN of the Speech-Language Pathology course in 2002, the mandatory supervised probation represents at least 20% (twenty percent) of the course load⁵. In healthcare, the supervised probation (training) is the privileged place of practice during undergraduate studies and is characterized as:

[...] compulsory curricular component designed as an educational, academic and supervised act which aim the learning of own skills in the professional activity, necessary for preparation to the productive work and to the civic life of future graduates6 (p.44).

The National Legislation provides that such training stages (probation) should be carried out in diverse scenarios in the hierarchical levels of healthcare of the SUS. During the same, the student must have direct contact with the practice of his profession, learning to learn with their professor, with the health system, and with the community^{5 , 7 , 8}.

In this study, we focused on the investigation of the training process of the Speech-Language Therapist during the practice of mandatory probation in undergraduate course of this profession, relatively new, which like other healthcare professions has its training still directed predominantly toward the logical content and to the dichotomy of theory and practice, focusing its practice course load predominantly at the end of the course. The professor who accompanies the student during this period is of great importance in encouraging to the theory-practice linkage, enabling a significant learning^{7 - 11}.

It is perceived that the careful and systematic study of the compulsory probation in Speech-Language Pathology is one of the main ways to understand better how the training of these professionals is. Given this and the lack of studies on the healthcare supervision in this area, this research aimed to investigate the supervisor (professor) profile of the probation in Speech-Language Pathology and how is his practice while the monitoring of the trainees (students).

Methods

This study was conducted after approval, in May 2012, by the Committee of Ethics in Research and Teaching of the Cesmac University Center (protocol #1309/12), pursuant to resolution 196/96 of the Brazilian National Health Council. All subjects who agreed to collaborate were informed about the research, signed a term of Free, Prior and Informed Consent (FPIC) and responded to an individually and confidentially interview.

Type and Location of the Study

It was performed a cross-sectional quantitative study, based on the application of a questionnaire to the supervisors of Mandatory Probation of Speech-Language Pathology from a Public IES of healthcare area in the State of Alagoas, in Brazil. In this research, we chose to use the term "supervisor", which represents - for the studied course - the professor itself who accompanies the trainees in the practical scenarious¹². The supervisor, according to the institutional documents that guide the course in question (Speech-Language Pathology), is responsible for monitoring, mentoring, observing and evaluating the students, as well as register their frequencies, discuss the cases and prepare the reports during the probation. Another term also verified in this study is the Training Advisor, characterized as a professor of the course, responsible for certain specific probation area, which plans, organizes and guides the student in exchange with the other supervisors related to that area¹³.

The Mandatory Supervised Probation (ESO, in Portuguese) in Speech-Language Pathology, field of this research, has most of its activities carried out in a school clinic linked to the course, but the students also have other practical places such as outpatient audiology school, two reference university hospitals, and a municipal basic health unit, encompassing the following areas of Speech-Language therapy: a) Primary Care b) Maternal and Child Health; c) Assessment and Diagnosis in Hearing Health; d) Evaluation and Diagnosis Speech-Language; e) Speech-Language Therapy; f) Occupational Health; g) Preventive; h) Interdisciplinary; i) Child Development ; j) Hearing Health; k) Voice Disorders; l) Language Disorders; m) Disorders of Orofacial Motricity.

The course has a faculty composed of fifty (50) professors, in which 25 (twenty five) are speech-language therapists, and from these, 22 (twenty two) act as supervisors in the ESO. However, for ethical reasons, the researcher who is part of this faculty, was deleted, thus totalling 21 (twenty one) study participants.

Instrument

The questionnaire - adapted from the works of Missaka⁸ and Trajman⁹ - was applied by the researcher together with the subjects. The questionnaire contemplated objective issues related to the characterization of the professional, to the academic trajectory and to the exercise of the supervision activity.

Data Analysis

After data collection, the data were stored in a spreadsheet (Microsoft Excel 2007(r), Redmond, WA, EUA) in format of database. The results were tabulated and the frequencies of variables in each group were calculated and arranged in tabular and graphical format. The tabulated data were processed by the applicative for microcomputers Statistical Package for Social Sciences (SPSS(c)) (version 15.0 for Windows, SPSS Inc.). The descriptive statistics for the numeric variables included calculations of mean, standard deviation (SD) and confidence interval of 95%.

Regarding to the exercise time of the activity, we chose to use the classification proposed by Huberman apud Isaia¹³, which is widely used in studies of teaching, and contemplates the life cycle of professors in various stages, summarized here:

[...] - Started in the Career (1-3 years): initial contact with the classroom, involving two components: survival and discovery.

Stabilization (4-6 years): implies belong to a teaching group, accompanying or preceding a growing sense of pedagogical competence.

Diversification (7-25 years): the establishment of individual pathways arises from the possibility of the professor, more stabilized, initiate new learning experiences.

Questioning (7-25 years): this thematic is parallel to the diversification and has by base a balance of the professional life that has passed, in face to the ideals and goals from start of the career.

Serenity - affective detachment (25-35 years): the serenity is possible by less vulnerability to the judgment of others (students, colleagues, and superiors), due to greater equilibrium between the ideal self and the real. The affective detachment regarding to the students may be in the generation differences between teachers and their students.

Conservatism (23-35 years): this thematic if parallel to the Serenity/Affective distancing. It involves the personal and professional obsolescing, towards increased resistance to the innovation, i.e., difficulty in change and accepting the change of the other, in terms of students, colleagues, or the system itself.

Non-Investment (35-40 years): at this stage, the professors begin to free itself gradually of the investment made in pedagogical work, preparing to the end of the career [...]13. (p.27-28).

Results

The study sample consisted of 21 supervisors who working in various areas of speech-language pathology at different levels of healthcare, as shown below:

Who is the probation supervisor in Speech-Language Pathology?

The characterization of the sample with respect to gender, age, job function, type of contract and level of care are presented in Table 1.

Table 1:
Characterization of the sample with respect to gender, age, job function, type of contract and level of care (N=21)

• Source: Authors, 2013.

Most supervisors (N=20/95.24%) are female, with a minimum age of 27 and maximum of 52 years, predominantly aged between 31 and 40 years (66.66% of participants). Eighteen (18) professionals (85.71%) have an effective contract with the institution. Most (N=12/57.14%) of the subjects simultaneously exercises the functions of supervisor and probation advisor.

The level of health care that has the largest number of supervisors is of averaged complexity (N=15/71.43%), comprising the various areas and specialties of speech-language pathology.

How did was the academic trajectory of these supervisors?

Table 2 presents the data about the academic trajectory of the studied supervisors.

Table 2:
Academic trajectory of the supervisors (N=21)

• Source: Authors, 2013.

Regarding to the academic trajectory, the studied group concluded the graduation in speech-language pathology between 1984 and 2006. The majority (N=17/80.95%) was graduated until 2002, the year of implementation of DCN of speech-language pathology.

All participants reported having postgraduate, with predominance in the master's course while maximum degree (85.71%, N=18).

The specific educational preparation for teaching was reported by twelve supervisors (57.14%, 12 participants), who claimed to have done it through the disciplines taught in specialization courses or Masters.

What the supervisors do in routine of your function?

Table 3 presents the scenario found among supervisors from the course of speech-language pathology in the aspects of workload and the reason for the entry into supervision activity.

Table 3:
Weekly workload and the reason for the entry into supervision activity (N=21)

• Source: Authors, 2013.

About the supervision activity itself, when asked the participants about their entry into the function, 14 participants (66.67%) indicated as the main reason the fact that this is an activity expected in the duties of the position.

Most professionals (N=16/76.19%) exercises the supervision function for about 7-25 years. The weekly workload of dedication to the activity with greater frequency was between 6 and 12 hours, reported by 42.86% (N=9) of participants. Each supervisor is responsible for an average of 5.55 (± 2.43) students per shift of supervision, ranging from 2 to 10 students, between trainees and students from other years of the course which observe the clinical practices.

The characterization of the supervision work of the group of professors surveyed is shown in Table 4.

Table 4:
Characterization of the activity of supervision regarding to the kind of activity performed, to the planning format of the activities and to the actions taken during the supervision (N=21)

The types of activities more developed, according to the professors surveyed were teamwork III (involving supervisors, students, service and user) and teamwork IV (composed by supervisors, students, service and managers), each one reported by seven participants (33.33%). In turn, the planning format of the activities that prevailed was teamwork II, with the participation of supervisors, students and service, referred by 33.33% (N=7) of participants.

In cases, type or format of planning of activity, it can be seen that the teamwork on type I (which includes the supervisor, the student and supervisors of other areas) is practiced in a very limited way, being each one referred only by a professional.

Discussion

The female predominance in this study corroborates with data collected in other studies of teachers characterization conducted in Brazil^{13 - 15}, which, among other things, pointing to the feminization in healthcare professions that is every day more noticeable^{16 , 17}.

Regarding to the type of employment with the IES, there is a predominance of effective contract; however, the course also has supervisors with temporary contracts which characterizes the precariousness of the teaching work, given the importance of carry out the public official examination for rendering effective and commitment of professors with the institution, the course and the students¹⁸.

The level of health care that focuses most of the supervisory practices of the participants (studied group) is the average complexity, one fact related to a main scenario of the practices of ESO to be the school clinic linked to the course, rather than the primary care level which has only one supervisor whose practical scenario is a basic unit of municipal healthcare. Such data, somewhat oppose to the literature about education in healthcare and public health, as the studies from Trajman⁹, Costa¹⁸, Campos¹⁹ and Gomes et al. ²⁰, which reaffirming the need for inclusion, as soon as possible, of the student from healthcare field in the network of SUS services for to live the everyday situations, and situations of challenges. Researchers emphasize the importance of the practice in primary care during the undergraduate courses in healthcare, as this is the gateway of the system and responsible for the solution of about 80% of the health problems of the population through prevention and healthcare promotion. The predominance of the average complexity can also suggest the maintaining of the biomedical model and early specialization focused on the technology employed in this level of care⁸.

Studies developed in Alagoas, such as Lima²¹ and Peixoto²², indicate that the most frequent pathologies in speech-language clinical are preventable and could have been avoided with promotion actions and prevention performed in primary care, minimizing the waiting time for specialized care of average complexity.

The data presented here suggest that the compulsory probation of the course studied tends to prepare future professionals to market, predominantly as specialist; however, it is necessary to consider the real needs of the population as well as prepare its graduates to work in healthcare promotion and prevention, particularly in light of the initiatives of the Ministry of Health with regard to the insertion of the speech-language therapist in primary care as a member of Nucleus of Support for Family Healthcare (NASF, in Portuguese), one of the field of action that may amplify the insertion of this profession in the SUS^{15 , 23}.

Regarding to the academic career of supervisors, the fact that most have completed graduation before deployment of the DCN may suggest that their formation occurred in the biomedical model, since such guidelines are configured in a milestone in the search for more integral and humanistic training^{5 , 8 , 10}.

Whole group of supervisors has graduate, being predominant the Academic Masters (stricto-sensu) with 85.72% of the cases, index higher than that presented by Morosini¹⁴ in its study about the reality of university teaching in Brazil, which pointing the percentage of 30% of professors in the country with titration of master.

Despite of the significant number of masters, the number of doctors from framework course is still limited (N=2), a fact that needs attention by the institution. Investment is needed in development of teaching, further strengthening the course and hence the University, since the graduate enables greater encouragement to seek new knowledge and greater independence of thought, besides being one of the indicators considered in external educational assessments²⁴. As pointed out by several authors, among them, Slabbert²⁵ and Alencar^{26 , 27}, an environment that does not give support to the creativity can inhibit or suppress the creative skills of the student, and the graduate is a great incentive to the creativity.

Although the development of teaching have been cited by the majority, it can be observed the direct link to disciplines of graduate Latu-sensu (specialization and MBA) and Stricto-sensu (Master and Doctorate), which suggesting a restricted workload directed to this issue. The literature shows that the professor of healthcare field should provide scientific expertise, teaching skills and humanistic formation, however, studies have shown that usually these professionals do not have specific preparation in the educational field - some engaged in teaching based on didactic training received in undergraduate courses (licensee for teaching), others bring their professional experience to the classroom and others have no teaching or professional experience^{14 , 18 , 28}.

Moreover, as point out Mosoroni¹⁴, he suffers various pressures for the qualifying of his performance, especially on didactic:

[...] from government with the aim of assessing the quality of higher education, imposed by the institution for the purpose of obtaining accreditation of the same together with the MEC and for capture the students and sought by the professor to maintain their employment and increased compensation, among other requirements14. (p.13)

The teaching training is a key to the change of paradigm in the healthcare education, since professors need to know more than their professional specialty, in this case, the speech-language pathology and their fields of actuation. Therefore, it is necessary to understand the overall view of the teaching function, especially at the moment of clinical supervision, essential process in the formation of future professionals, in which they must overcome its fears, anxiety and distress related to what awaits in practice during the probation^{7 , 18 , 29 , 30}.

Regarding to the time of exercise of supervision function, it is observed that 16 subjects (76.19%) lying predominantly in the phase of diversification/questioning, classified according to Huberman. This phase, according to the author, suggests that the most professionals have as tonic the motivation and the dynamism, the need to contribute to the reshaping of the system¹³. These results indicate that the investment, in development of teaching, during this phase can be decisive for the group approaching more and better of teaching, expanding the practice issue and oriented to the SUS³¹.

Regarding to the numerical ratio for students per probation supervisor, the course in question has not had any reference in its Pedagogical Project of Course (PPC) ¹¹. However, the Federal Council of Speech-Language Pathology presents a resolution about the non-compulsory probation which stipulates the maximum number of six (6) students per supervisor³². Other healthcare professions, such as physiotherapy and occupational therapy, determine the maximum number of six students per supervisor in the compulsory probation and three students per supervisor in the non-compulsory probation³³. The resolution about the compulsory probation⁸ of the IES which was studied also does not provide this numeric relationship, leaving to the discretion of courses such distribution. This course, however, lies in process of developing of a new PPC, featuring an opportune time for such regulations be made, supporting the execution of the supervision with the best distribution of students.

The continuous education is one of the competencies established by the DCNs for healthcare professionals. This competence is grounded on the concept of problem-based teaching and of meaningful learning, i.e., teaching-learning based on the production of knowledge which answer to questions that pertain to the universe of experiences and lives of those learn and that generate new questions about the human being and the acting in world^{1 , 34 , 35}.

In ESO, among the actions/activities that are held during the time of supervision, the professionals were unanimous regarding to the appointment of further reading and oral explanation: twenty of them said that demonstrate techniques and procedures for the trainees. These data confirm the importance of the figure of the supervisor in function of articulate theory and practice, as well as approaching the student to the clinical reasoning necessary for the profession, especially in the supervised probation^{7 , 9 , 18}.

The fact of the teamwork involving other areas have been reported only by one of the supervisors, reflects the absence of interdisciplinary practices in daily of ESO in Speech-Language Pathology, which opposes to which is put in the DCN of the course, as well as in studies about interdisciplinary in healthcare, pointing to the need for comprehensive healthcare, which is only possible on the interdisciplinary approach³⁶.

The teamwork performed in its entirety runs through the interdisciplinary actuation and the set of actions planning, consolidating Continuing Education in Healthcare, a competence which allows reflection on the practice and the solving everyday problems of healthcare services, facilitating the provision of services related with the factual needs of the people and the community^{1 , 4 , 34 - 37}.

The experience of interdisciplinary in healthcare can be achieved by the prioritizing of the competence work from Continuing Education, quoted earlier, that besides the constant pursuit of learning to learn, aims to reflect about the practice. This concept, based on education, gained status of policy in healthcare, in Brazil, with the aim of promoting joint spaces of reflection about the practice, involving several individuals such as professors and students from different areas, service professionals, managers and users, with a view to collectively solve the emerged problems of everyday practice, periodically, thus favoring the effectiveness of the teaching-service integration, which enables meaningful learning on the part of future professionals, awake the workers for critical reflection of the service, and offers to the community a comprehensive care to their real needs^{1 - 5 , 34 - 37}.

Conclusion

The results from research showed that most of supervisors are female, aged between 31 and 40 years, effective contract with the linked institution, and exercises the supervision activity between 7 to 18 years ago, with its practice centered mainly on the average complexity level.

The supervisors, in majority, concluded the graduation before the deployment of the DCN in the course of Speech-Language Pathology, in 2002, and have postgraduate in Masters Level, with specific capacitating for the teaching during their undergraduate courses.

Regarding to the supervision itself, the professionals dedicated between 6-12 hours per week, developing activities together with the team (supervisor, student and service), without the presence of other professional categories, i.e., without the interdisciplinary practice. The developed activities include, among others, the assignment of supplementary reading, oral explanation and demonstration of techniques and procedures for the trainees.

Finally, the results of this study reveal that the investment in teach development aiming a more problem-based and meaningful pedagogical practice as a method of teaching and learning which enables the creativity and growth of the professor as well as the revision of the PPC, are strategies capable of causing in these professors and, consequently, in the students, in the professionals of healthcare services and community new thinking, new pathways and new directions for the practice and the continuing education in health.

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Publication Dates

• Publication in this collection
  nov-dec 2014

History

• Received
  03 Oct 2013
• Accepted
  03 Feb 2014