The Clinician-Directed Hierarchy: Effective Clinical Instruction Across University Settings In this study, we investigated the efficacy of a hierarchical approach to clinical instruction aimed at developing clinical techniques and promoting independent decision-making in student clinicians. Ten clinical instructors who supervised 36 student clinicians with pediatric clients participated in a pretest-posttest control group study at two university-based clinics. We randomly ... Article
Article  |   June 01, 2013
The Clinician-Directed Hierarchy: Effective Clinical Instruction Across University Settings
Author Affiliations & Notes
  • Jill K. Duthie
    Department of Speech-Language Pathology, University of the Pacific, Stockton, CA
  • Robbins Montgomery
    Department of Speech and Hearing Sciences, Portland State University, Portland, OR
  • Disclosure: Jill K. Duthie has no financial or nonfinancial relationships related to the content of this article.
    Disclosure: Jill K. Duthie has no financial or nonfinancial relationships related to the content of this article.×
  • Disclosure: Desirae Robbins has no financial or nonfinancial relationships related to the content of this article.
    Disclosure: Desirae Robbins has no financial or nonfinancial relationships related to the content of this article.×
Article Information
Professional Issues & Training / Articles
Article   |   June 01, 2013
The Clinician-Directed Hierarchy: Effective Clinical Instruction Across University Settings
SIG 10 Perspectives on Issues in Higher Education, June 2013, Vol. 16, 4-16. doi:10.1044/ihe16.1.4
SIG 10 Perspectives on Issues in Higher Education, June 2013, Vol. 16, 4-16. doi:10.1044/ihe16.1.4

In this study, we investigated the efficacy of a hierarchical approach to clinical instruction aimed at developing clinical techniques and promoting independent decision-making in student clinicians. Ten clinical instructors who supervised 36 student clinicians with pediatric clients participated in a pretest-posttest control group study at two university-based clinics. We randomly assigned student clinicians to a treatment group or to a control group. Students and supervisors in the treatment group received training and materials for the Clinician Directed Hierarchy (CDH; Duthie, 2010b; 2010c). Students rated each phonological or morphosyntactic goal by intervention level (i.e., 1, 2, 3, 4, or 5) at the end of each therapy session, and they used the CDH to analyze their use of clinical techniques and plan for treatment generalization. Clinical instructors who used the CDH approach with their student clinicians reported significantly greater improvement in clinical competencies than the instructors in the control group at both university clinics. We found that the CDH was an effective clinical training tool for beginning student clinicians. Further investigation is needed to determine its efficacy at other training sites (e.g., school-based fieldwork) and with other treatment goals.

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