At The Informed SLP, we’re trying our best to connect clinicians and scientists with one another, toward the greater goal of getting more research into practice, and more practice into research. Given this, I’d like to extend an invitation to you all to help answer this particular question that we're picking at right now:
“How can we help clinicians make better use of current research evidence?”
Now, this is a BIG question. And not meant simply as "What can TISLP do?" but, globally, "What could be done?". By anyone! Now, some of you will be excited to discuss this. And others are just "over it", perhaps because you think the barriers are too high. Granted, discussion about evidence-based practice has been a hot topic for over a decade now, more recently morphing into talk of Implementation Science. But even though our field has made some nice progress, we’re nowhere near having an admirable hold on how to bring research into clinical practice efficiently. It simply isn’t happening.
So—if you’re ready and willing to chat about this, come along! But let’s impose some limits. First, let’s assume that, as SLPs, we aren’t going to radically change the way our jobs work (at least not easily, not right now, and not for everyone). We aren’t going to magically “appear” more than maybe 30 minutes per week, maximum, to work on something we don’t already work on. And, scientists—let’s assume that we aren’t going to magically revolutionize academia, either. Our responsibilities as university faculty limit us too, to maybe an extra 30 minutes per week, maximum, to work on this issue.
So, within these constraints, what needs to happen? What do scientists need to do? What do clinicians need to do? And can scientists and clinicians do it alone, together? Or does someone else need to take the wheel and help us out?
I’d also like to suggest a few things to consider while brainstorming this topic:
I hope you all can take some time to think on this for us! In the process, make sure to also listen. What are the needs of our clients? What are the needs our clinicians? What are the needs of our scientists? And—please—tell us what you need!
Hope you can "join us"!
Meredith Harold, PhD, CCC-SLP
The Informed SLP
For all our scientist members, I want you to take a moment to think back to why you became a speech–language scientist in the first place. Academia as a whole is motivated by knowledge. Motivated by learning. Motivated by the sheer joy of discovering new things. But we, as scientists in a clinical discipline, have the additional privilege of being motivated by changing people’s lives. You probably continue to be inspired by the idea of creating better assessment and treatment strategies in order to help people communicate.
Ah, it feels so good to be an idealistic scientist again for a minute, doesn’t it? Alright—time to break the trance and do a bit of self-evaluation: are you changing people’s lives? If you have a productive research career, you have information out there that is useful. But are clinicians using your research, or is your work trapped in the ivory tower, known only by fellow scientists within your area of expertise, and the few clinicians who read your articles or attend your conference presentations?
Yes, yes, yes. I’m aware that it’s not your job to make sure clinicians use your research. Your “job” is to apply for grants, perform the science, write journal articles, and present at conferences. But, if it’s not your job to make sure your research is being used by clinicians, then whose job is it? (And, P.S., if it’s news to you that many clinicians aren’t using your research, then simply Google “Research to Practice Gap”, and feel the terror for a moment.)
Now, whose fault is this? No one’s, really. All of ours, I guess. It’s scientists’ fault for not regularly communicating with clinicians. It’s universities’ faults (who employ scientists) for tacitly restricting scientists from reaching out, by only awarding them for publications and communication that occur within academia. It’s clinicians’ faults for not searching for evidence more often. It’s the middle man’s fault for not putting both sides in better communication with each other (but who even is the middle man? ASHA? Our state associations? NIH? We have TISLP now, but that’s a drop in the bucket.)
And—perhaps even scarier—it’s not just that clinicians aren’t using up-to-date evidence. Many of them aren’t using research evidence much at all. Scientists are losing the battle to small businesses who sell products to SLPs. The “new stuff” SLPs are using is whatever is most heavily marketed to them. Or, better yet, correctly marketed to them. Some of these businesses produce evidence-based products, some not (most not?). But what they all have in common is an advertising budget that puts them right in front of clinicians. And that should scare all of us. Let me state that again, because it matters now, more than ever: Companies are in the ear of SLPs, not scientists. And it’s one reason why resources like this need to exist at all.
Ensuring that clinicians use clinical techniques based on strong research evidence (your research!) is not easy. But all of us must take a small role in doing our part to put research in the hands of clinicians. So, for the scientists, here are some basic tips:
Step 1) Be aware of current barriers
My personal observation, as both a clinician and a scientist is that there are two primary barriers to SLPs’ awareness of research evidence (use delves deeper… we won’t go there yet).
To clinicians, speech–language research is:
We’ll address these within each of the following steps. Look! I only gave you three steps!
Step 2) Create an online presence
If someone is interested either in you (because of your work that they’ve seen at a conference or read in a textbook) or the topic you study, they need to be able to do a basic internet search to find you. Every scholar should have a professional or lab website, where they share information relevant to the people the research is being done for (clinicians, often!). This is for those go-getter SLPs who are trying to find your work. Don’t make it impossible for them by not having an online existence!
Then, you have to additionally ensure that they can read your stuff. So please try to make sure your work isn’t paywalled behind some exorbitant fee. It’s really quite easy to make most of your research available via your own website or somewhere like ResearchGate. There are even sites dedicated to helping you quickly figure out which version of your paper is legal to post online. For more about how to make your research easily accessible, see this excellent article.
OK, so step one is making sure you exist on the internet. It’s the age of the world wide web, people! The next step is much scarier for some, but I highly suggest you also…
Step 3) Get involved in social media.
It’s great to have your work shared online, so that people who are interested can find it. But you also must get people interested in the first place. Time to reach out!
Social media is no longer a thing for teenagers or millennials. This is a thing for everybody. News flash— millennials are SLPs now. Experienced SLPs, at that. And, perhaps even more where-did-the-time-go: millennials are now assistant and associate professors, too. Yeah.
Now, you may be thinking—yes, but social media isn’t how we communicate research. That’s just not how it’s done. Well it is now, my friend! No matter who you think your audience is, they are on social media. There are currently over 20K SLPs in the Speech Pathologists at Large group on Facebook. There are so many SLP Facebook groups, it's hard to keep up—everything from groups interested in pediatric dysphagia to groups specific to your favorite AAC system. But, some of you don’t communicate with clinicians all that much. Either because it’s not needed for your line of research, or because you just… don’t. If you’re not ready to dive into the SLP groups, fine. But get started by getting your feet wet with fellow scientists, many of whom hang out on Twitter. I’m telling you—you’re missing out on some great conversations if you're not using at least one social media platform! No matter who you want to learn from or talk to, they’re out there, as an audience, and you don’t need to pay airline fare, hotel room, and conference registration to interact.
I know you’re busy. And the responsibility of ensuring impact is enormous. But reaching out to the people who your work matters to is at least partly your job. Clinicians can’t carry the responsibility of evidence-based practice on their shoulders alone.
Below, I'll continue to post additional information related to this conversation:
9/21/16: "...researchers own the conversation..." and "...these platforms represent an unprecedented opportunity for dissemination and knowledge translation..."
We all know that ethical treatment of our clients is a result of strong evidence-based practice (EBP). So, how do we make that happen?
First, recall that evidence-based practice isn’t just about using the research, but considers client values and clinical expertise as well. How much weight you put on each EBP component varies case-to-case, but we’ll focus on research evidence for the moment.
In grad school, you simply follow your professors’ recommendations. And that’ll last you for a little bit, but what about when you’re 3, 5, 10 years out of grad school?
Some SLPs think that by participating in the required Continuing Education (CE) courses to maintain our ASHA CCCs and state licenses, that’s enough. Well, it certainly helps. But not all CE courses are based on research evidence. <Yikes!> There are many CE courses out there that have little to no research backing. So if you’re choosing mediocre CEUs, there’s a good chance you’re not implementing EBP.
So, what then? Here is my recommended course of action:
Now, (1) and (2) above are the bare minimum you should be doing in order to ethically practice as a Speech–Language Pathologist. If you’re not doing these two things (or an equivalent substitute), you're probably not using EBP.
So, start there. THEN, I would suggest that all good SLPs are additionally doing some of the following. Perhaps more in some years, less in others, but they're regularly making the attempt to:
It’s not enough to just show up for your clients. You must also be aware of good science in our field and beware pseudoscience. The best evidence will make your job easier— so you may treat clients more efficiently, and with better outcomes.
And, on a final note, evidence-based practice is only part of the solution. Yes, clinicians must access and use research evidence. But our scientists also must provide us with practice-based evidence. SLPs need relevant studies that are real-world applicable. And communication between clinicians and scholars about each other's work is essential to the health of our field. I will tell you that ASHA is working on EBP and Implementation Science initiatives for us. I promise to share with you any great new resources as they arise!
~ Meredith P. Harold, PhD, CCC-SLP
The primary way to obtain a journal article is to go to the publisher’s website and simply pay for it. This isn't what you had to do in grad school, but it's the way it works once you no longer have access as a university student. The journal's website is almost always the first thing that pops up when searching the article’s name. To purchase a single article from a journal reviewed by TISLP, it’ll cost you between $12 and $55. Some journals also allow you to rent the article for 48 hours for much cheaper (usually around $6). Just like anything else you’d need for therapy—books, toys, treatment materials—scholarly articles have an associated cost.
Now, a member of the American Speech–Language–Hearing Association (ASHA), you get access to their journals for free. If you’re additionally a member of at least one ASHA Special Interest Group (ASHA SIG), you get the Perspectives publications for free too. There are many reasons to belong to ASHA, but journal access is certainly an important one. (NOTE: There are similar perks for U.K. and Australian professionals, for different journals, so check with your national organization.)
But—back to the journals we DON'T get for free (which is most of them). Do people really have to pay in order to be able to read research? Well, yes. However, not everybody has to pay (because of where they work) and not everybody does pay (because they find a backdoor way to gain access). Here are some ways that people get access to journal articles for free:
So clearly there are many options. And, clearly, the method for accessing research articles for the general public is far from ideal. For now, we simply encourage you to be part of the conversation on academic publishing. Be part of the conversation on what SLPs need in order to be able to provide evidence-based practice.
***One more thing— the articles TISLP shows you are always brand new, usually ahead of print. These *new* articles tend to be more expensive at first, then get cheaper as time goes by (e.g. the publication embargo ends, they become open access (free), or available to rent for cheap, or end up available on a website). So if you're wanting an article and can stand to wait, you can always just add it to your "To Read" list and try later. In general, the longer you wait, the more likely you'll be able to find an article for free online.