Providing mobile FEES services is a fulfilling niche within the world of speech language pathology. Before your facility partners with a mobile provider, we strongly recommend vetting your options to ensure that the provider can serve you and your residents with safe, valid, and reliable FEES exams.
There is not a national or world recognized FEES certification, nor does ASHA provide regulatory oversight. Speech language pathologists are ethically bound to achieve an independent level of competency prior to administering FEES without supervision. There are two major components to achieving FEES competency: the technical component, which includes safe handling of the endoscope for optimal view and patient comfort; and the cognitive component, which includes comprehensive understanding of swallowing anatomy and physiology. Further, critical thinking, quick decision making, and a strong understanding of dysphagia are critical to interpret swallowing from an endoscopic view.
Decisions regarding bolus presentation and use of therapeutic maneuvers are driven by the endoscopist, therefore the clinician must be skilled at making real-time decisions regarding management options during the FEES. This comes with practice, a seasoned dysphagia background, and strong mentorship – and lots of it! This is what it takes to achieve mastery of the technical and cognitive components of FEES administration.
A recent tutorial paper by Langmore et al, 2022, lists training recommendations to attain both technical and cognitive competency in FEES. As a long-standing FEES expert, our very own Selena Reece co-authored this in-depth guide to identify and recommend best practice guidelines. Here is the recommended curriculum:
- Attend and Complete an ASHA CE Approved External FEES Course or Internal Facility Mentored Training.
- Take and Complete an Exam Based on the Content of the Course.
- Passing and Handling the Scope on Healthy Volunteers. This step is completed once the speech pathologist is deemed proficient by the mentor.
- Passing the Scope and Performing a FEES exam on Patients. This step should be conducted under direct supervision of a skilled SLP (or physician) mentor who is skilled in both performing FEES and interpreting FEES exams.
- Mentor assessment. The mentor “signs off” or recommends that the speech pathologist is competent to perform FEES.
- Indirect Supervision. A mentor reviews recorded FEES exams as well as the written report and gives feedback to the mentee.
FEES training is intensive to ensure safety across multiple fronts: safe handling of equipment, firm understanding of contraindications, and accurate interpretation of swallow physiology combined with an advanced understanding of dysphagia to facilitate airway safety and swallow efficiency.
Aside from safety, why is important for your FEES provider to have a strong FEES foundation and thorough experience? A recent study published just last month (Imaizumi & Murono, 2023) examined the diet recommendations provided for patients with swallowing impairment evaluated by experienced and inexperienced clinicians. This study demonstrated a difference in the recommended diet for patients with dysphagia between the examiners with different levels of experience. The results suggest that experienced SLP examiners recommend less restrictive diets for patients with dysphagia. This yields accurate and reliable results, as well as an improved quality of life and cost savings for the facility!
Here are some key questions that you can use when vetting a mobile FEES provider:
- How many FEES exams has the provider performed with mentorship?
- How many FEES exams has the provider performed independently?
- How many years of experience does the provider have with diagnosing and treating dysphagia?
- Does the provider use a patient centered approach when making recommendations?
- Does the provider’s report provide thorough information regarding swallow physiology, or are diet recommendations the only focus?
- How does the provider keep up with the latest in dysphagia research?
- Does the provider have a clinical lead available to provide ongoing supervision and feedback?
What does Carolina Speech Pathology (CSP) do to ensure that each of its employees are independently competent in performing FEES?
- CSP only hires speech language pathologists who have an extensive dysphagia background and are FEES trained
- CSP endoscopists hire on having already completed at least 500-1,000 FEES, then complete a competency skills check off prior to seeing patients for CSP
- CSP Clinical Leads conduct quarterly ride alongs, video and report reviews, and are available throughout the work day to support our clinicians
- CSP invests in supporting each employee’s clinical expertise by providing consistent access to dysphagia continuing education and journal club meetings
We hope to support your facility in continuing to use or choosing a provider who can serve with a consistent level of FEES mastery for your residents’ comfort and safety, and who can provide you with accurate results. As the industry leader in mobile FEES exams since 1996, we are here to answer any questions that you may have! Send us an email: email@example.com or give us a call: 877-390-1887.
Mitsuyoshi Imaizumi, Shigeyuki Murono. Will levels of experience of examiners affect the diet provided for patients with swallowing impairment? Auris Nasus Larynx. 2023. ISSN 0385-8146. https://doi.org/10.1016/j.anl.2023.02.001.
Langmore SE, Scarborough DR, Kelchner LN, Swigert NB, Murray J, Reece S, Cavanagh T, Harrigan LC, Scheel R, Gosa MM, Rule DK. Tutorial on Clinical Practice for Use of the Fiberoptic Endoscopic Evaluation of Swallowing Procedure With Adult Populations: Part 1. Am J Speech Lang Pathol. 2022 Jan 18;31(1):163-187.