When looking into FEES training, you may find a variety of formats based on the provider – virtual training, hands-on training, and hybrid options are all currently available. FEES training includes both a technical component and a cognitive component. The current FEES training guideline is for SLPs to receive in-person, direct supervision when working toward FEES competency. Let’s talk about why a strictly virtual format is not adequate.

Langmore et al’s recent Tutorial on Clinical Practice for Use of FEES describes how FEES training “should be conducted under direct supervision of a skilled SLP (or physician) mentor. Importantly, this mentor should be skilled in both performing flexible endoscopies and interpreting a FEES exam.” The paper goes on to say that “since different challenges are present when performing endoscopy with a patient as opposed to a health volunteer, it is imperative that this step not be shortened.”

In-person training is imperative. While assistance with interpretation can be conducted virtually, there are safety considerations when mentees are working on becoming competent with the technical component of the exam. Here is a list of technical competencies that must be mastered during FEES training:

  • Operate, maintain, and disinfect the equipment (adhering to infection control)
  • Apply anesthetic and/or nasal decongestant when clinically appropriate and authorized by the physician
  • Insert the scope, pass through the nare(s), continue through the velopharyngeal port, and end in “home position” in a manner that causes minimal discomfort and prevents unpleasant complications
  • Perform FEES exam with correct hand position on the left or right side of the patient
  • Anchor with finger on the face without obstructing the patient’s eyes or mouth
  • Maintain a good view in home position and to return to home position frequently
  • Manipulate the endoscope to obtain the desired view for the entire exam, know when an optimal view is not obtained, and repeat the task or the bolus trial
  • Accurately ascertain laryngeal sensation, directly and indirectly
  • Manipulate the endoscope to obtain the desired view when the patient is presented ice chips, foods, and/or liquids
  • Position the scope to view spillage before the swallow, penetration before the swallow, aspiration before the swallow, or residue after the swallow
  • State the bolus clearly for recording purposes
  • Pass to the endolarynx, scan for possible penetration and aspiration, and then retract the scope quickly while maintaining patient comfort
  • Deal with adherence of secretions/food/liquids to the tip of the scope effectively by various manipulations of the scope
  • Ask the patient to cough, clear throat, or dry swallow and get the desired view while still detecting aspiration
  • Find and maintain the desired view while testing different head and neck postures or while teaching a swallow strategy, such as the Mendelsohn maneuver, super-supraglottic swallow, or controlled swallow
  • Withdraw the scope at the end of the exam at a comfortable speed and without causing discomfort

Carolina Speech Pathology’s FEES training courses are a hybrid model: there is a prerequisite virtual course that participants complete prior to the live course, and the live course includes both lecture and a hands-on technical training portion. We support the above guidelines in terms of continuing FEES training with an onsite mentor following the completion of an Introduction to FEES training course. Carolina Speech Pathology can support you no matter where you are in your journey to FEES competency.

If you would like to explore other options for in-person FEES training, please look into providers who offer a hands-on training portion within their curriculum.

Happy FEES’ing!