FEES Competency and Program Development

Some state licensing boards have specific regulations about endoscopy, including the number of passes needed, documentation and supervision requirements, and other considerations. ASHA’s state by state webpage is a good starting point, but it is always recommended to contact your state’s board, even if your state isn’t listed.

A good question to ask your licensing board would be “is there anything in our practice act that requires me to have a certain number of endoscope passes and physician oversight, and if so, what documentation is required?”

Click here to visit ASHA’s state-specific webpage.

When a state does not have specific regulations or laws surrounding the use of FEES in practice, it is then up to the facility to create procedure protocols, safety guidelines, policies surrounding equipment, and competencies. The equipment manufacturer may have recommendations for some of those needs, so if you are or will be working with a representative from one of those companies, you may want to consider asking them for their input.

ASHA does not require additional certifications outside of the Certificate of Clinical Competence, so we don't set standards for other training or certification programs or for FEES competencies. The Code of Ethics does address competency as it relates to clinical activities (Principle I, Rule A), but it’s a self-identified level of competency, so it’s up to the individual clinician to make decisions about their skills and practice.

Different clinicians may require a different number of passes before they feel competent to perform the procedure independently. As with any new skill, there may be a lot of ground between meeting a minimum employer or state licensing standard and establishing competency at an independent level. As an example, completing an intensive course may help an SLP meet their state’s requirement for the minimal number of normal and disordered scope passes, but they may need many more months of collaborative learning to feel confident in the complexities of the assessment. It may be helpful to talk directly to some of the companies that offer FEES training about their or other health care facilities’ experiences for insight about clinicians’ average time to competency, lessons learned for clinicians new to FEES, and tips for translating newly learned skills into practice.

The Dysphagia Competency Verification Tool (DCVT) is another helpful tool developed by SIG 13: Swallowing and Swallowing Disorders and the American Board of Swallowing and Swallowing Disorders Joint Committee on Dysphagia Competencies, but it is not intended to replace formal instruction and instead can be used as a guide to develop your own competencies.

It’s usually a good idea to have written competencies to protect yourself from liability and because reviewers (like The Joint Commission) may want documentation of it; though ASHA doesn’t require written competencies for clinical skills, we’d be happy to support you and your facility in developing a competency plan that fits your needs.

Helpful Links:

ASHA Code of Ethics

The Dysphagia Competency Verification Tool (DCVT)

There are many options for training and equipment. ASHA does not endorse any particular program or product. Click on each bullet point below to access resources to help guide you in deciding which course and manufacturer may be right for you and your facility:

o Tips for Choosing and Evaluating Continuing Education Courses

o What to Ask When Evaluating Any Procedure, Product, or Program

o Certificates, Certifications, and Competency: Investing in Your Future

You’ll want to discuss starting a FEES program with your administrators and ask questions like:

• What budget do we have for training courses and purchasing equipment? Are there grants we can apply for or is there support from the facility’s charitable foundation?

• What is our facility’s current process for cleaning equipment and what is the turnover time?

• How will we fit time into our schedules to support training, practice, and mentorship? Will we have access to per diem help or can we advocate for a new position to support this program development?

• Are there video storage or integration limitations with our current EMR and if so, how can we bypass that to support collaboration between SLPs and the medical team?

The equipment manufacturer will likely provide you with information to share with your administrators about equipment cost and EMR integration and storage, as well as requirements for processing and caring for endoscopic equipment.

Physician involvement may or may not be needed when developing a FEES program, depending on your state’s practice act and guidelines and if you have a competent SLP who is independent in passing a scope on a variety of patients and is capable of mentoring others. Though you may not need a physician in a mentorship role for passing a scope, you likely want to involve your hospital’s medical leadership in developing guidelines for the procedure and for emergency protocols.

You will also want to consider who may be reviewing the FEES recordings with input from your medical leadership. Instrumental swallowing evaluations are certainly within the SLP scope of practice, but SLPs do not differentially diagnose medical conditions. If you or one of your colleagues identifies an anatomical impairment during a FEES, you will want to have a clear pathway for referral within the interprofessional team so you can expedite care for your patient.

Helpful Link:

SLP Scope of Practice

If you have more questions or want to take a deeper dive into all things FEES, here are a few other resources you might find helpful:

o Use of Endoscopy by Speech-Language Pathologists: Position Statement

o Frequently Asked Questions: Swallowing and Feeding (Dysphagia)

o Flexible Endoscopic Evaluation of Swallowing (FEES)