Training the Next Generation of SLPs: Inside the University of Tennessee's Clinical Education Model

Nola Radford didn't set out to run a clinic. She set out to change how clinicians are made.

After years as a public school speech-language pathologist, she noticed something. The quality of services families received depended heavily on how well the clinician had been trained. If she could influence that training, she could multiply her impact far beyond a single caseload. So she went back to school, earned her doctorate at the University of Memphis, and built a career in higher education that eventually brought her to the University of Tennessee Health Science Center in Knoxville.

Today, she directs clinical education for a program that graduates 35 master's-level speech-language pathologists each year, with 43 more on the way in. The program is large, specialized, and genuinely built to give students real-world clinical skills before they ever leave campus.

A Clinic That Operates Like a Practice

What makes UT's program different from many university clinics is that it functions as a for-pay operation. Students don't just practice therapy in a vacuum. They bill insurance, work with SOAP notes, learn coding for diagnoses, and interact with a full billing department staffed by medical billing specialists.

Each student is assigned roughly two to three patients per semester during their first clinical rotation. They complete case history forms, administer standardized assessments, write session documentation, develop long-term and short-term goals, and produce end-of-term reports. They also get exposure to Super Bills and the credentialing process for insurance payers.

"Our students get real-world experiences with those necessities," Nola says. That's not a line. The program was intentionally structured to mirror what clinicians face in private practice and medical settings, including the paperwork.

Specialization Over Generalization

Nola is honest about the limits of being a generalist. She calls herself one, but she's clear-eyed about the tradeoff.

"It's difficult to rise above just basic competence to expertise when you're functioning as a generalist."

That's why UT's clinical faculty is organized around areas of specialty. With roughly 12 clinical faculty members, each concentrating on a specific area of practice, students get supervised by someone who isn't just familiar with the population but deeply experienced. The Pediatric Language Clinic serves children on the autism spectrum. The Child Hearing Services Clinic has been working with deaf and hard-of-hearing children and their families for decades. There's a strong Augmentative Alternative Communication program, literacy-focused clinical experiences, and the Out Loud program for individuals with voice problems related to Parkinsonism.

Students can begin practicum their very first semester. That early exposure, paired with faculty who specialize rather than generalize, means graduates leave with a depth of clinical skill that's hard to replicate in smaller programs.

Simulations, Teletherapy, and Adapting to COVID

When COVID-19 suspended in-person services, UT didn't pause. They pivoted.

ASHA had already updated its standards on January 1, 2020, to formally recognize clinical simulations. UT leaned into that timing. Simulations gave students access to clinical scenarios that would be too risky to practice on a live patient, like certain endoscopic procedures that were off the table during the pandemic. They also allowed remediation and supplemental skill-building in a controlled environment.

Meanwhile, the program transitioned to teletherapy for patients who could continue receiving services remotely. The university's Office of Information Technology provided infrastructure support, cybersecurity guidance, and hands-on help getting faculty and students set up on Zoom.

"Kudos to the university, because we have a top-notch Office of Information Technology, and we've had a lot of support to make this transition," Nola says.

Students adapted quickly. Faculty checked in regularly through small-group Zoom sessions. The chair held open meetings. Clinical coordinators did daily check-ins with both students and colleagues. The whole team rallied.

The Funding Model Behind It All

Because UT's clinic bills for services, its budget isn't entirely dependent on university allocations. Clinic revenue funds consumables (disinfectant, bubbles for pediatric sessions, test protocols), instrumentation, and even major equipment purchases like the video endoscopy system they invested in three years ago.

Each semester, clinical supervisors submit requests for materials. Those go through a faculty meeting and then to the department chair for approval. It's structured, transparent, and driven by clinical need rather than bureaucratic cycles.

The billing operation itself is managed by a dedicated team of medical billing specialists overseen by a business manager. They handle credentialing with insurance companies, manage NPI numbers, and navigate the constantly shifting requirements of CMS and private payers. Nola is blunt about it: "It is a moving target."

What She Wants Students to Take With Them

Beyond clinical competence, Nola wants her students to leave with something harder to teach: the willingness to be imperfect.

"I want them to experience that it's okay to make a mistake. That's why we have erasers on the ends of pencils."

She encourages students to strive for excellence without being self-punishing. To ask for help without feeling diminished. To treat colleagues with the kind of respect they'd want for themselves. And she models that leadership openly, describing herself as a cheerleader, but not the sideline kind.

"I don't mean somebody that just runs along the side while you do all the work. I mean someone who engages with the work with you, but then takes the time to encourage you about your work and to acknowledge your value to the team."

For the graduating class of 2020, who had their off-campus rotations suspended and their program plans completely rewritten mid-semester, that kind of leadership mattered. They adapted. They gained teletherapy experience they never expected to have. And as Nola puts it: "We have made lemonade out of lemons."

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Transcript

Kadie: You are listening to Clinic Chats, the speech therapist's private practice podcast, a podcast full of personal journeys where we not only talk about success stories, but also real life struggles of small business startups. Clinic Chats is sponsored by ClinicNote, a HIPAA compliant, cloud-based EMR platform used specifically by private practice owners and university clinics. I'm your host, Kadie Jackstadt, and thank you for joining me today.

Kadie: I wanted to go ahead and get started and let our listeners know that today I have the pleasure of speaking with Nola Radford, who is a professor and director of clinical education at the University of Tennessee. Hi, Nola.

Nola: Hello. How are you?

Kadie: I'm doing great. I am excited for the listeners to hear you speak because just from our initial conversation, I can already tell you're fun to listen to and a really great storyteller, and I'm just excited. I think this is going to be a great episode, so I thank you for joining me.

Nola: Well, it's my pleasure to join you, and I thank you for the invitation.

Kadie: So we can go ahead and get started. I wanted to first learn a little bit about how you became interested in a clinical or university setting and how you came to find yourself in the position that you have.

Nola: I'm always excited to share a portion of my journey. I was inspired to pursue a doctorate in order to have an influence on future clinicians' preparation for service. That decision was motivated by my work as a public school speech-language pathologist years ago, and I was working with children and families with varied needs and circumstances.

Nola: I began to reason that if I could influence best practices and participate in educating and mentoring speech-language pathologists, that would be my best option for having a bigger impact on quality services. I returned to school and earned my doctorate in speech pathology at the University of Memphis. Thank you for allowing me to give a plug to my university, my alma mater, in the early 90s to prepare for work in higher education.

Nola: I completed a post-doctorate while serving at the University of Texas Pan American, which has now been renamed Rio Grande University, in the early 2000s. So I've had the pleasure of serving at several universities prior to the invitation to serve at the University of Tennessee Health Science Center here in Knoxville. So that's my journey.

Nola: I wanted to have positive influence on the field, and also, initially, I wanted people to feel good about the settings in which they serve, whether it's public schools, whether it's private practice, or whether it's a medical setting, because too often times there's a tension between those settings, and there are very different demands, and speech-language pathologists have a wonderful plethora of tools to bring to each of those settings.

Kadie: And you can tell you're just passionate, like you said, about bettering the profession and the upcoming professionals. Can you tell me a little bit about the courses that you currently teach?

Nola: Well, I get to oftentimes provide guest lectures because the administrative piece has been pretty heavy, but I am very, very fortunate to have a strong team of clinical faculty members. Our clinical team is considered non-tenure faculty, and there's about 12 of us that provide courses in clinical education.

Nola: So we have classroom instruction to prepare students to be ready for engaging in the clinical process before they start clinic. We get together as a team, and we revise a general orientation to clinic each semester. So I'm very excited about that piece, and it's near and dear to my heart because I get an opportunity to join with the clinical faculty and essentially welcome the students to the clinic, welcome them to the practice of their profession, and then alleviate some of their fears about what clinic will be like.

Nola: So we have the general orientation, students are divided into teams, then they participate in practicum, which of course is considered a clinical course, and they participate in clinical education series as well as professional series. And these are courses that are exclusively clinic oriented so that students can get prepared to work in the clinic.

Nola: Additionally, we have a fees course, which is offered by our specialists in swallowing and feeding, and we are expanding our services to provide introduction to those particular populations from birth through adult needs. Additionally, we have the Out Loud program that has just begun, and that's spearheaded by another very talented faculty member who's working with individuals who have voicing problems as a result of Parkinsonism.

Nola: Now I'm just highlighting a few of the services that we provide and how we deliver that instruction. We deliver it both through the clinical courses and also through actual supervision in the clinic when students work directly with patients.

Nola: As you can understand right now, we are providing services through teletherapy, so some services are temporarily suspended because of the risk to the clinician and to the patient. So for example, endoscopy right now, an actual examination of the vocal mechanism and the swallowing is not occurring right now.

Kadie: And that's unfortunate because it sounds like an awesome opportunity that they're usually provided.

Nola: Well, I'll tell you what's novel, we are going full speed ahead with the use of simulations. Kudos to ASHA, who just modified the standards January 1st, 2020. Simulations must be respected and developed very, very carefully because it cannot replace experience with a live patient, but it can be a real quality experience for preparing students for clinic.

Nola: It is also very useful to help students gain skills that they could not practice on a live patient as it might put the patient at too much risk. So it helps the students develop skills, it can be used for remediation, and it can also be used supplementally. So I've really been excited about offering some of the strobe experiences, not me directly, but for those on our team who are the experts in the area for the students.

Kadie: You're right, I mean, before COVID, I still think there was a need and a use for the simulations for students if they don't have those opportunities or just if they have a certain passion and want to look into a certain area more and that's not available.

Nola: I think it's useful in several ways.

Kadie: As far as once the students begin typically seeing clients in the clinic, how many are they usually assigned?

Nola: Our students are assigned three credit hours. Now that three credit hour assignment when they first enter the clinic will be one hour in the classroom and then two hours of credit, which translates to probably two to three patients that they serve during a semester.

Kadie: And what are the documentation pieces for each client from start of the semester to the end of the semester, something that you want each student to be working on for every client?

Nola: That's a very, very good question. As new patients or clients come into the clinic, our front office team works with them to complete all the necessary packet, notice of privacy information, some preliminary case history information. But this packet is very useful to students in the clinical team and they review it to make sure no documentation is missing.

Nola: Along with that, students will be involved in completing case history forms and we do have a standard form in the clinic for adults and for the pediatric population. Additionally, they will complete various test forms that equate with the particular standardized test or descriptive, informal measure that they are given.

Nola: Following each session, of course, students are responsible for participating in the completion of a SOAP note to document what occurred during the session. Students work very closely with their clinical supervisor to generate this document. As with all clinics, they're going to have to develop long-term goals or objectives and short-term objectives, and then also an end-of-term report.

Nola: So that's an introduction to some of the paperwork to which students are exposed during their clinical experience. Students also, in various courses, get exposure to our Super Bill and also coding that's appropriate for designating diagnoses.

Nola: Our clinic is unique in that we were among the first, thanks to the vision of our chairperson and other leaders, who have been here much longer than me, who had the forethought to really go into clinic for pay territory as the structure of opportunities was changing given the influence of insurance and the influence of Medicare and Medicaid.

Nola: So these were issues that influenced the faculty to move into services for pay. So we are an operating clinic. We do bill. Our students get real-world experiences with those necessities.

Kadie: Yes, and what a good opportunity. So I don't know if your hands are involved in all of that credentialing, but is it the school or clinic as a whole who's registered and then every supervisor then is carrying their NPI that's also under the Type 2 NPI, or is that someone else handling all of that?

Nola: I have an NPI number, and then the clinic has an overarching number. Each supervisor, it varies, may or may not have their own number. I think the majority of them do. Now, as big as this faculty is, the advantage is we have a billing department that monitors these requirements. So they do the credentialing for insurances as we come in.

Nola: And sometimes they can be a very protracted process, and you definitely need an expert, a medical billing specialist. And we have a team of medical billing specialists who work with us to get us credentialed with the various insurance companies that bill for our services. And that team is overseen by a business manager, and they report directly to our chair.

Nola: So the NPI numbers that are required are managed within our billing and coding department. Now, I am old school. So that means when I came here, I had an NPI number because I've served in many, many states. And on occasion, I do do direct services.

Nola: But I tell you what, it is a moving target. The requirements now are ballooning, I would say. So negotiating the contracts with various private insurances, the changes to CMS and other avenues for supporting our services, it just changes from day to day. But we have a top-notch team of experts, and it takes a team. And we can't all be experts on everything. So I am very, very grateful to have those individuals with which I can confer.

Nola: Additionally, the opportunity to confer with my counterpart in audiology, who came from private practice into higher education. So that individual has a totally different perspective, which is very, very nice. I've been groomed within the higher education setting. So my purview is very different.

Kadie: Absolutely. Well, it sounds like you all are doing it right by having a whole separate team in the billing department. And then you referred to your counterpart in the audiology department. Can you give a brief outline of what both departments look like as far as faculty numbers and student numbers? I know that might be a ballpark because it changes all the time.

Nola: It changes all the time. But let me say this, so that I don't misreport a very dynamic and wonderful program. I would invite you to have my colleague on to specifically talk about the audiology portion of our program in the future.

Nola: But I am prepared to talk about speech pathology, if I may. We currently have 35 master level speech language pathology students preparing for graduation. The program is divided, as I said, into several interesting offerings. We have the PhD programs, and there are three emphases: speech and hearing sciences, integrated biomedical sciences, and health outcomes and policy research are some PhD programs that are offered within the college at large.

Nola: And then specifically within our department, audiology and speech pathology, we have the bachelor of science in audiology and speech pathology, the doctor of audiology, master of science in speech pathology, and the PhD in speech and hearing science.

Nola: For the incoming class currently, and these numbers fluctuate, we have eight students who are considered levelers. That means they will have prerequisites to participating in the master level curriculum as they come in. And we have 43 students who have accepted seats in speech language pathology. Right now for the incoming clinical doctorate program, we have 19 students who have accepted offers. So that's just a smattering of information about the program.

Nola: The student who comes in with all the prerequisites is considered a second year student, and they spend three semesters on campus. And then beginning the fourth semester, these students prepare for off-campus rotations, as well as complete their comprehensive examinations for purposes of graduation.

Nola: Some students choose to work on a thesis, which is very, very exciting, because those might be students who are really inclined to pursue research degrees. And then the fifth semester is a semester devoted to a full-time rotation off-campus. And they choose between wonderful offerings within school or educational settings, or also in medical settings, including skilled nursing facilities, outpatient clinics, inpatient clinics. Some have experience in both acute care and then long-term care. So we are very fortunate to have all those resources to help students develop.

Nola: A strength of our clinic is that students are able to begin practicum right away their first semester. And because our clinical team is so large and varied, we have clinical faculty members who represent expertise in each of the areas of speech pathology.

Nola: So you can deliver a very different experience for students when the clinical faculty member is supported in concentrating on that particular area of practice. Now, I am a generalist. We have some very, very fine speech pathologists available, talented people who are generalists. So that means we practice across several areas, but we must be honest with ourselves. It's difficult to rise above just basic competence to expertise when you're functioning as a generalist.

Nola: In more recent years, beginning in the 2000s, I was able to return to my areas of specialty in terms of building, retooling. And again, I hear oftentimes the phrase perpetual learners. To be successful in any field in the current climate, we must be perpetual learners. So I'm still a student at heart because there's always more to learn.

Kadie: Always, isn't that the truth? Well, it sounds like the program is just incredibly special with so many faculty available to cater towards those specialties and interest of each student. I'm curious if there's anything particular that the clinic implements that works incredibly well for you all. Is there any special programs or group treatments that you provide or what comes to mind when I ask that?

Nola: Well, I have been pondering that question and honestly, because of the largesse of the program, we really have several areas of strength. I can begin, for example, with the Pediatric Language Clinic, where we serve children on the autism spectrum. I can also speak to the Child Hearing Services Clinic, whereby we've been serving hard of hearing children, deaf children, and their families for many, many years. That's a hallmark of the program.

Nola: And then, of course, the Hearing Speech Center, and it was recently renamed the Silverstein Looper Building in honor of Dr. Bernard Silverstein and Dr. Harold Looper. And Dr. Silverstein was the founding director of the center in 1953. They have been serving the families of East Tennessee for many, many, many years. And so we serve, again, birth to adulthood.

Nola: We have a very strong Augmentative Alternative Communication Program and related clinical experiences. There are strong introduction and concern for literacy. So I could go on and on.

Kadie: So many, yes, that is great. Whenever you were in-person clinic, how did supervisors provide feedback and how has that changed now?

Nola: My feedback was typically face-to-face, either in the professor's office, or perhaps they hung out in the clinic room after a session had ended, or perhaps they worked together in the conference room. So typically, follow-up and feedback occurs face-to-face.

Nola: But in this new world of COVID, now the debriefing, having been influenced by the language coming from simulations, the follow-up, the feedback, more often than not is occurring during a Zoom session that is scheduled after the actual clinical session.

Nola: Kudos to the university, because we have a top-notch Office of Information Technology, and we've had a lot of support to make this transition. So I'm really excited about that support, because it can be scary as we go into the cyberspace to deliver services.

Nola: But the chair has been visionary. So therefore, in-house, we have experts who understand cybersecurity and they work directly with us. And then we also have the infrastructure available through the Office of Information Technology across both campuses, the UTK campus where we are housed, University of Tennessee, Knoxville, and also our primary administrative offices that are housed in Memphis, University of Tennessee Health Science Center.

Nola: So we have the support of both those divisions, as well as the in-house personnel that are charged with assisting us in adapting to the use of Zoom, making sure our computers are properly secure, and talking with us about software issues and documentation storage.

Kadie: And how would you say the students are adjusting? I mean, I just feel for them, but I'm also thinking they are probably more tech-savvy than a lot of us. So how would you say they're adjusting to this new way of treatment?

Nola: I think the students have done a marvelous job. They've shown a lot of flexibility under very stressful circumstances for all of us. And I would also want to commend the faculty who have shown a lot of sensitivity to the likelihood that students are experiencing some stress.

Nola: Now, we are organized so that we have the clinic directors. Under us are the educational coordinators, both in audiology and speech pathology. And these individuals are charged with assisting clinical faculty members with their schedules, assisting with assigning students to different schedules. And they really are great cheerleaders and very personable individuals who do that day-to-day check up of both students and their colleagues.

Nola: So with this camaraderie, it helps everybody stay encouraged. And the chair has also led some Zoom sessions with the students. We followed that up with having individual Zoom sessions with smaller groups and doing check-ins with the students. And so if we find out if someone is having a difficulty, we do try to follow up with those students.

Kadie: And it sounds like everyone has just absolutely risen to the occasion, which you wouldn't expect any less, but it's always impressive to hear that things have continued to run and you're still providing services. You did mention that some families might've opted out or might not have been suitable for teletherapy, but for the most part, services are continuing?

Nola: Services are continuing. And again, right now, the chair is leading a lot of discussion of how do we resume normalcy as the stay-at-home orders are rescinded and when we are given the word that our clinic will be reopened.

Kadie: Absolutely. Who knows how that will look or when that will happen? Something that I wanted to ask you was some explanations for how you all are given funding for tests, materials. This may be a question that's silly whenever other universities are listening to it, but for me, from an outsider's perspective, I've always been intrigued about funding for the program.

Nola: In general, our budget for clinic materials and other necessities for both education and teaching are coming from our actual clinic budget because we are a for-pay clinic. Again, those clinic funds are also managed, our overall budget manager is the chair in conjunction with our office manager who provides advisement.

Nola: But let's say, for example, it's the beginning of the year, we have routines in place. There are certain consumables that have to be replaced every semester. So that might be disinfectant for the tables, it might be bubbles for the little ones who like to play bubbles. Just throwing out a few examples.

Nola: With those consumables, we pretty much know how many we will need at the beginning of each new semester. And so every clinical supervisor makes requests, we talk about it in a clinical faculty meeting, and we advance those requests to the chair for her consideration. Sometimes we might have to make some adjustments up or down.

Nola: So those consumables that we have to reorder every semester, that's how they're pretty much taken care of. The same goes for tests, materials, and also instrumentation. For example, three years ago, we made a substantial investment in acquiring new video endoscopy equipment. And we were delighted to have the support of the chair, and we were delighted to have opportunity to purchase those items.

Nola: Because again, being able to be the leaders in terms of training future professionals with up-to-date equipment is essential. And also, we have been known to serve area ENT physicians very well. And we have a senior speech pathologist who's an expert in voice, who also works with her counterpart on the academic side. Very talented, knowledgeable scholar and researcher in the area of voice. So they work together very closely.

Nola: And for me about trends, what our recommendation should be to the chair, and I'm very appreciative of that support. Because again, I think it's important to operationally define. So when I have shared with some people that I'm a cheerleader, I want you to have a positive impression of a cheerleader. I don't mean somebody that just runs along the side while you do all the work. But I mean, someone who engages with the work with you, but then takes the time to encourage you about your work and to acknowledge your value to the team.

Nola: I say that because it's so important for women administrators in particular because sometimes we are lacking role models about how to lead and how to lead genuinely and lead in the skin you're in. I have to assess what my weaknesses and strengths are. I have to be transparent and seek help to strengthen those areas or team with somebody else who has strengths that I don't have, but then use my strengths to my fullest ability.

Kadie: The university is just lucky to have you. Like you said, you're analyzing yourself because you want to be the best that you can be for the students and your team. I'm curious if there were to be anything that you wanted students to take away. Obviously, there are so many competencies that the students need to have, but general people and professional skills that you're trying to portray for the students to take away with them for life.

Nola: We have our professional ethics, so the code of ethics, but the code of ethics is really sort of like a capstone. People come to their professional decisions and choices in life with a whole lifetime of development behind them.

Nola: I think the majority of people are good people and they want to do a good work, but I want our students to always strive for excellence, but don't be self-punishing. You can only do so much. I want them to experience that it's okay to make a mistake. That's why we have erasers on the ends of pencils, and when they make that mistake, that's corrected.

Nola: Now, that doesn't mean I encourage sloppy work, but it does mean that I encourage people not to be afraid when they need some help, because a way to be unhealthy is to assume that you're perfect at everything. We just can't maintain that level of performance all the time, so look to value your colleagues. Be able to treat them with respect, treating others as you would want to be treated.

Kadie: Is there anything that we didn't touch on that you would like to share about the clinic, the program, yourself?

Nola: Oh, nothing about me. I've appreciated this opportunity to talk with you this afternoon. I would send a shout out to our students who are preparing to graduate. Go team. I really commend these young people. This has been a tough semester with COVID, and just consider that many of these students had to experience complete revamping of their program of study because their off-campus rotation necessary for graduation was suspended.

Nola: Then I commend the clinical and academic faculty who jumped in there with the chair and worked to address this issue with patience and persistence, as I've seen them do so many, many times before. Kudos to the university, the dean, the administrative team that worked really, really hard to support us as we work through this rough patch.

Kadie: Yes, you're right. They all are very commendable. As far as the students go, not to make light of the situation, but I sure wonder what their resumes are going to look like. I bet they'll have some revamping to do now that they have teletherapy under their belt.

Nola: Absolutely. In one sense, we have made lemonade out of lemons because now they have some unique and valuable quality experiences in teletherapy. We look forward to our incoming class. We want to continue through this successfully and with patience and persistence and good humor.

Kadie: Very good. Well, thank you so much for your time, Nola, and I look forward to keeping in touch as the program comes out of this hard time.

Nola: Thank you so much.

Kadie: Thank you for joining me and listening to Clinic Chats. If you have a moment, please leave a five-star review for Clinic Chats to help other SLPs and our podcast. If you'd like to share your own personal journey through private practice, please email me kadie@clinicnote.com. That's K-A-I-D-E at clinicnote.com.