In this study, the investigator aims to identify the threshold of food residue visualized in the throat during a FEES (fiberoptic endoscopic evaluation of swallowing) that speech-language pathologists allow before restricting a patient from eating. 60 speech-language pathologists will be required to participate, with half of them watching a pre-recorded video detailing current research about residue in the throat of pharynx. The group watching the video will then re-score their images. This investigates the impact of education on clinical decision-making. Finally, 8 clinicians will meet with the researcher individually to share their clinical decision-making rationale. With this information, the researcher hopes to identify a patient population who is at risk for diet restrictions in order to encourage speech-language pathologists to extend the swallow study and trial more compensatory strategies before restricting the patient's diet.
Speech language pathologists with at least one year of experience conducting FEES (flexible endoscopic evaluations of swallowing)
Anyone who is not a speech pathologist, or has less than one year of experience conducting FEES.
Parallel
education
Other interventionIn the second aim of the study, 30 (50%) of the clinicians participating in the study will watch a 30-minute educational presentation about current research on clinical decision making and aspiration risks of pharyngeal residue after they complete the image assessment task (Specific Aim 1). Several peer-reviewed articles will be presented via video recording. These articles support several key tenets of this research study and include: 1) recommendations should be based on clinical experience and training, not evidence-based practice,8 2) the location of pharyngeal residue does not increase or decrease penetration or aspiration risk,6 and 3) a correlation, not a causation exists between the amount of pharyngeal residue and aspiration risk.14 Other studies indicated that other factors should be investigated, such as the accumulation of residue over time.14 These clinicians would then re-test.
If a diet restriction occurs based on the residue amount and location
Clinicians will be rating if they would restrict an oral diet based on pictures of pharyngeal residue of various amounts (none, trace, mild, medium, severe) in two locations: the valleculae and pyriform sinuses.
Identifying if education impacts how pharyngeal residue is interpreted
The secondary measure is to identify if education (a pre-recorded presentation on up to date dysphagia management research) impacts how clinicians interpret the amount and location of pharyngeal residue during FEES. Clinicians will first rate randomized photos of pharyngeal residue of each category. Then the clinicians will watch a video, and will have to re-rate randomized photos. The amounts of pharyngeal residue will be categorized as none, trace, mild, moderate and severe based on the Yale Pharyngeal Residue Severity Rating Scale. Pictures presented will show each residue amount in two locations; the pyriform sinuses and valleculae. Clinicians will indicate if they would restrict oral eating based on the picture of pharyngeal residue.
Ivestigating the rationale behind clinical decision making during pharyngeal residue management
8 clinicians will be chosen to be interviewed to investigate the rationale behind their clinical decision-making
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