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Instruction in professional issues using a cooperative learning, case study approach.

This article describes a cooperative learning approach for instructing communication disorders students about professional issues. We developed case studies characteristic of the complex professional issues encountered in employment settings. We assigned students to cooperative learning groups to examine their assigned case study; collect and learn about policies and documents impacting professional practice; select, analyze, and synthesize materials to take an ethical and defensible position on the issue; and prepare and present their position orally and in writing. Evaluations of the approach indicated that students met the instructional objectives for the activity. This article presents implications and suggestions for future use of the approach.


Speech-language pathologists (SLPs) and audiologists often find it challenging to provide high-quality care in the current climate. Practitioners must balance competing demands of professional issues (e.g., quality service delivery, advocacy, and education), legal and regulatory issues, and ethical decision making. The scope of practice has expanded, requiring professionals to have a more extensive knowledge base and skills that include the use of increasingly invasive procedures (American Speech-Language-Hearing Association [ASHA], 2001, 2004a). Medical advances in the treatment of individuals with head injury, infants born premature, and other high-risk medical problems have resulted in an increase in the number of clients who are medically fragile or who have severe disabilities. Professionals working in health-care and school settings also may face the added responsibility of supervising speech-language pathology assistants and volunteers (Miller, 2001).

Preprofessional education programs must prepare graduates to deal with the complex issues they will encounter in today's workplace. This article describes the application of a pedagogically sound instructional strategy that has been broadly used in the humanities and some medical disciplines for the purpose of assisting students in communication disorders to learn about and deal effectively with the many professional issues found in clinical practice.


Professionals must manage the complex issues of the workplace in the context of increasingly scarce resources and the unique, and sometimes conflicting, requirements of professional organizations, regulatory agencies, and clinical stakeholders concerning service provision. They must also deal with patient advocacy and education of organizations, systems, and individuals. They must also be knowledgeable of, and able to provide information about, current laws and regulations guiding practice and demonstrate their applicability to practice.

In addition to the ethical standards of conduct and practice guidelines provided by ASHA, SLPs and audiologists are often subject to state licensure requirements, state teacher certification guidelines, and various federal and state laws and regulations. Employers and third-party payers may impose additional requirements.

The myriad of guidelines and requirements provided by regulatory agencies and various professional associations is confusing to students and professionals alike (Frazek, 2003). Frazek suggested that when there are conflicts in regulations, professionals should follow the higher standard. Although this is good advice, it fails to fully address what to do when agencies are in conflict such that meeting the requirements of one agency may put professionals in conflict with another. It also fails to address the responsibility of professionals to advocate for clients and educate colleagues and others regarding high-quality services and ethical conduct when faced with a professional dilemma.

Providing high-quality services and maintaining high standards of ethical conduct in the present environment requires professionals to have more than content-specific knowledge and professional judgment (Shapiro & Stefkovick, 2001). They must also have critical-thinking and problem-solving skills along with knowledge of professional practice issues so that they can make informed, ethical decisions (Hallowell, 1997). In addition, they must be able to work cooperatively with others and to tactfully and persuasively communicate their positions on issues in an effort to educate others and influence professional practice (Huffman, 2003).


The importance of teaching professional issues is evident in the test construction guidelines for the Praxis examinations in speech-language pathology and audiology. Eight percent of the test items deal with professional issues, psychometrics, and research; questions related to ethical practices, standards, and laws make up a portion of the examination (ASHA, n.d.d). Other subject areas relevant to the approach described here are counseling, interpersonal communication, efficacy, and documenting and monitoring client progress. Communication disorders education programs utilize various strategies for helping students acquire the necessary knowledge and skills required for ethical decision making and appropriate professional judgment, including discussion, lecture, and more active learning strategies (e.g., Gonzalez & Coleman, 1994; Pannbacker, Lass, & Middleton, 1993; Resnick, 1993).

Case Studies

One active learning strategy that instructors can use to develop these skills in students is the case study method (ASHA, 1993; Gillies & Ashman, 2003; Gonzalez & Coleman, 1994). Case study approaches are useful for teaching many different areas--ethics, professional skills, content knowledge, and decision making (Beck & Murphy, 1994; Shapiro & Stefkovick, 2001). Case study methods begin with real-life problems found in the workplace and rely on active engagement by students to determine possible solutions (Jonassen, 2004). Using cases provides a learning activity that mirrors the decision-making process needed in the workplace and helps students understand that learning must go beyond simply learning material to do well on examinations (Jonassen, 2004).

Barnes, Christensen, and Hansen (1994) defined case studies as narratives that provide data and essential information about a specific problem situation, which leads to determining possible solutions. These cases must be relevant and interesting to stimulate student participation in problem-solving activities. Interesting, well-crafted cases bring students together in a team approach to solve a problem that may be an accurate representation of the "complexity and ambiguity of the practical world" (Rippin, Booth, Bowie, & Jordan, 2002, p. 431).

This strategy can be effective in helping students learn about a topic and develop problem-solving strategies and critical-thinking skills (Barnes, Christensen, & Hansen, 1994; Bonwell & Eison, 1991; Davis, 1993). Students are able to apply theory to practice when the case study provides them with an authentic or real-life context for the problem or dilemma. In addition, they learn to identify the important issues and the impact of possible solutions (Quarstein & Peterson, 2001). Unfortunately, available case studies tend to describe circumstances with obvious, clear-cut solutions and fail to capture the subtle, complex issues practitioners encounter in their work (e.g., ASHA, 1993, n.d.c).

More successful case study methods involve the use of challenging case studies that facilitate the development of students' critical-thinking and problem-solving skills. Students gain experience in solving complex problems based on actual clinical and management examples. They learn to apply clinical knowledge to issues dealing with advocacy, patient education, laws and regulations, ethics, and practice (Hayward & Cairns, 2001). Fisch (1997) suggested that well-crafted cases are short, open ended, and realistic; have impact; and trigger discussion.

The literature on problem-based learning highlights some important concepts that educators should apply to the case study method. Savin-Baden (2000) outlined critical features of problem-based learning. These include practical situations that focus on outcomes that would occur in the workplace. Real-life scenarios that call upon best practices allow students to gain important knowledge and skills (Savin-Baden, 2000). These same features can be applied to case studies to ensure mastery of professional problem solving and decision making as well as refinement of critical-thinking and cognitive skills (Rippin, Booth, Bowie, & Jordan, 2002).

Cooperative Learning

Educators often deliver case study instruction using a cooperative learning approach. Cooperative learning is a structured, systematic instructional strategy in which small groups work together toward a common goal. Research has shown the effectiveness of this teaching strategy (e.g., Astin, 1997; D. W. Johnson, Johnson, & Smith, 1998; McKeachie, 2002) for a wide range of topic areas. Cooperative learning helps students develop better high-level reasoning and critical-thinking skills and the ability to see the perspective of others (Quarstein & Peterson, 2001).

Using the cooperative learning approach, instructors provide students with activities that promote interaction and require accountability. Instruction in group processing enhances cooperative learning so that students learn how to work together effectively (R. T. Johnson & Johnson, n.d.). Johnson and Johnson stated that instructors should design tasks that hold students accountable both individually and as a group. One strategy to ensure accountability is to provide both individual and group grades for the assignment. In addition, self-evaluation and peer evaluation should be part of the evaluation process.

Instructors should design the process so that students perceive individual benefits from group participation (McWhaw, Schnackenberg, Sclater, & Abrami, 2003). This approach to learning provides opportunities for students to learn to work together (Cotton, Smith, & Lait, 2002) and to improve interpersonal communication skills as well as learn to deal with diverse student groups (McWhaw, Schnackenberg, Sclater, & Abrami, 2003). Pairing case studies with cooperative learning allows students to work together to solve problems and develop increased knowledge of professional issues.


We intended our description of the cooperative learning, case study approach to highlight a pedagogically sound instructional strategy to help students in communication disorders learn about and deal effectively with professional issues through active problem solving and decision making. To avoid the pitfalls of some published case studies, we developed cases that closely approximated the types of complex professional dilemmas typically encountered in the workplace and provided specific questions to students to guide their study. To complete the case studies, students worked in cooperative learning groups to make decisions by selecting, analyzing, and synthesizing information from a variety of sources. Finally, students communicated their position to other practitioners or stakeholders in a role play. Specific goals of the instructional activity were as follows:

1. for students to learn about current issues impacting the communication disorders professions;

2. for students to learn about policies and documents impacting professional practice;

3. for students to gain experience selecting, analyzing, and synthesizing material to formulate an ethical and defensible position on a professional issue;

4. for students to work cooperatively to prepare and present their position orally and in writing to educate and persuade peers and employers about the issue.



All 29 undergraduate students enrolled in a communication disorders program at a mid-southern university participated in the activity. They completed the assignment as part of a first semester, senior-level course on professional issues taught by the first author. Prior to enrollment in the professional issues course, students completed an introductory communication disorders course and several courses pertaining to normal development and processes, such as phonetics, anatomy and physiology, basic audiology, and speech science. Concurrent with the professional issues course, students took courses in normal language development and completed 25 hr of supervised clinical observation.

Instructional Materials

Case Studies. We developed 10 case studies for class use. We intended these case studies to address diverse professional issues and problems across a range of employment settings. We initiated the process of developing case studies by examining published materials concerning professional issues (e.g., ASHA, 1993, n.d.c) and generating a list of possible issues applicable to various clinical employment settings (e.g., hospitals, schools, clinics, private practice). To ensure that the case study topics were still current and relevant to professional practice, we then interviewed faculty colleagues and clinical practitioners in the region who were employed in these settings to obtain additional suggestions about relevant issues and to verify the selection of issues that we had identified.

After we had identified a pool of topics and settings, we prepared 10 case studies by selecting 10 topics that represented a broad base of issues applied to six employment settings. We expanded the topics into scenarios that described the employment setting, the presenting issues or problems, the expected outcome (e.g., issues to be addressed or questions to be answered in the form of a report or written policy recommendations), and the audience (e.g., employers, colleagues, other professionals, the public). We then listed the resources applicable to the issue(s), including core documents and other required resources. Finally, a faculty member and selected clinicians examined the completed case studies for feedback and final modifications. Table 1 shows the list of topics and employment settings, and a sample case study appears in Appendix A.

The handout for each case study contained a scenario describing the professional issue or problem, the employment site, professions of the presenters (audiologists or SLPs), professional credentials, and the audience. The assignment handout also contained a list of core documents, such as the state licensure laws (Kentucky Board of Speech-Language Pathology and Audiology, 2001); and ASHA's Code of Ethics (ASHA, 2003), Scope of Practice in Speech-Language Pathology (ASHA, 2001), Scope of Practice in Audiology (ASHA, 2004b), Preferred Practice Patterns for the Profession of Speech-Language Pathology (ASHA, 2004a), and Preferred Practice Patterns for the Profession of Audiology (ASHA, 1997). We also provided a list of several required resources (e.g., applicable laws and regulations, position papers, guidelines, and tutorials), and we instructed students to obtain at least two additional sources not on the list to complete the assignment. Appendix A shows a sample case study handout.

Procedural Guidelines. We developed specific procedural guidelines for assignment completion, shown in Appendix B. These written guidelines, which we provided to students at the beginning of the assignment, contained a description of the rationale for the assignment, assignment goals, and steps for assignment completion.

Case Study Assignment Planning Form. We developed a planning form to facilitate organization and communication between group members and the instructor. The form contained spaces for recording group members' names and contact information, identifying the designated student group coordinator, listing preferred case studies, assigning the final study, and listing important meeting and presentation dates. Figure 1 shows the planning form.

Evaluation Forms. We developed instructor evaluation, team evaluation, and peer evaluation forms to evaluate students. The rather complicated evaluation process was consistent with recommendations made by experts for use in cooperative learning procedures (Davis, 1993; Fiechtner & Davis, 1992; King, 1993). Experts indicated that instructors should use multiple sources of information for student evaluation pertaining to cooperative or collaborative learning tasks.

Students' grades comprised both group and individual components. We based the grade on evaluation by the instructor and evaluation by group members using the instructor evaluation form and the team evaluation form, respectively.

The instructor evaluation form listed specific points concerning the presentation, class handout, and teamwork and preparation. Point values assigned to each segment informed students of the relative importance of each portion of the assignment. Appendix C shows the instructor evaluation form.

The team evaluation form allowed group members to judge their teammates' contributions to the assignment. Students divided two pie charts, to indicate the relative amount of time spent by each team member and their contribution to the assignment. The form also provided a comment section. Figure 2 displays the team evaluation form.

Although feedback from the class was not a factor in grading, classmates completed a peer evaluation form to provide students with feedback on their presentation and class handout. The audience (classmates) wrote (a) the best thing about the presentation, (b) one suggestion for improvement, and (c) general comments.

Implementation Procedures

The collaborative learning activity required several weeks to complete, and all groups followed the same procedure, with the exception of a recommended (but optional) meeting with the instructor that was held shortly after the groups received their specific case study assignment. During the first class meeting, students received the case study descriptions, procedural guidelines, evaluation forms, and case study assignment planning forms, and the instructor described the assignment in detail.

Background Information and Core Documents. During the next three 2.5-hr weekly class meetings, the instructor presented information about (a) the communication disorders professions, (b) professional organizations and resources, and (c) core documents. The instructor provided general information on the professions--such as a brief history of the profession; demographic information for the professions by gender, age, and race/ethnicity; expected salary; employment settings; and credentialing information--to give students background knowledge and context for the professional issues.

The presentation on professional organizations and resources included information about ASHA, the state professional association, and regulatory organizations that impact professional activity in various employment settings, such as the state Department of Education and the Occupational Safety and Health Administration. Students also received a list of professional newsletters and journals for their use.

The presentation of core professional documents included the Preferred Practice Patterns for the Profession of Speech-Language Pathology (ASHA, 2004a) and Preferred Practice Patterns for the Profession of Audiology (ASHA, 1997), the state Laws and Regulations Relating to the Practice of Speech-Language Pathology and Audiology (Kentucky Board of Speech-Language Pathology and Audiology, 2001), the Membership and Certification Handbook for Speech-Language Pathology (ASHA, n.d.b) and the Membership and Certification Handbook for Audiology (ASHA, n.d.a), the ASHA Code of Ethics (ASHA, 2003), and the Scope of Practice in Speech-Language Pathology (ASHA, 2001) and Scope of Practice in Audiology (ASHA, 2004b).

Student Preparation of Case Studies. We used portions of two class meetings to organize groups and tasks. Students self-selected into nine groups of two or three members. The instructor gave each group a list of the case study topics and employment sites and provided a verbal overview of each case. Groups completed case study assignment planning forms listing the group members' names, phone numbers, and e-mail addresses. The groups identified a coordinator who communicated information to the group, organized meetings, and served as the contact person for correspondence with the instructor. After discussion among the group about the case studies, the group listed three case studies of greatest interest on the planning form and submitted it to the instructor.

The instructor then made assignments, attempting to give each group one of their three choices. Each group prepared one case study, and each group received a different case study. The instructor assigned a presentation date to coincide with class lectures relevant to the case study. At the next class meeting, groups began preliminary discussions about the content and organization of the presentation, made individual assignments, and scheduled their first meeting outside of class. The required meeting between each group and the instructor (held about 1 week prior to the presentation) was also scheduled.

The instructor encouraged the groups to schedule additional meetings with the instructor, and most groups met with the instructor shortly after the assignment was made. The purpose of these meetings was to discuss any concerns or questions of the students, such as clarification or additional information regarding the selected issue, discussion about the roles and responsibilities of group members, and suggestions about how to complete the assignment in the context of a cooperative learning group. Thereafter, the groups met outside of class to collect information, organize content, create the class handout, and practice the presentations.

During the required meeting between the group and the instructor held about 1 week before the presentation date, the students showed their proposed slides or overheads and other audiovisual material, provided a copy of the proposed class handout, and described how they planned to give their oral presentation. The instructor provided feedback about the materials and the presentation.

Case Study Presentation and Feedback. The instructor introduced each presentation to the class by providing introductory background information (scenario) relevant to the case. Prior to the presentation, each group member gave the instructor individually completed team evaluation forms and gave handouts to the class.

The groups gave 20-min presentations and referenced the class handout. To ensure that all students gained experience in giving oral presentations, the instructor required the oral presentation to be divided equally among group members. The presentation and written class handout explicitly stated the group's position on its professional issue and provided supporting information and documentation. The instructor cautioned each group to consider its audience and attempt to educate them and persuade them to adopt the group's position. Class members were free to make comments and ask questions.

The instructor completed the instructor evaluation form (Appendix C) addressing the presentation, class handout, and teamwork and preparation. The instructor used her own judgment when evaluating the presentation and class handout. The instructor assessed teamwork and preparation by using her impressions during group meetings with the instructor along with group members' comments on the team evaluation form. Although all students in the group received the same number of points for the class handout, students received separate grades for the overall assignment because points awarded for presentation and teamwork and preparation varied.

Class members completed the peer evaluation forms anonymously and submitted them to the instructor. The intent of these evaluations was to provide group participants with helpful feedback for future reference. The instructor did not use them to determine grades but compiled student comments and gave them to the group members.

Students were responsible for the content of the presentation and class handouts on examinations. The instructor distributed study guides highlighting material from the instructor's lectures and the groups' oral and written presentations.


At the end of the activity, students completed a student evaluation of the assignment that contained 11 statements intended to tap into the conduct of the assignment and how well the assignment had achieved stated goals. Students rated each statement from 1 (strongly disagree) to 4 (strongly agree). We judged scores of 3 or 4 as agreement with the statements. Table 2 contains the statements and mean scores. The instructor used the student evaluation of the assignment forms, student performance on the assignment, student test performance, and her own observations and impressions to evaluate the activity. Results for each assignment goal follow.

Goal 1 was for students to learn about current issues impacting the communication disorders professions.

Overall, students indicated that they learned about current professional issues, especially the issue for their case study. As expected, the mean score for the item "I learned about the topic in my case study" (3.51) was higher than the mean score for the statement "I learned about others' topics from their presentations and handouts" (3.34). Ten students wrote that a strength of the assignment was the opportunity to learn about a variety of current professional topics.

Student presentations and class handouts indicated that students learned about their topic. All groups provided accurate and pertinent information during oral presentations and in writing. The second and third examinations assessed students' knowledge of case study issues, and the mean test scores were 92% and 91%, respectively.

Goal 2 was for students to learn about policies and documents impacting professional practice.

Most students responded that they learned about documents important to their case study issue (3.41), although 2 students disagreed with the statement. Three students wrote that learning about document contents was a particular strength of the assignment. Student performance on assignments and tests indicated that most students learned about important documents and policies.

Goal 3 was for students to gain experience analyzing, selecting, and synthesizing material to formulate an ethical and defensible position on a professional issue.

All students responded that they learned how to select, analyze, and synthesize information about their case study (3.34). Three students wrote that having to seek information independently was beneficial. However, 4 students stated that they needed more guidance in locating documents. Meetings between the instructor and student groups revealed that this was a challenge for some groups. Group variation on this task was probably due, at least in part, to differences in case study difficulty.

Goal 4 was for students to work cooperatively to prepare and present their position on an issue orally and in writing to educate and persuade peers and employers about the issue.

All students indicated that the activity helped them learn how to make an effective oral presentation (3.31) and an informative handout (3.51). Respondents also indicated that they learned how to state and defend their position clearly and persuasively (3.48). Five students wrote that creating the class handouts was helpful, and 3 indicated that giving an oral presentation was beneficial. One student wrote that her group "blew away" students in another class because they knew how to make an oral presentation and create a handout for the class, which no other group in that class knew how to do.

Students were less sure that the activity helped them learn how to work collaboratively (3.11). In fact, the mean score on this item was the lowest of all 11 items. Although 8 students agreed that the activity helped them to learn to work in groups, 3 students indicated that the activity was not helpful in helping them learn to work collaboratively.

Student responses were consistent with the instructor's observations. Two groups did not receive full credit for teamwork and preparation based on responses to the peer evaluation form and the instructor's impressions during meetings with the groups. The instructor was aware of difficulties with one group. The group leader approached the instructor early on and stated that an individual was not doing her share. The instructor immediately convened a special meeting of that group. The instructor described the task in greater detail and helped the group make specific assignments and set a calendar. Although the situation reportedly improved, 2 of 3 students indicated in the evaluation that members did not share equally in the assignment preparation. The instructor was unaware of any problem with the second group until the assignment was completed and 1 group member stated that she had done the majority of the work.

Assignment Procedures

The student evaluation contained several items pertaining to the effectiveness of the procedures used in the activity. All but 1 student indicated that the assignment was well organized and explained (3.58). One student wrote that she did not know what to do at the beginning of the assignment, and 5 students stated they needed more guidance regarding where to find information. Three students indicated that a meeting between the instructor and group near the beginning of the assignment should be required, and 3 others indicated that they benefited from scheduling such a meeting. Most groups scheduled an early meeting, and the instructor concurred that these meetings were helpful in coordinating and planning the assignment.

Several students wrote comments about the case studies. Although some students responded positively to the use of realistic topics and opportunities to apply information to real-life situations, others noted that the case studies varied in complexity and in ease of finding and interpreting relevant documents.

Finally, several students commented about evaluation procedures. Only 1 student disagreed with the statement "Grading was fair" (3.68). Three students indicated that they did not find the feedback helpful (3.34). Every student who wrote about this issue stated that the instructor's comments and suggestions were helpful but that class peer evaluations were not useful. Some disliked having to write comments, whereas others stated that peer comments were vague, contradictory, erroneous, and sometimes rude.

Implications and Suggestions for Future Use

The collaborative learning activity using case studies described in this article appears to be a viable strategy for helping students learn about professional issues, obtain relevant information, work cooperatively to develop a position concerning the issue, and present their positions effectively orally and in writing. Nevertheless, some changes could improve the activity. First, in response to students' feedback, the instructor should evaluate and modify current case studies to ensure that they are similar in complexity and difficulty and have similar amounts of available resources. As part of the revision of case studies, the instructor should add new studies that continue to reflect timely issues.

Although the instructor attempted to provide students with specific guidelines, additional specificity was needed for some aspects of the assignment. The instructor should more clearly state and explain the expectation that students are to examine the core documents and identify additional materials independently. Some students were distressed at having to "dig out" pertinent information in the core documents and indicated that they wanted the instructor to provide all reference materials. However, we believe that having students locate the materials was important to the learning process and better reflects the reality of an employment situation.

Students also needed additional guidance concerning strategies for working in cooperative groups. Strategies for addressing this issue may include providing more information during the initial presentation of the activity regarding how groups function and strategies for managing problems in the group, and regularly scheduled meetings between the group and the instructor for the partial purpose of discussing how the group is functioning and addressing issues pertaining to the group process. The activity described here required one meeting near the time of the presentation, and the instructor invited students to schedule an optional earlier meeting. It may be beneficial to require an early meeting between the groups and the instructor rather than make the meeting optional. This meeting would provide an opportunity to clarify the assignment, discuss how the group will function, identify individual responsibilities, and set timelines. It may be particularly beneficial for undergraduate students to require at least two meetings (and perhaps more) for the purpose of helping groups obtain answers to questions and issues that arise and are beyond the knowledge and skill levels of group members (Quarstein & Peterson, 2001).

As suggested by R. T. Johnson and Johnson (n.d.), the instructor could also provide additional guidance regarding how to handle problem situations as part of the initial presentation of the collaborative learning activity. Although Davis (1993) suggested that group members be advised that each group must find its own way to handle unproductive group behavior and that groups be allowed to dismiss members who are not contributing once they have exhausted all alternatives, it is likely that students lack the knowledge and skills to know which strategies to apply to help make their groups more cooperative and productive.

Educators might strengthen use of the collaborative learning method by requiring students to consider ethical questions using a structured framework that could transfer across issues and situations, such as the framework described by Chabon and Morris (2004). They presented a strategy for ethical decision making that begins with the question of whether the professional is facing an ethical dilemma. If so, the professional then considers the dilemma in light of all of the relevant facts, values, and beliefs of all involved, including those with different perspectives and individuals who have an interest in the outcome. The professional collects information and utilizes it to determine the possible courses of action and the possible effects of each. Once the professional has identified the courses of action, he or she evaluates them in light of personal interests, social roles, and expectations (including their obligations and the ASHA code of ethics).

Educators might also enhance the collaborative learning activity by requiring students in the audience to be more participatory during the case study presentations. Because the presenters already have a particular audience (e.g., teachers, parents and clients, employers, colleagues), instructors could require students in the class to ask questions or participate in a manner consistent with the identified audience. Instructors could (a) assign selected students roles in which they take a stance on the issue and convey that to the presenters or (b) require students to prepare relevant questions as part of their class assignment.

Finally, class peer evaluations should be revised or omitted. Student criticisms of peer evaluation indicated that they did not find it beneficial either to provide the evaluations or to receive them. Class peer evaluation forms with more specific questions might have guided students to provide more helpful and specific feedback.


Huffman (2003) noted that professionals need to be prepared to make ethically based decisions by knowing the code of ethics, anticipating ethical issues, and being able to document and provide a rationale for decisions and actions. As we noted in the introduction, educators have effectively used case studies and cooperative learning to provide instruction in a variety of disciplines. In this article, we described the application of a cooperative learning, case study approach to instruction in professional issues in speech-language pathology and audiology. Instead of using some of the presently available case studies, we prepared complex case studies that required a synthesis of information from several sources and required students to make decisions in the presence of competing interests or viewpoints. Because case studies can approximate real-life circumstances, case studies that incorporate a role-playing component, such as those used in this assignment, allow students to experience situations in a relatively benign classroom environment that they might face in the future (Bonwell & Eison, 1991). Consequently, the strategies described in this assignment may be valuable because they build students' skills in critical analysis and problem solving and because they help bridge the gap between having topic knowledge and applying it to professional practice.

Although there is considerable evidence that the cooperative learning, case study approach can be an effective instructional tool, the field needs empirical studies to verify the application of this approach to enhancing knowledge and skills in professional issues and to clarify which aspects of the approach contribute most to student learning.


Site: Hospital clinic

Role: Licensed and certified speech-language pathologists (SLPs)

Credentials: ASHA-certified, state-licensed SLPs

Audience: Clinic director, hospital administrator, new SLPs

Scenario: Your group of SLPs belongs to a private practice that has a contract to provide services at an outpatient hospital clinic. The hospital is located in a large metropolitan area where the Hispanic population is growing rapidly. The SLPs conduct evaluations and make intervention recommendations. The hospital administration has asked the practice to address (a) the volume of referrals for individuals from culturally and linguistically diverse backgrounds, (b) important changes in the client base, and (c) problems related to these changes. The issues include the following:

1. None of the current SLPs hired by the hospital are bilingual. Consequently, referred individuals and SLPs often cannot communicate effectively.

2. Prior to the hiring of the private practice group, most individuals referred from the Hispanic community failed the speech and language evaluations.

3. Most individuals were told that they had a language disorder and were referred for therapy. A review of patient files failed to support the diagnosis that all of these individuals had difficulty learning language.

4. Counseling the clients and their families is difficult. Often, the entire family comes to the evaluation. When recommendations are made, clients frequently fail to follow them.

Your group and the director of rehabilitation know that these issues must be addressed. Your task is to develop a detailed report for the director, other hospital administrators, and SLPs working at the clinic. The report should address the issues of personnel qualifications; appropriate assessment and referral procedures for the clients; and improved interaction and communication between clients, families, and the SLPs. You have also been charged to make recommendations for future policies and procedures.

Resources: The following resources may be pertinent to this case study. Be sure to examine them carefully and reference them using APA style.

1. Core Documents


* Preferred Practice Patterns for the Profession of Speech-Language Pathology

* Scope of Practice in Speech-Language Pathology

* Code of Ethics

* Prevention of Communication Disorders Tutorial (on reserve)

Kentucky Board of Speech-Language Pathology and Audiology

* Laws and Regulations Relating to the Practice of Speech-Language Pathology & Audiology

2. Other Required Resources

* "Multicultural Action Agenda 2000," ASHA Desk Reference

* "Clinical Management of Communicatively Handicapped Minority Language Populations, 1985," ASHA Desk Reference

3. Additional Resources Obtained by the Group (at least 2)


Rationale: Speech-language pathologists and audiologists are in the difficult position of having to fulfill the professional obligations set forth by their professional organizations while taking into account the requirements of other regulatory agencies and clinical stakeholders. Professionals must be able to access information from a variety of resources to make informed decisions. This requires that they know what documents and policies impact their practice, how to prioritize and integrate this information to make appropriate professional decisions, and how to convey these decisions to others effectively.

Goals: By the end of this exercise, students will

* become acquainted with professional documents from a variety of sources;

* select and synthesize information from these documents to address professional issues or problems they might encounter; and

* clearly present their position on the issue or problem orally and in writing to educate and persuade peers and employers about the issue.


* Students will work in small groups to examine case studies. The case studies describe the scenario, employment site, professionals' roles and qualifications, audience, and list of required documents for the case. Each student will complete a portion of the case study assignment planning form by exchanging names and phone numbers, identifying a group coordinator, and listing the group's three preferred case studies. The group will complete an additional planning form for the instructor.

* Groups will receive their case study assignment in the next class. Students will complete the remainder of the planning form by noting the final case assignment and presentation date and setting a date for the required meeting with the instructor. The group will begin making decisions about responsibilities for oral and written components of the assignment.

* The group will meet with the instructor at least 1 week prior to the presentation. At that time, a proposed final draft of the class handout and slides or overheads will be due. The meeting will include a discussion of student roles for the oral presentation for instructor feedback.

* The group will present the case study on the assigned date. The presentation will have both oral and written components. The group will give the instructor a handout, individually completed team evaluation forms, and a copy of the evaluation guidelines. All classmates will receive a handout.

* Classmates will complete peer evaluation forms and give them to the instructor after the presentation. They are also invited to ask questions.

* During the next class, the instructor will return the evaluation guidelines with the instructor's comments and a grade. Peer evaluation comments will be compiled and given to group members for future reference. Peer comments will remain anonymous.

* All students are responsible for case study information on future tests.



Team #:

Submit this form and the team evaluation form before your oral presentation. The instructor will return this form to you with comments and total points earned. The team evaluation form will not be returned.


Length of presentation as required (15-20 min)


Introduced team members, title of case study, and general topic

Thoroughly addressed each issue or concern

Demonstrated clear understanding of issue/concern

Stated team position(s) clearly

Persuasively justified position(s) and recommendations with appropriate documentation

Adequately addressed audience questions


Sufficient number of slides used

Media content appropriate, easily read by all in the room, contained main points

Speaker referred to slides appropriately

Speaker spoke loudly, clearly, and slowly

Speaker shared equally in oral presentation

Speaker appeared and behaved professionally



Contained identifying information--names of presenters, case study title, and description

Stated each issue or concern, demonstrated clear understanding of issue, clearly stated and justified positions and recommendations

Presentation outline contained all information shown on slides/overheads

References listed using APA style

Used all references assigned and at least two additional, appropriate references

Summarized assigned documents thoroughly and accurately


Document was of appropriate length and style, 3-hole punched, stapled

Correct spelling, punctuation, grammar

Logical organization and use of headings


Prepared for meeting with instructor

Was a valuable team member (effort, contribution)



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American Speech-Language-Hearing Association. (2003). Code of ethics (revised). ASHA Supplement, 23, 13-15.

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American Speech-Language-Hearing Association. (n.d.a). Membership and certification handbook for audiology. Retrieved February 25, 2005, from handbooks/aud/default.htm

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Sharon R. Stewart and Lori S. Gonzalez

University of Kentucky

Sharon R. Stewart, EdD, is an associate professor in the Division of Communication Disorders and is an associate dean in the College of Health Sciences at the University of Kentucky. Lori S. Gonzalez, Phi), is a professor in the Division of Communication Disorders and is dean of the College of Health Sciences at the University of Kentucky. In addition to their research and teaching related to child phonology, language, and literacy, Drs. Stewart and Gonzalez are interested in, and have written several publications pertaining to, pedagogy and other issues related to higher education. Address: Sharon R. Stewart, University of Kentucky, CTW 123, 900 South Limestone, Lexington, KY 40536; e-mail:
TABLE 1. Case Study Topics

Topic                                            site

Multi-skilling                                   Home health
Medicaid reimbursement                           Public school
Audiology contract                               Public school
Infection control                                Preschool
Linguistically and culturally diverse clients    Hospital clinic
Record keeping                                   Nursing home
Use of speech-language pathology assistants      Public school
Child abuse                                      Private practice
Dysphagia assessment and treatment               Nursing home
Caseload size                                    Public school

TABLE 2. Summary of Student Evaluations

             Statement                              M     Range (1-4)

Grading was fair.                                  3.68       2-4
The task was well organized and clearly            3.58       2-4
The study helped me learn how to make an           3.51       3-4
  informative handout.
I learned about the topic in my case study.        3.51       1-4
I learned how to state and defend our position     3.48       3-4
  clearly and persuasively.
I learned about documents important to the         3.41       2-4
  case study issue.
I learned how to select and synthesize             3.34       3-4
  information on the issue.
I learned about others' topics from their          3.34       2-4
  presentations and handouts.
Evaluation and feedback were helpful.              3.34       2-4
The study helped me learn how to make an           3.31       3-4
  effective oral presentation, including the
  use of media.
I learned how to work collaboratively with         3.11       2-4
  other professionals.

FIGURE 1. Case study assignment planning form.


Name        Phone           e-mail

** Indicate Group Coordinator

Preferred Topic




Final Topic Assignment

Meeting w/Dr. Stewart              1)

Presentation Date

FIGURE 2. Team evaluation form.

Name:                    Case Study:

Submit this form before your oral presentation. Complete all
identifying information (name & and case study number). List the
name of each team member below, including yourself. Complete the
pie charts showing the relative value of each member's contribution
to the project. Be sure to put the number of the team member in the
appropriate section of the charts.

Team Members


Indicate the relative amount of time each team member spent on
the project.


Indicate the relative value of each team member's contribution
to the project.


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Author:Stewart, Sharon R.; Gonzalez, Lori S.
Publication:Communication Disorders Quarterly
Geographic Code:1USA
Date:Mar 22, 2006
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