The Right Choice for Right Now . . . Choosing a Clinical Fellowship

As students studying communication sciences and disorders (CSD), we have so many options to consider and explore—from differing patient populations to work settings. Some students may be excited by the abundance of options, whereas other students may be anxious and intimidated by it. But you’re not bound by your externships or clinical fellowship experience: You’re allowed to change your mind! Take it from me—it’s okay.

My Journey

When I first entered my undergraduate speech-language pathology program, I was adamant about working at the Veterans Affairs hospital—at the urging of my parents, who believed that a federal job would pay well.

My program primarily provided opportunities to work with children, and even though I had no interest in working with child populations, their cute faces and funny personalities made me want to work with them. Toward the end of my program, I realized that I had even more options for a clinical fellowship. I would find myself alternating between options: For instance, one day, I might be thinking that I wanted to work in private practice, and the next day, I would find myself migrating toward a path that involved working in home health.

Fast-forward to entering my graduate program: I realized that my passion was higher education—or so I thought. I wanted to graduate and enter a doctoral program right away. At the time, it didn’t matter what my clinical fellowship placement was—because I knew that it was a small step toward reaching my end goal. Nonetheless, by the time you read this, I will have graduated with my Masters+30 and found my interests again changing. This time, my mind was constantly going back and forth on the right clinical fellowship for me.

  • Did I want to work with children in my current setting at an early childhood center, where I can make a difference in the lives of many people at a very young age?
  • Should I work in a private practice, where I can make more of an individual impact on children, one child at a time?  
  • Or do I want to go out on a limb and work at a hospital, where I have no experience? While initially scary, this could potentially be a rewarding opportunity over time.

Decisions, decisions.

Initially, what made me anxious was making sure that I was making the “right” decision. But, what is the “right” decision? I didn’t want to decide on a setting that I felt I wouldn’t be happy in or that could impact me negatively in the future. For instance, I didn’t want to work in a skilled nursing facility because I heard that the productivity expectations would be high, and the level of supervision would vary. On the other hand, I didn’t want to work in a hospital because I lacked experience. The decision making became overwhelming. Having a Type-A personality, I felt like I had to have everything planned out before I graduated.

I spoke to my parents, supervisors, and other speech-language pathologist (SLP) mentors. I even referred to Facebook groups and threads on Reddit to help me with my decision making. But I was just at a loss.

Questions to ask yourself.

So, how did I get out of this spiral? I did some self-reflection and made a list of things that I wanted most in a clinical fellowship setting. If you’re overwhelmed and anxious about decisions like I was, consider making a similar list:

  • With what population do I want to work? I knew that I wanted to work with children. Although I’ve worked with pediatric and adult populations, I realized that I had the greatest satisfaction working with children.
  • With whom do I want to work, given my work style? I wanted to work alongside an SLP with whom I would have a great rapport—and someone who would continue challenging me. I wanted the SLP to supervise me but still provide me with the flexibility to make decisions and mistakes independently so I could learn. Opportunities to collaborate with other professionals like physical therapists, occupational therapists, nurses, and so forth, was also important to me.
  • Where will I truly be happy? I knew that I would thrive in a setting where I could have experience in various areas—such as augmentative and alternative communication (AAC), social communication, language, articulation, and fluency.

I finally decided to complete my clinical fellowship at the early childhood center where I’ve been working as a speech-language pathology assistant. The work environment of this center encompasses what my list showed I wanted most in a clinical fellowship. I would be working with young students. I had a great rapport with the SLP. I would gain experience working in the school and the community. I would be collaborating with the principal, special education teachers, general education teachers, nurses, occupational therapists, physical therapists, and the special education director. And, lastly, I would be utilizing what I learned in my CE courses on pediatric dysphagia because the school system was about to begin implementing that very soon. In the end, I landed exactly where I was meant to land—thanks to a careful process of self-reflection and list-making.

There is no perfection in this profession – choose what is best for you.

In closing, my choosing this clinical fellowship does not define me—and your choices don’t define, or confine, you. I’ve learned that it’s okay to try one type of clinical work setting only to realize that you want to do something different. It’s all part of growing as a clinician! There isn’t a “right” decision when it comes to choosing a clinical fellowship. It’s all part of the journey that we take as SLPs.

We must be open to trying different things, and if those things don’t work out, that’s okay! Instead of looking at previous work settings as mistakes, take them as learning experiences—because, as I’ve learned from my mentor, there is no perfection in this profession.

Read more by perspectives by Alexis Lawton. “Dialect – A Difference, Not a Disorder” (The ASHA LeaderLive)

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