FEES Competency Training:
FEES Competency Training beyond basic training is strongly recommended if planning to provide endoscopic instrumental swallowing assessment services in any medical setting. SA Swallowing Services delivers a rigorous, one-week competency field training experience for qualified SLPs. Trainees accompany supervising SASS Associates to medical facilities and perform FEES assessments with actual patients. The training practices begin with patient chart reviews, then equipment and test materials setup to FEES administration to endoscope disinfecting to analysis and final report.
To be competent, the SLP must be able to:
(1) perform the setup of the specific FEES videoendoscopy equipment and show a thorough understanding of its operation and functions;
(2) explain the rationale for and demonstrate the proper and consistent use of a predetermined, standard FEES administration protocol with every patient (1, 2, 3);
(3) explain the rationale for discontinuing a study prematurely based upon a predetermined “bail-out” criteria;
(4) safely perform the hand-eye coordinated skills of endoscope insertion and manipulation to ensure the endoscope is placed properly for optimum video-recording observations of each swallowing event, and that the quality of the images will allow high-quality analyses (3);
(5) identify, name, and describe the anatomical structures of the pharynx, larynx, and proximal trachea and their physiological functions for swallowing peristalsis and airway protection before, during, and after a swallow event (1);
(6) identify the presence of possible pathology in the pharynx, larynx, and proximal trachea and describe it based on factors such as structural asymmetry, location, mass effects, color, mobility, and size (1, 3);
(7) identify and explain the potential medical complications that could occur during the FEES procedure and demonstrate what steps, or protocol, to take if they should happen (1,2,3);
(8) describe and show a thorough understanding of infection control procedures, whether using high-level disinfectant or sterilization (2);
(9) identify and describe the observable consequences (normal or abnormal) of each swallowing event using predetermined and standard scoring systems for swallowing peristalsis and airway protection;
(10) quantify the scored results for swallowing peristalsis and airway protection and differentiate normal from abnormal swallowing consequences;
(11) to judge the significance and severity of any swallowing impairment from the results of the FEES study and relate the dysphagia to the underlying primary patient illness or illnesses.
(12) write a concise and usable clinical report.
(13) describe, demonstrate, and apply all of the above criteria in the presence of a qualified, experienced, and competent mentor using a minimum of 10 actual patients (2).
Note: Contrary to some opinions, FEES competency cannot be accomplished through a two-day training course and with a day or so of supervised scope practice. Supervised training must be from a qualified, experienced FEES provider, not a physician, occasional FEES user, or non-SLPs.
The “Magical 25” Endoscope Passes:
♦-Newly trained FEES clinicians are not prepared to assess the elderly, combative patients, or the young TBI patient after only twenty-five endoscope passes on normal volunteers.
♦-Langmore, Scarborough, Kelchner…Rule (2021) (1) recommends that during training, SLPs should “pass and handle” the endoscope under supervision with a minimum of 10 healthy volunteers (during or) after the basic training course. They further recommend 15 more supervised procedures with patients. The “25 passes,” as a requirement, is only required at the local facility policy level or at the state regulatory level, such as in Tennessee. It is not an ASHA policy or recommendation.
♦-SASS requires, during its basic FEES training course, a minimum of 15 supervised scoping “procedures” on normal volunteers. This “procedure” training follows a step-by-step, progressive training protocol designed to help the SLP develop technical and cognitive skills and confidence when inserting and manipulating the endoscope. Included in this training is establishing the best position for viewing the swallow event (Position 1 or Home), announcing the swallow trial with test volume and consistency, into a close view of the subglottic area (Position 2), and being able to carry out this procedure over multiple trials (3). The remaining practice procedures should be carried out on real patients with suspected dysphagia under appropriate supervision until competency is established.
SASS Qualifications & Requirements:
♦-Because training course content, procedures, and supervision vary widely across instructors and FEES courses, some SLPs are not adequately prepared for competency training. To qualify for SASS FEES Competency training, the SLP must complete the SASS basic FEES Training Course. Requests for competency training will not be considered unless the SLP has attended the SASS basic training course.
- Miller, C. K., Schroeder, J. W., Jr, & Langmore, S. (2020). Fiberoptic Endoscopic Evaluation of Swallowing Across the Age Spectrum. American Journal of Speech-Language Pathology, 29(2S), 967–978. https://doi.org/10.1044/2019_AJSLP-19-00072
- Langmore, S. E., Scarborough, D. R., Kelchner, L. N., Swigert, N. B., Murray, J., Reece, S., Cavanagh, T., Harrigan, L. C., Scheel, R., Gosa, M. M., & Rule, D. K. (2022). Tutorial on Clinical Practice for Use of the Fiberoptic Endoscopic Evaluation of Swallowing Procedure With Adult Populations: Part 1. American Journal of Speech-Language Pathology, 31(1), 163–187. https://doi.org/10.1044/2021_AJSLP-20-003482
- Langmore, S. (2001). Endoscopic evaluation and treatment of swallowing disorders. 1st ed. New York: Thieme.
For more information and planning, contact Michelle Skelley, M.Ed., CCC-SLP at 615-306-3693 or Michelle@sasspllc.com.