FEES Competency Training Description

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 to equipment and test materials setup to FEES administration to endoscope disinfecting to analysis and final report.

To be competent, the SLP must:

1) be thoroughly trained in the use of their specific equipment;
(2) use and adhere to a predetermined, standard FEES administration protocol with every patient;
(3) be prepared to encounter uncooperative patients and complete the instrumental swallow assessment;
(4) have a thorough understanding of the anatomy and biomechanics of both swallow peristalsis and airway protection mechanisms;
(5) have a thorough understanding of infection control procedures, whether using high-level disinfectant or sterilization;
(6) be knowledgeable of the potential medical complications that could occur during the procedure and know what steps to take if they occur;
(7) be practiced in the mechanical aspects of the FEES procedure to ensure the study is video-recorded, the endoscope is placed correctly, and that the quality of the images will allow high-quality analyses;
(8) be able to recognize structural abnormalities and to be able to describe them professionally;
(9) be able to analyze the completed study using a predetermined scored analysis system
(10) be able to analyze the findings as they relate to both swallow peristalsis and airway protection and their efficiency;
(11) be able to quantify the results of the FEES study and write a concise and usable clinical report.

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 patient, or the young TBI patient after only twenty-five endoscope passes on normal volunteers.
      • ♦-ASHA does not endorse this “requirement” and states that competency cannot be judged based on a number of endoscope passes. The “25 passes” requirement is only required at the local facility policy level or at the state regulatory level, such as in Tennessee.
      • ♦-SASS requires, during its basic FEES training course, a minimum of 15 supervised scope passes on normal volunteers. This training follows a step-by-step, progressive training protocol designed to help the SLP develop skill and confidence when inserting and manipulating the endoscope. Included in this training is establishing the best position for viewing the swallow event, announcing the swallow trial with test volume and consistency, and being able to carry out this procedure over multiple trials. 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 either the SASS basic FEES Training Course and/or advanced FEES training course. SLPs trained through other basic training courses must complete the SASS advanced FEES training course before being considered for SASS competency training.  Requests for competency training will not be considered unless the SLP has attended a SASS training course.
      • ♦-FEES Competence Training may be individually accomplished by coming to Nashville, Tennessee for the week, and traveling with the SASS clinical team.  There are limited slots available for the 2022 training. The trainee must be able to dedicate 5 days (Monday-Friday) to competency training.  On Sunday afternoon/evening prior to training on Monday, the trainee receives orientation and scope practicing with the training team.
      • Onsite FEES competency training is now available. Contact Michelle Skelley regarding scheduling.

For more information and planning, contact Michelle Skelley, M.Ed., CCC-SLP at 615-306-3693 or Michelle@sasspllc.com.