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 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;
(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;
(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;
(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;
(7) identify and explain the potential medical complications that could occur during the FEES procedure and to demonstrate what steps, or protocol, to take if they should happen;
(8) describe and show a thorough understanding of infection control procedures, whether using high-level disinfectant or sterilization;
(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.

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.