SA Swallowing Services has opted not to provide FEES training, either basic or advanced, virtually. This position is based upon years of training hundreds of SLPs and years of clinical experience administering this instrumental procedure to thousands of patients and nursing home residents. Face-to-face, hands-on, real-time, and real people training with an experienced mentor is the best avenue to properly learn to use a nasoendoscope, to feel confident to perform the FEES protocols and procedures, and to accurately score and interpret the results for a well-written and meaningful report.
FEES is a professionally-technical specialty procedure that, if used properly and to its fullest potential, is a very sensitive and highly useful clinical and research tool. It is required to properly assess one of the most complex neuromotor/sensory functions of the human body–oropharyngeal swallowing.
FEES is more than simply sticking the nasoendoscope into the nasopharyngeal cavities and looking for aspiration. It requires finesse and dexterity to properly manipulate the endoscope so it does not cause pain or injure the patient. Scope handling skills used during a 20+ trial FEES protocol must be taught, learned, and critiqued face-to-face with an instructor. Will it help you learn if your training volunteer moves their head back and forth while being scoped, imitates refusal, yells, and curses you while you are trying to insert the endoscope? Yes. It prepares you for the real world of FEES. Virtual cannot.
Additionally, it is paramount that views of the structures, their movements, and movement of test material through the pharynx are concisely recorded for later analysis. What cannot be observed cannot be considered when analyzing. Without an accurate analysis of the consequences and their implications, clinical decision options are lost to the detriment of the patient.
Online education has its place in disseminating information and knowledge and is widely used, but it has its limits. The academic-related issues of FEES can be taught virtually-anatomy, physiology, infection control, equipment, and medical issues, but not scope manipulation, not protocol/procedures, not scoring analysis, and not report writing. These latter skills have to be taught and mentored in-person for the SLP to become a confident and competent FEES clinician.
Our training experience has proven time and again that new FEES learners who learn some aspects of FEES online and then meet up later to do the hands-on skill learning have major problems. First and foremost, they are rusty having forgotten important information and this has to be retaught. This relearning process is time-consuming and makes scope manipulation training and its relationship to administering the protocol more difficult. We have found that receiving all of the training live and at one time enhances learning.
FEES is a medical procedure. It is an invasive procedure. It can be a significant source of cross-contamination of pathogens. It requires expertise with expensive, delicate equipment. It requires extensive and expert training and is much more than simply inserting the scope into the pharynx. Only a trained, licensed electrician will rewire my house or a trained surgeon will repair my heart. Neither can be learned through virtual training. Every MBS or FEES impacts our patients and the quality of their lives.
John R. Ashford, Ph.D., Education/Research Director, SA Swallowing Services, Nashville, TN