Virtual FEES Training

SA Swallowing Services ( will not offer or provide virtual FEES training for any of its course offerings.  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, feel confident to perform the FEES protocols and procedures, and 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 to assess oropharyngeal swallowing functions.  It is required to properly assess one of the most complex neuromotor/sensory functions of the human body.

FEES is more than simply sticking the nasoendoscope into the nasopharyngeal cavities and looking for aspiration. Its primary function is to assess swallowing, or the movement of liquid and food from the mouth to the esophagus on its way to the stomach, and not just airway protection. Langmore, Scarborough, Kelchner, et al., 2021, AJSLP, ( provide an excellent clinical practice tutorial describing what training is needed for FEES.  It requires finesse and dexterity to properly manipulate the endoscope so it does not inflict pain or injure the patient. Scope handling skills used during 20+ trials using a standard 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 the movement of test material through the pharynx are concisely recorded for later analysis.  Inserting the endoscope and administering the FEES protocol is less than 90% of a FEES study.  And, what was not observed and captured on video/audio recording, cannot be analyzed or talked about.  Without an accurate analysis of the consequences and their implications, clinical decision options for hydration and proper nutrition are lost to the detriment of the patient.

Virtual education has its place in disseminating information and knowledge, but it has its limits.  The academic-related issues of FEES maybe can be presented virtually-anatomy, physiology, infection control, equipment, and medical issues, but not scope manipulation, not protocol/procedures, not scoring and 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 for over 15 years has proven time and again that new FEES learners who received virtual FEES training have major problems later.  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 face-to-face is the best avenue to learn this professional procedure and to be readily useable following training.

FEES is an invasive medical 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 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.

No virtual learning from SASS.

John R. Ashford, Ph.D., Education/Research Director,                SA Swallowing Services, Nashville, TN