New93 role standards, now public
MedTality
Role standards

Therapy and rehabilitation

Speech-language pathologist

What a speech-language pathologist finishing the clinical fellowship must do safely on their own: assess swallowing and communication, recognise when a finding cannot wait, and set diet and therapy plans the team can follow, drawn from the skills outcomes ASHA requires for the Certificate of Clinical Competence.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
4
Sources
4
Version
1

Built from American Speech-Language-Hearing Association, International Dysphagia Diet Standardisation Initiative. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent speech-language pathologist does on day one, dimension by dimension.

Clinical skills

  • Assesses swallowing from the history, the person's alertness and a structured bedside examination, knows what a bedside examination cannot show, and gets an instrumental study when the answer depends on it.
  • Differentiates aphasia, apraxia of speech, dysarthria and cognitive-communication disorders from what the person actually does, and treats a new or sudden change as a possible medical emergency rather than a therapy referral.

Workflow and tools

  • Turns an assessment into a plan the team can act on: named textures and liquid levels, strategies, medications, measurable goals, and when it will be reviewed.
  • Records what was assessed, what was found, what it means and what is recommended, so the next clinician can act on it without phoning.

Patient communication

  • Communicates with a person with aphasia, dementia or delirium in a way that lets them understand and take part, and checks how reliable their answers are before relying on them.
  • Teaches patients and carers the strategies and warning signs that keep the plan safe at home, and confirms they can do them.

Compliance and safety

  • Recognises the swallowing and neurological findings that put a person at immediate risk, and gets the right help now rather than recording them for later.
  • Makes sure a person who chooses to eat and drink with known risk, or who is offered an instrumental study, understands the choice, using whatever communication support they need.

Role knowledge

  • Works with medicine, nursing, dietetics and pharmacy so the swallowing and communication plan is actually carried out, and resolves disagreement about it through the patient and the evidence.
  • Judges an intervention by the quality of its evidence and the outcomes that matter to the person, and can say what the evidence does and does not show.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Clears a person for food or thin liquids when they are not alert enough to take part, or when the trials showed signs of aspiration, on the grounds that they did not cough, their oxygen saturation held, or they want to eat.

    Silent aspiration is common after stroke and prolonged intubation and a bedside examination cannot exclude it; a diet cleared on absent coughing puts food and fluid into the lungs of the people least able to clear it.

  • Continues the session, waits, or plans to mention it later when a person shows new signs of stroke, airway obstruction, or respiratory distress after swallowing, instead of stopping and calling for emergency help now.

    Stroke treatment and a blocked airway are both measured in minutes; the delay is the harm.

  • Recommends nil by mouth and leaves it there, without making sure the medical team knows that fluids, nutrition and time-critical medications now need another route or a plan.

    A missed anti-epileptic or Parkinson's dose, or days without fluid, harms the patient even though the swallowing advice itself was right.

  • Treats a nod or 'yes' from a person with aphasia or dementia as their informed agreement or refusal of a risk decision without checking comprehension, or decides they cannot make the decision because they cannot speak.

    Either way the person's right to decide is lost: they are held to a choice they did not understand, or denied one they could have made with support.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not diagnose medical conditions such as aspiration pneumonia or stroke, or interpret imaging for medical diagnosis.Reports the swallowing and communication findings, escalates the signs, and leaves the medical diagnosis to the physician or advanced practice provider.
  • Does not enter or change a diet order on their own authority unless facility policy delegates diet-order entry to speech-language pathology.Makes a clear recommendation in standard terms and confirms with the ordering clinician that the order matches it.
  • Does not perform endoscopic swallowing evaluation, tracheostomy cuff deflation or suctioning without the specific training and facility credentialing required, and where state licensure law allows it.Arranges a credentialed colleague or works jointly with respiratory therapy or nursing under the facility protocol.
  • Does not decide whether a person has a feeding tube or stays nil by mouth.Supplies the swallowing evidence and supports the conversation between the person, their surrogate and the medical team who make the decision.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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