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Speech and Swallowing In-service Training

November 28, 2013, by Rinki Varindani, category DYSPHAGIA, MEDICAL SLP


What is an in-service training?

The World English Dictionary defines an  ‘in-service’ as follows:

in-service /ɪnˈsɜrvɪs/ (adj) : training that is given to employees during the course of employment

Whether you are a speech language pathologist in a school,rehab center, nursing home or hospital, you may be asked to (or in most cases, may ‘need’ to) provide an in-service training at some point in your career. An in-service is a training course provided to an audience primarily for the purpose of educating them about a specific topic related to your profession. The goals of an in-service and content may vary from one setting and one individual to another, depending on the intended purpose.

I gave my first in-service presentation at the hospital I work at last week. I decided to share my experience via a blog post; to serve as a guide, a starting point or just something that may help spark similar ideas for those of you planning to organize one as well.

Purpose of an in-service training

  • EDUCATE: I consider education to be the primary purpose of any SLP service training. It may be done to educate the nursing staff who work first-hand with the patients on a daily basis. It may also be done to educate other medical professionals (rehab staff, respiratory therapists, dietary staff, case managers and even physicians) to bridge the gap between them and the SLP and help them develop a better understanding of what we do as speech language pathologists. Sometimes an in-service training could also be set up for family members to better understand their loved ones’ diagnosis, precautions, specific management strategies or to help carry over activities from therapy to the home environment.
  • ADVOCATE:  In-service trainings are extremely important and useful tools for advocating patient safety, our profession and our competency as SLPs.
  • REFERRALS: Once the nursing staff and other medical professionals have been educated and are better informed about what we do as SLPs, it would eventually lead to more awareness and a greater number of patient referrals.
  • PREVENTION: In-services may play an important role in possibly avoiding medical errors; signs/symptoms that the staff may overlook otherwise or ignore while working with patients with speech/language, cognitive or swallowing disorders. This may help in prevention of the same.

How I organized my first in-service training

1. Purpose and Memo

The specific purpose of my in-service was to focus on swallowing disorders, aspiration precautions and strategies to maximize patient safety. I work in a long term acute care hospital (click here to read my post about working in an LTACH setting). Majority of my caseload consists of patients with dysphagia. Many of these are trach/vent patients and those with critical illnesses. Despite putting up signs with instructions and precautions to follow, I found that a lot of nurses were continuing to ignore aspiration precautions, thin liquids were being left in the room despite patients being on modified diets and even the respiratory staff was not always careful while dealing with trach/vent patients on PO diets. I decided I would educate as much and as many as possible by organizing an in-service training, with the intended audience being all the clinical staff. I spoke to my rehab manager, organized a room to have it, decided specific days and time slots (so as to cover as many nurses/techs as possible on different shifts) and printed out a memo that I stuck in highly visible areas throughout the hospital a week prior to the in-service. I also had my manager announce it each morning to generate a buzz.

2. Content

I wanted my presentation to be as informative as possible, but also simple enough for the staff to understand and to sustain their interest. I decided I would have about 12-15 slides and not go over 20 minutes, leaving 10 minutes for Q&As and distributing handouts. Instead of a typical powerpoint, I made an interesting presentation using Prezi. I have summarized the content of my in-service training below. (Please note: You can modify this based on your intended audience, purpose of the in-service and the caseload you see. I modified this one to suit my needs.) The slides I presented have been summarized below:

  • Who are Speech Language Pathologists (SLPs) and what do they do?
  • What disorders do SLPs treat? (Focus on aphasia, voice {particularly in trach/vent patients}, cognitive disorders and dysphagia)
  • What causes these disorders? (Focus on primary diagnoses that might indicate the need for an SLP referral)
  • How speech therapy makes a difference (Focus on statistics indicating how SLP intervention brings about positive change in patients with dysphagia)

Here onwards, I shifted the focus of the presentation to the primary purpose for the training i.e. dysphagia.

  • What is normal swallowing? (Quick explanation of the phases and a video demonstrating the same)
  • What is dysphagia and aspiration? (Focus on silent aspiration)
  • What are the overt signs/symptoms of dysphagia/aspiration?
  • How can dysphagia be assessed? (Quick explanation of a bedside swallow evaluation and a Modified Barium Swallow Study)
  • Focus on dysphagia screens and how nursing staff can help.
  • Treatment. (Quick review of how the SLP can help treat dysphagia)
  • Focus on aspiration precautions and compensatory strategies.


Visual aids can make or break a presentation. Despite everything I had bulleted and highlighted, I knew I could drive home the point using effective media and visual aids. I demonstrated a few MBSS videos (30 sec-1 minute long via YouTube) to show the audience what normal swallowing and what aspiration looks like. I can tell you this is the part of my in-service that evoked the most ‘oohs’ and ‘aahs’!

Here is an example of a video I used to demonstrate aspiration in a patient. Here is another one that makes a great visual aid too. (Actually ‘seeing’ what aspiration looks like made a very big impact on the audience. I would recommend this to everyone doing to an in-service training on dysphagia.)

I also showed them a couple of images of the brain and the different centers responsible for controlling speech, language, cognitive processes and swallowing to demonstrate the relationship between the brain and these processes.

(On a side note: I downloaded the YouTube videos via an app called PlayTube on my iPad to make them available offline. That way I did not have to bother about a poor internet connection interfering with my presentation and wasting valuable time. Highly recommended tip!)


I ended with focussing on how we all are a team and each one of us play a critical role to maximize patient safety. I went over some things that the nursing staff should remember, specific pointers for the RTs and dietary staff as well.The presentation took about 20 minutes as planned and gave me enough time to answer specific questions and give out some handouts as well. The page long handout I created was just to go over some basic signs/symptoms of dysphagia and some compensatory strategies to remember. It is really simple but has proven to be effective.

I have made it available offline and you can access it by clicking here.

Here is a link to some ASHA in-service handouts for SLPs in different settings that you may find helpful.

The image you see below was the last slide of my presentation. Helped to end on a light note. Everyone left with a smile.


I cannot make my in-service presentation available currently since it has some information associated with my hospital, but will make it available in due time. In the mean while, I really hope this was helpful. If you have any questions or just want to bounce off ideas, please feel free to leave a comment below or contact me here. Thank you for reading!


So, what do you think ?