Toward a Theory of Clinical Expertise in Speech-Language Pathology

There have been considerable efforts in the last few years to address a common complaint among practitioners that conferences and journals do not contain enough presentations and articles on treatment issues. The result of these efforts is that we know much more now than we used to know about the appropriateness and effectiveness of different treatment procedures. Clearly, there is a great deal remaining to be learned. However, I would like to suggest that our attention and research efforts not be restricted to comparing the relative effectiveness of treatment approaches. Clinical research has tended to focus on the technical and procedural aspects of treatment. Little is known, however, about the decision-making skills, interpersonal skills, and attitudes that characterize clinical expertise in our field. The need for a theory of clinical expertise has been recognized in fields such as medicine (e.g., Kassirer, Kuipers, & Gorry, 1982) and clinical psychology (Kiesler, 1981). With a few minor changes, the introductory paragraph in the Kassirer et al. article on clinical expertise in medicine would seem as if it were written about speechlanguage pathology. The changes are bracketed.