Brown Jenna
Voice Study Centre, University of Wales Trinity St David, Carmarthen, Wales, United Kingdom.
J Voice. 2024 Dec 14. doi: 10.1016/j.jvoice.2024.11.040.
Despite anecdotal evidence highlighting the benefits of singing teacher involvement in voice rehabilitation for effective and sustainable biopsychosocial treatment of vocal injury, singing teachers working as singing voice rehabilitation specialists (SVRS) in the United Kingdom (UK) have often been criticized for working beyond their scope of practice. With limited empirical research into the role, concern and confusion has fueled challenges to its legitimacy. The lack of regulation raises questions around safeguarding, skills, and demarcation of roles within the multidiscipline team. Previous research into patient experiences in the voice clinic has suggested hierarchy and power imbalances between patients and clinicians are impeding development of rehabilitation practices and outcomes. The aim of this pilot study is to explore whether similar socioeconomic and epistemological structures are perceived as contributing to critique of SVRS involvement in rehabilitation and whether formal professionalization of the role may provide a solution to the debate.
To systematically explore the views and experiences of professionals working in the multidisciplinary voice clinic team in the UK, a deductive, qualitative methodology was adopted. Recognizing the majority female workforce in this context, MFST was applied to semistructured interviews with nine female-identifying participants: three Otolaryngologists, three SLTs, and three SVRS. Data were analyzed according to the themes and concepts of materialist feminism, using in vivo and embodied facial coding to capture verbal and non-verbal communication.
Participants viewed the SVRS role as a positive addition to clinical practice. They indicate that in their experiences, some of the concepts found in materialist femininist analysis of organizations and women's role in the workplace hold true, and may be reasonably said to contribute to skepticism surrounding the SVRS role. They suggest there are challenges and benefits to professionaling the role. These relate to relationships, management and oversight; navigating and respecting professional identity; individual scope of practice, skills, and qualifications; establishing and managing shared ethical and economic values.
Overall, professionalization for SVRS was viewed positively, to enhance integration into existing workplace structures. Professional training, certification, and regulation was felt to be important for creating a shared language between clinicians and nonclinicians. It was noted, however, that there are challenges within the current medical paradigm, which would be less advantageous to pursue. The requirements of professionalization should be carefully negotiated alongside the current freedoms and creative practices employed by SVRSs.
尽管有传闻证据强调歌唱教师参与嗓音康复对于有效且可持续地进行嗓音损伤生物心理社会治疗的益处，但在英国，担任歌唱嗓音康复专家（SVRS）的歌唱教师常常因超出其执业范围而受到批评。由于对该角色的实证研究有限，人们的担忧和困惑引发了对其合法性的质疑。缺乏监管引发了关于多学科团队中保障措施、技能以及角色划分的问题。先前对嗓音诊所患者体验的研究表明，患者与临床医生之间的等级制度和权力不平衡阻碍了康复实践和效果的发展。这项试点研究的目的是探讨是否类似的社会经济和认识论结构被认为是对SVRS参与康复的批评的原因，以及该角色的正式专业化是否可能为这场辩论提供解决方案。
为了系统地探索英国多学科嗓音诊所团队中专业人员的观点和经验，采用了一种演绎性的定性方法。考虑到在这种情况下女性员工占多数，MFST被应用于对九名自我认同为女性的参与者进行的半结构化访谈：三名耳鼻喉科医生、三名言语和语言治疗师以及三名SVRS。根据唯物主义女权主义的主题和概念对数据进行分析，使用现场和体现性面部编码来捕捉言语和非言语交流。
参与者认为SVRS的角色是临床实践的积极补充。他们表示，根据他们的经验，唯物主义女权主义对组织和女性在工作场所角色的分析中发现的一些概念是成立的，可以合理地说这些概念导致了对SVRS角色的怀疑。他们指出该角色专业化存在挑战和益处。这些涉及关系、管理和监督；驾驭和尊重职业身份；个人执业范围、技能和资质；建立和管理共同的道德和经济价值观。
总体而言，SVRS的专业化受到积极看待，有助于更好地融入现有工作场所结构。专业培训、认证和监管被认为对于在临床医生和非临床医生之间创造一种共同语言很重要。然而，需要注意的是，当前医学范式存在一些挑战，追求这些挑战可能不太有利。专业化的要求应与SVRS目前所享有的自由和创造性实践仔细协商。
