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Enhancing Pediatric Feeding in Rural Communities: Building Competencies and Diminishing Misinformation

 

 

Brianna Miluk: Hello, hello, and welcome to The Feeding Pod. This is your host, I'm Bri, Brianna Miluk, and I am a speech language pathologist and certified lactation counselor. I specialize in infant and medically complex feeding and primarily see patients in the home health setting, although I do have some that I see an outpatient or via tele practice.

I'm also an instructor at the university level and a PhD student studying communication and information sciences. I have a huge passion for evidence-based practice and supporting information literacy in speech, language, hearing, feeding, swallowing sciences, specifically as it pertains to social media and translational research.

This podcast is meant to share anything and everything related to being a pediatric feeding SLP feeding therapist with sprinkling in a little bit about working in academia, being a Ph. D. student, and how to access, appraise, and implement research into clinical practice. Some episodes may contain guests, and I'm already looking forward to some of those coming up, while others might just be me rambling about something that's been on my mind.

Regardless, my goal with this podcast is that you walk away not just with newfound knowledge, but with the inspiration to think critically and not be afraid of research. So, without further ado, let's get into today's episode.

Welcome back to The Feeding Pod. I am so excited today because I have Rebecca Smith with me and I love Rebecca so dearly, and she's one of the mentors in the advanced group as well but she's so much more than that, and I'm really excited because she brings a lot of experience behind working in rural communities and developing pediatric feeding competencies when there's a lot of barriers present, and so that's what we're going to talk about today, but before we dive into the ins and outs of all of that, Rebecca, why don't you just kind of give everybody a brief intro about where you're at, what you're doing, and kind of some of your clinical experience.

Rebecca Smith: So, I'm excited to be here. I'm Rebecca Smith. I'm a speech pathologist. I've been a speech pathologist for, I guess, we're approaching 10 years. I have worked in a lot of different settings. Right now, I am a clinical educator and adjunct instructor at Appalachian State University in Boone, North Carolina.

Before most of my experience was NICU in a couple different hospitals and level three neonatal intensive care units, and then I also did adult ICU and cross covered on adult inpatient rehabilitation units. Right now, I serve as our primary speech pathologist in our outpatient clinic, which is a university based medical clinic of voice and swallowing lab.

And I serve pediatric feeding disorder in that clinic. And I also do infant breast- and bottle-feeding referrals. I'm a lactation counselor and a board-certified specialist in swallowing and swallowing disorders. And I teach our graduate level pediatric dysphagia course, which is available for our second-year master's students as an elective.

So, I'm getting my PhD and I'm hopefully going to be finishing that in about a year, probably a little bit longer, but definitely excited to be here. And yes, lots of experience working in rural communities. And I know a lot of listeners and your followers can relate. So. 

Brianna Miluk: Yeah, definitely. I mean, obviously you're not, not at all busy at all, you know, with all the things that you do. I do want to, before we go into it, can you give us like the, just the, the brief, I say brief, but as someone who's also working on our, my PhD, I know it's so hard to do this, but I would love for just listeners to know like what you're looking at in your PhD and just kind of give a little bit about, about your topic.

Rebecca Smith: So, my dissertation is called Screening for Pediatric Feeding Disorder Moving Towards Clinical Practice Standardization, and I'm going to be looking at parents and caregivers of children birth to four years old, filling out the infant child feeding questionnaire by Feeding Matters, and also filling out either the NeoEAT or PediEAT developed by Britt Pados Infant Feeding Care Team.

And I'm going to see if there are any relationships between positive and negative scores on that infant and child feeding questionnaire tool and the PediEAT and NeoEAT concern levels. And then we're also going to be looking at specific demographic data in the parents and children and seeing how. What the relationships between that data is to positive and negative results on the screening tool and concern levels on the NeoEAT and PediEAT.

So hopefully starting data collection in September but it might, you know, as everything be a little delayed for IRB and all that good stuff, but I am really happy with my committee. Dr. Katherine Sanchez, who also serves as a mentor for Bri's group is on my committee and Dr. Jordan Hazelwood and Dr. Gary McCullough as well. And they're both faculty members here at Appalachian State University interprofessional clinic and within just the Department of Rehabilitation Sciences, so I'm really excited. It's going to be, I think, a good study and yield some valuable information as long as I can get enough participants, so. 

Brianna Miluk: Yeah, that's like the hardest part for sure, but I think that's super exciting and. I think it just aligns so well with the things that you're passionate about, like, which, you know, we're going to talk about today because how that can open up so many doors to the barriers for, you know, screening for to get access for services for children sooner and to be able to find, you know, any sort of correlations or patterns toward who might qualify or who we need to be, you know, extra cognizant of screening in in those early childhood spaces and we all know all listeners probably know how important early intervention is. So, I feel like you focusing on that birth to 4-year-old population is really awesome.

I'm excited. I'm so excited for you. Okay. Let's get into the topic now for today. So, let's sort of start out with just talking about what we mean by pediatric and feeding, pediatric feeding and swallowing competencies. So, when we're, we're talking about competencies related to that, we're focusing on the professional side, right? So, Rebecca, why don't you kind of just give a brief overview of sort of what we mean when we're going to be using that throughout the podcast. 

Rebecca Smith: So, I've learned a lot about competencies, especially as it relates to supervising and performing in the adult dysphagia arena. I very much was competent in adult dysphagia long before I ever was in the pediatric and feeding and swallowing arena, but my colleague and committee member Jordan Hazelwood, she does a lot of like research into how students and early clinicians achieve competency. So, if you haven't ever looked at Dr. Hazelwood's research on that. I highly, highly recommend it as a read.

And when she served in ASHA SIG 13, this is just a side note, not exactly defining competency, but when she served, when she served in ASHA SIG 13, ASHA SIG 13 and DRS came together and created the dysphagia competency verification tool. And, that is pertaining, you know, I feel like more to the adult population but I think that there are like subcategories that you can rank yourself on as an early clinician or a student and in that you could put some of the elements of PFD in there, but I just wanted to mention that because it's an excellent tool if you are, a supervisor or someone looking to grow your competency and dysphagia, I would download it.

But when we use the word competency, it means not confident in skill, but rather competent, which I find that to be synonymous with excelling in a certain area, a balance of having knowledge that you have taken through advanced specialty certifications or university-based core coursework, you have experience that has been, you know, applied.

Through your professional practice, preferably under a mentor, if not, you know, through something virtually like Bri's mentorship group. And then the last piece is that you consider yourself to be well read in evidence-based practice in that arena. So, I'm kind of kind of going back to, like, the ASHA evidence-based practice triangle, which I know leaves a lot open to interpretation and for the limitations of that triangle. Bri and I have talked about that a lot, but just the education you accumulate along with the experience and the vastness with which you are read on a topic determines your overall competency. 

Brianna Miluk: Yeah, I love that you mentioned also that like there is a difference between confidence and competence. So, there's something called the Dunning-Kruger effect. And I, have we talked about this before? I can't remember. Probably, probably. 

Rebecca Smith: Probably. 

Brianna Miluk: But for listeners. So, the Dunning-Kruger effect is basically where we have this like cognitive bias that the more we know. The less we think we know and the more we're like, oh my gosh, I need to learn more.

I'm not as confident in this. Like I realized like I need to know more because the more, you know, the more you can kind of like acknowledge your gaps in knowledge and the less, you know, the more you tend to feel very confident in your skills and not think you need to know more. And obviously we can see where this is a problem in both directions because we have the one side where someone may actually be very competent in something, but if they don't have the confidence to say like, I can do this, that's sort of that like imposter syndrome where you don't feel like you're good enough. But then there's the other side, which is very dangerous as well. When we think about patient care, where like, you think you know everything, but you don't.

And it can really lead to gaps in knowledge and expanding your knowledge and having an open mind to new information and new science and new practices, which can lead you to not actually achieving competence in a skill. So, you might hold the confidence part, but you don't actually have the competence. And I think, you know, we, we want a mix of both, but the competence pieces is really, really important in-patient care. And then. 

Rebecca Smith: And I think, and I would argue that we are kind of setting our students up to have that confidence without competence in some ways. I know that when I was in graduate school, even though I had an excellent experience, I remember just over the course of my clinical career and just our experiences in graduate school that that fake it till you make it thing was real like popular. People were saying that. And I mean, it's just like. 

Brianna Miluk: Oh, doing something is better than nothing. Like, at least you're doing something. And it's like, is, is doing something always better than nothing? 

Rebecca Smith: Yeah, I mean, and I know that in my early clinical experiences, we were just throwing everything at the wall and seeing what stuck. You know what I mean? And it was just so, and it was so, not like necessarily something that the patient could sustain in home practice, but also it just made no sense because physicians wouldn't do that necessarily a good physician wouldn't. So why are we, you know, just because we're providing non pharmacological, you know, treatments, we, we don't see that that is essentially the same in terms of being unethical. So. 

Brianna Miluk: Yeah, absolutely. There's a, there's an article I was looking, I was pulling it up while, while you were talking. It was done by Mahmood in 2016, and the title of it was, Do People Overestimate Their Information Literacy Skills, A Systematic Review of Empirical Evidence on the Dunning-Kruger Effect, which is the effect that I was just talking about.

And now this one was specific to communication and information literacy. So being able to like find and appraise research and evidence and being able to determine like, is this relevant for me, applicable, how to apply it. And what I thought was really interesting in their findings was that they found that students, while, while they're students were pretty good about like estimating their skills and what they actually are.

But once people became professionals, is when there was more of a discrepancy, which I think is exactly what you were talking about is like, we're preparing students the whole time, but then as soon as they go in the field, they feel like they like, well, you have to know it. And it's like, well, you actually don't have to like it's okay to say I need to build more skill in this area.

It's okay to still ask questions. It's okay to like acknowledge that you will still have gaps in knowledge. And I think like that, you know, just like bleeds into like what we're, we're talking about today as well in building competencies. And I think one of the biggest barriers to building competencies is when you are in a rural area without access to a lot of resources or other providers that have expertise in the area you might be seeking out. So, let's kind of transition this into like why these competencies are essential in rural areas. You know, kind of why, why do you feel like this is an important, why, why are we having this conversation basically? Like, why is this important to clinicians?

Rebecca Smith: Well, I feel like based on a lot of literature, which I can't directly cite off the top of my head, but we know that there are more medically complex infants and children surviving for longer, you know, and getting to that point. 

Brianna Miluk: We'll reference the article. We'll reference, we'll reference the findings, but I mean, yeah *talking at the same time* advances in medical care, tell us. 

Rebecca Smith: Yeah, can, can, attribute- you know, and that's because you know, the increased prevalence of autism, like the more the increased morbidity or decreased morbidity and mortality rates of infants and children that are hospitalized because of these life sustaining treatments. And we know that that's creating more children that are requiring services targeting feeding skill from speech language pathologists in this area of PFD. And they are everywhere, right? They're not just in metropolitan areas. A lot of them live in rural community. And although they're willing to drive. You know, monthly for appointments for to physicians, they don't necessarily want to receive their weekly therapy, you know, two or three hours away to where they're having to commute.

So, it's, it's becoming imperative for rural speech pathologists serving communities to, to step up and establish competencies in areas they're less familiar in. But it's hard when, when there isn't a whole lot of awareness of just exactly what is evidence based in that area, what is not when there are less specialty providers operating in an area to, like, be able to recognize when a referral is appropriate.

It's certainly harder because I've learned just from living in different states that what qualifies children automatically to participate in early intervention is not the same in state to state. Which is wild, but You know, so there are patients that slip through the cracks, and if there are not providers that even know that there's someone in the area that can work with these patients and know what to look for, then it's really hard to build up your caseload in this space, and it's almost like for this specific setting, it's, you have to start with a patient and have a strong mentorship through networking and community that you build in PFD, and then as you become comfortable with that patient and grow in your knowledge and skill in that way, then you can start expanding your caseload.

So, it's not like you necessarily get put in a place where you're trained to do a job, which I think is what we historically think of when we're learning a skill, but rather, if you want to begin a skill in a space you almost have to like start with taking the patient. Obviously, you've done research and taken courses and stuff before that, but like you learn, you're learning a little bit more as you go and you don't have that direct support space like that support person in your space like you have to have established that connection through networking. So, I mean, it's it's a unique challenge and and it's, it's definitely not for everyone. 

Brianna Miluk: Yeah, absolutely. No, I think that what you said is you know, really, why, like, why this is so important is families are finding themselves traveling hours to see a specialist, traveling hours to see a therapist. And in some cases, even in the rural area, if they're traveling within their community to a therapist, they still might be traveling upwards of an hour to see that local provider. Yeah. 

Rebecca Smith: That's how- That's how long they travel to come to me, some of them. 

Brianna Miluk: Because if you're really out there, you know, an hour might be the closest city in any form of the word. And so, by doing that- Sometimes I think it almost is like this responsibility of the provider to say patients are coming to me because I am the provider in this community to support them, and we should hold that responsibility to ensure we are competent in what we're doing to ensure that we are competent, not just in the skill set, but competent in how we can learn and, and in things like information literacy and identifying pseudoscience and being aware of misinformation. And I feel like these communities tend to be more vulnerable though we see it everywhere, but more vulnerable for, Hey, just do this course and then you'll be good to go.

And, but if you don't have anybody to go over that information with or, you know, seek, you don't have the time because you are the sole provider in this community. You don't have the time to fact check the information you're getting in. It can really get you stuck. And so, I like how you were saying when you are getting new information or you are learning these things, not going too fast, not saying, you know what, I took a course.

Nobody else is doing this here. So, I'm just going to go ahead and do it because we sometimes can provide more damage by just pretending like we know what we're doing than actually just slowing down a little bit and then slowly taking it on. Like, the need is there. And yes, you want to fill that need, but you don't want to fill that need with poor service.

Rebecca Smith: No, and usually if you're in a home in a home-based care environment or you're in an outpatient clinic, you know, you, you, you do, whether or not you feel comfortable exercising that autonomy over your caseload, you do have it. You, you just have to say, I'm not going to do it. And I know that people are, might be listening and be thinking, Oh, but this, Oh, but that, you just say, but you come in here and treat this child.

You have as much knowledge as I do. And like, you just straight up, do have to put your foot down sometimes because it's not appropriate to, to work with a patient that you know, you don't necessarily have the qualifications to work with quite yet. 

Brianna Miluk: Yeah. I mean, if you knowingly say, yes, I'll treat this patient and I am not fully competent in doing so, I mean, that's an ethics violation. Like you, you actually need to reflect on that. And, and as hard as it is, as much pressure as you might get for them to say, no, you have to treat this patient. You can pull that and say, if you would like me to treat these types of patients, like to your, you know, your supervisor, your boss, you know, whoever it is to say, if you would like me to treat these types of patients, that's fine, but I need training first. I need to seek these competencies out before you can put them on my caseload. You know, and so being open to it is one thing, actually getting the competencies is another. 

Rebecca Smith: And that being said, what's unique about Pediatric Feeding Disorder, and I really have, I can honestly say there's very few areas of practice and ages that I haven't seen at this point.

Like I've just seen almost all the things, not saying I've seen everything that's ever existed, but I have had. And I've been blessed with that because it's helped me a lot. But it's you, even if you take a course, a mentorship group, you're going to see something tomorrow that you've never seen before.

And it's, it's more like that in this space than any other area of practice that I've ever worked in. And so, you won't ever necessarily feel completely competent with like. Anything that you was you're still going to have to return to the literature. You're still going to have to return to your mentors. So, it's not like I can take every CEU ever about every you know, chromosomal and genetic condition that exists because it's just not possible. There's too many. 

Brianna Miluk: Yeah. Well, and I think that's where it's not just the competency in your skill of like the strategies and interventions you use, but it is the competencies in continuing your learning and being competent in I know how to access resources. I know how to appraise the information. I know how to fact check things that I see online. And like, the competencies go beyond because I agree. I think so much of pediatric feeding is like not just what do I do from a treatment standpoint, but also the critical thinking past that because you will. I constantly am getting kids that I'm like, never seen that before. Haven't seen that diagnosis. And you might see the same diagnosis, but the child presents totally different. So yeah, I'm, I'm glad you brought that up. 

Rebecca Smith: And the, and the, and the competencies, You know, I mean, it's just, it's, it's, it's, there's not a standard measurement for this yet. And so, I think that that makes it so hard. And when you're in a space where you're educating students on how to be confident, they, students. If you're listening, you know, I love you, but you can't handle that. You know what I mean? Like it's just too much for you to be able to, to handle right now that like, well, you're telling me that there's no like specific set of standards that's like nationwide or international that I'm operating towards. And the answer is no. And there's a lot of areas that we don't know about this yet because we're still doing the studies and the studies are expensive and they're hard to do because of sensitive subjects. And, you know. 

Brianna Miluk: It's constantly changing. 

Rebecca Smith: It's constantly changing. And I think, I think that part of what we try to educate students on for competency purposes and for young professionals operating in rural community is being able to look at the patient from a systems, you know, from a systems viewpoint and, you know, seeing how your intervention would play into that, and if that's even the primary problem, and being able to admit when there's nothing you can do. So, I think that that is a whole lot of establishing competency you know, with what we have now with the data that we have now. 

Brianna Miluk: Yeah. Yeah. I think that kind of goes into this next part we were going to talk about too, which I mean, overall, hopefully everyone is seeing this theme that like ultimately not seeking out these competencies or not fully fulfilling different levels of competencies ultimately affects patient care.

And so that's why it's so important because it ultimately affects the quality of life and the outcomes that we're trying to achieve. So, if we're thinking about achieving competencies in the rural community, and we've touched on a couple of these, but let's kind of go through some of the other barriers before we get into more of the solutions side, some potential solutions to it.

Let's talk about just like the challenges in rural communities in accessing mentorship in accessing, you know, supervision or support to kind of build competencies. So, you know, kind of based on your experience and just, you know, conversations we've had and with others, what would you say are some of the more, more major themes to those barriers?

Rebecca Smith: I mean, I think that, I think this isn't necessarily a barrier that's unique to rural community, but I mean, just taking one, like, facet of, like, treatment or evaluation and just clinging to that to do your life, and like- 

Brianna Miluk: Yes, like your whole clinical identity is around this, like, one strategy or one diagnosis or one tool.

Rebecca Smith: Yes. Because then it's like when that's ruled out, what then? Kind of thing, you know, and so I think that that really puts, you know, newer clinicians seeking mentorship at a disadvantage because they're like, okay, well, I know that could be it. But what else? And like, you know, after XYZ intervention has been applied, what do I do then if those problems still persist? So, I think it's like finding a mentor that is highly skilled, but not only that, prompts you to critically think about your patient. 

Brianna Miluk: Yeah. 

Rebecca Smith: Not just you know, a flowchart of if you do this, do this, if you see this, do this. 

Brianna Miluk: Yeah. If anyone's teaching you like, I feel like that's like a red flag. If anybody's teaching you like a very strict like cookbook method or like, Oh, we progress with like this tool. And then when they master that, you go to this one and then you go to this one and then you go to this one. And like these, like, I mean, y'all know what I'm talking about. When you're, you think of like like these, like whistle protocols for building like lip strength or something and you're just like, dude, what? Like any of those things should be like, first of all, red flags. Secondly, like probably not the type of provider that you want to seek mentorship or supervision from. You want to make sure that they have you know, I'm thinking like obviously they have competencies in the space that you want to, but ensuring that those competencies aren't limiting, like you're talking about, where it's not like, oh, I'm very competent in this one very specific protocol, and outside of that, so sorry, but if they also think that their protocol is going to work for every patient.

That's just not true. You know, we have a lot of literature to support, I think, some, like, theoretical principles. Like, if we think about just dysphagia, whether we're thinking of adult or pediatrics, like, motor learning principles, neuroplasticity, like, responsive feeding practices, like, we have, like, a lot of information on those, but none of those, those are philosophies or approaches, but it's not a specific treatment regimen that's gonna go to it. And so, kind of, like, that balance. I don't know. That's just where my brain went when you were talking about that where it's like, yeah, if someone's like, oh, I'm trained in like this one method. It's like, I don't know about that. 

Rebecca Smith: You're absolutely right. So, I mean, the barrier to finding good, good support is that there's less people, obviously, that you have to vet them, which you would in any location you lived in, but you have to vet them, you know, hard.

Because you, you, I mean, especially if it's not somebody that you've directly learned under, like, in a professor student relationship, or was your... Like, you know, supervisor in your CF and you know how they practice clinically. I mean, people can misrepresent what they're actually doing behind closed doors with patients, and so you're having to like vet them and on what they're saying, but then also like if they're walking the walk and, you know, talking to talk, walking the walk, and that's super hard.

And then, you know, just, I think it's like. I think that, and this is not, and I, I am a small-town gal, I think, you know, I mean, my boyfriend. 

Brianna Miluk: I think you are, and I mean, I come from a small town, like where I grew up in West Virginia, you know, we had like 3000 people, you know. 

Rebecca Smith: Yeah, I mean I keep saying I'm going to move and like, go to a bigger place and I just never end up in a bigger place. And so, I just feel like it's like. And I, I don't know my boyfriend might not agree, but I really feel like I am pretty small town and so I feel like I know about small towns and I can say this and it's not to be derogatory about small towns because I appreciate the convictions that they hold in certain spaces. But when it's when it's misguided convictions. It's, it's very hard to change that mind of tradition and and it's uniquely challenging in this setting than I think in other areas where it's very common to challenge your thinking all the time. 

Brianna Miluk: Well, I mean, I think if you just, in general, if we think about, like, ties between people and social and cultural influences of stuff, if you're in a smaller community, it's more likely that more people in that community know people, there's gonna be peer influence, there's gonna be, like, cultural influence, traditional influence, that happens because everybody's a little bit closer connected, whereas if you're in a city, You're going to have people that you cross constantly that you've never even seen in your life.

And so, you're more likely to encounter like, more innovative or novel information as compared to a small town where there's like, a lot of like, this confirmation bias that happens because everyone believes the same thing and everyone trains the same way and everyone feels the same way because that's the way it is. And, and there's not very many people that come in or you come across that like rock that boat. Whereas in cities, there's a lot more of that diversity. 

Rebecca Smith: Yeah, and I think, and I think that it's like you go, you said, you know, when you know someone you when you know. Like, let's say you're getting therapy from somebody that you know personally, you know, as a parent, you're not going to necessarily think twice about what they're saying, even if it doesn't make any sense. So, it's like, those personal connections, like, make things- make everything they say more sacrosanct than it would be if it was. 

Brianna Miluk: Yes! No, *talking at the same time* even like clinicians I've like had messaged me or that I've talked to that are like, you know, I am an SLP, but my child's having trouble with feeding and I work with adults.

But my friend who's an SLP and works with kids says this, and that's, you know, I, I saw you say something different on, you know, your social media or in your podcast or whatever. And like, I'm just very confused because like, that's my friend, but. So, I expect them to be, you know, doing what they're supposed to do in their space because, like, as an SLP, I don't have, I don't have competencies in adult dysphagia.

Like, you put me in that room and, like, I'm going to need a lot of support. And so, you know, if I was to have a family member who had a stroke and, you know, required SLP services and they went and saw, and I was like, oh, go see my friend. I want to trust what they're saying a lot more than a stranger. And I think that like, Oh, I think that's just such a good point because in small towns, everybody knows everybody.

And like, that is so true. That is like when I go back home to West Virginia, I always will run into like 50 people that I know because everybody's there and everybody knows everybody. Whereas, like, where I'm at in Greenville, and like, Greenville's like, you know, medium sized, it's definitely not a large city, but I will go a whole day without seeing a single person I know if I go through town.

I won't see a single person. That does not happen in Lewisburg, West Virginia. But that influence, like, that tie to somebody- Which, random plug about, like, the stuff that I'm doing in my PhD, I'm, I'm learning about, like, social network theory. And one of them is talking about, like, the strength of ties.

And so, like, the stronger the tie is, the more influence. The weaker the tie is, like, the less influence. But when we go to people that we don't have as strong of a tie for, a lot of the times we can get more innovative information from them. Because we're not surrounded by people that believe and think the same way as us only. We're, we're able to pull in from another network. Which I think is super cool and very relevant to, to what we're talking about right now. 

Rebecca Smith: It is. It's, everybody listening probably knows what we're talking about.

Brianna Miluk: Yeah, and I think that ultimately kind of leads to these risks of misinformation. And the risk of misinformation and pseudoscience being spread because one person who know, you know, is the sole provider in the community that is like, you know, starting to see these, you know, like, oh, I'm the provider in this small community that does feeding and I did these courses and they told me this, but I didn't fact check it.

I didn't vet it. I didn't, you know, corroborate that information with existing literature and then they become the provider that starts to spread in that community. Then then we kind of have those dangers. I'm gonna let you kind of talk on that a little bit more too and sort of like, I mean, your experience, I've, I've seen it too, but even your experiences with seeing like misinformation and pseudoscience being spread and kind of how that, how that can also impact competencies in patient care. 

Rebecca Smith: So, so I definitely have seen lots of misinformation spread through like mom Facebook groups and whether that be providers be getting on the mom Facebook groups to promote whatever service it is or it just be moms talking to other moms like, you know, in a helpful way and I think that I think- 

Brianna Miluk: But also like, where did the moms get that information from to begin with?

Rebecca Smith: I mean, it's, it's never necessarily provided. And if it is, it's, you know, usually kind of sketch in terms of the source, but not to say that you can't get good things out of mom Facebook groups. Cause I'm absolutely sure you can get emotional support and all those things. But I mean, I just, I think that, I think that it's just hard because.

It's harder and you're more susceptible to that influence in rural community because there's just less providers around that are familiar with complex medical condition, and you're going to likely have to travel to get that information, and you want something to fix it quick. You don't want something that's going to take lots of travel, lots of physician appointments, even going to one physician, I mean, rarely ever do you go to the physician that helps you, like, you have to usually go to several after that, and it's that advocacy piece, and so it's just, it's, it's that desperation for help that kind of, you know, exacerbates just the spread of misinformation between providers and parents and caregivers and, and, you know, it's just the rural community is much more susceptible to that because they have less access. And I mean, I think that. I want to say that people who are spreading misinformation or just inaccurately attributing patient progress to certain interventions, I don't think that it's malicious.

I think that everybody's trying to help. And I think that that I get kind of frustrated sometimes. And like you do, I know, and I think that if we just remember that people are trying to be helpful, and, you know, for the most part, and there are people who are marketing their technique because they're greedy, right?

Like that just exists. But there are a lot of people that I know who believe in something so powerful that's not you know, rooted in evidence, but it's because they just want to help or they feel so strongly about one ideal, like breastfeeding as being the only answer that it's like, hell or high water, I'm going to rid the mouth of all tethers that exist in this life, or, you know, not really, because I'm trying to achieve this goal.

And it's not because it's not- It's not like because they don't want what's best. It's just because they're so convinced that this feeding method is the only way that's best, right? So, like. It's very easy for providers and parents and caregivers to fall into that, to fall into that, and I just, I think that as a provider, you want to support your parents and caregivers, so if you hear them talking about something they're really excited about, and you're not really 100% sure, I mean, you can get caught up in, caught up in it, like when you haven't even done your homework on it yet, so.

Brianna Miluk: Yeah. I think that's where, you know, the dangers of, relying too heavily, even like in the Facebook groups, like relying too heavily on anecdotes or testimonials to be evidence of something happening and being really careful not to let those sway. I mean, one of the, like, one of the main characteristics of pseudoscience is that the primary body of evidence to support it is anecdotes and testimonials and clinical practice only. So, if we are considering what literature shows and we're like, well, it doesn't really matter because I have all these, you know, testimonies and anecdotes and stories that oftentimes super hardcore appeal to emotion. So, when you have a vulnerable population, you have a desperate parent, they're even more likely to fall for that information than that leads to just.

You know, delaying the intervention the child actually needs you know, putting an emotional toll on the, on the child and the families. And I think too, a lot of the times what you'll see in pseudoscience is- That kind of the other the other side of it that you'll see is like this idea that science is like against their ways or that like science hasn't caught up to it or I don't need science to tell me what I see in my practice like those sorts of phrases that ultimately lead to more mistrust on the medical community and more mistrust on providers who are trying to provide evidence based care.

And so it also leads to, you know, just like overall, just like aggravating the issues at hand where like the child's not getting the services they need, the family is going in circles, they're feeling frustrated, you may be missing, you're not doing the actual intervention the child needs, or you're missing a certain diagnosis or key component of it because all you see is this one method or this one thing, and you don't feel that you have the resources or support to learn otherwise, so you, you know, kind of end up doing this like one intervention or one strategy that you are trained in and feel good about and seems like a quick fix to help families. And then you end up stuck because you haven't continued to seek out, you know, that support. 

Rebecca Smith: Yeah I think that another reason that we fall into the misinformation trap more uniquely in rural community, I also want to say that I absolutely believe that there are times in which a tethered oral tissue might be present and causing breastfeeding pain. I just use that as an example because it can't be a Bri podcast without talking about TOTs. But that's why I had to. 

Brianna Miluk: Yeah, it's like it is a real diagnosis, but it's when that's all you see. 

Rebecca Smith: And it, yeah. And I, I- Another reason that we, we kind of fall into that trap uniquely here, I think, is because there's so many studies that are conducted at large facilities that have a lot of access to things and to teams, and that, and translating that to you is really hard.

Like, it's just hard. And I mean, I, I can't, I can't argue with that logic. I mean, other than to say, you know, it's obviously hard to replicate that in a community where there's maybe even little interest and, you know, filing an IRB on the subject, but also, you know, with with protections being what they are for this sensitive population anyway, like, it is it's it's really frustrating when you get like feedback that.

You know, you need to be doing all these things that you just feasibly cannot do because you don't have access to it, including like interdisciplinary practice within your like, you know, little place that you work, which the place that you work may just be you if you're in private practice, or, you know, you and maybe you do have an interdisciplinary team, like through your EI program, but you know, that's not to say that it's the same as having like an aerodigestive team at your fingertips. So, it's, that's another reason is people in rural community often feel like the research just doesn't apply to them and it wasn't made for them. So. 

Brianna Miluk: No, that's such a good point because I think that, you know, you do, there, there is just that lack of like translation in a lot of studies, but I think that goes, you know, sort of back to building those competencies of being able to like.

Fully appraise information and think critically through, okay, based on this. How does that or does that not apply? How would this maybe be modified with my existing knowledge with the existing literature that, you know, also relates to this topic? Because I definitely feel that of like, you know, having access to, you know, a multidisciplinary team and imaging and all of these things all at the same time is just not realistic. And so. 

Rebecca Smith: And I feel, I feel bad because like it is, it's so important to have access to imaging. Like I, and this argument, you know, happens a lot on the adult side. And there's people that are just like, but I don't, and there's just crickets when people say that. And there, cause it's like, you know what I mean?

There's there, what do you do? So, I, I mean, it's, yeah. It does it makes you feel like the literature doesn't apply to you, but I think that if, if people would step up and take more of an interest in participating in courses that teach you how to appraise articles, because you know what, I didn't learn how to do that in grad school.

And once again, it was a great program. I, I think that I learned a lot clinically, but when it came to, like, learning how to use critical appraisal tools, I didn't learn that until I was in my PhD program. So. And like students, even now, and like, you just feel like it's just such useless information and I'm not interested in research.

So here I am, like, this is dumb. And you're like, well. But it's not it's it's not meant to just be for you. It's meant to I mean, it's not meant to just be for the researcher or the person who's interested in research. It's meant to be for all of us. And it's but it's like you're you have to take a part.

Okay. This is statistically significant. But what is the clinical significance of this paper? And I mean, there is I think more burden on the shoulders of faculty members to explain to students how this is relevant to them in just a really honest way, but at some point, you have to, like, take responsibility for your education and you have to, like, take a course on learning how to read an article. And I mean, there's no shame in that. Like, you read something, you're like, I don't know what this means. That's fine, you know? 

Brianna Miluk: Yeah, no, I, I completely agree. I mean, obviously, I teach for Penn West, and one of the courses I teach is Information Literacy in CSD, and while we do talk about dissecting articles and being able to support information literacy in research articles, we also talk about information literacy when you appraise stuff that you see on social media or on a website or a blog that was written by, you know, a quote unquote expert in the field so that you can better appraise information that you see in the masses, because we're kidding our self if we don't think that students and professionals get information from these other sources now.

And that's not to say that those sources are always poor. Like many, I, you know, I have many people that I follow that I'm like, this is good quality information. You know, I've gone through appraising it and fact checking it and referencing other literature and support with it. But. In the same breath.

There's a ton of misinformation on social media and online. And so being able to appraise across the board. And I think like you said, Rebecca, there's like this pressure in academia to tell students like, Hey, here's the information. Here's how it applies clinically. But we almost need more focus on how do you think this applies clinically? And you know- 

Rebecca Smith: They don't like that, if you're a student and you're listening, sorry, but you don't, you don't like it when I asked that. And I mean, I do, I do love them. And this semester we are taking out discussion posts because I, I do discussions for my PhD. And I have to be honest, I know that they're crap.

Like I know that a lot of them are just ridiculous. Like, I know, but. They are easy to grade. And so, I was like, look, they're in here last semester because they were easy to grade. I'm taking them out because people feel like they're pointless. And I am putting in a journal article for like, as a graded assignment instead. And I'm sure some people will be like, why am I doing this? 

Brianna Miluk: Yeah, yeah. Oh, in my class, I, they are constantly in breakout groups to dissect information because I think. Another big thing about it. And this is, I think, something that, you know, maybe kind of goes into these potential solutions that we'll kind of talk about too it that, like, maybe can help overcome these barriers.

But one of those is with dissecting research and being able to feel like to feel more comfortable and to build competencies in appraising information, you truly just have to do it. And you have to do it over and over again. And you just have to repeat the process. And You know, being able to take the time to do it while you are a student is great, but, you know, for professionals listening, like, it's never too late to start that.

And you're gonna, when you first start doing that, like, I'm sure, Rebecca, you know, like, when you first started taking the course of propraising it, it's like, it takes forever, but now, it's so much more automatic. Like, you can very quickly be like, ooh, you know, this part's relevant, this part's not, or like, I love the outcome of this study, but the methods are totally flawed. So, like, is this even relevant? Like, and you get a lot better at it, but it really does just take time and a lot of, a lot of repetitive practice, but that is something that you can do, even if you are in a rural community with limited access to resources, you can just start that. You can start taking the time to go through that. 

Rebecca Smith: And I will say that. You're not going to run up against issues with that. If you are a provider in rural community looking for time to do this, you know, you don't have time. I know one, you don't have it, but I'm, I'm thinking there's just so much more available than there was when I started.

It's wild, like, The Informed SLP is a great resource. You can listen to the critical appraisals of the open access articles, you know, on I think you can listen to them on audio. So, if you're driving between locations on audio. There are paywalls that exist for certain papers, but you know what you can, you know, email me, I'll give you the article free. Like, I- 

Brianna Miluk: Email the author they'll give you the article. 

Rebecca Smith: The author will and, you know, even if they take a minute, they will get I've never had an author not give it to me when I was like, hey, this is behind a paywall and I really need it. I emailed Dr. Gosa because I wanted to cite her paper in my dissertation perspectives and I was like, Hey, I really want that.

And it was a new paper that just came out, the Clinimetric review that they did of feeding skill, parent reported outcome measures. And so, I emailed her and she, she got it to me. And I think there was another author who was that, who was it? It was the lady, it was Dr. Dodrill and then it was another lady, Jeanne. I feel like that name is wrong. You're muted. 

Brianna Miluk: Was it, was it Jenny Reynolds or Jeanne Marshall? 

Rebecca Smith: No, it might've been Marshall. It might've been Marshall. We'll put, we'll, we'll give you the exact in the notes. Cause I have it now, but she emailed me back like, and was like, Hey. Sorry, this took forever, but here's.

Brianna Miluk: Yeah, it was Jeannie Marshall. I just looked at it. 

Rebecca Smith: Yes. Yes. Yeah, and so I mean it was a good paper and it was very meaningful to my literature review section and I mean, all we had to do is reach out to them. So, and I know that that seems like scary and weird, but it's really not scary or weird like they- Authors love to hear 

Brianna Miluk: that you're referencing their article, you know that you're reading the work that they've done. So, you know, researchers don't I like you said, I've never had somebody not give it to me. And a lot of times they send it really quickly. So yeah, cool. 

Okay. So, when going into kind of more potential solutions. So, we've, we've talked about, you know, seeking out training, but also making sure that you spend time vetting the information and vetting the trainings. You know, collaborating with specialists that aren't just in your community, but outside of your community as well.

So, taking the time to seek out that mentorship, to build your competencies. I think another point to make is the importance of also taking the time to support caregivers in these situations so that, you know, we can kind of take on that role with, you know, within our scope of counseling on what's going on with the child, their plan of care, our treatment recommendations, and helping the caregivers to feel more confident and competent in care and advocating for, you know, referrals or testing or whatever it is to, you know, to be done.

Rebecca Smith: I definitely have lots of parents and caregivers who are pretty active on Instagram and following, you know, Solid Starts or things like that. So, I don't, I mean, it's, it's hard to, you know, have when you're in a first interaction with a parent, especially, and if they mentioned that they're subscribing to sources that are less than reputable to like have that conversation, but you can just say, you know.

You can have an honest conversation and try to direct them to the reputable sources and a lot of times they are open to that. That's why they came to you, you know what I mean? But like, understanding, you know, how to best support them. A lot of times you need to, if even if they don't offer it up, ask, what do you know about this?

What information have you looked at before? And like, just asking them what, and then you find out, well, you know, I, I didn't think it could be this, but then I looked it up because my mom's friend's cousin follows this person on Instagram or whatever and then, you know, you are directed to the source that has been providing them a lot of education up to this point and most of the time they're not connected with this person providing education.

So, they're going to be more trusting of you as the provider. You know, to, to support them with with reputable places to get the information. So, I think one step of empowering parents that we overlook a lot of times is asking them what they've tried so far to remediate the feeding and swallowing issue and what made them try that. What, where did you look for that information? 

Brianna Miluk: Yeah. I mean, I think. There, you know, there is a level of responsibility that we should have on as providers to be well versed in the current evidence and best practices for certain things so that way when parents say, hey, you know, I came across this because sometimes parents come across resources and I'm like, this is great.

This one is so good. Oh, my goodness. Like, or, you know, I've, I've even had some parents are like, I read this article that talked about, you know, XYZ cause they've been waiting for therapeutic services and they weren't really sure where to go. And it's like, Hey, that's actually a great tool. Like let's talk about how we can make this work for you and your family.

But then of course there are those times that it's less than reputable and being able to articulate that, but we don't want to, you know, we want to make sure that we are well versed in what is best practice and what the evidence does say so that we can navigate that conversation. Cause if we aren't well versed, it could also be easy for us to see something and be like, well, sure, let's try that.

And it's not actually very effective. And I think, you know, recognizing as a provider that Parents are getting information from social media and online, like, you know, just going on the Google and, you know, searching whatever, and that can be risky. They might come across good information, but it's important that we're just aware that, like, that's happening.

And I think, like you said, just asking the question, like- Where did you get that information? Or where have you started searching for things? Like, obviously they've been searching, you know, I'm sure all of us can say that like, if you get a diagnosis or you're on a medication for something, you look it up, you know, we all do it. So just acknowledging that I think can be really helpful. And then also, like you said, potentially powerful to the caregiver to be like, yeah, I did take initiative. And like, this is kind of where I was put. 

Rebecca Smith: And giving them positive, no matter if they tell you, you know, something off the wall, you just, like, praise them for trying to find information, right?

Because it's not like, they don't have the knowledge in this space that you do, but they know their child better than you, so you need to give them the respect that they deserve in that moment for, for trying to advocate and figure out what's going on. So, yeah. 

Brianna Miluk: Yeah, I agree with that 100% because yeah, we can help support them in guiding like which information might be more reputable than others and where it goes with that. But ultimately it is their decision. So, like our role is like helping parents make well informed decision by providing them all the information, not only one side of information or leaving out, you know, pieces of information because of our clinical experience. Our responsibility is to provide them with all the information. 

Rebecca Smith: And sometimes they'll do, you know, things you wouldn't advise them to do. There's I've had that happen before, and you just have to be like, you know, you're not the parent and you just have to, like, get off your high horse and be like, I don't necessarily agree with this, but it's not my child and it's fine. You know what I mean? And so and supporting them. And providing the therapy that you can provide them, you know, within your scope. And you had a conversation about it and you documented that and you were kind and supportive and that's all you can do sometimes. So. 

Brianna Miluk: Yeah, for sure. No, I, I completely agree. Like if a caregiver was like, you know, I was given this recommendation by, you know, the, the swallow study or something, but. I'm, I'm not going to totally do that. I want to also do this. Then, you know, our role is providing them with the information on the risks, providing them with like, okay, well, if we're going to do this, here's the safest way to do it. You know, here's the best way to go about it. But ultimately like they're going to make their decisions. So. 

Rebecca Smith: I honestly love it when they tell me they're not going to do what the swallow study says. I'm just going to be honest. Like, I'm just like, I'm like, let's not, because most of the time, unless I did it. LOL. I'm not in love with myself, but like. 

Brianna Miluk: But even then, like, you're aware of the flexibility of what you see in that moment. 

Rebecca Smith: Yeah, and I mean, I mean, a lot of times if you get a, if you get a medically complex patient and you're working with them in a rural space, you aren't necessarily the one doing the swallow study, so you're getting these results from the view of a person who's never seen this patient who doesn't know this parent, who captured a moment in time. And a lot of times that comes with really inflexible recommendations. And so, you know, I, I, when they were like, I don't want to, I'm like me either. So, it's just. 

Brianna Miluk: Yeah. Or you get the recommendation where they're like, Hey, they told us like, you know, moderately thick because they penetrated on mildly. And you're like, so we're not going to do that. You're like, let's talk about how we can do some things safely. Okay. Anything else you want to share from a potential solution or considerations for supporting building competencies? 

Rebecca Smith: I definitely feel that if you are in a rural community and you are a feeding and swallowing speech pathologist or feeding provider and you're new to the game, having community within that community is important. You may feel like you're the only one and you might be that only one for like an hour, but if you go a little bit further out, you may find your network of other therapists and you can share in that, that camaraderie and then that's just really, really helpful to have people alongside you, whether or not, and if they're not prescribing it the same, you know, treatment and evaluation methods that you are, it's a great time for a shared education because you're in a learning space and you're sharing your willing to listen to each other.

So, I would say finding your people within locally, as local as you can is important. I would say that, you know, finding a, if you really wanna pursue your career long-term in this space, finding supervisors who are, you know, very supportive of you growing your caseload and through and providing you know, the parent education opportunities, getting the supplies that you need and helping you be creative and how you figure out how you're going to get those things.

And I would also say that networking with local providers on, on what you do and what's available within the community for these patient populations and just the vast presentations of PFD. Most of them have no idea. I don't as much as I love my providers in this community that I've come to know, I don't get a single 1 of them that gives me a PFD diagnostic code on an eval. Like, I have to put it on there myself. I still get other feeding difficulties. I still get feeding problems. I don't get the, the appropriate code that, you know, Goudeau and colleagues outlined in 2019. So, they still need to know. So, you need to, you know, find your partners that can help you educate these providers.

And it's going to take guess what? It's going to take more than 1 time. And I think that that's what's annoying too. I actually had a former colleague who is, she works more in the adult space and I love her. She's great. But I remember one time she was like, I just get so tired of saying the same things and I'm like, it's just, it's never going to end.

Like it's, and you just have to get right with that. You know what I mean? You have to, you know, accept that spiritually that you are just going to be just a record on repeat for the rest of your life. Probably. So at least for years until after something becomes new, right? Like, maybe in 10 years, I expect everybody to know what PFD is, but I don't have any expectation that that's going to happen in the next year or two. It's just. Yeah. So. 

Brianna Miluk: Yeah, no, I think that's great. And I think with, you know, having to have- more and more people being familiar with like virtual meeting options, I think opens up that space even more. So, you know, we're not saying, Oh yeah, just drive an hour to, you know, once a month have coffee with a colleague.

It's like. No, you actually have a lot more accessibility because you can meet virtually. You know, I meet with people virtually all the time to talk about things and provide mentorship because Like we don't have to be as limited by proximity anymore, like physical proximity, we can still seek mentorship and get support and be able to like, you know, talk about the research article we just read and the patients on our caseload in a virtual manner. And I think that really opens up a lot of access in those rural communities where you do feel isolated. So. 

Rebecca Smith: I think that making and I read atomic habits recently, which was one of the best books of my life, I have to say. But I am a habit girly. I love habits. I love a routine. I would say that if you want to be in the literature more, then you just take those steps as outlined by our Lord and Savior, James Clear.

He's so good. And that's just like, you know, doing the first step to make a habit a habit and then doing it a little more until it's just a part of your identity. And you can just take like, 10 minutes one day a week to where you're going to read one article and even with just that one article that you add and that's even something I need to do in all honestly and Dr. Hazelwood actually sent me let me tell you this.

She sent me this. Let me see what she said. It was this Listening.io, have you heard of this? It's a website that all PhD students are raving about. Granted it was a ad on Instagram. 

Brianna Miluk: Mm-hmm. 

Rebecca Smith: But you can listen to research papers and take notes on key ideas. Key ideas with one click. And I think it is a paid service, but you can try it free for a couple weeks.

So- 

Brianna Miluk: I just looked it up. Yeah. Very interesting. I love that. So, it's basically like AI that reads the article to you. 

Rebecca Smith: I know AI is getting just, it is getting downright scary. I'm not gonna lie. I'm a little afraid that like, that my doppelganger will just be. 

Brianna Miluk: I literally love it so much. I think, I don't think AI is going to like, replace anything and everything we do, but I think it's just going to enhance and save us so much time and like, being able to use it, and there are some AIs available even now that give you like the quick synopsis of articles. I can't remember the one I'm thinking of. Hold on. 

Rebecca Smith: We are going to be the Jetsons very shortly. It's going to be, yeah, this is wild, isn't it? This Listening.io, you can pick which sections to listen to. I just wonder what. Like how you get access to the papers that they pull up, like where?

Brianna Miluk: Yeah, I don't, I don't know. Yeah, this one, for example, is Sci Summary and it says use AI to summarize scientific articles in seconds. So, it like summarizes the, the information that was one there was another one I came across. I'm trying to remember what it was called. It might have been the Scholarcy one where again, it's AR powered article summary.

I think with those, though, for example, like, I think that's great to give you like the key concepts, but I really think that only supports you in knowing if it's relevant. For you to continue reading, like I still think it's helpful for just like very quick, like, okay, what does that article say, but I still think it's so important for you to read it yourself to be able to determine like, okay, well, what are the methods?

What's the quality of execution? Like, you know, who are the authors? Were there any biases present? What were the limitations in it? Like, we still have to look at all of that. 

Rebecca Smith: Well, and it's, and it's. You know, you may think, why do I have to go to all that trouble? But it's because there's a lot of peer review journals that are just, that don't even- 

Brianna Miluk: That have a super biased peer body.

Rebecca Smith: Yeah. So, like, who is, who is reviewing it? You know what I mean? And like all that thing. And I, I think it's like, you know, recognizing who the audience was meant for and like what journal was that published, published in, and. 

Brianna Miluk: Yeah. 

Rebecca Smith: And all of those things. So. 

Brianna Miluk: Yeah, it sucks that we have to do that. Like it, I truly, it just, it sucks that we have to even appraise like the scientific information we come across. Like you would like to hope that it's all like, Oh, well intended low bias. Like, but it's just not. And so, we have to be really careful coming across those. So, okay, really quick before we kind of give our quick summary. I have some rapid-fire questions for you. So, this is the part where I just kind of ask you two or three questions on the fly that have nothing to do with anything. I just. Ask the questions and I want to hear your, your answer to them. So, one that I always like to ask is what are you currently reading or what is your favorite children's book? So, you can answer either one. 

Rebecca Smith: Okay. So, I feel like, I feel like my favorite, one of my favorite, I have so many favorite children's books, but one of them was Brown Bear. I love Brown Bear. I love Rainbow Fish and I love Hungry Caterpillar. 

Brianna Miluk: Oh my gosh, I loved, loved Rainbow Fish when I was a kid. Oh, that's a really good one. That's a good one. Okay. 

Rebecca Smith: I just finished Atomic Habits, but right now I'm reading a book about hormones. So... Yeah. 

Brianna Miluk: I love this switch. I'm the same way, though. Like, it's all over the place when I'm selecting the book I want to read. Okay. Next question is, do you have a favorite... drink, like, like drink of choice order for the morning, like a coffee, like a specific coffee order or specific tea order. Like what, what's your go to in the morning? 

Rebecca Smith: Well, I've been actually, which I mean, people won't watch this on YouTube hopefully, but I've been weaning caffeine a little bit. So that's another reason why I look like just like a bridge troll. 

Brianna Miluk: Oh my gosh. I actually recently weaned caffeine, but it was on accident. Like I wasn't like planning to, but when we went to Europe in May, the coffee there is so strong. I was, this is so TMI, but like I was just pooping my pants every day. It was horrible. And so, I was just like hard pass, like just stop. And so. 

Rebecca Smith: Traumatic. *Talking at the same time* 

Brianna Miluk: Sip soda a little bit. Yeah, I like just would sip soda like just enough to like take off the edge of the like caffeine deprivation, but since then I’ve just been drinking tea in the morning. 

Rebecca Smith: I've been drinking some matcha and then if I’m gonna have coffee, I honestly just have it black. But, and, and then I do in the mornings, I've been going to the gym, like pretty early, so I'll do like the amino lean, like pre workout. I really like that. Cause it's like clean, whatever. 

Brianna Miluk: Your morning drink of choice is like a protein shake basically, or like. 

Rebecca Smith: Yeah. 

Brianna Miluk: I'll take that. I'll take that. Okay. So, summarize it all together. Basically, we're just reiterating that it is very important to make sure that your competencies are, you know, up to par in pediatric feeding and we acknowledge the barriers to achieving those in rural settings, but hopefully have provided a couple solutions for supporting and moving forward with that.

And I think also, you know. We just want to encourage listeners to recognize that the competencies are not just specific to skill-based care, but the competencies also need to be in information literacy, accessing research, appraising research, because ultimately that's going to help. Because like Rebecca said, these competencies are kind of never ending, and they're always changing, because we have so much new information coming, and especially in the pediatric world where it's a lot more difficult to have research studies done with kids that are immediately applicable to every single setting and especially rural settings that we have to be, we have to be constantly refining our critical thinking skills. So, is there anything else you want to add to summarizing there? 

Rebecca Smith: I think that this was a lot of fun. I enjoyed it. I felt really sleepy before, but now I'm awake and just. 

Brianna Miluk: Yay! 

Rebecca Smith: Information literacy. I wish I could take your information literacy course, but. 

Brianna Miluk: You can just be a ghost learner in the back of the room. I'll just throw you in there. You're the one person that has their camera off, just like chilling in the back. 

Rebecca Smith: Do you make everyone turn their camera on? 

Brianna Miluk: I do. I do. Because of what I said earlier, where information literacy is a skill that you have to practice. It's like very seminar based. So, I actually learned that from you with like backwards classroom models. So, I use that approach with this class, but I do some lecture. And then we do a lot of just like, it's very, like, seminar based, so it's very discussion based, like, get into small groups, we talk about it, we appraise stuff, like, live, together, and so, I like their cameras on, so that, one, I don't feel so alone, and two, I know that they're engaging in that, because I think that's really the only way to, to achieve competencies with it, is to be, like, I'm in it. We're, we're doing it. We're participating. So yeah. 

Rebecca Smith: That sounds like a lot of fun. Wish I could be there. 

Brianna Miluk: It is. I have to say it's a lot of fun. I mean, it's my class, so I think it's fun. I hope my students think it's fun. Well, thank you so much, Rebecca. I appreciate you like just to no end. I love you so much. And I'm excited to see your, your PhD stuff evolve.

Rebecca Smith: One of these days, man, it's gonna, it's gonna come full circle and then I'll have just all the knowledge. Just kidding. I'll still have none. Thank you. 

Brianna Miluk: Yeah, I love it. All right. Thank you so much.

Thanks for tuning in to The Feeding Pod this week. If you enjoyed today's episode, please don't hesitate to share this podcast with your friends and colleagues and leave us a five-star review wherever you're listening from. If you're interested in learning more about pediatric feeding and swallowing, be sure to follow Bri, me, on Instagram @PediatricFeedingSLP, or check out my website where you can get access to more courses and information, www.pediatricfeedingslp.com. Again, thanks for being here and listening to my ramblings, and I hope you'll keep listening. Until next time, cheers.

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