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An Interview with Kathryn Yorkston, PhD

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As a member of the Department of Rehabilitation Medicine's faculty, Kathryn Yorkston, PhD works in the Neuromuscular Clinic for Speech and Swallowing Disorders, and focuses her research on motor speech disorders in adults.

The following interview with Dr. Yorkston was conducted by Jane Pimentel for the Academy of Neurologic Communication Disorders & Sciences (ANCDS), and appeared in their Spring 2009 Newsletter.

Describe a typical work day.

The only thing that is very typical for me is my two hours of writing everyday. I schedule that in as early as possible in the day and then the rest of my day is like any typical academic day – a little bit of research and teaching, meeting with students. I’m teaching more now that we have the doctoral program (in Rehabilitation Sciences).

Also, in a typical day I try to leave with my email inbox pretty close to empty and then I just check it in the morning and only take care of emails I can do in less than five minutes and then get on with my writing. I try to look at emails only one time just as you try to handle a piece of paper only one time.

The amount of writing you accomplish is impressive. What advice do you have for faculty and professionals writing to publish?

If I don’t write first thing in the morning I wind up not doing it or being so fragmented it just doesn’t happen. I think the piece of advice I would give people is to treat it like it is a priority and that’s why people look at my schedule and say "what’s that block of time every morning?"

Like, this afternoon, I am doing a doctoral seminar – I have that scheduled and I also, in the morning, have my writing scheduled. It puts responsibility on me to treat it as if it were mandatory. Just like appearing at the Doc seminar I am running this quarter is mandatory; my writing is mandatory. Writing has to get high on my priority list even though nobody is telling me "you have to write" so I have to tell myself. So many other things compete for your time if you don’t have it scheduled in.

You mentioned University of Washington’s Rehabilitative Sciences Doctoral Program, when did that start?

It started in fall of 2006. We have structured the program so that a cohort of students enters the program every other year. So the students enter fall of even years and they take a 2-year series of seminars so they function and work as a coordinated cohort of doc students; this allows them to really coalesce as a group.

We thought that was important because they come from all different disciplines. They have generally come from clinical backgrounds such as OT, PT, and Speech-Language Pathology but they want to enter a career that involves teaching and research.

That is interesting; I was going to ask how SLP’s fit into the Rehabilitation Sciences doctoral program.

The core courses really have a rehabilitation emphasis. For example, the seminar I did last quarter was Foundations of Rehabilitation Science which was about models of disablement like the ICF model and everyone brings their own clinical practice to that model in discussions of where the model can be improved and how the model addresses life span issues etc.

The seminar this quarter is on evidence-based practice so that everyone has done a systematic review; the SLP’s do a review on things that are of interest to them but they all learn the same strategies; just apply it differently.

It’s a great group of people. What we find is that so much of either clinical practice or research is done not singlely but in teams and what we hope to have with this cohort model is people that are very used to talking to each other but bring with them a basic skill set already. Then they take these seminars like Epidemiology and Assistive Technology; so that all of the seminars in this seven seminar series are generic with a rehabilitation emphasis that you can apply to your own discipline.

Which seminars are you involved in teaching?

The Evidence-Based Practice seminar and the Foundations in Rehab Science. Like all of the core faculty, I’m involved in planning the seminar series that also includes seminars on Measuring Outcomes, Assistive Technology, Epidemiology of Disability, Neural Subtrates of Movement. When I’m not teaching a seminar, I often sit in on them because I learn as much as the doc students do.

Besides teaching, what other role do you have in this doctoral program?

We now have 13 doctoral students in the program; 6 in the first cohort and 7 in the second and that is the size that we want to maintain. Once the student completes the core courses and selects a direction for research they set up their doctoral committee and I am the Chair of those doctoral students that are speech pathologist’s going through the program. It’s very exciting to see the first cohort moving through their research projects.

And all the professions, PT, OT, Speech, all have such a looming faculty shortage problem. I think that our students won’t have any problem finding work.

You were an inaugural member of the ANCDS EBP guidelines project in the area of dysarthria. Have the guidelines turned out as you envisioned them?

They were surprising to me in a couple ways. I think personally the most important thing that comes out of the systematic reviews is to stop and take a look at what we’ve done so we can figure out what the future direction should be. That emphasis on how much they direct the future was not apparent to me when I started. I thought it would be more of a set of practice guidelines, telling you what you should or shouldn’t do.

But it soon become very clear, that the field is not at a point where we can do that. Yet identifying the gaps in our understanding and saying we really need to do a better job in this area or that area will help direct our field in the future. So, I think that the practice guidelines suggest that we have lots to do and, in my opinion, suggest very strongly what those next steps should be.

I don’t think we are at a point where we can dictate specific practice procedures yet in any of our populations. I think that ANCDS should earn several gold stars for making the practice guidelines available on their website. I can’t tell you how many emails I get asking me for presentations I’ve done over the years on dysarthria treatment; now, I can just direct them to the ANCDS website.

How can the systematic reviews and guidelines be best promoted to get into the hands of practicing clinicians?

I think that changing the practice of a clinician that has been practicing 20 years is very difficult. I think their real power will be in integrating them into curricular development in masters level speech pathology programs. That’s where students have to begin to think about what the evidence supports.

In addition, if students are going to do a Master’s project then suggestions for future research may help them identify a project. I also see the guidelines being integrated into textbooks. Dave Beukelman, Edy Strand, Mark Hakel and I just finished doing the 3rd edition of the Motor Speech Disorders textbook and with each of the chapters we tried to integrate those systematic reviews into the chapters. Hopefully students will get used to seeing those reviews and going out and finding other systematic reviews.

It’s so easy to put the key word "systematic review" in your search and I think as more of those come available clinicians are going to be able to say, for example: "multiple sclerosis", then "systematic review", "intervention" and come up with work that is synthesized to cover a broad area of knowledge. These systematic reviews are part of this era of knowledge translation; distilling what the state of the art is in a variety of topics pertinent to our field. This will help the research become accessible to both clinicians and consumers.

On a very different note, with all you have going on in your professional life, how do you manage to be so consistently present, pleasant, responsive and engaged when interacting with students, colleagues and professionals?

I am a terrible multi-tasker, I hate multi-tasking, it wears me out if I have to do two things at once. The skill I try to cultivate in myself is to be a very good task-switcher and to tell myself I am doing one thing and one thing only. I think that personally makes me a lot calmer and more focused and less feeling scattered.

So one of the tasks that I do is to do one thing at a time, that’s why I schedule my writing in the morning. I have my two hours of writing when I tell myself the rest of the world isn’t there and I’m just going to focus on this. I think that that gives me a chance to be not so frantic with things.

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