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ISHA Member, Tiffani Wallace, Shares about her experience

01/24/2013 12:41 PM | Anonymous


It's official! I finally did it and am so extremely happy and excited!!


I finally, not only had my application accepted by the BRS-S (Board Recognized Specialty in Swallowing) and passed the exam. I can officially put the title BRS-S after my credentials!


I wish that I could say that it was an easy process, but it really wasn't. I will say though that I have learned so much along the way and have met so many new and wonderful process through this amazing journey.


The main reason for writing this post is to, hopefully encourage others to do the same. This was something to me that several years ago seemed completely unreachable. I mean really, I'll never compare to the Jeri Logemann's of the world!


Many people have asked me about applying for and taking the exam for the BRS-S.  Here is post about my experience.


I had went to many conferences and saw speakers with BRS-S after their names. I went to the website,, and started looking into what it would take to become BRS-S.  WOW! Not only do you have to prove that you have gone over and beyond in the area of swallowing and dysphagia, but you have to have 75 CEU's in dysphagia,

3 years experience post graduation and letters of recommendation.


The BRS-S does offer the opportunity to utilize a mentor during the entire process. I decided that it wouldn't hurt to look into a mentor to even see if this is something possible for me. I actually did, 2 years ago, I applied for a mentor. I ended up with Nancy Swigert, who I truly can never thank enough for not only giving me the courage and the confidence to believe that I could do this, but also endlessly reviewed and helped my revise my very very very long application.

If you are looking into applying for BRS-S, the website has the following listed as requirements:


Requirements for All Applicants


1. ASHA Certification.

All applicants must currently hold the ASHA Certificate of Clinical Competence in Speech-Language Pathology (CCC/SLP).


2. Continuing Education.

All applicants must document receipt of at least 7.5 CEUs that relate to dysphagia within the last 3 years. A minimum of 4.5 of the CEUs need to be ASHA sponsored courses and up to 3.0 of the CEUs may be non- ASHA sponsored continuing education activities.


Individuals attending workshops which do not give ASHA CEUs may apply for independent study through ASHA to receive ASHA CEUs. Please provide evidence of attendance at other educational activities in closely related fields. Detailed descriptions of all non-ASHA sponsored CEU activities is required. Continuing education activities may include Workshops, meetings or courses in swallowing and swallowing disorders, video and audio courses, telemedicine, and other electronic media) Independent study (e.g., course development, research projects, publications, internships) Self-study (e.g., videotapes, audiotapes, journals). Continuing education courses must be directly related to dysphagia. If the title of the course is unclear (as it relates to dysphagia), an applicant should submit a program or brochure to provide substantiation for its inclusion.


When applying CEUs from the ASHA National convention or other multi-offering events, applicants must list specific course/workshop

titles and corresponding CEUs in the application table. CEUs will be applied for only those courses/workshop relative to dysphagia.

College Courses. If an applicant has completed a college level course in dysphagia, accrued credits can be applied to continuing education requirements. Graduate university coursework must be accompanied by

a syllabus or transcript. One college credit is equivalent to 1 CEU (as it relates to application for BRS-S). The applicant must submit a transcript or other document verifying completion of those credits.


Instructor or Invited Lecturer. If an applicant teaches a dysphagia course at an approved university/college or provides dysphagia-related lectures at a conference which provides ASHA CEUs, a maximum of 3.5 CEUs may be applied to the 7.5 CEU requirement for BRS-S. One college credit is equivalent to 1 CEU. Each course may only be applied only one time within an application (even though the same course/conference may be taught several times during an academic year or in consecutive years). The applicant must submit appropriate evidence and documentation of the lectures that were related to dysphagia.


3. Post-Certification Clinical Experience.

All applicants must have completed a minimum of 3 years post certification (CCC/SLP) clinical work that has a focus in dysphagia.

BRS-S has established two tracks to meet the diversity of clinical service environments for professionals at all levels of advancement within the profession:Clinical Track and Academic/Administrative Track. The Clinical Track looks to identify professionals who demonstrate strong advanced clinical skills through direct provision of services to patients/ clients. The Academic/Administrative Track looks to identify

researchers, instructors and administrators who have advanced in different employment environments. These individuals maintain clinical skills through ongoing patient/client contact, while promoting improved patient care through research and teaching/training of clinicians within this specialized area of practice.


a. Clinical Track: a minimum of 350 clock hours of evaluation and/or treatment of swallowing disorders completed within a year for each of 3 years prior to applying for BRS-S. Supervision of speech-language pathology staff members and students providing evaluation and treatment to infants, children or adults with feeding and swallowing disorders can account for 100 of the required 350 hours/year. Supervisors must submit a statement affirming that all of the 100 hours of supervision were for dysphagia cases. The balance of the hours must be obtained from direct face-to-face clinical service to patients.


b. Academic/Administrative Track: a minimum of 100 clock hours of clinical evaluation and/or treatment of persons with swallowing disorders completed within a year for each of 3 years prior to applying for BRS-S. These hours must all be direct patient contact hours.


In place of the higher number of clock hours required of those in the Clinical track, applicants in the Academic/Administrative tract shall hold either:


a. an academic position in a degree-granting institution with a combination of teaching, and research, and academic advising with a focus on swallowing and swallowing disorders. Evidence of student advising, teaching, and research must be included in the narrative section of this application. Evidence of teaching should include a syllabus of the dysphagia course taught. Research must include clinical research in normal or disordered swallowing with direct contact with human subjects as part of the methodology.




b. an official administrative or supervisory position in a setting that provides clinical services to persons with swallowing disorders. Responsibilities will include training and supervision of clinical staff, program development, and leadership in the institution directly related to swallowing and swallowing disorders. Multiple examples and evidence

of these areas of leadership must be included in the narrative section of the application (e.g. policy/protocol development regarding swallowing program, development and implementation of dysphagia quality improvement program).


4. Advanced Skill Documentation

Through the documentation of advanced level skills in swallowing and swallowing disorders, candidates must demonstrate that they have applied the highest level of ethical standards in their practice (i.e. service delivery and in the conduct of scholarship, research, and training). The expectation is that applicants can demonstrate "advanced" clinical and professional skills over the past 3 years. In other words, the applicant has achieved the highest standard of excellence, displays professionalism, is committed to continuous advanced learning, and displays characteristics that reflect achievements that go above and beyond expectations. Applicants may indicate a clinical preference or advanced level of experience in either pediatrics or adults but this is optional as applicants will have knowledge of swallowing and its disorders regardless of age.


There are distinctly different requirements for each track.


a. Applicants in the Clinical Track must evidence advanced skills either by satisfying at a minimum: two activity types within one category or

one activity in two different category types. In other words, the applicant can choose to provide documentation in just one of 3 advanced areas.


b. Applicants in the Academic/Administrative Track must evidence advanced skills in at least two different category types.


Examples of activities fulfilling qualification criteria

The following are examples of activity types within the 3 categorized advanced areas:



Served on various interdisciplinary committees at place of employment. Chaired a committee within your organization. Describe the scope of the project and your leadership role. Held leadership positions in ASHA or other professional organizations whose mission includes a focus on swallowing and swallowing disorders (Chair of committee, officer, etc). Give specifics. Participated in development of ASHA or state association position papers or guidelines on swallowing and swallowing disorders. Give specifics. Attach document if complete. - Served on major committees of regional, state, or national organizations dealing with swallowing and swallowing disorders. Describe the work of the committee. Serves in official supervisory position(s) at hospital, rehabilitation, education, or university programs in swallowing and swallowing disorders with responsibilities for training and supervision of staff clinicians providing dysphagia services. This could be supervisor, director, lead clinician, etc. Describe these services. Developed a formal swallowing program within the institution with involvement of multiple disciplines. Responsible for ongoing monitoring and quality improvement program within the institution for swallowing program. Describe the program in detail and include protocol. Developed a new function/role of the dysphagia program at the institution (e.g. added an instrumental format; oral care program).



Presented a paper or poster at the state association, perhaps in partnership with another speech-language pathologist. This might be a report on a quality improvement initiative, description of specialized dysphagia program you offer, etc. Served as supervisor for multiple clinicians/students in swallowing and swallowing disorders over last 3+ years. Details regarding number of clinicians supervised and level of supervision/training provided must be included. Started or regularly participated in journal group and made evidence- based presentations to the group. Developed content and taught related professionals within your facility about swallowing and swallowing disorders(e.g. Grand Rounds, nursing orientation) Taught a community based group (e.g. normal elderly on effects of aging; disease-specific support groups) Provided guest lectures in graduate course at local university. Taught graduate course on swallowing and swallowing disorders in ASHA CAA accredited university program in the past 3 years. The course syllabus should be attached. Educational presentations at major regional, state, national, or international conferences and/or post graduate workshops on swallowing and/or swallowing disorders. These lectures must have been presented to an audience that extended beyond the applicant's institution. Title of presentation, date, participant objectives, and audience should be delineated.

Developed facility-specific patient or staff educational materials. Attach copy of the materials. Developed and published clinical educational programs and/or materials on swallowing and swallowing disorders that are disseminated outside of the institution/program in which the applicant works. The product can be in the form of electronic media or hard copy. Copy of the program or material should be attached. Serve as primary advisor to a masters or doctoral student to guide their research for a thesis or dissertation



Published at least one peer-reviewed research article with the applicant as primary or secondary author of this article. Attach the article. Published a chapter directly related to normal swallowing or swallowing disorders in a peer reviewed textbook. Give specific reference or attach chapter. Presented a peer reviewed research paper or poster at a scientific meeting. Actively participated in research activities in normal swallowing and/or swallowing disorders involving some form of direct patient contact such as conducting a survey or applying research methods under study (diagnostic tools or treatments). State the specific research questions of the project, the results, and publications or presentations emanating from it - or if still underway, state the progress to date, the anticipated completion of the project, and plans for publication.


Supporting Materials for Application


Reference Letters

An applicant must submit a minimum of three or more reference letters for consideration. Additional letters in support of the applicant can also be included if there is a need to describe specific activities or accomplishments. The letters of reference should attest to the applicant's character, accomplishments, expertise, and value to their program. The authors should be familiar with the applicants' current or recent professional experience (as opposed to previous professional relationships). Applicants should carefully choose referents who can attest to those qualities. Reference letters must be currently dated and written specifically for purposes of the BRS-S application. General recommendation letters or letters with previous dates will not be accepted. Appropriate referents may include physicians, administrative managers/directors, coworkers, program directors or coordinators, instructors or professors, etc. One of the letters must attest to the applicant's attainment of a minimum of 350 clinical hours/year (clinical track) or 100 clinical hours/year (research/teaching track) in dysphagia related clinical service.


Biographical Summary

The biographical summary should provide, in 200 words, a statement of both qualifications and interest in and rationale for obtaining BRS-S. Yes, Yikes!!! I knew I had the ASHA credentials, I actually did have the continuing ed requirements, the hours of experience (thank you to all my SNF experience and the hospital). My area that I was lacking was my advanced experiences. Nancy gave me some wonderful ideas such as presenting poster presentations at my state convention, at ASHA, presenting within the community. I also added things like my Facebook groups, my Twitter experiences, online journal club. I live and work in a very rural area (25 bed hospital), so some of these advanced skills took some creativity. I also was very fortunate in that at the time I started my application process, I had the opportunity to supervise 2 CF's and a student. Everything just seemed to come together at the perfect time!


I did end up doing a poster session at my state convention in 2011, then a poster presentation that same year at ASHA. I had the Facebook groups, CF supervision and several experiences with education of nursing staff etc. I felt that I was ready at that point. After sending in four copies of my very lengthy application, submitting my payment for application and several long weeks of waiting, I received a letter in the mail. I wasn't accepted at that point.


The nicest part of the rejection letter, was that the board didn't just tell me it wasn't good enough at that point. They highlighted my areas of weakness and strength with suggestions for improving those weak areas and improving them for future application.


I'll admit, that I spend a couple of days feeling sorry for myself. I cried a little. After encouragement and support from Nancy, my family and several friends, I decided to get back on it.


After another year of presenting to the community, speaking to a nursing class, reworking my application and basically doing all the things that were suggested by the board, i resubmitted my application. 4 more copies, $75 more, MANY revisions of the application, 4 letters of recommendation and letters from former patients. After an agonizing 8 weeks, I was sitting on the couch one evening, checking my email. I had an email from the BRS-S. MY APPLICATION WAS ACCEPTED!!! I had to email and text everybody I knew!! It was like an absolute dream!


Then came the scary part. I had to pass the exam. What is on the exam?? That is what every person that has not taken the exam would like to know!!! There is a study guide that is submitted with your acceptance email, however, basically, you need to know a little bit of everything about swallowing and dysphagia. I have spent about the last month and a half studying everything I could get my hands on regarding swallowing and dysphagia, pediatrics, Dr. Logemann's book, journal articles, everything!


I signed up to take my exam on Oct 2. I was a nervous wreck. I couldn't eat and was just anxious. The time came to take the exam. I signed in (you have 2 hours to take the 110 question exam). I do remember several times thinking, why didn't I study that more or what in the heck is that??


I actually finished the exam in less than an hour, thinking I would review my answers. I then decided that if I went back over my answers, I would change them and do worse.


I very quickly decided to then click on submit, which I did and waited. My score appeared within seconds, 92%!!!!! I needed an 80% to pass. I could barely believe that I passed!!! I actually obtained Board Recognized Specialty in Swallowing!!


I do believe that anyone who wants to achieve this great honor, should! It is a tough process, it is very taxing, but it is so very rewarding in the end. It is an amazing feeling to know that you have done something that very few people have accomplished at this point.


It is so important in the time of changing health care and the need to "prove" our services, that we have something that we can "prove" the worth of our services and that we are the ones that specialize in the area of swallowing!



Tiffani Wallace has been an SLP specializing in Dysphagia for over 11 years. Tiffani has been very active in the social media world, creating 2 Facebook groups, Dysphagia Therapy Group and Dysphagia Therapy Group-Professional Edition. Tiffani is also the co-author of the app Dysphagia2Go, available on iTunes. She is traveling nationally speaking on the topic of Dysphagia. Tiffani writes a blog called Dysphagia Ramblings, found at and is the author of She is a 5 time ACE awardee and recently obtained her BRS-S.


Check out Tiffani's recent ASHAsphere blog posting:


  • 01/31/2013 11:55 AM | Dorothy Dean Floridis
    Congratulations! What an achievement! Good for you! I've been in the profession for over 50 years and it is wonderful to see someone so dedicated and enthusiastic about being a Speech/Language Pathologist! My very best to you in the coming years. You go girl!
    Link  •  Reply
    • 02/18/2013 5:59 PM | Tiffani Wallace
      Thank you so much!!!
      Link  •  Reply

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