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Research |
University of Louisiana at Monroe
University of Arkansas at Little Rock University of Arkansas for Medical Sciences
Contact author: Ida J. Stockman, Michigan State University, Department of Communication Sciences & Disorders, Oyer Speech and Hearing Clinic, East Lansing, MI 48824-1212. E-mail: stockma1{at}msu.edu.
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Abstract |
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 Top Abstract MethodResultsDiscussionAppendix AReferences |
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Method: A 49-item questionnaire elicited anonymous responses from administrators, faculty, and teaching clinical supervisors at educational programs accredited by the American Speech-Language-Hearing Association in the United States. The data were provided by 731 respondents from 79.6% of 231 accredited U.S. programs. They included instructors who taught courses dedicated to MMI and those who did not.
Results: Respondents were generally committed to multicultural instruction, but they varied in their reported instructional practices and perceived levels of preparedness, effectiveness, and needs. General curricular infusion without an MMI-dedicated course was the most common instructional model used. Students were judged to be at least modestly prepared to deal with diversity issues as a result of their multicultural instruction, although current instructional approaches were not viewed as optimal. More positive outcomes were reported by instructors of MMI-dedicated than MMI-nondedicated courses.
Conclusion: The instructional models and strategies used for MMI education vary, and programs are challenged by multiple issues in complying with the mandate for MMI curricular infusion.
Key Words: faculty, multicultural/multilingual issues, curricular infusion
Population shifts in the latter half of the 20th century have expanded the cultural contexts for the professional practices of speech-language pathologists (SLPs) and audiologists in the United States (Battle, 2002) and abroad (Cheng, Battle, Murdoch, & Martin, 2001). The politics of war and the decolonization of some African, Asian, and Latin American nations have contributed to the unprecedented growth of non-White minority groups in countries with predominantly White populations.1 This trend has continued into the 21st century, given an increasingly interdependent world community enabled by communication and transportation technology (Banks, 1994; Morey, 2000). Thus, all professions have been forced to pay attention to multicultural/multilingual issues (MMI),2 particularly the human service professions such as law, education, medicine, and the allied health sciences, including communication disorders.
The current study focused specifically on the United States, where cultural diversity has been fueled not only by immigration from other countries but also by the social status of the country's native and racial (Black or African, Asian, and Hispanic Americans) minorities. As a result of civil rights legislation (Screen & Anderson, 1994), a critical question for applied fields like speech-language pathology and audiology has been how to prepare a largely White, English-speaking work force to deliver professional services to a culturally diverse population. The same question is equally relevant to other English-speaking, western nations such as Canada, the United Kingdom, and Australia (Allan & Hill, 2004; Banks, 1989, 1994; Cheng et al., 2001; Figuero, 2004).
The credentialing standards for professional practices reflect the progress being made toward preparing professionals to serve a diverse clientele. In the education field, which is focally concerned with pedagogy, the National Council for Accreditation of Teacher Education modified its standards to include MMI instruction in 1978 (Gay, 1997). Since 1994, the American Speech-Language-Hearing Association (ASHA) has required MMI instruction for the credentialing of SLPs and audiologists, who were the focus of the current study. This latter requirement was reaffirmed with the reauthorization of clinical certification and program accreditation standards in 1999 (ASHA, 2004).
Adequacy of MMI Knowledge Among Prospective and Practicing Professionals
The earliest research on MMI instructional practices determined via surveys whether prospective and practicing professionals were knowledgeable about cultural and language diversity issues, and whether they could deal with them comfortably after finishing their educational programs. We identified just three such studies that focused on speech-language pathology professionals in the United States, but none that included audiologists. Campbell and Taylor (1992) surveyed the self-perceived competencies of 713 veteran SLPs with the ASHA Certificate of Clinical Competence. Their areas of greatest perceived incompetence included evaluation and intervention for speakers of "variations from the linguistic standard" (Campbell & Taylor, 1992, p. 169). Wallace (1997) revealed further that 62% of 37 certified SLPs who were surveyed about clinical practices in adult neurogenics "did not feel competent to provide clinical services to diverse populations, particularly when a language or dialect difference was involved" (p. 116). As many as 43% reported that their professional education had not included MMI instruction. It had been minimal among the 57% with some exposure during their professional education. Levey (2004) reported that even while enrolled in educational programs, many of the 167 undergraduate and graduate speech-language pathology students who were surveyed in a New York City sample appeared uninformed about commonly known characteristics of minority language speakers in the United States. For example, the omission of bound morphemes in words (e.g., "two boys live" vs. "two boy live") can be observed among some typical African American speakers and does not indicate a language problem. The percentages of accurate responses to questions about commonly known language differences were judged as low even among the students with bilingual skills.
The education field also has relied on surveys to reveal teachers' knowledge and views on a range of multicultural issues. Cochran-Smith, Davis, and Fries (2004) identified eight such studies of prospective teachers, which were done between 1993 and 2001. The authors concluded that most participants in these studies reported few experiences with diversity and uneven program preparation to deal with it. For example, Pang and Sablan (1998) administered a 30-item survey to a sample of 175 prospective and practicing teachers before they began a multicultural education course. In this predominantly White sample, the outcomes were mixed in terms of perceived personal and instructional efficacy in working with African American children. The authors concluded that both groups had limited knowledge of African American children. In a later study, Kea, Trent, and Davis (2002) observed that the 41 prospective African American teachers in their survey were more knowledgeable about African American children than about other groups. None scored at the highest level of preparation to teach about cultural diversity.
Studies like those cited above suggest variable and perhaps less than optimal MMI education for schoolteachers and SLPs. Sleeter (2001) called attention to the quality of MMI instruction as one of the reasons for teachers' poor preparedness to deal with diversity issues. In Talbot (2006), 31% (321) of a sample of student teachers reported that diversity was not covered in their professional education; 21% rated diversity coverage as low to very low, and 40% rated it as moderately effective. Sogunro (2001) concluded from a survey of Canadian teachers that although the intent of multicultural education was encouraged, pedagogical practices were inadequate for preparing teachers to deal with diversity issues. In the sample of 31 teachers surveyed, 90% agreed that MMI instruction in teacher preparation programs was inadequate.
Such observations ought not to be surprising, given that faculty are likely to face challenges in delivering MMI instruction (Gallavan, 2000). The following discussion reveals that the challenges stem from issues related to the adequacy of preparation for such instruction in addition to the skills and resources for engaging in responsible pedagogical practices.
Faculty Preparation for MMI Instruction
According to Clark (2002), the issue was no longer whether MMI instruction should be done, but rather how to do it. Faculty in all human service fields have been expected to deliver MMI instruction even though their own professional education did not require it. Ladson-Billings (1999, p. 98) asked how can professionals teach what they do not know? To prepare for such instruction, faculty encounter issues related to the availability of financial and human resources and to their philosophical commitment to the idea of MMI instruction (Gallavan, 2000; Sogunro, 2001). Ideological conflict can create faculty discomfort when MMI instruction is viewed as antithetical to the traditional assimilationist goal of making all individuals simply Americans in the United States as opposed to members of specific ethnic groups (Banks, 1989, 1994).
No study appears to have been done on faculty in educational programs for SLPs and audiologists in the United States and Puerto Rico. In the education field, two studies illustrate the uneven pattern of faculty preparedness for MMI instruction. Talbot and Kocarek (1997) examined responses to questionnaires from a mostly White sample of 49 faculty for a student affairs program. They reported that women faculty were more comfortable with their skill level than were men. Both groups were more comfortable with their knowledge of gender than ethnic issues, and they were least comfortable with their knowledge of sexual orientation.
Pope and Mueller (2005) surveyed the views on MMI instruction among 147 faculty at 81 schools. They reported that African American participants were more comfortable than were the White ones. Females rated higher in comfort level than did males, and younger faculty were more comfortable with their skill and knowledge levels than were older faculty. Those who had taught MMI-dedicated courses reported more knowledge and a higher instructional comfort level than did those who had not taught such courses.
Faculty Instructional Practices
The adequacy of MMI instruction extends beyond faculty preparedness. There also are pedagogical challenges related to what and how to teach such information.
MMI Curricular Content
Faculty are expected to select their own instructional content. The MMI content could not be guided early on by a history of instructional practices. Therefore it was unclear what information should be taught in an emerging field that crossed multiple academic disciplines including sociology, anthropology, history, linguistics, sociolinguistics, and the applied fields of law, education, and communication disorders. Selecting the academic content is daunting, given the increased MMI-related research and pedagogical discourse over the past 25 years. Cole (1990) identified more than 1,400 MMI-related references in speech-language pathology and audiology, and this number has increased in the years since that publication.
The challenge is to determine which academic topics should be relevant, if not all of them. There appear to be preferences for the subject matter regarded as most MMI-relevant. For example, Clark (2002) stated that the natural sciences have been viewed as less relevant than the social sciences. Sleeter (1989) supported this claim in a study of MMI infusion practices by 416 elementary and secondary teachers who had taken a diversity course. MMI infusion was most likely to occur when teaching literature and art as opposed to mathematics and science. It also was more likely to occur when teaching at the elementary than at the secondary level, and when teaching about gender as opposed to race or ethnicity. Sexual orientation was least often covered.
Preferences also exist for the type of populations judged as relevant to MMI instruction. A multicultural population has been viewed historically as those minority racial and ethnic groups that motivated the U.S. civil rights movement, namely Black or African, Hispanic, Asian, and Native American. However, the concept of a multicultural population is expanding to include other groups that are marginalized by gender, socioeconomic status, sexual orientation, and special education needs (Banks, 1989, 1994).
MMI Instructional Goals
Faculty also must determine what the MMI instructional goals should be, despite lack of consensus about the purpose and the disciplinary boundaries of multicultural education (Banks, 1989). Among competing views, the curricular content can vary on a continuum between two extremes. At one extreme, the conventional view emphasizes the presentation of known facts about different groups with a detached ideological view of the world. At the other extreme, a social-action perspective focuses instruction on students' unexamined beliefs and attitudes about diversity with the larger goal of empowering them to take actions that impact social justice (Banks, 1994; Clark, 2002; Gay, 1997; Morey, 2000). Instructors of courses in communication disorders must determine where on the continuum their own MMI instruction belongs.
MMI Instructional Models
Another issue for faculty concerns how to deliver whatever information is judged to be MMI-relevant. ASHA's Committee on the Status of Racial Minorities (1987) described multiple approaches that can be used by educational programs in speech-language pathology and audiology. They included the possibilities of offering one or more MMI-dedicated courses in a curriculum and infusing MMI content throughout existing courses in a curriculum or in one or more units of instruction. Providing opportunities for clinical practicum experience with minority groups was also encouraged. No data were provided about the use or effectiveness of any of these approaches.
According to Gay (1997), a model of general curricular infusion without dedicated MMI course instruction is widely embraced across professional disciplines and programs in the education field. This observation was supported by Pope and Mueller (2005). Of the 147 faculty participants surveyed in an educational program for student affairs, 80% reported that instruction relied on a model of general curricular infusion as opposed to discrete MMI courses (67%). The authors stated that faculty who had taught MMI-dedicated courses reported significantly higher levels of multicultural competence than did those who had not. Sleeter (2001) observed that too few data exist about the effectiveness of any instructional approach inclusive of general curricular infusion. Such a strong claim justifies future research that focuses on whether and how faculty deliver MMI instruction in addition to whether their instruction is effective.
On its face, the exclusive reliance on a general model of curricular infusion may not well serve an already established pedagogical philosophy and preference for a social action approach to MMI instruction (Banks, 1989, 1994; Cochran-Smith et al., 2004; Gay, 1997). Meeting the latter goal of transforming attitudes toward diversity requires students to do in-depth self-examination of their own cultures and beliefs. This might not be possible or easily done when using a model of general curricular infusion.
Motivation for Present Study
There are multiple challenges to optimizing MMI instruction across disciplines. They include issues related to the level of faculty preparation for such instruction and the adequacy of resources, models, and strategies to undertake it. Given that MMI education is an emerging curricular area, there is likely to be variability among educational programs in how instruction is done. The current survey focused on faculty instruction at educational programs for SLPs and audiologists in the United States and Puerto Rico. But its outcomes are likely to be relevant to these professions as practiced in other countries, particularly the predominantly English-speaking countries (i.e., Canada, Australia, and the United Kingdom) that have agreed to recognize U.S. clinical certification standards (Boswell, 2004). Cheng et al. (2001) reported that of the nine university programs surveyed in Australia and New Zealand, only three offered any MMI instruction at all. The authors concluded that the level of theoretical and practical training was inadequate to prepare speech-language pathology and audiology students for multicultural professional experiences in the two countries.
A critical question to address is what constitutes optimal MMI education for SLPs and audiologists. Research is especially needed on the effectiveness of a general curricular infusion model, given the claim that it is a widely used instructional approach (Gay, 1997). Pope and Mueller (2005) stated that such studies may provide better understanding of the structure and relationship of infusion to the multicultural competence of faculty.
To date, there is no published information about the types of MMI instructional models used to prepare SLPs and audiologists to deal with cultural and linguistic diversity, not to mention their effectiveness for doing so. Even in the education field, Sleeter (2001) observed that research has emphasized the cross-cultural attitudes and knowledge of White prospective teachers and not the strategies used to prepare them to teach in multicultural contexts. Cochran-Smith et al. (2004) reviewed more than a dozen studies of the impact of MMI instruction on teaching practices and concluded that research had yielded modest and uneven outcomes. When the effectiveness of pedagogical practices has been studied, the research usually has focused on MMI-dedicated course instruction and not the general infusion model believed to be used widely. This mismatch between pedagogical practices and research emphasis may exist because investigators can achieve better empirical control over what is taught in a specific course than in an entire curriculum when trying to isolate the effects of MMI instruction on students.
Our review identified no study that compared the effectiveness of MMI-dedicated course instruction with other instructional models, even in the education field. Furthermore, there appears to be limited public information about how MMI instruction is being done, and how effective it may be. This appears to be the case for the professional education of SLPs and audiologists in the United States, although more than a decade now has passed since some kind of MMI instruction was required. The three cited surveys of SLPs in the United States focused on the preparedness of students or practicing professionals who benefit from MMI instruction. They did not focus on the faculty who provide it, and none linked their findings to specific instructional models or strategies.
A survey of perceived practices and issues in the professional education of SLPs and audiologists ought to be useful. First, it makes good sense to evaluate a new initiative, if for no other purpose than to reinforce the reason for taking the action in the first place. Second, survey outcomes can inform the guidelines used to evaluate compliance with professional standards. Finally, a survey of perceived practices and obstacles may be useful to the ASHA Offices of Multicultural Affairs and Academic Affairs in their efforts to support faculty instruction.
Purpose of Study
This study surveyed the faculty at programs in speech-language pathology and audiology within the United States and Puerto Rico in order to determine how MMI instructional requirements were met and the perceived adequacy of instructional practices. Specifically, the study was guided by the following questions:
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Method |
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TopAbstractMethodResultsDiscussionAppendix AReferences |
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Description of Questionnaire
The questionnaire was developed by the authors. It was revised with solicited informal feedback from professional colleagues and staff employees at the ASHA Offices of Multicultural Affairs and Academic Affairs. Questionnaire construction was guided by what seemed to be important issues to survey based on past research, the authors' own teaching experiences, and reviews of course syllabi for MMI-dedicated courses. Four areas were targeted: instructional preparation, strategies, effectiveness, and obstacles/needs. The 49 multiple-choice items in the questionnaire consisted of three parts, as shown in Appendix A. Part I (17 questions) was completed by all respondents. Part II (18 questions) targeted the faculty who taught one or more courses in which cultural issues were expected to be infused. Part III (14 questions) targeted faculty who taught one or more MMI-dedicated courses. The latter group of respondents also completed Part II, if they taught MMI-nondedicated courses. Individual items and sets of related items were randomly distributed within each part except for the related subgroups of items that were successively ordered. Nine items in Part II and Part III were comparable enough in their form and content so that the instructors of MMI-nondedicated and MMI-dedicated courses could be compared. Each paired-item analysis was based on orthogonal instructional groups. This was achieved by excluding from the group of MMI-nondedicated course instructors those participants who also responded to the corresponding item for MMI-dedicated course instructors.
The 49 items included 29 (59%) that allowed more than one response option to be chosen, and 20 (41%) that required a single response. Space was provided at the end of the questionnaire to comment on "any concerns about multicultural/multilingual education and requirements for the profession, to make suggestions about how educational preparation can be improved, and/or to comment on the questionnaire."
Data Collection Procedures
Distribution of Questionnaire
Before this survey was done, approval for using and distributing the questionnaire to the participants was obtained from the institutional review board at the first author's home institution. The number of faculty to target was estimated from Web site descriptions of the teaching faculty identified at each CAA-accredited program. Of the 3,076 questionnaires distributed, 200 were circulated at the November 2002 ASHA Convention. Respondent anonymity was maintained by requiring the completed questionnaire to be returned to a designated Convention site. In December of the same year, the remaining questionnaires were distributed by mail to educational programs in the United States and Puerto Rico. Each respondent anonymously returned a completed questionnaire in the preaddressed, postage-paid envelope provided. The returned questionnaires were tracked separately by program, but individual respondents remained anonymous. The 64 questionnaires completed at the ASHA Convention could not be tracked by program.
Respondent Instructions
Respondents were oriented to the survey by a letter printed on the first page of the questionnaire. This letter provided background information about the project, instructions for doing the task, and information about the consent to participate. Respondents marked their responses on printed and computer-readable questionnaire forms. A cover letter stated that persons should not respond to the questionnaire if they had already done so at the ASHA Convention.
Data Analysis
The questionnaire responses were computer-scanned, and frequency counts for each item's response choices were provided. The response frequencies were pooled across response choices within and across items to answer some questions. For the items that allowed multiple responses, the number of respondents to each response choice was determined, and the mean number of response choices selected was computed and compared for the instructors of MMI-nondedicated and dedicated courses.
Statistical analyses involved nonparametric tests appropriate for analyzing the distribution and correlation of response frequencies. For items with multiple response choices, orthogonal categories of response patterns were created by combining nonoverlapping sets of response choices that could be compared statistically within and between the two groups of instructors using chi-square tests of equal proportions and independence. In addition, t tests, adapted to unequal group sizes and variances, were used to statistically compare the mean number of response choices selected by the two groups of instructors.
Volunteered written responses in the comment section were separately and manually analyzed. Two observers, who were speech-language pathology undergraduates and naive to the survey goals, independently sorted comments into one of five a priori categories. Four categories were selected because they related to the main MMI instructional aspects that were the focus of the survey, namely, (a) the pedagogical strategies used, (b) the faculty preparedness for instruction, (c) the adequacy of student preparation following instruction, and (d) the faculty needs and obstacles. The fifth category targeted the adequacy of the questionnaire form.
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Results |
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TopAbstractMethodResultsDiscussionAppendix AReferences |
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Respondent Characteristics (Q1*, 2, 3, 4*, 5*, 15*, 16*, 18, 36)
Participants represented a broad range of educational programs and professional and instructional roles, as summarized in Table 1. Speech-language pathology faculty with one or more professional roles represented more than half (55.4%) of the respondents identified in Table 1 (Q1*) and 65% (N = 727) overall.
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Most respondents were at public institutions (Q3) that offered the bachelor's and master's degrees (Q4*) in speech-language pathology (Q5*). They were most often self-identified (73.7%) as instructors of one or more courses that only infuse MMI instruction into existing courses (Q18). The instructors of MMI-dedicated courses (Q36) more often taught one than two or more courses within their own programs and were not always the only ones to do so as shown.
Instruction typically served students in more than one racial/ethnic group (Q15*), although White students were included in 51% of the specific response patterns identified in Table 1 and in 77% (N = 722) of all responses to the item. Similarly, White clients (Q16*) were the population most often served by respondents' programs. They were included in 96.4% (N = 724) of all response patterns for the item.
Instructional Approaches
Curricular Strategies (Q6, 7, 17, 18)
Figure 1 shows differences among respondents in the instructional strategies used (Q6). The differences were statistically significant, 
2(3, N = 717) = 427.28, p < .001. The largest percentage relied on a curricular infusion model only (B). This response was chosen significantly more often than were the other three options combined, 2(1, N = 717) = 9.15, p = .001. The finding coincided with the responses to Q17, which revealed that most respondents (60.3%, N = 428, C and D choices combined) were in programs that did not require master's students to take an MMI-dedicated course; 81% (N = 338) reported no plans to offer such a course (Q7; A and E choices combined). As pointed out earlier, most respondents were self-identified as instructors of MMI-nondedicated courses in Table 1 (Q18).
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2(4, N = 663) = 572.4, p < .001. The majority (85%, N = 663) agreed that more than incidental MMI coverage in a course was warranted. Figure 2 shows that most respondents reported that MMI content should be included as relevant and integral course content (A) or added throughout a course while devoting specific lecture and discussion time to it (C).
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2(1, N = 659) = 8.09, p = .004, from the other four response choices combined, which included most class time (A), a moderate amount of class time (B), no class time (D), and not sure (E). Third, some academic subjects were viewed as ideally more relevant to MMI instruction than were others (Q9*–12*). The mean number of response options chosen for each of the four items ranged from 3.15 (SD = 1.5) to 4.43 (SD = 1.28) for the 671 to 715 respondents to these items. The frequencies for the 20 responses were submitted to a hierarchical cluster analysis using the centroid linkage method. The rank-ordered response frequencies, which are shown in Figure 4, reveal four clusters that resulted from the data analysis. Cluster A included a cross-section of developmental and applied speech, language and hearing academic areas, which most respondents viewed as relevant to MMI instruction. Cluster D, which had the smallest response frequencies, included the basic science areas exclusively. The B and C clusters, which were respectively ranked as 2 and 3, included a variety of other applied and basic science areas.
Thus, the findings reflected a preference for infusing MMI curricular content into the applied/clinical areas and not the basic sciences, as distinguished by asterisks in Figure 4. This distinction between academic areas was based on their fit with the basic science and clinical core curricula for ASHA clinical certification, as judged by investigator consensus. The Mann–Whitney test revealed that the applied/clinical areas were viewed as relevant to MMI instruction significantly more often than were the theoretical/scientific curricular areas, U(11, 9) = 20, z = 2.2, p = .03. The academic areas identified as most MMI-relevant in an ideal sense (Q9*–Q12*) were significantly correlated with those that respondents targeted for MMI infusion in the courses actually taught (Q20*–23*), rs(N = 20) = .87, p < .001.
Instructional Strategies (Q24*, 25*, 30*, 31, 32*, 41*, 42*, 43*, 44, 45*)
The instructors of MMI-nondedicated and dedicated courses were compared on the type of response patterns and the number of options chosen for items related to the topic and group focus of instruction as well as the special instructional experiences provided (see Table 2). There were two main findings.
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Second, the instructors of MMI-dedicated courses chose significantly more options than did those who taught just MMI-nondedicated courses for items that allowed multiple responses. Robust effect sizes (Cohen's d ranging from .90 to 1.34) were associated with the significant t tests obtained. Further information on the response patterns of the two groups is provided below.
Topic Focus of Instruction
For the applied topics (Q24*, Q41*), few instructors of MMI-nondedicated (8%) and MMI-dedicated courses (1.0 %) focused exclusively on the two clinical topics: evaluation and treatment of communication disorders (C) and disease patterns affecting communication disorders in different minority groups (D). See Table 2. When there was an exclusive focus, it was more likely to involve the three related topics identified in the items (culture, language, and communication relationships [A], dialect differences [B], and social attitudes and tolerance of communication disorders in minority groups [E]). However, each group's predominant tendency was to combine one or both clinical topics with one or more of the three general topics. The largest percentage of MMI-dedicated course instructors (Q41*) chose response combinations that included all five choices (ABCDE). The largest percentage of MMI-nondedicated course instructors (Q24*) chose the remaining combinations, which included a subset of the clinical and general diversity topics. These two response patterns together accounted for a larger percentage of the responses given by the instructors of MMI-dedicated than nondedicated courses (87% and 64.2%). The group difference was significant for the type, 2(3, 668) = 51.49, p < .001, and number, t(113) = –7.86, p < .001, d = .90, of choices made.
For the basic science topics (Q25*, Q42*), both groups of instructors focused most often on research paradigms and methods (A) and typical development (D) in cross-cultural perspective. Table 2 shows that one or both topics also were combined with other topics: hearing sensitivity (B), measurement of normal speech and hearing (C), and typical anatomical characteristics (E) across different racial/ethnic groups. The latter pattern was chosen more often by instructors of MMI-dedicated than nondedicated courses (38% vs. 32%, respectively) and contributed to the significant group differences observed in the type, 2(3, 545) = 13.8, p < .003, and number, t(93) = –3.83, p < .001, d = 1.34, of responses.
Group Focus of Instruction
The instructors of MMI-dedicated and MMI-nondedicated courses both emphasized group differences based on race (A), ethnicity (B), or both (AB) more often than those based on just geographical region (C), socioeconomic class (D), or gender (E). However, they more often combined race and ethnicity with their coverage of the other three sources of diversity. Table 2 shows that half of the MMI-dedicated course instructors (Q43*) chose all five options (ABCDE), and more than half of the MMI-nondedicated course instructors (Q30*) chose the remaining combinations, which combined race or ethnicity with at least one of the other sources of diversity. No significant group difference was observed, 2(3, 661) = 6.8, p = .08, although significantly more options were chosen by instructors of MMI-dedicated than nondedicated courses, t(102) = –2.19, p = .03, d = .26.
When asked whether MMI instruction emphasized some groups more than others (Q31, Q44), the majority of both groups of instructors reported that they try to cover all groups equally (A) as opposed to catering to the local population in their area (B) or to the instructor's research or expertise (C). See Table 2. No significant group difference was observed in the type of choices made, 2 (2, 585) = 2.32, p = .31.
Special Instructional Experiences Provided
Table 2 reveals marked differences between the instructors of MMI-nondedicated (Q32*) and dedicated (Q45*) courses in the types of instructional experiences provided. The largest percentage (41.9%) of MMI-nondedicated course instructors reported that no special learning experiences were provided. Those that were provided consisted of a single type of experience (e.g., media presentations only) about as often as multiple experiences (28.9% summed for single A, C, D, and B choices, and 29.2% summed for response combinations).
In contrast, few (5.9%) instructors of MMI-dedicated courses reported that they provided no special experiences. The largest percentage (57.9%) chose a combination of learning experiences. That is, media presentations (A) were used in addition to providing opportunities for students to interact with persons from other cultures (B), introspectively study their own culture and attitudes (C), or observe clinical services for minority groups (D). Altogether, the combinations of choices represented 81.4% of the responses made by the instructors of MMI-dedicated courses compared with 29.2% of those who taught only MMI-nondedicated courses. The two groups differed significantly in the type, 2(6, 662) = 100.31, p < .001, and number, t(97) = –10.31, p < .001, d = 1.34, of choices made.
Faculty Preparation for MMI Instruction (Q8, 14*, 27*, 28, 29*, 37*, 48, 49*)
Two aspects of preparedness were targeted: commitment and instructional preparedness. There were three main findings.
Commitment
First, most (77%, N =724) respondents reported that they were strongly committed to MMI instruction (A). This response to Q8 was chosen significantly, 2(1, N = 724) = 205.8, p = .001, more often than were the other three options combined: agreeable but not enthusiastic (B), no opinion (C), somewhat hesitant (D), strongly opposed (E), and unsure (F).
Instructional Preparedness
Second, respondents typically reported that they had received some preparation for MMI instruction (Q14*). The majority (73.9%, N = 722) reported having received more than one type of preparatory experience, that number averaging 2.20 (1.0). To prepare for such instruction, continuing education (C) and clinical service delivery to clients from diverse cultural backgrounds (D) were chosen most often. One or both strategies were included in 95.7% of all the responses made to this item.
Third, the two groups of instructors chose significantly different response patterns for items related to the strategies used to prepare for MMI instruction and the level of comfort with that preparation (see Table 2). For items allowing multiple responses, significantly more choices were made by the instructors of MMI-dedicated than MMI-nondedicated courses. Moderate to large effect sizes were associated with the significant t-test differences observed (Cohen's d ranging from .45 to .87). Table 2 provides the supporting data for these results, which are described below.
Preparation Experiences Most Useful
Table 2 shows that most (46.4%) instructors of MMI-nondedicated courses (Q27*) chose continuing education (A) and clinical service delivery to diverse populations (D) as their most useful preparation experiences. They nearly as often (43%) combined these two responses with one or more other experiences, namely, a specific MMI course (B), mentoring (C), or reviews of syllabi and textbooks (E). This latter pattern of remaining combinations was used even more often by the instructors of MMI-dedicated courses (59.7%), as was the pattern that included all response choices (13%). Significant group differences were observed in the type, 2(3, 647) = 70.3, p = .003, and number, t(96) = –6.02, p < .001, d = .79, of choices made.
Comfort Level With Instructional Preparation
The instructors of MMI-dedicated courses were the most comfortable with their level of preparation (Q48). Table 2 shows that as many reported being very comfortable (A) as comfortable (B), the two options accounting for 98% of their responses. In contrast, the instructors of MMI-nondedicated courses most often reported being comfortable, and they more often reported being uncomfortable relative to the other group. The groups differed significantly in their relative frequency of response choices, 2(3, 672) = 87.9, p < .001.
Preparation Experiences Most Needed
To better prepare for MMI instruction (Q*29, 49*), most respondents in each group of instructors preferred continuing education workshops (A) and access to Web site material and other instructional media (E). See Table 2. Other respondents combined one or both of these options with the opportunity for one or more of the other preparation experiences listed in the items: a specific MMI course (B), mentoring (C), and clinical service delivery to diverse populations (D). This latter set of response combinations was chosen even more often by the instructors of MMI-dedicated courses. It contributed to the significant group differences observed in the type, 2(3, 610) = 15.6, p < .001, and number, t(89) = –3.26, p = .002, d = .45, of choices made.
Instructional Effectiveness (Q13, 33*, 34, 35, 46, 47*)
Instructional effectiveness focused on the perceived student outcomes from MMI instruction and the general satisfaction with the MMI curricular model used in the respondents' programs. Two findings were inferred from their responses: First, student outcomes were viewed more favorably by the instructors of MMI-dedicated than nondedicated courses. Second, most respondents did not view MMI curricular infusion alone as an optimal instructional approach.
Perceived Student Outcomes of MMI Instruction
When asked how well prepared students were to apply their knowledge to clients from diverse backgrounds after completing their educational programs in the professions (Q13), 49% (N = 724) of the respondents judged them as exceptionally (9.1%) or adequately (40%) prepared. Just 8% judged students as poorly prepared. This favorable perception of educational program outcomes camouflaged differences between the instructors of MMI-nondedicated and MMI-dedicated courses when judging how prepared students were to apply information after taking courses. A major finding from the survey was that the instructors of MMI-dedicated courses reported the most favorable outcomes in regards to (a) how well prepared students were to apply information to diverse populations after taking courses (Q35, Q46), and (b) what students had learned to do as a result of instruction (Q33*, Q47*). These results are described below.
Overall Student Preparedness to Apply MMI Instruction
Most (65%, N = 85) instructors of MMI-dedicated courses judged students to be adequately (45%) or exceptionally (20%) prepared to deliver speech, language, and hearing services to diverse populations (Q46); just 35% judged them to be somewhat prepared to do so or were unsure. The identical question was not asked of MMI-nondedicated course instructors, but they did not give the most favorable answer possible, when asked simply how prepared students were to apply information from their courses to diverse populations (Q35). Most (58%, N = 582) judged students to be only somewhat or poorly prepared to do so, or they were unsure. Comparatively fewer (42%) respondents judged students as exceptionally (4%) and adequately prepared (38%).
Specific Student Skills Acquired From MMI Instruction
When asked to identify what students were prepared to do after taking their courses, Table 2 shows that the instructors of MMI-nondedicated (Q33*) and dedicated (Q47*) courses more often chose understanding one's own culture and attitudes (C) and locating MMI information (D) as opposed to diagnosing (A) and treating (B) communication disorders. However, each group's predominant tendency was to combine one or both clinical topics with one or both of the other two skills identified in the items. This pattern was particularly characteristic of the MMI-dedicated course instructors. They most often chose all four response options and did so considerably more often than did the MMI-nondedicated course instructors, who were more often unsure about what students were prepared to do. Significant group differences were observed in the type, 2(4, 661) = 83.5, p < .001, and number, t(109) = –7.53, p = .001, d = .87, of choices made.
Satisfaction With MMI Curricular Approaches
The second finding regarding instructional effectiveness focused on the respondents' views of the manner in which MMI was treated in their program's curricula (Q34). The data revealed that most (80.3%, N = 654) respondents did not embrace the use of curricular infusion alone (option A).This was the case even though the largest percentage of them reported that their programs relied solely on infusing MMI throughout the curriculum wherever such issues were relevant (Q6; see Figure 1). When responding to Q34, however, they more often chose the options that modified this approach. That is, 35% judged that curricular infusion alone would be adequate if the plan for infusion were more specific (B), and 30.4% judged infusion alone to be inadequate without an MMI-dedicated course (C). These two choices accounted for 66% of the responses to the item, and when combined, they differed significantly, 2(1, N = 654) = 68.7, p <.001, from the combined percentages of respondents who chose the other three options: infusion alone is adequate without an MMI course (A), a specific course is adequate without general infusion (D), and do not know (E). These data suggested that respondents rejected the status quo as the optimal curricular model for MMI instruction.
Perceived Obstacles to MMI-Dedicated Course Instruction (Q38, 39, 40*)
When asked how comfortable respondents were with teaching MMI-dedicated courses (Q38), the largest percentage, 60% (85) reported being very comfortable (A). More than half reported some difficulty in doing the teaching (Q39, A, B, and C responses combined). But the percentages with (53%) and without (45%) reported difficulty did not differ significantly, 2(1, N = 85) = 0.59, p > .05. The remaining 2% was unsure.
Of the 45 respondents who reported obstacles and difficulty (Q40*), the largest percentage (53.3%, N = 45) reported that the lack of a culturally diverse population for clinical practicum education was an instructional obstacle (D). A smaller percentage, 31.1%, targeted student interest (B) and preparedness (C). Just 15.6% (N = 45) chose the lack of administrative support (A).
Post Hoc Comments and Concerns
Among the 731 respondents, 25% (183) provided write-in comments. They generated 254 individual statements that investigators sorted into five categories, as previously described. These comments, sorted by category, can be viewed at www.ulm.edu/
boult. They also are available from the first author upon request. The absolute frequency counts assigned to each category varied, and their percentages (N = 254) were ranked in the following order:
Two naive observers separately assigned each of the 254 statements into one of the five a priori categories identified above. High agreement was observed between their category assignments and those that had been made by investigators. Their separate point-to-point agreements with the preassigned categories for each statement were 93.1% and 91.3%. Their agreement with each other was 93.3% in making the same category assignments.
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The faculty in the surveyed programs generally favored MMI instruction. Its infusion into existing courses without MMI-dedicated courses in the curriculum was the dominant curricular model used. In such courses, faculty were likely to devote little time to MMI instruction, particularly when teaching basic science as opposed to applied courses. Nevertheless, most respondents did not view this status quo as optimal. More positive outcomes were obtained from instructors of MMI-dedicated than nondedicated courses in all areas of instruction compared, despite some obstacles encountered in teaching such courses. Both groups agreed that continuing education workshops and Web-based tutorials would be helpful to preparing for MMI instruction.
Like any study of self-selected participants, these results may have been biased in unknown ways by the type of persons who chose to do the survey. For example, the participant sample may have included the faculty who were the most interested in MMI instruction. Self-reported perceptions can be flawed in that they may reflect what participants desire to believe or do as opposed to what they actually believe or do. Pope and Mueller (2005) pointed out that sensitive areas like multicultural competence and social prejudice, in particular, may be influenced by social desirability effects. This factor may account for some of the inconsistent data trends observed in the current study. For example, the respondents generally reported that students were adequately prepared to deal with MMI, despite their reported perception that (a) a minimal amount of time was devoted to MMI in courses, and (b) more optimal instructional models were needed. Our results also were likely influenced by the type of answers elicited. For example, our questionnaire was not designed to probe all sources of diversity that now are recognized as relevant to MMI instruction. Despite these caveats, this first survey of perceived MMI instructional practices in the speech-language pathology and audiology professions yielded a profile of perceived practices that can be useful to the professions.
Practical Value of Findings
Survey outcomes are particularly valuable when they have practical application. Our survey provided a broad profile of perceived instructional practices and challenges that can inform a program's own self-study efforts when seeking program accreditation. It also can inform site visitor training and evaluation of program compliance with accreditation standards. For example, a program that requires its students to take an MMI-dedicated course would exceed reported practices, and one that relies on a general curricular infusion model would reflect the status quo. Self-study efforts also may profit from the participants' open-ended comments about instructional problems experienced with MMI instruction in their own programs. In fact, the largest category of the respondents' write-in comments (see www.ulm.edu/boult) focused on instructional problems and obstacles to MMI instruction. They identified some of the strategies used to solve instructional problems.
Our survey revealed perceived challenges to MMI instruction that can inform the ASHA goal of disseminating information that may help programs to meet their instructional goals. It suggested that faculty need and want more information in order to better prepare for MMI instruction. The varied forms of preparation reported by the participants included an MMI-dedicated course less often than other experiences, inclusive of on-the-job delivery of clinical services to culturally diverse groups. The inadequacy of preparation for MMI instruction may be among the reasons why respondents reported that they most often devoted a minimal amount of time to MMI in their courses, despite their reported view that such information should be infused throughout a course. Their two most preferred forms of future preparation, continuing education workshops and Web-based instruction, are within the scope of the ASHA program initiatives. Continuing education generally is valued by ASHA, which now requires a specified number of units to maintain clinical certification. The Office of Multicultural Affairs has been sensitive to the need for more instructional resources. Its Web site (www.asha.org/about/Leadership-projects/multicultural/) has been expanded recently to include a variety of MMI instructional material (e.g., course syllabi, video and film titles, references, teaching strategies). This material will be continually updated to include new information as it becomes available.
Educational Challenges for MMI Instruction
Our findings suggested that MMI instruction may not be optimal. The survey respondents' open-ended comments reflected a range of concerns about MMI instruction in communication disorders. They referred to the lack of pedagogical models for MMI instruction and professional standards for defining MMI curricular content. There were comments about the lack of adequate instructional resources and diverse clinical populations for practicum education, as well as attitudinal, cognitive, and philosophical teaching constraints. Thus, the faculty in programs of communication disorders face the same kind of challenges that have been identified for other fields such as education (Gallavan, 2000; Sleeter, 2001). These challenges pertaining to instructional preparedness, strategies, and effectiveness are relevant not only to the United States (Banks, 1989) but also to other predominantly English-speaking countries such as Canada (Sogunro, 2001), Australia (Allan & Hill, 2004), and the United Kingdom (Figuero, 2004).
Changing the status quo is likely to require attention to more than faculty preparedness and personal comfort with MMI instruction. Practical and conceptual issues should be addressed. Two issues illustrate the scope of the instructional challenge. One issue concerns the terminology or the meaningful use of the terms multicultural and multilingual. The other one relates to the exclusive reliance on a model of general curricular infusion for MMI instruction.
Multicultural and Multilingual Terminology
The terms multicultural and multilingual define the conceptual boundaries of MMI education. They should be reconceptualized to represent the broad spectrum of group differences that can influence the professional practices of SLPs and audiologists.
The Multicultural Term
Race and ethnicity were chosen often as the focus of MMI instruction in our survey but were not the exclusive focus. Respondents reported that they more often than not combined their coverage of such differences with other sources of diversity identified in the questionnaire, namely gender, social class, and regional location. In addition, write-in comments revealed that MMI instruction ought to include groups defined by deafness and sexual orientation/gender identification (i.e., the gay, lesbian, bisexual, and transgendered, or GLBT). The GLBT populations have been less often embraced as a source of cultural diversity in the fields of education (McCarthy, 2003) and communication disorders (Richard Adler, personal communication, July 28, 2006). It also is well known that persons with deafness may identify with a different culture than that of hearing persons (Berent, 2006). Place of national origin can be yet another source of cultural difference among people within and outside of the broadly defined groups of minority (cf. Hispanic speakers from Puerto Rico and Mexico) and nonminority (cf. White English speakers in the United States, the British Isles, and Australia) racial/ethnic populations.
These additional sources of diversity are likely to contribute to cultural differences that can influence professional practices. Consequently, the meaning of the multicultural term for instruction needs to encompass more than the historically recognized U.S. minorities without White ancestral ties to the English commonwealth countries or to Europe, namely Native Americans and groups with ancestral ties to Africa, Asia, and South America.
The Multilingual Term
In this article, the terms multicultural and multilingual were used concurrently on the assumption that language is a major expression of cultural differences that directly affects professionals in communication disorders. The term multilingual is too often used narrowly to refer to just those speakers who acquire two or more oral or spoken languages that are not mutually understood. As a result, monolingual speakers with more than one dialect of the same language are excluded. Bidialectal speakers may include those who speak both a Standard English variety and a nonstandard English variety that is not easily understood outside of their linguistic community (e.g., the Ebonics dialect spoken by some African Americans). A narrow view of multilingualism also excludes the bilingual deaf, who learn both American Sign Language (ASL) and spoken English in all racial/ethnic groups (Berent, 2006).
Such exclusionary criteria for defining a multilingual population create a conceptual difference between multicultural and multilingual populations that does not represent the reality of service delivery practices for SLPs or audiologists. For example, accent-modification services are now within the scope of professional practice for SLPs. In the United States, such services are used to modify not only the foreign-accented speech of those who learn English as a second language but also the speech of those who want to alter a native regional or social dialect or to acquire a new one. ASL speakers with deafness may use the same services to improve the clarity of a spoken language learned as a second language.
Implication of Terminology Issues for MMI Instruction
When so many groups are included under the multicultural/multilingual umbrella, the issue of which ones to focus on in MMI instruction is not resolved simply by proposing equal coverage of each one, as so many of our survey respondents claimed that they do. It also is likely to be difficult to cover all groups within the minimal amount of time given to MMI instruction in nondedicated courses. An even more pressing issue is whether a single instructor can and should learn about all possible groups that could be covered, even with available instructional time. More inclusive descriptive models obviously are needed to guide instructional efforts in order to capture the complex identities created by an individual's simultaneous memberships in different groups as defined by social class, gender, race, nationality, sexual orientation, and so on. Banks (1989) proposed that a core macroculture with overlapping microcultures may be a more authentic representation of cultural differences than is the historical view of a multicultural population.
Applying a General MMI Infusion Model of Instruction
Our survey revealed that the professional preparation of SLPs and audiologists, like that of professionals in other fields such as education (Gay, 1997), depends on a general infusion model of instruction. This model has been easily embraced for conceptual and practical reasons. Conceptually, general curricular infusion makes sense because culture is a cross-cutting curricular area of communication disorders in the same way that other areas such as speech and language development have been viewed. General curricular infusion also has been a practical strategy to implement when few faculty can claim expertise in cultural and diversity issues. Gay (1997) acknowledged that infusion, although "a powerful idea pedagogically, is a very challenging one operationally" (p. 158). Pope and Mueller (2005) argued that a more critical examination of the curricular infusion notion is warranted. Our survey respondents echoed the same sentiment when a third of them indicated that a general infusion alone is inadequate without modifying how it is done. The following discussion identifies two challenges to optimizing the use of a general infusion model of MMI instruction.
The Challenge of Increasing MMI Information
One challenge to sole reliance on a general infusion model of MMI instruction concerns the burgeoning amount of information that appears to be relevant. For example, our survey respondents regarded MMI instruction as relevant to other groups besides the minority racial/ethnic groups that have been historically defined. They also judged that other topics were relevant to MMI instruction in addition to those related to clinical service delivery. So there is the practical question of how to infuse information about all the different groups and relevant topics into existing courses. Functional time pressures are magnified if MMI instruction is viewed simply as the addition of separate information to what else is already taught in existing courses. An additive approach (after Banks, 1989) obviously requires more instructional time. It suggests that multicultural information is tangential to the main course content. Banks (1989) pointed out that an additive approach was one of the earliest and least mature approaches to MMI instruction.
Alternatively, Stockman, Boult, and Robinson (2004) proposed that instruction ought to evolve toward what can be viewed as integral infusion. In this view, multicultural content neither adds to nor replaces existing course content. The existing content in a discipline is reframed to take stock of if and how MMI may mitigate known facts, theories, and clinical practices. As a result, both the existing course content and the MMI content should be richer than when each is taught in isolation of the other. Most of our survey respondents reflected this view in judging that neither a single MMI-dedicated course nor a general infusion model alone optimized MMI instruction.
The Challenge of Implementing a General MMI Curricular Infusion Model
A second challenge to exclusive reliance on a general infusion model of MMI instruction relates to its focal aims. We were surprised that the instructors of neither MMI-nondedicated nor MMI-dedicated courses identified clinical assessment and intervention as the focal instructional priority in isolation of broader issues related to cross-cultural interactions, attitude toward, and tolerance of cultural and language differences. This outlook is justified. In the United States and in some countries abroad, a culturally diverse population most often receives speech, language, and hearing services from White English-speaking professionals. The cultural mismatch between service providers and their recipients can compromise clinical service delivery when professionals lack information about cultures and languages that are not their own. Yet the opportunities to get cross-cultural information from ordinary daily experience can be limited by multiple factors (Gay, 1997). They include the density of minority populations in a community and the degree to which communities are segregated by race, ethnicity, or social class. Most (90%) of our respondents resided in areas with 40% or fewer minority persons. Service providers are likely to be less familiar with the life experiences of clients who are outside rather than inside their own neighborhoods and social groups.
Information about the cultural and language differences of other groups is unlikely to come simply from the transmission of textbook knowledge. MMI pedagogical discourse in the education field favors "hands-on" instruction, which aims to give students the opportunities for cross-cultural experiences and examination of their own beliefs about cultural differences. According to Morey (2000), multicultural education theory emphasizes "personal development and empowerment, social reform, critical analysis and is fundamentally reconstructive and transformative in purpose" (p. 25). Similarly, Cheng et al. (2001) proposed negotiation as opposed to transmission models of MMI instruction for communication disorders.
MMI-dedicated course instruction. The type of instructional goals identified above are akin to the pedagogical strategies that were most likely to be used by the instructors of MMI-dedicated courses in our survey. Comparatively fewer of the instructors of MMI-nondedicated courses involved students in special experiences that included cross-cultural interactions. As Pope and Mueller (2005) had reported for schoolteachers, our survey revealed significantly higher levels of perceived instructional comfort, preparedness, and student learning for instructors of MMI-dedicated than nondedicated courses in communication disorders. In fact, most areas of instruction compared in our survey yielded significant quantitative and qualitative differences between the two groups. These differences may reflect the available course time as much as the faculty preparation to do MMI instruction. There is not likely to be enough time in any one MMI-nondedicated course to achieve the broader mission of socialization and cultural analysis that some advocates of MMI instruction embrace (Banks, 1989, 1994). So it should not be surprising that so many of the MMI-nondedicated course instructors in our survey reported that they provided no special MMI instructional experiences in their courses, and they also were more often unsure about what MMI information students gained from their instruction when compared with instructors of MMI-dedicated courses.
However, few respondents to our survey were in programs that offered MMI-dedicated courses. The reasons may extend beyond the practical problem of finding qualified faculty and funds for teaching such courses. Existing curricula for SLPs and audiologists are already taxed by the increased scope of professional practices for SLPs and audiologists and the amount of advanced education now required for entry-level clinical certification. Some write-in comments referred to such curricular pressures. A respondent stated, "it is getting difficult to cover all the core information in a class AND all the extra information such as MMI."
A post hoc analysis revealed that our survey respondents whose educational curricula offered MMI-dedicated courses tended to be located in geographic areas with the largest minority population density. Respondents were identified in Q18 as instructors who either taught MMI-dedicated courses (A and C choices combined) or who did not (B, D, and E choices combined). These two groups were compared on their respective frequencies in the five locations where participants were sampled (Q2). Location A, which had the largest percentage of racial/ethnic minorities, was the only one with significantly more than the expected number of respondents who taught MMI-dedicated courses, 2(4, N = 662) = 30.91, p = .001. This outcome was likely due to the possibility that heavily populated, minority areas increase the need to serve diverse groups and the success with recruiting minority instructors and students as well as clients for practicum education.
ASHA's new model of curricular accountability for clinical certification. Some survey respondents reported that a model of general MMI curricular infusion would be adequate if there were a better infusion plan. Educational programs now are able to rely on multiple means to meet ASHA's mandate to infuse MMI content into the professional preparation of SLPs and audiologists. The current model of academic accountability for clinical certification, Knowledge and Skills Acquisition, offers flexible ways for students to obtain their knowledge and skills (ASHA, 2003). To be effective, however, the faculty for a given educational program may have to agree on which knowledge and skills are needed to prepare culturally competent professionals, as identified, for example, by Coleman and McCabe-Smith (2000) for communication disorders and Fearn (1997) for education. After that, a program's faculty may need to collectively plan where particular MMI learning goals can be accomplished within an existing curriculum. The opportunity for the valued cross-cultural experiences may be built into some existing courses more easily than in others. Such a planned approach to general MMI curricular infusion contrasts with one that relies solely on the will and skill of individual faculty members to infuse MMI into their courses. A planned approach to curricular infusion ought to be enabled over time as the theory and praxis for specific clinical areas in the professions continue to evolve in ways that include an MMI perspective. This perspective is illustrated in Wallace (1997) and Payne (1997) for acquired neurogenic disorders.
Research Implications
To date, there has been limited pedagogical discourse on MMI education in the professions of speech-language pathology and audiology. Future research on faculty instructional practices in the speech-language pathology and audiology professions should determine how the trends inferred from the current study compare with actual instructional practices, as can be verified by more than self-reported responses. Direct evidence of instructional and curricular practices is needed.
Our survey included fewer participants with than without MMI-dedicated course experience. Larger participant samples in future research may temper the optimistic outcomes that were observed for MMI-dedicated instruction in this survey.
The current survey's outcomes also were influenced by the large number of SLPs included in the sample. It is unknown whether their views of MMI instruction differ from those faculty who teach courses in just audiology or the speech, language, and hearing sciences.
Our study was limited further in that it did not systematically explore how MMI instructional problems and student outcomes may vary with the curricular model used. Such research could inform curricular decisions, particularly if it shows that learning outcomes and resource needs are differentially influenced by the type of instructional model used.
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2 The combined use of the words multicultural and multilingual reflects the frequent and expected coexistence of language differences among speakers within and across different cultures. The multilingual term explicitly identifies language as the aspect of culture that is focally relevant to the academic disciplines concerned with communication disorders.
Received April 10, 2006
Revision received October 19, 2006
Accepted December 18, 2007
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