Teaching Vestibular Courses to Graduate Students – Part I

We have a guest blogger this week. Jim Baer, Au.D. is a former student of mine, now a faculty member at Lamar University. Jim teaches vestibular assessment and management courses, which gives him a unique perspective on up and coming audiologist’s interests and abilities. Here is his take on the subject:

 How much training in vestibular assessment do students really need? Part I

A couple of years ago, we undertook a very detailed examination of our curriculum. As in all graduate programs, striving for continuous quality improvement is an undertaking that the faculty takes seriously and which is an ongoing process. After speaking with current and former students we felt that one area in which students seemed to feel consistently under-trained was vestibular assessment. Really, it’s not surprising that this challenging and rewarding area of audiology is one in which students can feel under-prepared. The anatomy and physiology are complex, the testing can be extensive and involved, and dizziness itself has so many etiologies that the information can seem overwhelming. As great as our Au.D. students are, it’s a lot to learn.

Our program, perhaps like many others, included two courses in electrophysiology. Electrophysiology I focused primarily on Auditory Evoked potentials such as OAE, ABR, ASSR, and various measures of auditory evoked latency responses and their clinical applications. The Electrophysiology II course, which at the time was the last course in the electrophysiology progression, included EcochG, VEMP, EnoG, ENG/VNG, Rotary Chair, and posturography (of both the computerized and “poor man’s” variety). In addition to the technical skills of completing these basic evaluations, students had to learn how to take a thorough vestibular case history (and the critical importance thereof), all of the various pathologies associated with dizziness, the clinical findings which help to differentiate between the pathologies, report writing, and appropriate treatment and referral techniques. The class was an exhausting marathon from the first day of class until the final examination. Fortunately, the average doctoral student enrolled in an Au.D. program is not an “average student” by any definition, and they were able to cope. But that begs the question: Is “coping” good enough?

What we learned from talking with our students and graduates was that vestibular assessment was of great interest to the majority of them and that putting in the hard work of understanding the material was a task gladly undertaken. However, after the course was complete, many students and graduates did not feel adequately confident in their vestibular assessment abilities to seek out employment opportunities in clinics offering these services.

We added the “Electrophysiology III: Advanced Vestibular Diagnostics” course to our curriculum two years ago. The first year that it was offered, the course received some very positive reviews. Using student feedback and the benefit of hindsight, the course was “tweaked”. This past year the course received rave reviews from our students. Every student enrolled in the class expressed a wish for the class to have lasted the entire summer rather than just half of the summer, but also noted that they felt “more confident”, “better prepared” and that the vast amount of information learned in the Electrophysiology II course finally “came together” for them. The content of the course focused primarily on getting a lot of practice in performing VNG, rotary chair, and CDP assessments on friends, family, and peers. Though this practice was all completed on non-pathologic subjects, we believe that you have to see a lot of “normal” in order to truly understand “abnormal” when you see it. In addition, the students completed several very complex case studies in which they were given the information and had to integrate the patient history and the test results in order to identify the pathology or, in several cases, multiple pathologies.

To promote discussion and build confidence the first case study was a group project with the entire class working in concert and presenting the results in grand rounds fashion to the professor. Then the students were broken into successively smaller and smaller teams as they worked on additional case studies. The process culminated in each student receiving his or her own case study to analyze and present.

Next week, Jim gives some perspective on what he has learned from his students.




About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.