by Mike Metz
Remember the theories of trickle-down economics from some of those old time politicians of 30-40 years ago? Did anyone every figure out what was wrong about these ideas? How much trickled down? Are there lessons that can be mined from these theories?
A friend of mine constantly tells me that we should sue our graduate programs to get our money back since they didn’t teach us all we needed to know. I’ve always thought that he really meant that he didn’t learn what he needed in order to succeed as well as he has. But, his statement also contains more than a little truth.
Chuck Berlin and others said: “We stand on the shoulders of those who preceded us”. There are clinical standards that result from the investigative and clinical works of those who contributed to audiology education and research. The field has prospered to the extent it has, because past clinical education was anchored appropriately. Anchoring starts with basics at the undergraduate level—attached firmly to the sciences as well as to the humanities.
If one looks closely at graduate programs and many practicing audiologists, one will find few with a strong base of math and science. Many audiologists came to their graduate work with degrees in the humanities. Too many graduate programs require too little science for admission, or settle for a “refresher” class or two in deficient science areas. A weak science foundation eventually produces clinicians who may not be as skilled as the future will require. A criticism of physicians may be that they seem to value science more than empathy, and audiology could be criticized for dealing more with social and sales skills than with science. Some suggest that both are desirable, but if only one is attainable, which should we choose?
In the movement from Master’s degree to the Doctor of Audiology degree, many held hope that a better foundation would be required. In my teaching experience, I saw too many students with little or no science courses on their transcripts. And, as new AuD programs sprang into existence, the apparent movement was toward less science in favor of quickly training more audiologists—perhaps the opposite of what should have occurred.
That’s where the “trickle down” theory arises to haunt us. In our haste to get going on the AuD, we forgot that every time we started a new graduate program in audiology without more basics in place, we produced a program that contained not quite as much science and quality as those from which these new programs sprang. Really good scientists (producing good research) went to high-quality institutions. As faculty demand increased, AuD graduates began to teach and do research. No one can dispute that there are some really good AuD people in university or research positions, but I suspect that they are the exception and not the rule for AuDs. Recalling the arguments, the AuD degree was meant to be clinical and not geared towards research or teaching—not enough time to train for both was the argument. Many students opted for the AuD because it was easier, quicker, and could be done “at a distance”, without interrupting current clinical employment, as well as often not being all that rigorous.
I think the field thought that, over time, we would improve our educational standards as soon as the field got the AuD degree stuff in place. But, as our teachers trickled down to new programs, our graduate training seems to have suffered. As our undergraduate science education decreased to a trickle, researchers and investigators are fewer and focus on less complicated issues. Our innovations in testing have slowed to a trickle—some perhaps fueled by good research audiologists but ultimately adopted by few clinicians. Our services to the hearing impaired seem to have largely decreased to the trickle of retail device sales.
Harsh words, I realize. And, I expect that many of you could or should take issue. But ultimately, in the health care business, a professional profile requires more than screaming loud and often about quality, and a great deal more than letters behind a name. It requires excellence in education, value in clinical service to others, and advancement of the science. Trickle down won’t work here either.
An ex-student friend, employed in a well-known clinic, once told me he feared that audiologists would end up without a field—a lonely, elective course or two, trickled down to an undergraduate psychology department.
I hope he was incorrect.
Dr. Metz has been a practicing audiologist for over 45 years, having taught in several university settings and, in partnership with Bob Sandlin, providing continuing education for audiology and dispensing in California for over 3 decades. Mike owned and operated a private practice in Southern California for over 30 years. He has been professionally active in such areas as electric response testing, hearing conservation, hearing aid dispensing, and legal/ethical issues. He continues to practice in a limited manner in Irvine, California.
