Ensuring a Quality AuD Externship Experience: A Step in the Right Direction

Holly Hosford-Dunn
September 13, 2016
Harvey Abrams PhD

Harvey Abrams PhD

by Harvey Abrams, PhD.


“Peeling the Onion” is a monthly column by Harvey Abrams, PhD.

I was very excited to learn about the American Board of Audiology’s (ABA) Certificate Program for the CH-AP™  Certificate Holder-Audiology Preceptor (CH-AP™) described in excellent detail by Bob Traynor in his last HHTM post.  Among its other stated goals, the ABA developed this program to “teach preceptors how to facilitate an AuD student’s transition from novice clinician to competent, independent professional.”1


Program Benefits Students as Well as Faculty


I see the value of this program not so much for university clinical faculty who train AuD students every day (though such training can only strengthen their skills) but for audiologists who serve as preceptors as part of the students’ clinical rotations and, most critically, their 4th year externship.2  The CH-AP™ represents a much needed training program that recognizes the importance of the clinical rotation and year-long externship experiences and the specialized knowledge and critical skills required by the preceptor to ensure that the 4th year experience, in particular, contributes to the continued growth of competent and skilled clinicians.

Currently, students are provided some support by their training institutions or, in some unfortunate situations, are left on their own to secure a 4th year placement. In many cases, the decision to select a particular placement is not made on the basis of the quality of the facility, program or preceptor or the best fit for the student, but rather on the basis of geographical convenience, compensation levels, and worst of all, a desperate need to “lock-in” a placement before the limited number of externships are taken risking leaving the student out in the cold.

This situation highlights the need for a more structured system for placing students in these 4th year clinical externships to include, perhaps, a formal matching program similar to those practiced in most other doctoral-level training programs (a discussion for a later time).


How Others Do It


Unlike other doctoral training programs, the facility or practice in which AuD students complete their 4th year externship is not necessarily affiliated with or vetted by the student’s AuD university training program. This is in contrast to 4th year optometry rotations where the rotation site has a formal affiliation agreement with the training institution. 

The 4th year clinical rotation program at New England College of Optometry is one example. This training approach reflects an entirely different vision of the 4th year training experience; instead of a full-time, entry-level position as is a common model for many AuD training programs, the 4th year optometry experience is designed to give the student (and they are still considered students) concentrated experiences in different specialty areas of optometric medicine coinciding with the academic calendar.


How A Few of Ours Do It


We do have a few similar models in Audiology. The AuD program at Northwestern University is one such example. However, in the absence of structured 4th year university-directed externship experiences for most AuD students, CH-AP™ certification carries considerable importance as it provides important information to the university’s clinical faculty and students in pursuit of a 4th year placement and serves as an imperfect but important surrogate for the quality of the program/facility represented by the preceptor. The ABA also maintains a CHAP™ certificate holder directory.”

As welcome as the CH-AP™ certification program is, it represents only part of the picture to ensure a quality 4th year externship experience. Not only does the preceptor need to be credentialed, but the clinic in which the student is receiving their training should meet some minimum set of standards related to their case mix, productivity and quality indicators.

One model to consider is the VA’s Associated Health Education Program  which awards their limited training funds though a merit-based system in which VA audiology programs (among others) submit applications which are evaluated on a number of productivity, quality, and programmatic criteria. The trainees, and the funds associated with their appointment, are awarded to those VA facilities with the highest scores. It’s important to stress that the VA does not employ students as staff. All students, trainees, and residents (audiologists, pharmacists, psychologists, physicians, etc.) and the staff who supervise them must comply with prescribed traineeship policies to include constant on-site supervision. The supervisor signs off on and is responsible for every patient encounter.


Few Choices, Many Challenges


I appreciate that creating the organizational logistics associated with establishing a set of standards for 4th year externships will take time and resources but I don’t see where we have a choice if we want to be recognized as a doctoring profession on par with physicians, optometrists, dentists, etc. Each of these professions has done the heavy lifting to create the necessary infrastructure and so must we. In the meantime, I think it’s incumbent upon the university training programs to ensure that their students are accepting 4th year placements at only those clinics that can ensure a quality experience.

We should never allow our students to accept a placement at an ENT practice, for example, where “the girl in the back will test your hearing.” 

But there’s an even bigger challenge here – the number of students seeking 4th year placements will far exceed the number of quality placements willing to train them but that’s because:

  • we admit too many students,
    • and that’s because we have too many programs,
      • and that’s because we don’t have a rigorous set of training program standards in place,
        • and that’s because we created the degree before we created the standards,
          • and that’s because we were eager to become a doctoring profession,
            • and that’s because, hmmm…

Talk about peeling the onion!


Two Rounds of Applause


The ABA should be applauded for creating CH-AP™. We can reasonably assume that, in the absence of a set of standards for 4th year placements, those who have pursued and been awarded the CH-AP™ will take their clinical training responsibilities seriously and will do well by their charges.

The ABA should also be commended for the development of advanced practice, specialty certification programs in cochlear implants and pediatric audiology.   Bravo! This is what our profession needs – rigorous, evidenced-based and skill-based post-graduate programs whose successful certificate holders are much more worthy of board-certification recognition than those who hold “Board Certification in Audiology” which, at best, is an oxymoron and at worst, diminishes the rigor associated with board  certification status in every other doctoring profession.

But more about that next time.  



References and Footnotes


1Participant Handbook Certificate Program for the CH-AP Certificate Holder—Audiology Preceptor ABA.June2016.CHAP-HB.V04

2I realize that there are several 3-year AuD programs available. My comments in this post refer to the externship experience in general, whether that occurs in the program’s 3rd or 4th year.


This is Part 19 of the Peeling the Onion series.  Click here for Part 1,Part 2,  Part 3,  Part 4,Part 5, Part 6, Part 7, Part 8, Part 9Part 10,Part 11,  Part 12, Part 13, Part 14, Part 15, Part 16, Part 17, Part 18.


Harvey Abrams, PhD, is a consulting research audiologist in the hearing aid industry. Dr. Abrams has served in various clinical, research, and administrative capacities in the industry, the Department of Veterans Affairs and the Department of Defense. Dr. Abrams received his master’s and doctoral degrees from the University of Florida. His research has focused on treatment efficacy and improved quality of life associated with audiologic intervention. He has authored and co-authored several recent papers and book chapters and frequently lectures on post-fitting audiologic rehabilitation, outcome measures, health-related quality of life, and evidence-based audiologic practice.  Dr. Abrams can be reached at[email protected]

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