Some countries have chosen to educate audiologists in a physician model. In this model audiologists become physicians first then do a residency in the field of audiology. Hinchcliff (2005) describes the audiological physician as a medical, non-surgical specialty 
entrusted with the investigation, care and management of patients with hearing and balance disorders. In these countries, the relationship of the audiological physician to an ear, nose, throat surgeon is analogous to that between the neurologist and the neurosurgeon, or to that between the cardiologist and the cardiac surgeon. In these countries, the audiological physician’s role is concerned primarily with patients suffering from disorders of auditory communication, equilibrium and spatial disorientation, i.e. ‘deaf and dizzy’ patients while the non physician audiologist is typically a
scientist (or technician). In other parts of the world, non physician audiologists and their colleagues in otolaryngology are those that treat patients with hearing and balance disorders. Over the past two decades a transition of non physician audiologists to a greater clinical depth has been achieved by the Doctor of Audiology education model.
The Doctor of Audiology (Au.D.)
Since audiologists are physicians in many countries, the world has yet to totally embrace the Doctor of Audiology (Au.D.) education model which is now considered the gold standard for audiology education in the United States. Elsewhere in the world, the Au.D. is 
now beginning to catch on as can be seen by the enrollment of foreign students in US Au.D. Distance Learning programs such as the University of Florida and Nova Southeastern University.
While not intending to train physicians, the Doctor of Audiology education model is designed to produce audiologists skilled in providing diagnostic, rehabilitative, and other services associated with hearing, balance, tinnitus management, and related audiological fields. These clinicians assist patients with hearing problems primarily by diagnosing hearing loss and fitting hearing assistive devices as well as assessing and treating some balance disorders. While most Au.D. programs have some sort of research component to their programs, there is an emphasis on the clinical learning experience. As of 2007, the Au.D. has, at least in the United States, replaced Masters Degree audiology programs as the entry-level degree as the minimum to practice the profession and most university programs have adopted this model for their students. In the United States, once the degree is in hand, then each individual state requires a license before the
new practitioner may practice the profession.
What is a Preceptor?
In the Doctor of Audiology model, there is a great deal of clinical work by the students and this is supervised by a faculty member. While a preceptor can be a clinical supervisor of a student audiologist in any year of their program, the last year of education is a residency year, conducted off campus in a facility that offers 4th year training. The people that are involved in the supervision of these students, especially during these 4th year residency programs have become known as “Preceptors”. Preceptors are instructors or specialists that teach, counsel, and serve as role models while supporting the growth and development of an audiology doctoral candidate for a limited time, with the specific purpose of socializing the candidate into a new clinical role. Definitions indicate that preceptors fill the same role as mentors, but for a more limited time frame. It is the preceptors who provide critically important opportunities for students to apply classroom learning in authentic clinical settings, and facilitate the student’s transition from novice clinician to competent, independent professional. Until recently was no orientation training for preceptors. While the on campus, students and clinical supervisors knew what to expect, during the 4th year of the program, 25% of a students training was conducted by those outside the university program Those who precepted often had no idea of what to expect from the student, their professional responsibilities to the student, the educational program or their profession. Additionally, students had no idea of what to expect from a preceptor.
At the request of preceptors for Au.D. programs in years 1-4, students as well as training programs across the country, the American Board of Audiology (ABA) took on the project of streamlining the preceptor role for all Au.D. students. A new, reasonable cost program for prospective preceptors to obtain training in how to act in this role was launched May 1, 2016 by ABA called, Certificate Holder–Audiology Preceptor (CH-AP™). The CH-AP™ training program is for any licensed audiologist who wants to learn:
1) professional responsibilities, obligations and attributes of an effective preceptor.
2) legal obligations and considerations for preceptors.
3) role of assessments in clinical education, including setting realistic goals for the clinical experience.
4) effective instructional strategies for the clinical setting, including adult teaching and learning principles, learning styles and models of learning.
5) professional ethics in precepting.
6) billing and coding issues related to precepting.
To become a Certificate Holder–Audiology Preceptor (CH-AP™), the applicant does not need to hold ABA board certification nor do they need previous knowledge of precepting to take the certificate program. The CH-AP™ program is an assessment-based certificate that uses evidence-based instructional design principles to ensure efficient learning and retention of the information. It is an online self-study program where the learning is supplemented with a toolbox of resources. The ABA’s goals for this program are to:
a) teach preceptors how to facilitate an AuD student’s transition from novice clinician to competent, independent professional.
b) create training standards around the vocation of audiology precepting, advancing a pathway for an individual to become recognized as an audiology preceptor.
c) develop a greater pool of trained audiology preceptors to provide critically important opportunities for students to apply classroom learning in authentic clinical setting.
The CH-AP™ program consists of 4 online modules:
Module 1: Role of the Preceptor in a Clinical Environment
Module 2: Clinical Dynamics – Assessment and Performance
Module 3: Creating Effective Learning Programs
Module 4: Legal, Ethical and Professional Considerations
The CH-AP™ program is based on the industry’s first large-scale job analysis in Clinical Audiology conducted by ABA in 2013 to identify the responsibilities and duties of today’s audiology professional. The results of this job analysis were re-validated by a group of subject matter experts from the Steering Committee and Practice Analysis in Clinical Audiology Task Force. A Preceptor Task Force of subject matter experts created a set of online courses to teach participants the fundamentals of precepting, and also utilized the Practice Analysis in the development of the CH-AP™. In building the CH-AP™ Certificate Program, the ABA aligned the development of the training program to ASTM E2659-15 Standard Practice for Certificate Programs. ASTM International is one of the largest voluntary standards developing organizations in the world. Training and assessments are tightly linked, and designed around the training program’s learning objectives.
As one of the creators put it, “the role I see for audiology preceptors – and really the role promoted by the CH-AP™ Certificate Program– is that of a clinical educator. The CH-AP™ training addresses many education topics to which a great number of clinical audiologists have never been exposed.”
References:
American Board of Audiology (2016). Certificate Holder–Audiology Preceptor (CH-AP™) Retrieved August 31, 2016.
Executive Committee (2016). Certificate Holder- Audiology Preceptor. Board of Governors, American Board of Audiology, Reston VA. Personal Communication August 31, 2016.
Hinchcliff, R. (2005). Audiological medicine in the UK: the historical perspective of its role and scope. J Laryngol Otol. Sep., 119(9):672-7. Retrieved August 31, 2016.
