By Angela Loavenbruck, Ed.D
Ever since I agreed to join my illustrious colleagues writing for Hearing Views (a decision that coincided with a brief moment of insanity, given my hatred of writing deadlines), I’ve been thinking a lot about Lucy Van Pelt, my all-time favorite cartoon character. She was pretty crabby, and after 45 years of practicing audiology, there are some things that bring out the Lucy in me. I’m going to start small and look at our entire system of educating future audiologists.
Early Study Revealed Shortcomings of Audiology Education
Way back in 1987, I participated in an elegantly designed study that ASHA developed with the Educational Testing Service (ETS).{{1}}[[1]]Greenberg, S., & Smith, I.L. (1987). Evaluation of the Requirements for the Certificates of Clinical Competence of the American Speech-Language_Hearing Association. New York: Professional Examination Service.[[1]]A similar study was repeated in 1996.{{2}}[[2]]Tannenbaum, Richard J., & Rosenfeld, Michael (1995). The Practice of Audiology: A Study of Clinical Activities and Knowledge Areas for the Certified Audiologist. Division of Applied Measurement Research, Educational Testing Service, Princeton, NJ[[2]]The studies were intended to define the tasks, knowledge and skills needed for the Certificates of Clinical Competence. Note that the study was not designed to determine what was needed for licensure or for graduation from an accredited audiology program, but rather for the purchase of ASHA’s certificates in speech-language pathology and audiology.
The initial study brought together large numbers of audiologists from various practice settings who were asked to outline every task performed by audiologists, and then to delineate the knowledge and skills needed for each of those tasks. Following this massive undertaking, participants were asked at which point in the continuum of education the knowledge and skills should be obtained – in the academic program, in the clinical fellowship year (CFY), or as part of continuing education after the attainment of the certificate.
Three groups of participants (practicing audiologists, employers and supervisors of audiologists, and academics) were then asked how well the then-current educational system was working; i.e., was the appropriate knowledge and skill set being attained at the appropriate place in the continuum? So the questions were: What knowledge and skills do you need, where should you learn them, and where did you actually learn them?
The results were surprising – or maybe not. Practicing audiologists and supervisors and employers indicated that the vast majority of knowledge and skill should be attained in the academic program. Academics felt that less needed to be taught in the academic program, putting more responsibility on the CFY year and continuing education.
Finally, each group was asked how well the educational responsibilities were being carried out by the respective groups. Academic participants almost universally felt the university programs were doing a great job.
However, practicing audiologists and their supervisors and employers felt very differently. They said that academic programs were producing graduates who had far less knowledge and skill than they needed to practice, and they said that too much of the educational process was being left to employers and continuing education.
The dramatically different perceptions among the various groups in the study were among the earliest indications that the master’s degree/CFY package was not sufficient for instilling the knowledge and skills that an entry-level audiologist needed.
The findings lent support to the audiologists who had begun talking about the need for a professional doctorate as the entry-level degree in the profession.
Still Crabby After All These Years…
Enough to make you crabby! Too many mediocre AuD programs continue to be accredited. Image courtesy islandperspectives.
So, why am I crabby about all of this? As a participant in the long, ongoing struggle to improve and change the accreditation and culture of our audiology educational programs, I think today’s AuD programs still fall short in their content and rigor, and I believe that far too many mediocre programs are accredited.
Too many students are left to find externships in hopes that unpaid supervisors will instill in them the knowledge and skill that should have been the responsibility of the program.
Employers are expected to pay young audiologists while simultaneously providing education and training that should have been completed under the auspices of the academic program. Furthermore, our professional audiology organizations are focused mostly on creating continuing education institutions to solve the problem, instead of investing fully in creating and enforcing rigorous standards for recruiting and educating future audiologists in our academic programs.
In my next several blogs, I’d like to look more closely at these issues and their effects on how students are recruited, educated and employed, and on the culture of our profession in general. As Lucy van Pelt said: “Look out, everybody, I’m going to be crabby for the rest of the day!”
Your post illuminates 2 important issues in this discussion:
1) supervisors aren’t being paid to “teach” and yet the practice often is expected to pay them.
2) despite the expectation to pay, its actually not uncommon for 4th year externships to be unpaid or very low paid. Yet frequently fulltime tuition is still required to be paid to university.
The current AuD model was poorly designed, leaving students and their supervisors frustrated; although for different reasons. More clinical experience should be required in all programs prior to externship and the AuD should be conferred at year 3 with year 4 as a type of residency (general, pediatrics, etc; a system which could coincide nicely with various board certifications if done properly following a medical education model). Among other issues, this is one way to resolve some of the murky billing issues when testing is completed by a student and questions arise over how to bill since the student has no degree or license. Is an AuD student that has already had a year more training than past cfy’s (who had a degree and could bill) not as qualified to conduct and bill for a basic audiogram?
I think accreditation standards should address these issues. And as you will see in future posts – “board certification” is another thing that makes me very very crabby….Thanks so much for the comments.
You are correct. There are way too many lousy programs, functioning as diploma mills. As a retired professor of audiology, I was recently asked by someone in charge of a 4th year externship how he should handle the “poor fit” of one of his 4th years with the private practice willing to mentor the student. His first idea was to move the student to another practice. As I questioned him, it became glaringly apparent that the site was a good one and that the student should never have been allowed to go to an externship, period. Instead, the student should have been dismissed from the program based on crappy grades and having to take the qualifying exams several times (yes, several times). What kind of message does that send to busy private practices and other sites who train students for free while the universities collect tuition? The student tried to blame his performance it on the preceptor saying that she was too strict and should realize that record- keeping and other duties associated with the job were not the student’s “strong suit.” Whaaaat?! Shape up or ship out. Our field needs to tighten the reins and get on board with rigorous accreditation so that every consumer in America can expect to receive standardized, evidence-based care by professional (who also can keep good records). Your crabbiness will never match mine. Mine calls for a stiff drink and a two-week trip to an island.
Who said I wasn’t drinking? 😉
You can’t build a house on a weak foundation of sand.
The problem as I see it is that the undergrad standards required to enter an Au.D. program are a joke; and in fact are barely an extension of the overarching societal problem of today’s Millenials graduating with a worthless degree in Art History or Feminist Studies — And accumulating tens of thousands of dollars in student loans in the process.
In fact, there’s been talk of students fresh out of high school going straight into a clinical doctorate program. Although that may be a bridge too far, an intensive 2 year degree specifically tailored to prepare students for an Au.D. program is more than adequate.
Millennial bashing aside, I agree with much of your premise. The reality is not the weakness to be accepted, since most programs require a lot on paper for entry; the problem is ridding bad students appropriately and not letting them continue.
More often students come out overqualified with their doctorate to a field with most of the well paying jobs in hearing aids. The real tragedy is that “audiology” often doesn’t pay.
No need to bash the number of incredibly bright young people who have been forced into this system.
Certainly recruitment and undergraduate requirements are part of the solution – how to get there will be the subject of future posts too.
I don’t know if we can expect students just after high school to know that they want to be audiologists or anything else for that matter – but I do think we have to cast our nets much wider than the typical “Communication Disorders” major.
When you go to your audiologist’s office, look at the diploma on the wall: How do you know that she was actually trained at a real school, and not some mail-order diploma mill… Or worse?
Fortunately, the people over at US News & World Report rank the various Au.D. clinical doctorate programs out of the 73 in the U.S.; and from our dealings with their alumni, these 3 pages of rankings are surprisingly accurate, especially the bottom-of-the-barrel programs on page 3.
I worry that the criteria used by US News and World Report don’t reflect all of the program qualities that I will value – I think the accreditation process is flawed and hope to discuss that further. Thanks for the comment…this is a discussion that needs to be held.
I’m an audiologist with 3 decades of experience. The situation was really bad in the early 80’s, as I had to find my own CFY and had little to no real supervision. So I went on for a PhD because I realized I needed to know much more. Today’s students spend far more money and years on their education. Some programs have really risen to the AuD challenge and are excellent, so I don’t want to tar all programs. The biggest problem is that we are still recruiting more than 90% of our AuD pool from speech and hearing undergrads who didn’t know about audiology until their junior or senior year, and they have had little math or science.
There are some really important things we must do to improve the preparation of future audiologists, and provide a better paying, more independent career for them:
1. Require undergrad courses in calculus, biology, chemistry and physics, in addition to linguistics and psychology.
2. Educate pre-med majors about audiology as a career choice and try to recruit them into Audiology (many of them do not end up going to med school).
3. Make the first year courses more rigorous, and do not pass those who do poorly.
4. Require students to pass a rigorous practical exam before going on practicums and a case based exam before graduation.
5. Audiology programs need to step up to embrace higher standards. We cannot any longer tolerate the mediocrity of ASHA’s accreditation. It’s unfair to students who are investing so much.
Thanks for your comments and suggestions – I hope to cover a good deal of this in upcoming posts….we have a lot of work to do and standards are the most important step.
Dear Dr. Loavenbruck,
Having just read the excellent article “The Crabby Audiologist: Who’s Teaching Whom” which appears in the February 2015 Hearing Review, I’d like to say that I couldn’t agree more that the current AuD process seems to leave much room for improvement. As a professional sound / music / recording engineer who later studied audiology and who has worked for decades in audiology research and development (see http://www.revitronix.com), it has become clear that the vast majority of today’s audiologists know far too little about “audio” to be fully effective in the tuning and programming of today’s hearing aids.
Clinicians who fit today’s complex, yet potentially very effective, hearing aids need to be trained in applied sound engineering. The in-depth teaching of the rudiments of multi-band compression and limiting, equalization, expansion, damping, frequency range and response, microphone design, digital audio processing, etc., especially as related to the special needs of those with impaired hearing, ought to be taught comprehensively in training programs for audiologists.
At present, it is my experience that the typical technical-minded musician can be far more effective in tuning one’s own hearing aid programming than can the typical professional audiologist. I even suspect that hearing aid companies may be holding back potentially important new features in hearing aid designs, for fear that fitters couldn’t comfortably deal with greater audio complexity and flexibility.
I believe this situation could be improved if at least one full-semester course in applied audio techniques were included in AuD programs, perhaps with an advanced course offered for those who wish to become top experts at fitting hearing aids for professional musicians and sound-engineerings.
In brief, we need to bring more “audio” to “audiology”. Thanks for listening.
Dear Dr. Revitt – thanks so much for your thoughtful comments. I had an interesting experience several months ago – I saw a patient who had experienced a sudden unilateral hearing loss which resulted in a mild/moderate sensorineural hearing loss in his left ear. He is a sound engineer whose work involves adding sounds to movie tracks – he’s the guy that makes sure that the music matches the mood of the movie. It’s delicate work for sure and requires him to accurately hear and more importantly localize sounds so that the movie track accomplishes what is intended. At the end of our discussion, he told me that he had consulted with three other audiologists before me, and had never been able to have the conversation that he had with me because I understood the problems he was conveying and could translate his “sound engineer” language into “audiology and hearing aid” language. There are a lot of changes that need to be made in the standards for our AuD programs and in many ways, the accreditation standards used by most AuD programs do not result in the kind of culture, knowledge, skills and competencies needed by audiologists now and for the future. ACAE is an accreditation program developed under the auspices of AAA (and ADA in the beginning years), and its standards and accreditation process would be a great improvement over the CAA accreditation process used by many programs. Several AuD programs now hold ACAE accreditation with more in the pipeline. I’ll be talking in more detail about accreditation in future blogs – you can take a look at the blog series on hearinghealthmatters.org. Thanks again for your comments. Angela Loavenbruck