Muddying the Waters: the Mixed Message Dilemma

By Angela Loavenbruck, Ed.D.

Here’s the issue: for 90 to 95% of the individuals with sensorineural hearing loss seen by audiologists, the only treatment for the resulting communication difficulties is the use of some type of amplification system and acquiring the skills, competencies and knowledge to understand and manage the hearing loss in their daily lives.

Audiologists need to acquire the skills, competencies and knowledge to evaluate and diagnose hearing loss and to guide people to and through this process.

Whatever terminology we end up using (referring to what we do as “selling” makes a lot of audiologists uncomfortable), the bottom line is that both products and services need to be purchased.

In discussing commoditization in an earlier post, I wondered whether the education of new audiologists contributes to the problem?  Do academic programs help students understand the value and scope of their work in various practice settings, especially private practice? How do academic programs approach the importance of autonomy?  How do they teach students the role of the audiologist in guiding patients to a decision to purchase necessary products and and audiology services?

What Are AuD Students Learning?

In trying to answer some of these questions, I’ve had some illuminating conversations with AuD students and recent graduates this past week.  My sample is small (8 students, four different university programs), but the discussions were sobering.

I asked a series of questions about curriculum and practice in hearing aids, hearing aid evaluations, methods of guiding patients toward the purchase of products and audiology services. I asked whether any of the individuals teaching hearing aid courses were actively involved in dispensing practices.  I also asked whether concepts like autonomy were discussed, what was taught about certification vs. licensure, and how various practice settings were presented.  And finally, I asked how students viewed themselves in this process.

The students I spoke with reported that each of their programs had from one to three separate amplification courses.  All described these courses as academic courses that covered the technical aspects of hearing aids, hearing aid features and topics like real ear measurement. Each of the programs had an on-campus clinic and students reported that the clinic was where the more practical aspects of hearing aid fitting/dispensing were learned. All of the students stated that their outside placements provided the bulk of the teaching about how to lead patients to follow the recommendations of the audiologist.

Private Practice: Experiences and Attitudes

Each of the students had spent some time in a private practice setting as part of their rotations. While the students I interviewed spoke highly of their private practice preceptors, several were critical of private placements where  audiologists were “sales driven, rather than wanting to help people.”  Several expressed concern about audiologists “pushing hearing aids” or  recommending more expensive technology than was necessary.

One student said that, although she herself had not observed this, she had heard that there were some private practice audiologists who had lost sight of patients’ needs and became too involved in “pushing” higher level amplification. I asked how one differentiated between “making a recommendation for hearing aids and follow up services based on patient needs” and “pushing hearing aids”. The students had no clear answer.

Several students stated that placements in private practice settings were not as admired as placements in settings like ENT offices, hospitals or the VA.  They said that the selling part was not really discussed but there was a clear feeling that discussing money or commercial aspects of the profession was frowned upon.

Autonomy and Certification

Each student stated that professional issues like autonomy were touched upon but that there was no sense that it was particularly important. Indeed, if students are feeling more rewarded for choosing placements in ENT offices or hospitals, do some academic programs actually undermine the importance of autonomous practice?

Our professional organizations routinely place goals like “encourage autonomous practice” at the top of their short and long-term lists, based on input from members. Should academic programs incorporate these ideas into their curriculum?

In terms of licensure vs. certification, all students stated that they were encouraged to apply for the ASHA CCC’s, and therefore to only acquire supervised hours from audiologists holding the CCC’s.  Students were told that their employment opportunities would be broader if they had the CCC’s.

Several students stated that only ASHA approved hours could be applied toward graduation requirements. They believed that, since their programs were ASHA accredited, the ASHA CCC’s were a requirement for preceptors.

Several students who chose externships in practices where audiologists did not hold the CCC’s stated that faculty members scheduled meetings to tell them the dangers of not acquiring the CCC’s.

Obviously, this is a small sample of students, but none of the attitudes expressed are surprising – we all know that the ASHA certification money mill starts with programs actively pushing (and sometimes forcing) students to pay for a private certificate in addition to paying the tuition for their degrees. And we all know that students internalize the attitudes of their professors and often do not have enough information or insight to question subtle assumptions.

What Can We Make of It?

Does any of this play into the commoditization of our profession?  I see it as a kind of schizophrenic underlying attitude about a major professional activity we must engage in if we are to help the people who arrive on our practice doorsteps.

If programs are leaving this educational task up to the vagaries of various practice settings, or manufacturers, rather than modeling best practices, I’d say the answer is a resounding yes.

Images courtesy: laserfgblogspot.com; parentingbehavior.com; ylift.com