Improving Clinical Training in Audiology and Hearing Healthcare: Interview with Rob Koch of AHead Simulations

Bob Traynor 0:09
Welcome to This Week in Hearing where listeners get the latest information on hearing care. And we’re always looking for high technology, innovative procedures, various issues that will help us in the practice of our profession. Today, my guest is Rob Koch, CEO and founder of AHead simulations out of Canada, actually. And my name is Bob Traynor, and I’m your host for this particular episode. This is a fabulous concept that I really wasn’t aware of until recently. And we had a nice discussion the other day, Rob. And so hopefully, you can give me an idea of what, how you really got into this idea and, and a little bit about what CARL is, and you maybe we can talk a little bit about CARL, and how to meet CARL, and get to know him just a little bit better.

Rob Koch 1:15
Absolutely. Thanks so much, Bob. So actually, CARL, the concept and the company in general, started back in 2015. So I was a undergrad engineer at the time, an undergrad electrical engineer. Hearing care and hearing always fascinated me, I remember my first ear biomechanics class, it was just fascinating how you know, these invisible waves in the ear enables you to hear and you know, as an engineer, it’s incredible. And around that time, I was fortunate enough to get connected with the National Centre for Audiology, and Susan Scollie and the wonderful people there. At the time, I was looking for, you know, a project to start with, as an engineer, I wanted something interesting, I wanted something new. And they really identified that, you know, looking at all these other disciplines outside of audiology, like nursing and med schools, they were using all these cool training simulators. So they could practice procedures on a simulator before practicing practicing them in clinic. And audiology really didn’t have anything like that at the time. So, you know, I went to a craft store, got a foam, little foam head, I 3d printed in an ear, put it in the side showed, you know is this sort of what you’re looking for? And that’s when CARL was born in a very, very rough way. So you know, the concept of simulation isn’t necessarily new to the medical field. But in audiology, you know, for a long time, it was practicing procedures, practicing hearing aid fitting practicing normal impressions on other students, or just on patients in general. So the idea of CARL really provided an outlet in which you could practice those procedures in a safe and comfortable way. So from 2015, all the way to 2018. We were developing the product, we were improving the product and validating the product. And CARL was officially released to market in 2018. And what CARL is today is a clinically validated hands on hearing healthcare training platform. CARL itself stands for your Clinical Assistant for Research and Learning. And he really is your stand in patient for a numerous, numerous number of tasks.

Bob Traynor 3:32
So now, you know, how does CARL actually differ from Kemar? I mean, I know we’ve had Kemar around for a long time. And and I guess the the the first thing that I would think as a clinician is, Oh gee, now I’m going to have a Kemar in my clinic and, and that kind of thing. So how what’s the differences between CARL and Kemar?

Rob Koch 3:59
I would say the first thing is sort of the cost. I think that’s the thing that everyone thinks of when they think of a Kemar it’s you know, $30 – $40,000 It’s this big piece of equipment that you set up in an anechoic chamber or research lab. And CARL is quite the opposite. So CARL, we tried to design so that it’s cost efficient, you know, around $5000 or even less than that, ballpark. And it’s made to be very, very portable. So you could put it right on a desk. You could carry it with you you know we carry it to trade shows, and it’s no problem at all. The other big difference is that Kemar You know it is perfectly engineered to be the average patient and the average response and a perfect 2cc coupler within the ear. CARL itself, we make the ears directly from clinical, clinical CT scans. So this makes for, instead of a perfectly average anatomy, a very different patient specific anatomy. There’s different anatomies that you can plug into the same head. And the material that we use makes it not only a realistic anatomical model, but the acoustic model is also realistic as well. So when you fit a hearing aid on CARL, it looks like you’re fitting it on a patient. Again, comparing it to Kemar. It doesn’t have a microphone functionality yet. But it can, you know, be that stand in patient in which you may typically think of using a Kemar, or you know, just do it with a volunteer or a classmate.

Bob Traynor 5:31
Yeah, as, as one who has taught classes in the past a number of times, I can see that this particular device would be really helpful to ramming home some of those concepts that are necessary. And when you’re doing earmold impressions, even if somebody messes it up a little bit, it doesn’t create any lasting difficulties for the participants, it looks like.

Rob Koch 5:57
So yeah, and I think something something that was that was interesting in the last little while that we’ve seen, especially with COVID, is that there’s a lot of these online training that are popping up, which is fantastic. And it really bridges the gap. But at the end of the day, you know, you really got to in our whole motto is learn by doing, you need to just do it, you need to get in there, whether it’s a new procedure and your new clinician, or maybe you just have a new piece of equipment, you just need to start experimenting with that. And a lot of the time CARL can be CARL can be the solution there. And you can also do things wrong on purpose, you know, you can fit a hearing aid improperly, you can do a blow by you can do all these things. And you know, observe it being wrong and learn from that, instead of always being hesitant and nervous to do those kinds of things.

Bob Traynor 6:44
Well, also, when I would think you do cerumen management with this device. And absolutely, and that is one thing that is very difficult for students to actually get any experience with, unless they have a bunch of people with a bunch of wax in their ears laying around someplace that they can work on. So now, I know you guys have been in business for three or four years here, but do you have some people that are actually using CARL routinely already?

Rob Koch 7:17
Absolutely. So we’re happy to say that over about 75% of the hearing healthcare training institutions across North America are actively using CARL. So whether it’s AuD programs, or whether it’s dispensing programs, they’re using CARL to provide a new outlet for their training, and even to you know, have an opportunity outside of class hours, where they can practice that. Because CARL is such an a sandbox piece of equipment, we like to say, you know, even people like equipment manufacturers are using it for their own equipment training, or for their own r&d purposes. And recently, we’ve seen the interest on the clinical side as well, with you know, everyone wanting to raise the bar and raise the standard of care within their clinic, and using CARL as a standardized patient to really measure that, and help improve that.

Bob Traynor 8:11
Great. So we so basically, the some of the industry, people that are doing training are using CARL and university programs are as well. And my guess is that, that any place that is any place that’s training or any any type of training that goes around the ear, could be could be conducted with the with the CARL device. Um, so. So there’s, there’s a lot of changes in the industry, and how do you think CARL will fit in to some of the changes that have been going on in with all the things that are happening with legislation and, and clinical procedures and so on?

Rob Koch 9:03
Yeah, I think it’s sort of hard to keep up with all of the the changes in the industry these days. I think two trends that we’ve really identified and I and I think a lot of people will agree with is that, you know, clinicians need to operate at the top of their license and really provide that level of care to their patients. And second, the patient experiences really need to be top notch and add considerable value to, to the journey that they’re going through with their hearing loss and with their hearing aid. And I think CARL really fits into those two realms really well. So first of all on the need to operate at the top of their license. Now CARL can be an outlet to not only get people to the place in which they’re, you know, able to operate at the top of their license, but also give people such as clinics a way to measure and to standardize what exactly does operate at the top of their license mean for that clinic. You know, what are their values? What are their practice criteria, and CARL can really be used to standardize that. The second piece, which is the patient experience is something we’ve been piloting with CARL recently, which is really exciting. And that using CARL to educate the patient on their hearing aid, whether it be different styles, or whether it even be just the placement of the hearing aid on CARL in general, you know, the ‘Learn by Doing’, ‘Learn by Doing’, ‘Learn by Doing’, that made that may not only be relevant for clinicians, but also for patients to make sure that when they leave the Hearing Clinic, they’re not going to come back, you know, a week later and say that, you know, the sound quality isn’t what I wanted, or it’s whistling, when in reality, they just aren’t placing their hearing aid in the ear properly. So a local clinic is using it to, you know, gradually teach their patients how to place the hearing aid in their ear, give them a different experience, give them you know, a new protocol in which they can teach their patients to make sure that they’re successful with your hearing aid. And we’re seeing a lot of success there.

Bob Traynor 11:12
Great. Yeah, I, you know, I think that this could almost be the type of thing that that professors could say, you need to take wax out of 10 CARL ears, before you come to class, and we talk about it, or you need to do some, try all the different formulas on CARL and look at the differences and all these different things that the students usually don’t get much of a chance to do. And, and so it looks like it feels quite a niche in the, in the training program, that that the Doctors of Audiology programs need to get this hesitancy away from students as they go out to intern and those kinds of things. So, absolutely. So, um, is CARL just a kind of one of those heads that you put put wigs on, or if you guys could done some further design than that?

Rob Koch 12:16
Yeah, I think something that, that makes us unique is that we make all of our own products. So we’re located in Cambridge, Ontario, up in Canada, and we do everything. So we 3d print the head itself, we finish it, we make the ears by hand, it’s all done by us. And that may sound a little bit labor intensive and a little bit crazy. But something that allows us to do is to be able to make changes and to be able to listen to people who are using CARL and continue to fine tune it. The ears have undergone considerable improvements since when we first started just because you know, we try to practice what we preach and that every CARL that’s leaving the door is a little bit better than the one before because we learn from the people who are using it. So I think after the course of you know, three years of this really being in the field, we’ve gotten to a place where you know, it’s accurate, it really applies to the clinical workflow and the training workflow. All the pieces fit together really nicely. And ultimately, we’re really, really proud of the mannequin and where it’s gotten today. I’m sure there’s a lot of you know, there’s a lot more improvements in the future. And hopefully in two years, we can look back and say, Oh, we didn’t know what we’re talking about back then it’s so much better now. But that’s, that’s really our goal.

Bob Traynor 13:37
Well, that that kind of goes along with the development of just about everything, where you start in a certain place, it gets a little better, a little better and a little better. We’ve all seen that in, in our hearing aid fittings and in our treatment programs that we’ve offered in clinics over the last 50 years or so anyway, so. So as CARL develops, it will simply just be a even more improved device that can be used to work with individuals learning certain techniques within the field.

Rob Koch 14:13
And I think something that’s been really interesting as well throughout the lifecycle of CARL, is that you know, quite early on, it was considered and we thought about it as a probe to placement training simulator and a real ear measurement training simulator. And that was really our first core use case. And then when we got it into the hands of people, it was oh, wait, you know, we can use this for earmold impressions. We can use this for cerumen management, we can use it for equipment training. Most recently, the patient education side of it is ‘oh wow, maybe we can use this to interface with our patients’. And really, you know, show the learn by doing with them. So I’m really, really excited to see not only the product evolve, but also the use cases and in the creativity that our users in the industry really have to make use of this tool.

Bob Traynor 15:00
I think the cool thing about this, Rob is that it comes from kind of a grass roots place, you know, first year calculations with all the various things that went into the engineering of, of the, of the device itself. And then then listening to clinicians as to well, how can we use this? And what do we need? Well, why don’t you try it this way? Why don’t you think about doing this with it, and that with it, and all these things, because again, as a, as a person who’s supervised brand new students coming into a clinic, you always got to watch those kids pretty, pretty closely for the first, you know, you know, a couple of weeks at least, and because they’re hesitant about things, and when that passes on to the patient, then they patients get a little hesitant as well, and, and so all of us that have worked with, with students to try to develop colleagues within the profession, looks like CARL is going to be quite an addition to any kind of an orientation program for audiologists and dispensers as well.

Rob Koch 16:12
Absolutely couldn’t agree more.

Bob Traynor 16:13
Yeah. So, um, so do you have any specific ideas as to as to where other other areas might take CARL? I know, we’re looking at universities and the industry and as well as now clinical kinds of things with CARL, you guys have some other things on the horizon that you’re thinking about for uses with this device?

Rob Koch 16:39
Yeah, I think primarily, our first case is to be able to, you know, really prove out these use cases and show them, you know, we can talk about using CARL, for patient education, for example, that might seem a little mysterious for some people, but to be able to really show that use case, you know, film it and create materials around it is something that we’re looking to do for both clinician education and the patient education side of things. I think what most of our users may see as a logical progression is giving CARL the sense of hearing, I think it’s, you know, a logical next step. And we have some really exciting use cases to come in the in the next few months.

Bob Traynor 17:21
So for example, something like you could put a 2cc coupler in for as an option or some other kind of a thing and as options. So that, yes, you could have this kind of a CARL, but you can have, you can have a little better CARL, or you can have a really superduper CARL, all that kind of thing.

Rob Koch 17:39
Yeah, and, you know, I think that’s something that is unique about CARL as well, is that it is built to be modular, modular. So you can swap in different years, we have a camera that you can swap inside of the head. And then in the future, you know, when that functionality comes, there may be a mic inside. And I think in the realm of simulation, I guess, even, you know, clinic, there’s all this very specialized equipment, that takes up a lot of room. And it’s incredibly expensive, and, but you need all of it. And what we’re hoping to do with CARL, both in a training program sense, but hopefully even a clinic sense is that you know, there’s this one piece, there’s this one core tool that you can swap things in and out, depending on what you’re using for it, you don’t need to invest a ton of money upfront to just focus on one or two use cases. And you can really expand with it as you as you grow.

Bob Traynor 18:28
One of the things you guys showed me the other day was that, that CARL could be used to simulate hearing loss hearing testing some of the first hearing tests that people do, that’s always been, Okay, where am I going to find these 10 people? And where am I going to find anybody with a hearing loss and all these different things. And there have been some simulators that have come out over the years, but it looks like this may be a another type of a simulator. So in other words, instead of just doing the real ear or the cerumen or, or other kinds of thing, impressions or whatever, you could also use it as a as a simulator for brand new students learning what to do relative to testing.

Rob Koch 19:13
Yeah, that’s, and we’re going to be coming out with that next year, which is really exciting. And I think it’s still, you know, the same model of Learn by Doing learn by doing, you know, you can use these online simulators, and they’re great, they really are. But to bridge that gap from online, you know, simulator with an interface that you have to learn how to use to actually going to clinic and working with patients on actual audiometers I think that’s something that CARL can really bridge that gap with. And something that’s unique is that you actually use the clinical equipment which you will be using in clinic. You don’t need to you don’t basically learn how to use the simulator, and then you learn how to use the equipment. CARL’s quite literally you’re stand in patient, and you can use any piece of equipment you want on him.

Bob Traynor 20:00
Wow. Yeah, again, training stuff is is getting so, so much better than we’ve ever had it in the past and my professorial colleagues will will really benefit as well as their students from all the kinds of things that you guys have put into CARL to facilitate some of these things. So I’d like to really thank you, Rob, number one for your invention of CARL number two for all the benefits that are that are coming about using this device. And today, my guest has been Rob Koch from AHead Simulations and in discussing his invention of CARL, which is a simulator for many, many procedures within the field of audiology. Thanks so much for being with us today at This Week in Hearing