The Accreditation Commission for Audiology Education (ACAE), in collaboration with the Council of Academic Programs in Communication Sciences and Disorders (CAPCSD), offered the third annual Clinical Education Forum in conjunction with AAA 2018. ACAE organizes the forum to highlight the innovations, opportunities, and challenges for audiology clinical education, as well as to offer educators the opportunity to strategize on how to address challenges. 

The Clinical Education Forum this year focused on the theme “Readying AuD Students for Clinical Practice.” Invited speakers and participants identified several high priority challenges that must be addressed as soon as possible. 

The forum began with brief reviews of topics covered in three previous related conferences. Lisa Hunter, former chair of the ACAE board, summarized the discussions at the 2017 forum. Ann Eddins, representing CAPCSD, presented a recap of the first Clinical Education Forum in 2016. Neil DiSarno provided an update on the progress of the working groups formed as an outgrowth of the Education Summit hosted recently by ASHA. 

The Panel Image
Panelists participating in the Third Annual Clinical Education Forum hosted by ACAE and CAPCSD on April 21, 2018, at the American Academy of Audiology Annual Conference. From left to right: James W. Hall III (speaking), Roupa Balachandran, Hannah Siburt, Nancy Nelson, Ann Eddins (standing), Gail Whitelaw, Tracy Swanson, David Zapala, Riley DeBacker, and Hanna Sawher.

Panel Group Discussions

One of the main features of the Clinical Education Forum was a panel discussion offering varied perspectives on AuD student readiness for clinical practice. Panel members represented different roles in student education, including on-campus faculty members and program directors, on-campus preceptors, off-campus preceptors, and third- and fouth-year AuD students. 

Rupa Balanchandran of the University of the Pacific described building a new three-year AuD program that emphasizes competency-documentation of progress in student clinical education. Hannah Sibert of the University of North Carolina–Chapel Hill discussed her program’s use of formative and summative simulation for clinical preparation. 

Preceptor presentations followed. Gail Whitelaw of Ohio State University and Nancy Nelson of Indiana University represented the on-campus perspective. Gail offered considerations for a competence-ladder model, pointing out that students may enter clinical experiences with “conscious competence” while aspiring to achieve “unconscious competence.” 

Off-campus preceptors Tracy Swanson, who coordinates the clinics at a Charlotte Ear, Nose, and Throat Associates in North Carolina, and Dave Zapala, of the Mayo Clinic Jacksonville, provided a real-world perspective on AuD student readiness for clinical practice. Tracy gave recommendations for how students can stand out in the interview process, and Dr. Zapala identified three important components of student readiness:

  • Understanding nonverbal communication by patients, recognizing that audiology is just as personal as it is technical
  • Communicating concisely 
  • Acknowledging risk

Panel presentations concluded with student perspectives on the practical challenges of making the transition from clinical learning to clinical practice. Riley DeBacker, a third-year AuD/PhD student at Ohio State, listed the limited opportunities for students to practice specialized clinical skills and to access specialty practice experiences. He also commented on the lack of standardization in supervision, gaps in education, and the difficulty in differentiating oneself from another student in the externship application process. Hannah Sawher of the University of Wisconsin noted that AuD students may lack the confidence necessary to practice independently at graduation.

Working Group Discussions

Next, all audiologists attending the Clinical Education Forum engaged in roundtable discussions focusing on one or more topics related to AuD student readiness for clinical practice. The five themes and a selection of the main points discussed are as follows:

  1. Educational challenges in readying students for clinical practice
  • Need for consistency of competency-based assessment
  • Balancing academic freedom with consistency across programs
  • Use of simulation and on-site clinics versus off-site clinical rotations
  • Perception of in-house clinic education versus off-site clinic rotations 
  1. Critical review of student readiness for different clinical services 
  • Problem with externship supervisors not grading appropriately to be “nice”
  • Need for distinct check points for competency assessment to allow time for remediation
  • Consistent feedback to offer encouragement and growth is lacking
  • Lack of clarity about the role of the research capstone supplement to build on clinical skills
  1. Role of university in readying students for clinical practice
  • Accreditation can drive accountability in programs
  • Academic programs have let go control of the externship
  • More precise definition is needed of expectations for programs to prepare students for clinical experiences
  1. Role of off-campus sites in readying students for clinical practice
  • Insufficient communication by programs of expectations for clinical placements
  • Lack of consistency in supervision skills of preceptors
  • Inconsistency in AuD student evaluations
  1. Solutions for improving student readiness for clinical practice
  • Instill in students the ability to think about the patients’ perspective
  • Use standardized patient clinical practicum 
  • Offer case-based exams and internal clinical experience to assess readiness 
  • Provide supervisor training to increase comfort in the evaluation role and to help standardize student assessment

Call to Action

At the 2018 Clinical Education Forum in Nashville, we clearly identified or refocused on specific problems in AuD clinical education. Actually, some of these problems have been discussed repeatedly over the years. There is general consensus among those involved in AuD student education that we don't need more discussion...we need action. 

Conclusion

ACAE will again co-sponsor the Clinical Education Forum at AAA 2019 in Columbus, Ohio. The main focus there, building on the outcome of the most recent forum, will be practical strategies to address specific weaknesses or challenges in clinical education of AuD students. The scope of challenges and limitations in AuD student clinical education may seem insurmountable, yet we must start somewhere. Step by step, strategy by strategy, we can make a difference. 

In collaboration with CAPCSD, ACAE has started planning for the Clinical Education Forum next year. We will use this column in the months ahead to share our plans with the audiology community. In the meantime, we encourage anyone involved in the education of doctor of audiology students to offer suggestions and to participate in the fourth annual Clinical Education Forum.