A majority of my life has been spent in pursuit of education; however, now I am seeing that chapter quickly coming to an end as I finish my second year of the master of science in audiology program at Queen Margaret University, Edinburgh, Scotland.
With dissertation hand-in dates looming, I have taken time to really reflect on my experience as an international audiology master’s student amid a global pandemic. It has definitely been a learning curve—navigating differing registration processes, and the U.K.’s National Health Service (NHS) can be confusing at times—but I now have the foundations I need to be a good clinician and to start my career.
My Path to Audiology
In my fourth year (of undergrad) at the University of Toronto, I took a course taught by an audiologist and was thus introduced to the field. Until then, I had no idea the area even existed. In one of the lectures, she invited a panel of colleagues to discuss the different job opportunities within the larger field. After learning about the work undertaken by a pediatric audiologist, something clicked; the combination of using continuously developing technology and employing a multitude communication tactics gripped my attention. It was that class that made all the difference.
At the same time, I was trying to figure out what to do after graduation. I considered taking some time off to travel. My grandmother was born in Scotland and left to move to Canada when she was five years old, and I had always wanted to investigate where my family came from. While planning the trip, I stumbled upon the master’s of science program in audiology in Edinburgh. It felt too good to be true. With a lot of encouragement from my family, I filled out the application.
The program focuses on clinical experience, providing students with extensive hands-on training, both on campus in the labs and in the field on clinical placement, and enforced through theory and problem-based learning in lectures. Everything fell into place, and I started the program in September 2018. I feel like I am right where I am supposed to be.
Audiology in the United Kingdom (UK)
Moving to a new country can be daunting. On top of all the other social changes, I had a lot to learn about how audiology services are delivered in the United Kingdom. There are generally two recognized streams in which audiologists can work, the NHS and the private sector. There are a number of ways to be qualified as a hearing-care professional, such as a higher education certificate or a foundation degree, which would allow an individual to register with the Health and Care Professions Council (HCPC) as an associate audiologist or hearing aid audiologist.1 Additionally, there are undergraduate programs that allow graduates to practice as audiologists, though this pathway is only recognized domestically. I chose to apply to the master’s program as the graduate degree would give me the flexibility to work outside of the United Kingdom as well. After completing the master’s degree, there is a further option to apply to a three-year training program to register as a clinical scientist.
These courses are generally undertaken by those who have previous, relevant experience and allows them to test hearing, prescribe, and sell hearing aids without medical referral.2 Private dispensers largely work with those experiencing age related hearing loss, and if there are contraindications, can refer patients back to their general practitioner to be seen by the NHS.
Registration with the Register Council for Clinical Physiologists (RCCP) is necessary to work in the NHS as a clinical audiologist.3 Qualification for this title typically involves a master’s of science degree or a post-graduate diploma (PGDip) in audiology. Students enrolled in these programs generally do not have previous audiology experience but have completed a relevant undergraduate degree or equivalent. Audiologists in the NHS will treat patients with hearing loss, provide rehabilitation services, and assess and treat balance disorders.4
Master of Audiology Program
The master of audiology program that I have undertaken trains students to work as clinical audiologists. We are required to complete 2.5 years of instruction, which is inclusive of a dissertation module.
The structure of the placements allows students to obtain almost 1,200 hours of clinical experience.5 Practical instruction largely takes place in off-campus clinics, where each student has a logbook to complete with their respective supervisor.
Placement began on a part-time basis within the first semester of the course. Direct supervision is eased as students progressed, with the aim of the final placement being to encourage independent work. I was responsible for my own patient list for all three of my placement blocks, which allowed me to be very well prepared for the final clinical exam.
Students must be able to demonstrate their ability to take patient history, conduct and interpret audiometric and impedance assessments, and efficiently fit hearing aids to the British Society of Audiology (BSA) guidelines.
Knowledge and safety measures are assessed throughout placement and are graded during the final examination. Students must also at least participate in pediatric and vestibular assessment and rehabilitation, though it is not necessary to be signed off as fully competent in vestibular studies.
In the United Kingdom, there are very few vestibular centers and it is expected that expertise in the field will be gained through further on-the-job training. We are taught some techniques that may be used in tinnitus management and introduced to advanced audiological assessment tools for pathologies such as auditory processing disorder.
The department I was working in had the capacity to refer directly for magnetic resonance imaging (MRI) when deemed necessary, and I was able to learn from specialist doctors in the ear, nose, and throat (ENT) and neurology departments.
Completion of practical hours qualifies students for a certificate in clinical competence (CCC). I benefited from working closely with the pediatric team while on placement, which still piques my interest greatly and is the area I intend to focus on during my career.
A person-centered approach is the foundation of all instruction, which I feel has really shaped who I am as a clinician. Students are encouraged to use available technology to assist patients’ rehabilitation, instead of assuming that hearing aid prescription is the only treatment option.
During my short time in practice, I have found that the development of this relationship within a multidisciplinary team is extremely beneficial for patient rehabilitation and adjustment to life with hearing aids.
NHS Hearing Health Care
While the NHS provides free hearing care services—including the prescription of hearing aids—the cost of long waiting lists may be the price.
More invasive otologic services, such as cerumen removal, are not within the remit of NHS audiologists. Additional training is required, generally delivered through a two- to three-day intensive presented to already accredited hearing-care professionals who are instructed by ENT consultants or doctors of audiology.6
Many private sector hearing-care providers offer this service, and ENT departments may have a practice nurse trained to treat patients. In the department I worked in, for example, should a patient have trouble getting an appointment or be unable to pay out of pocket for private cerumen removal, we could directly refer to the ENT practice nurse for treatment.
I have learned first-hand that waiting times are always a challenge where health care is not privatized. While these wait times may vary depending on the area, NHS Lothian—an area covering over 700 square miles—currently reports approximately 8 months waiting time for routine wax removal by microsuction.7
These wait times are like those for assessment. In my personal experience, time between direct referral for hearing assessment to first hearing aid fitting was approximately 6-8 weeks. NHS Lothian currently reports the 90 percent of adult outpatients will be seen at the ENT department within 35 weeks of referral; for pediatric patients, the wait is approximately 42 weeks.8
Comparatively, private dispensers sport much shorter wait times and are attractive because they may offer a wide range of hearing aid models. Essentially, there is not one straightforward path patients can take to receive audiological care. While it can be difficult to navigate all of the options, the outlets available theoretically prevent any citizens of the United Kingdom from going without assistance when needed.
The Challenges of COVID
Service delivery in the United Kingdom has been complicated with the onset of COVID-19. In fact, a lot of changes have had to be made in clinics due to the nature of the job and consistently being in close quarters with patients.
Like many other health services, a telephone triage system has been put in place to screen patients and provide remote treatment where possible. Hearing aid repairs and battery replacements have been conducted through the mail; some NHS health boards have hearing aids on contract that the fitting software allows for acoustic adjustments to be made wirelessly through an app at the patient’s request.9
With the constant advancement of technology and after working with patients every day, I appreciate the role the audiologist plays in facilitating communication, rehabilitation and the impact that has on patients’ overall wellbeing. But will there be changes made to service delivery? Will we start to see telehealth appointments carried out more routinely?
While it is fortunate that we can provide services in this format, as a new audiologist, it instills a sense of anxiety in terms of job security. There is no way to know for sure what audiology in the United Kingdom will look like when the threat of COVID-19 has cleared, but it is my hope that the rehabilitative aspect of face-to-face appointments is not overlooked.
Looking forward, I am excited to see what the future holds for my career and for audiology. Technology is advancing all the time, and the students at Queen Margaret are constantly being encouraged to explore new ways and methods of delivering quality care to patients.
I am now beginning the process of applying for Canadian equivalency for when it is time to leave the United Kingdom.
Moving to the United Kingdom has taught me to be flexible and to have patience. I have learned so much from having the opportunity to complete my master’s in a place where service delivery takes on a different form, and where there is an abundance of opportunity to learn from practical experience.
Regardless of where I am in the world, my goal is always to put my patients first. I hope to continuously build on my skills as a clinician. There is, of course, always more to learn, but studying to be a clinical audiologist in the United Kingdom has given me the foundation I needed to get started.