News Bytes

Making the Most of Your Virtual Conference Experience

Making the Most of Your Virtual Conference Experience

AAA 2021 Virtual, April 14-16
Presenting Sponsor: Starkey

Samantha Ramirez, AuD, is a clinical audiologist at Kaiser Permanente in Northern California. She is the committee chair for the Academy’s New Professionals Committee and committee member of the Academy’s Nominations Committee.

Everything has changed since the onset of the COVID-19 pandemic, including the way we attend conferences and professional events. I am grateful that the Academy and other professional organizations are continuing to offer educational content, networking, and the expo hall virtually and safely.

I am reminiscent of the small experiences from past in-person conferences, like wearing my lanyard badge, flipping through the pages of a printed program, and running into old classmates and colleagues in the halls of a convention center.

Even though we cannot meet face-to-face this year, there are several ways to make the most out of your AAA 2021 Virtual conference experience.


Ergonomics

In the days of in-person conferences many of us would pack comfy back-up shoes, the alternative to this in a virtual setting is good ergonomics. A quiet, bright space with a supportive chair, desk table, and laptop/computer is optimal for your work from home and virtual conference experience. Make sure to take breaks between sessions to move your body, stretch, and give your eyes a rest. Check out this article from the BBC How to work from home - comfortably.


Giving Back

The cost for an Academy Member to attend AAA 2021 Virtual is $299. For two and a half days of educational content, this is a great deal! The cost of an in-person conference racks up very easily due to travel, lodging, food, and drink. Consider registering and attending the PAC Wine-Tasting event for $50 or AAA Foundation's Trivia Night (sponsored by Signia) for $40. Learn more about the PAC and the AAA Foundation and how they are directly impacting and advancing our profession.


Networking

You can still meet-up with colleagues and build professional relationships in the virtual setting. Check out the list of Interactive Lounges, which highlight nine different topics and areas of interest. Follow @AAA_Conference (Twitter), @aaa_conference (Instagram), and @AAAConference (Facebook) to get important updates about the conference. Tag these handles in your posts to show your enthusiasm for AAA 2021 Virtual! For the busy attendee who cannot always follow social media, sign up for SMS alerts, msg&data rates may apply.


Exhibit Hall Freebies

Will you miss going booth to booth collecting pens, lip balms, and other useful, but branded gadgets? Check out the virtual exhibit hall and collect points as you visit each exhibitor to earn curated prizes! There will be 75+ exhibitors to interact with during these times, Wednesday, April 14: 12:00–4:00 pm; Thursday, April 15: 11:30 am–6:00 pm; Friday, April 16: 10:00 am–3:30 pm.


New Professionals Committee Learning Module

Traditionally, our committee hosts the popular “Speak Up, Speak Out” session where new professionals come together for stimulating conversations surrounding topics pertinent to early-career audiologists. For AAA 2021 Virtual, we prepared a CEU-approved session, Avoiding Burnout Through Student Loan Management. This session will be held on Friday, April 16, 2:15-2:45 pm. We will be breaking down the signs of workplace burnout and how student loan repayment plans or forgiveness can aid in a fulfilling and comfortable career.

Join Us!

OPINION EDITORIAL: Providing Services for “Unbundled Devices”

OPINION EDITORIAL: Providing Services for “Unbundled Devices”

Recently, our clinic ran into a situation regarding a previous patient wanting to have his new devices serviced. He was fit with hearing aids at our clinic a few years ago and asked our front office staff if he could see an audiologist to service his new devices. The immediate issue was that he purchased the devices outside of our clinicspecifically devices purchased online. We did not have the opportunity to discuss the patient’s concerns further because he left after being advised of our current clinic policy: we do not service devices purchased online. I am newer to the clinic and was not made aware of this policy. However, this situation did make me want to reevaluate this policy and determine if it is worth changing.

Most of us should be familiar with Bundled vs. Unbundled service models; designating audiological services included in the purchase of devices (Bundled) versus purchasing the devices and paying for services as needed (Unbundled). I have seen different models where services might be available up to one year following the fitting date, throughout the warranty period from the manufacturer, or even the lifetime of the device.

This is not a discussion about the future of over-the-counter (OTC) devices and how our profession should navigate this topic. We can and should be forward-thinking about how audiology will change over time, but we also need to be proactive as we encounter patient concerns in the present. I’d like to discuss how we handle, and more importantly, serve patients coming in with “non-traditional” devices that they did not purchase directly from us. I am going to refer to these devices as “Unbundled Devices.” Unbundled Devices may include, but are not limited to the following:

  • Personal sound amplification products (PSAPs) and “Hearables”
    • Pocket talkers
    • Bluetooth-enabled earpieces
    • Over-the-ear amplifiers
  • Hearing Aids fit at another clinic
    • Previous clinic closes
    • Patient relocates to a new city/state/country
  • Hearing Aids previously worn by a family member or friend
  • Over-the-counter devices (OTCs)

While the list above may appear daunting, it can also be viewed as opportunity. As audiologists, we have the tools and knowledge to educate our communities and provide services, regardless of what someone is coming to us for. During hearing aid consults, we have all heard patients say, “well, you’re the expert” or “what do you think is best?” Individuals with communication difficulties are coming to us for guidance and we have to step up and lead them in the right direction. We have the chance to show our value as healthcare providers and remind the general public who audiologists are and what we do. 

Lastly, I want to provide practical ways audiologists can continue to serve anyone walking into the clinic:

  1. Hearing Aid Consult. Following a comprehensive examination, we can then discuss the results and educate the patient. We can determine the degree of hearing loss and identify if medical evaluation is needed.
  2. Check and Clean. At the very least, we can make sure the device is working.
  3. Re-programming. Confirm with the manufacturer and have the device re-issued under the individual you are seeing. If the device is appropriate for the hearing loss, go ahead and program.
  4. Real Ear Measures (REMs). If available, run REMs as a conformity evaluation, especially on devices that we are unable to program. Again, this could really be an educational opportunity for the patient.

None of these services are new and innovative ideas. The difference is that we are expanding our services to everyone, not just the individuals whom are ready to purchase new hearing aids. This is a proactive approach, giving us a chance to build rapport with a new patient population. Implementing services for unbundled devices will look different across clinic settings, but the idea should at least be considered by all audiologists.

I am happy to discuss this in more detail and hear how your clinic is handling services for unbundled devices. Please contact me via email as needed: jasonbakeraudiology@gmail.com

Jason Baker, AuD

Disclaimer

This article represents the opinions of the author and not those of the American Academy of Audiology.

Professional Networking Outside of Audiology

Professional Networking Outside of Audiology

Individuals entering the workforce are often taught the value of professional networking early on in their university, college, or professional training program. Networking for audiologists is typically seen as attending professional conferences, continuing education, participating in research projects, joining or volunteering for the national or state audiology organizations. Professional networking is essential to audiology as it ensures the advancement of one’s career and the profession itself.

Networking is often the key to job offers and the quintessential, "It's About Who You Know" has some truth. However, networking is not simply about finding job opportunities. Audiology itself is a very small profession, and we are naive to believe that audiologists alone can move the profession forward.

Let’s think beyond the primary care physicians, otolaryngologists, and speech pathologists. Similar to the general public, many health professionals are unaware that audiology even exists. Creating collaborative relationships with other specialties will create a direct path to referrals and serve our patients better. The vestibular patients will have a physical therapist and optometrist. The patients suffering from memory loss or cognitive decline will have appropriate guidance and expectations from their psychologist. The pharmacist who now has OTC hearing devices at their store will have an audiologist he/she can refer patients to when they need more help with their hearing. How do we connect with these professionals? This type of networking can be easier when working for a larger health system or medical center. You can start by attending employee events like lectures, lunches, town halls, or leadership meetings. For the smaller clinic or practitioner, research the specialties in your area - contact those offices to meet for coffee or invite them to your office.

Who are better advocates for audiologic services than the patients receiving those services? Many clinics utilize patient testimonials, reviews, and referrals, but actively playing a role in the local community, not only increases clinic visibility, but allows audiologists to create dialogue and ask for these patients to become our advocates. Many audiologists provide consumer content by publishing podcasts, blogs, online videos, and coordinating aural rehabilitation groups. These tools help spread awareness about audiologic care and as the general public learns about audiology, eventually they can be called to action to help support awareness campaigns and legislative efforts. Even small actions like your clinic participating in a local health fair or sponsoring a community sports team creates visibility for audiology.

Networking efforts always start with small acts. If we begin to think of every patient encounter, continuing education training, or staff meeting as a networking event, audiology visibility will grow and be seen as important to our legislators, leaders, and communities.

For information on different networking opportunities available through the Academy visit the networking opportunities web page

Thinking About Thinking: Discussing Bias Within Audiology

Thinking About Thinking: Discussing Bias Within Audiology

As audiologists, it is necessary that we are able to quickly obtain results and put together relevant clinical information to properly care for our patients. Reasoning through available information is an important part of our clinical decision making. How we base our decisions can impact our test procedures, the patient’s diagnosis, how their treatment plan is fashioned, referrals to ENT physicians or other allied healthcare professions, and how we decide to make use of resources that are available to us. It’s easy to imagine that in our day-to-day we are constantly bombarded by information in our environment. Sometimes we are able to sit down and deliberate each piece of information that’s available to us, but other times we make quick decisions and adapt on the fly. We take what snapshot of information we have available to us and apply some of our previous experiences. This problem-solving strategy called heuristics is what often allows us to come to a quick judgment. While heuristics are helpful in navigating the myriad of choices we have each day, that doesn’t always mean they are always correct. Using shortcuts can lead to poor judgment and in some cases, bias our decision-making potential.

What does this mean for us as hearing healthcare professionals? If we as audiologists don’t challenge the heuristics that guide our decision-making, our cognitive bias may lead to ineffectiveness and poorer health outcomes for our patients. While there are many types of cognitive bias that have been well-studied in psychological research, it is important that we make ourselves aware of potential pitfalls so that we can become better clinicians. Below is a table adapted from Schlonsky et al. (2019) that looks at a few that are commonly documented in the medical field.

Cognitive Bias

Definition

Affective

Tendency for a decision to be influenced by affective states (e.g., emotion, feelings, etc.)

Anchoring

Relying excessively on an initial piece of information (i.e., the “anchor”) to make subsequent judgments during a

decision-making process

Ascertainment

Shaping a decision or judgment based on a prior expectation

Attentional

Tendency for perceptions or judgments to be influenced by a person's recurring thoughts at that time

Availability

Making judgments about the likelihood of an event based on how readily examples come to mind

Confirmation

Tendency to search for, interpret, favor, and/or recall information that confirms an existing belief or hypothesis

Framing Effect

Being disproportionately influenced by how a problem is described (e.g., with positive or negative semantics)

Overconfidence

Tendency to think one knows more than one does, especially if placing faith in opinions without gathering necessary supporting evidence


Preventable medical errors are estimated to cost the US healthcare system $20 billion annually. Misdiagnosis in medicine has been explored in critically acclaimed texts such as To Err is Human: Building a Safer Health System, and How Doctors Think. Medical errors have also made it to the big screen in documentaries such as HBO’s Bleed Out (2018). In a recent analysis by Galvin et al. (2019) in the Journal of the American Academy of Audiology (JAAA), they found no peer-reviewed studies that look at strategies to reduce biases in the audiology clinic. Best practices continue to be a hot-button issue within audiology and is a topic that is often explored within our Academy. It’s a topic that is heavily researched and was likely emphasized throughout your educational coursework, one that is increasingly prevalent in social media, and one that our patients are continuing to be aware of as they walk through the doors of our clinic. While more research continues to explore this topic, what can we do in our day-to-day to help reduce cognitive bias and ensure we are sticking to best practices?

How can we start to address these issues as they pertain to the work that we do? First off, we should do our best to listen to the opinions of our coworkers and patients. Our intuitions are very useful, but not always 100% correct. Reminding ourselves about the importance of being open-minded and accepting that we are not always right is perhaps the first step in talking about potential bias that may be influencing our work. In a recent column in Signal & Noise by Brian Taylor,1 the following suggestions were made to help override our executive processes and avoid blind spots in routine clinical testing:

  1. Collecting a thorough case history and performing a comprehensive audiological assessment
  2. Using checklists to ensure that every step of the evaluation has been conducted
  3. Conducting all tests in a manner that reflects current bests practices
  4. Taking a diagnostic “time out” to review your work and ensure you are not missing details
  5. Reporting all findings with referring physicians, including when findings indicate a possible nonbenign condition
  6. Conducting meetings or grand rounds with staff to discuss challenging or unusual cases
  7. Using Big Data to build your own set of normative data for each test you conduct

More research needs to be done on how bias can impact other aspects of our scope such as hearing aid dispensing, vestibular assessment, and other special testing considerations within our profession. Take a moment to think about your own clinical practice and how you make quick decisions. Sometimes it’s a good thing for all of us to pause, stop, and consider how we think with ourselves and others, and walk through how we reach our clinical impressions.

Works Cited

  • Taylor B. Avoiding clinical blind spots with good audiology. Hearing Health & Technology Matters Web site. https://hearinghealthmatters.org/hearingeconomics/2017/audiology-clinical-blind-spots/. Updated 2017.
  • Groopman J. How doctors think. First Mariner Books; 2008.
  • To Err is Human: Building a safer health system. Washington DC: National Academies Press; 2000.
  • Shlonsky A, Featherston R, Galvin K, et al. Interventions to mitigate cognitive biases in the decision making of eye care professionals: A systematic review. Optometry and Vision Science. 2019;96(11):818-82 https://search.proquest.com/docview/2310675514. doi: 10.1097/OPX.0000000000001445.
  • Galvin KL, Featherston RJ, Downie LE, et al. A systematic review of interventions to reduce the effects of cognitive biases in the decision-making of audiologists. Journal of the American Academy of Audiology. 2019. https://www.ncbi.nlm.nih.gov/pubmed/31287054. doi: 10.3766/jaaa18096.

Additional Resources & Further Reading

  • Take a Quiz! There’s plenty of websites out there that will try to pinpoint what may be steering your decisions. This one only takes a few minutes.
  • https://www.ideastogo.com/articles-on-innovation/quiz-what-cognitive-bias-are-you
  • Quick Youtube infographic video on heuristics
  • https://www.youtube.com/watch?v=ReFqFPJHLhA
  • Hosford-Dunn H. Audiologists not immune to dunning-kruger effect. Hearing Health & Technology Matters Web site. https://hearinghealthmatters.org/hearingeconomics/2017/dunning-kruger-effect/. Updated 2017.
  • Saposnik G, Redelmeier D, Ruff CC, Tobler PN. Cognitive biases associated with medical decisions: A systematic review. BMC medical informatics and decision making. 2016;16(1):138. https://www.ncbi.nlm.nih.gov/pubmed/27809908. doi: 10.1186/s12911-016-0377-1.

 

Eric Bostwik, AuD is currently an Instructor and Clinical Audiologist at Temple University Hospital. He attended the University of Wisconsin-Madison for both his Doctorate of Audiology and Bachelor of Arts degree. His current clinical scope includes comprehensive diagnostic testing, vestibular evaluation, electrophysiological testing, and auditory rehabilitation (hearing aids and implantable devices).

Workplace Burnout

Workplace Burnout

The World Health Organization (WHO) has redefined burn-out in the new version of the International Classification of Diseases (ICD 11). Burn-out is a syndrome tied to “chronic workplace stress that has not been managed.” Burn-out is not classified as a medical condition but considers it an “occupational phenomenon” that can influence an individual’s health. The Harvard Business review reported that the problems of employees with burn-out cost up to $190 Billion a year in the US. What does this mean for a new professional, and how can it be avoided or managed?

WHO characterizes burn-out by the following: feelings of energy depletion or exhaustion, increased mental distance from one’s job, feelings of negativity or cynicism related to one’s job, reduced professional efficacy. It specifies that these feelings and behaviors relate specifically to the workplace and should not be applied to other aspects of life. Burn-out can result from multiple things: unclear job expectations, workplace dynamics, lack of control over things such as schedule or workload, monotony or high demand at work, feelings of isolation, poor work life balance. Many of these factors are not within the employee’s control, but there are things that a person can do to alleviate some work-related stress.

How can a person help avoid or reverse workplace burnout? First you should identify your strengths and weaknesses. Identify your passions, the things that make you excited about audiology; look at new projects that are engaging and interesting to break the rut.  Identify weaknesses that are holding you back from succeeding; would additional training or learning about new subject areas improve your daily workload.  Next, talk with your supervisor or manager; communicate your needs and discuss ways top relieve workplace stress. Develop partnerships with your coworkers; having someone to talk to about workplace stress is good for your mental health. Additionally, keeping good health habits can affect your daily attitude and mental health; make sure to get plenty of sleep, eat a balanced diet, and exercise regularly.  Finally, if you have done all of these things, and are still feeling burnout, consider a change; sometimes a workplace is just not a good fit.


Other Resources on Workplace Burnout:

 

Public Student Loan Forgiveness Program: How Does It Work and What Do You Need to Know?

Public Student Loan Forgiveness Program: How Does It Work and What Do You Need to Know?

Today, more Americans are burdened by student loan debt than ever before. Student loan debt affects new professionals across many professions, including audiology. There are many loan repayment options and programs available, but for many new professionals, the first time you learn about the options and programs is when you’re about to graduate and have to choose a payment plan. One program that has received some media attention over the past few years is the Public Service Loan Forgiveness Program, or the PSLF. Under the PSLF program, the balance of your loans are forgiven after you have made 120 qualifying monthly payments while working full-time for a qualifying employer. Pay attention to that very important word: qualifying. In order to be eligible for this program, you have to make a certain type of payment and work for a certain setting/employer.

So the question is, do I qualify for this program? First, let’s look at the type of monthly payment. A qualifying monthly payment is one that is made after October 1, 2007, is under a qualifying repayment plan, is for the full amount due, is no later than 15 days after the due date, and is made while employed full -time for a qualifying provider. Payments made while you are in school, during a grace period, in deferment, or in forbearance do not count. The qualifying payments do not need to be consecutive; however, you only receive credit for one payment per month. If you’re paying ahead, you cannot receive credit for a qualifying PSLF payment during a month when no payment is due. 

For the repayment plan type itself, only certain ones are eligible for the PSLF program. All of the income driven repayment plans will work, as well as the 10 year standard repayment plan. Be careful there, though. If you choose the 10 year standard repayment plan, you will have no loans left to forgive once you have made the 120 qualifying PSLF payments. 

The type of loan also matters for this program. Only Direct Loans are eligible for PSLF.  If you have Federal Family Education Loans (FFEL) or Federal Perkins Loans you can make these eligible by consolidating them into a Direct Consolidation Loan, but any payments made prior to the consolidation do not count towards the 120 required PSLF payments. If you have both Direct Loans and other loans and consolidate those types, you lose credit for any qualifying PSLF payments you made prior to consolidation. Additionally, the Standard Repayment Plan for Direct Consolidation Loans is not the same as the Ten Year Standard Repayment plan, and the payments made under the Standard Repayment Plan for Direct Consolidation Loans do not usually qualify as PSLF payments. Therefore you must be paying income driven payments if you have consolidated other loans into a Direct Loan.

In regards to employers, qualifying employers include government organizations at any level (excluding for-profit government contractors), 501(c)3 nonprofit organizations, and other types of nonprofit organizations that may not be 501(c)3 status if their primary purpose is to provide certain types of qualifying public services. These services include emergency management, military service, public safety, law enforcement, public interest law services, early childhood education, public service for individuals with disabilities or the elderly, public health, public education, public library services, and other school-based services. You also must meet the employer’s definition of full-time or work at least 30 hours per week, whichever is greater. Your employment can be certified by an official who has access to your employment records and is authorized by your employer. Typically this is someone in the HR department, but may be another individual with your department.

If you choose to apply for PSLF or are working towards PSLF, it is strongly recommended to complete and submit the Employment Certification for Public Service Loan Forgiveness form annually and any time you change employers. This form is used to track whether you are making qualifying payments and help determine if the type of payment you’re making needs to change. If this form is not submitted as stated above, when you apply for forgiveness after your 120 payments you will be required to submit this form for each employer where you worked during that 10 year or 120 payment period. Once the Employment Certification Form is received, it will be reviewed to ensure your loans and employment qualify for the PSLF program.  If your employer or loans do not qualify, you will be notified. If your loans and employment do qualify, the loans will be transferred to FedLoan Servicing if they are not already serviced by that group. FedLoan Servicing will determine how many qualifying payments you have made and how many you still need to make to achieve loan forgiveness. This number will be updated every time you submit another Employment Certification Form.

After you’ve made your 120th qualifying payment, you will need to submit the PSLF application to receive loan forgiveness. You must be working for a qualifying employer when the application is submitted and at the time the remaining balance is forgiven. Loan amounts forgiven under the PSLF program are not considered taxable income, so you do not have to pay federal income taxes on the amount that is being forgiven.

The first round of participants were eligible for repayment in 2017, and in December 2018 the Department of Education revealed that only 1% of the 54,000 borrowers who have applied for loan discharges were approved. Many rejected applicants did not make qualifying payments or did not work for qualifying employers during the entire 10 year repayment period. In 2018, Congress passed a $700 million temporary fix, forgiving the loans of some rejected applicants who entered the wrong income-based program, but this did not solve the dilemma of all rejected applicants. Currently, it is unknown whether the program will continue to exist. The elimination of the program for new loan borrowers has been proposed and would begin in July 2020. 

For more information, you can visit the Federal Student Aid website. There are many resources available to assist in the process of deciding whether or not you’re eligible for PSLF and whether or not you’re interested. As there are many nuances for this program, make sure to verify all of the details; type of loan, type of payment, employer, etc. 

Kathryn Makowiec, AuD

Social Media Usage of Hearing Loss Patients

Social Media Usage of Hearing Loss Patients

Facebook, Twitter, and other social media platforms have infiltrated nearly every aspect of daily living; healthcare is not an exception. According to the Pew Research Center (2018), “some 88% of 18- to 29-year-olds indicate that they use any form of social media.  That share falls to 78% among those ages 30 to 49, to 64% among those ages 50 to 64 and to 37% among Americans 65 and older.”  Although this statistic would indicate whether your patient is more or less likely to utilize social media depending on their age bracket, the clinician should also consider the patient’s caretaker and their social media usage. Therefore, it is beneficial to inform yourself of your patient’s online behaviors to better understand their needs and perspective. Two of the most influential social media platforms in healthcare are Twitter and Facebook. Twitter was designed to present short blurbs of information. Facebook can contain more content and has more intricacies including “Pages” and “Groups”. According to Facebook, Pages were designed to be the official profiles for entities, such as celebrities, brands or businesses. Facebook Groups are the place for small group communication and for people to share their common interests and express their opinion.

There are three recent articles specifically related to hearing loss patients and social media. Saxena et al. (2015) investigated social media usage of cochlear implant recipients and their families. Choudhury et al. (2017) utilized a similar study design to investigate usage in hearing aid patients and their families. These articles gathered data about patient’s behaviors on social media sites. Overall, they found social media is often used for sharing advice and offering support (Choudhury et al., 2017). Twitter and Facebook Pages are the most-used medium by hearing aid and cochlear implant “service providers” (manufacturers, dispensers, healthcare providers) (Choudhury et al., 2017 and Saxena et al. 2015). Facebook Groups are most commonly used by hearing aid and cochlear implant users. The authors report frequently discussed topics are hearing aid prices and reasoning for discontinuing hearing aid use. Additionally, Facebook is the most-used medium for brand discussions for cochlear implant manufacturers (Saxena et al. 2015). One of the limitations of these studies is they were unable to include data from “private” Facebook groups- groups that require approval by a member to join. Therefore, some of the data may be skewed to the information that is publicly available.

When working with your patients, it is important to keep in mind that they may be part of these groups and receive information and advice from fellow users on the internet. Although it may not be apparent in your visits, their decision-making regarding device use, device manufacturer, follow-up, etc. may be influenced by things they have read online. One of the benefits to social media is you can direct your patients to various Facebook groups and Twitter pages if they are looking for a support network but are unable to join an in-person group. One future direction for research could be an investigation into the positive effects of a social media participation for people with hearing loss on their mental health and well-being.

The third article, O’Brien et al. (2019), investigated misinformation presented online to tinnitus patients. They looked at Facebook Pages, Facebook Groups, Twitter Accounts, and YouTube videos. Below are the percentages of misinformation in each category.

  • Facebook Pages: 42.7%
  • Facebook Groups: 13.5%
  • Twitter Accounts: 34.6%
  • YouTube Videos: 21.5%

Although there is a high percentage of misinformation regarding tinnitus present in social media, in particular on Facebook Pages, O’Brien et al. (2019) notes there are other categories present within these social media platforms. 59.5% of the information in public Facebook Groups was categorized as “support group”. Therefore, patients should not necessarily be dissuaded from utilizing social media groups, but clinicians should be prepared to discuss misinformation with their patients.

Overall, social media can be a useful tool for patients to find information, connect with peers, share their stories, and find providers.  There are some downfalls to using social media which include misinformation and subsequent changes in patient compliance, follow-up, or commitment to the treatment plan. Audiologists should be aware of both the benefits and challenges that are present and be prepared to address them in the clinical setting.

References

  1. Choudhury, M., Dinger, Z., & Fichera, E. (2017). The utilization of social media in the hearing aid community. American Journal of Audiology, 26(1), 1-9. doi:10.1044/2016_aja-16-0044.
  2. O’Brien, C., Deshpande, A.K., & Desphande, S. (2019). Tinnitus awareness and misinformation on social media. The Hearing Journal, 72(1), 18-21.
  3. Pew Research Center (2018). Social Media Use in 2018. Retrieved from: http://www.pewinternet.org/2018/03/01/social-media-use-in-2018/.
  4. Saxena, R.C., Lehmann, A.E., Hight, A.E., Darrow, K., Remenschneider, A., Kozin, E.D., Lee, D.J. (2015). Social media utilization in the cochlear implant community. JAAA, 26(2), 197-204. doi: 10.3766/jaaa.26.2.8.


Emily Jo Venskytis, AuD, UPMC Children’s Hospital of Pittsburgh

Implementing New Clinical Services

Implementing New Clinical Services

Jason Baker, AuD

Although this entry is intended for new professionals, the message and the information provided is actually applicable to all audiologists. As a new professional, I would like to share my experience as it pertains to ear canal management.

As we all know, in order to perform the majority of audiological assessments, the ear canal(s) must be free of debris. In a study looking at the effects of cerumen occlusion on pure-tone thresholds, the authors report a prevalence of cerumen occlusion in 10% of children, 5-8% of adults, 34-57% of elderly adults, and 22-36% of those with developmental delays (Roeser et al., 2005). When we are faced with an occluded ear canal, we have two options:

  1. Perform cerumen management OR
  2. Send them out the door (PCP, ENT, Otologist, etc.).

Many state licensing boards do not allow audiologists to perform cerumen removal. According to the American Speech Language Hearing Association (ASHA), twenty-two of the fifty U.S. licensing boards allow audiologists to perform cerumen management. However, in some settings, it may be “easier” or the protocol is to send the patient to the ENT or otologist for a “quicker” removal. Rules and regulations on who can perform ear canal management is an entirely different conversation.

I am interested in hearing from audiologists that recognize the need for ear canal management, are allowed to perform cerumen removal under the scope of practice in that particular state, but do not perform the procedure. I am curious to know the reasons why some audiologists simply are not performing ear canal management. Reasons I’ve heard include:

Charging for Services:

  • Does the audiologist not want to charge the patient for these services? – At the very least, the patient should be made aware that the removal procedure may not be covered by insurance if performed by an audiologist. Dr. Kim Cavitt (2011) states that if the patient has Medicare and does want the cerumen impaction resolved, an Advance Beneficiary Notice (ABN) can be submitted and the patient can pay out-of-pocket. Some patients might actually prefer to have the procedure completed at that point and time and are willing to pay for it.

Duration of Services:

  • Does the audiologist think it will take too long? – Is it quicker and easier to send the patient over to ENT if the physician is down the hall? What if it would be a quick removal? According to the American Academy of Otolaryngology (AAO) Clinical Practice Guideline, it should take less than 5 minutes to instill cerumenolytic drops, less than 30 minutes for irrigation removal (including prep time), and only a few minutes for manual removal (Schwartz et al., 2017).

Confidence in Skills:

  • Throughout clinical training, is there limited exposure to and practice of cerumen removal?

The last question is what I am going to continue focusing on. Just like any skill, practice makes perfect. In the classroom, I was provided with knowledge regarding various ear canal management techniques. In clinic, I had some opportunities for ear canal management, but it was usually dependent on the setting and the comfort of the preceptor. In addition to regular clinical rotations, I was able to further develop my cerumen removal abilities while on various humanitarian trips to South Africa and Brazil. In these instances, the need was there and if we were not going to perform removal procedures, no one was.

When I began my job at the Callier Center for Communication Disorders, which is affiliated with UT Dallas, I knew there was a need for an Ear Canal Management (ECM) Clinic. I knew this would greatly benefit the local community and the graduate students participating. For the most part, none of the attending students had any previous experience with cerumen removal – mechanical or irrigation. However, even after a half day in the ECM Clinic, the students reported increased confidence in their cerumen removal abilities. I know one day in clinic will not make someone an expert, but when it comes to cerumen management, it is necessary to build-up confidence in this particular skill. The idea is to continue providing hands-on experience to graduate students and to increase their exposure to cerumen removal. For many of us, cerumen removal is a necessary procedure that we are allowed to perform. Ear canal management is an important part of audiology and as a profession, we must ensure that it is a skill that is implemented clinically and taught to future audiologists.

References

Roeser, R., Lai, L., & Clark, J. (2005). Effect of ear canal occlusion on pure-tone threshold sensitivity. The Journal of the American Academy of Audiology, 16: 740-746.

American Speech Language Hearing Association (2019). State Cerumen Management Requirements. https://www.asha.org/Advocacy/state/State-Cerumen-Management-Requirements/#TX

Cavitt, K. & White, S. (2011). Billing for cerumen removal under medicare. AudiologyOnline, https://www.audiologyonline.com/ask-the-experts/billing-for-cerumen-removal-under-40

Schwartz et al. (2017). Clinical practice guideline (update): Earwax (cerumen impaction). Journal of Otolaryngology – Head and Neck Surgery, 156(IS): S1-S29.

CEU Breakdown: Tips and Tools to Track CEUs

CEU Breakdown: Tips and Tools to Track CEUs

For many new professionals in the field of Audiology, continuing education hours seems to be a frequent source of confusion. How many do I need? Are CEUs different for licensure and membership to professional organizations? Is there anything out there that can make keeping track of all of this easier? Often, these questions are not answered as a part of an AuD program because, let’s face it, it’s difficult enough to get in all of the information needed just to see patients independently and successfully. There often is not much time left to discuss what happens AFTER graduation and how to keep up with your licensure, certifications, and professional memberships.

Fortunately, both the American Academy of Audiology (AAA) and the American Speech, Language, and Hearing Association (ASHA) provide information about CEUs on their websites, as well as options to track the hours you earn through conferences, webinars, etc. Information about AAA’s CEU policy can be found within AAA's professional development resources and information about ASHA’s CEU policy can be found on ASHA's continuing education web page. For additional tips and tools, refer to The New Professionals Guide to Continuing Education.

First, let’s start with the Academy. Through AAA, there are no set CEU requirements to maintain membership. However, the American Board of Audiology (ABA) requires 60 CEU hours in a 3-year period, with 15 Tier 1 CE hours and 3 hours in professional ethics, to maintain certification status. Tier 1 CE hours have a few requirements: 1) approval by AAA, 2) a minimum of 3 hours (one 3-hour sitting or two 1.5-hour sittings) on the same subject area, 3) include an interactive component (i.e., polling or clinical demonstration), and 4) participants need to indicate to the CE Provider that they are ABA certified and are seeking Tier 1 credits. Visit the ABA's web page for more information.

If you are a member of AAA, you are automatically given access to a CE Registry at no additional cost. The registry stores and organizes all reported CEU activities from Academy approved CE providers and also indicates if ABA Tier 1 hours have been earned. The transcript can be obtained two different ways. It can be printed from online through your member profile or you can complete a Transcript Request Form and have a transcript dated back to 2012 mailed or faxed to you. A transcript older than the past two years can be requested this way and costs $10 per calendar year requested. If you are not a member of AAA, don’t fret!  You can still obtain CEU hours through AAA if you join the annual CE Registry, which costs $60 per year. An AAA CE Transcript meets most state licensure regulatory requirements.

AAA additionally offers ways to obtain CEUs other than by attending conferences or watching webinars. One of these is through the completion of an independent study, and the other is through the Peer-to-Peer Mentoring Program. More information on how to set up either of these options, how to apply, and the cost can be found on the Academy website.

Now, on to ASHA. ASHA requires a minimum of 30 CEUs every 3 years to maintain certification. These hours must be tracked on a Compliance Form to be submitted on or before 12/31 of the year the interval is completed (i.e., the end of the 3-year period), but the hours can be submitted any time within the 3 year interval. In order to obtain ASHA CEU’s, you need to attend a course registered for ASHA CEUs and fill out the ASHA participant form.

Like AAA, ASHA also offers a CE Registry. The annual cost of the ASHA CE Registry is $28 if you are a member, and $38 if you are not. If you have the ASHA CE Registry, it automatically notifies the certification department when you have reached 30 hours; no need to submit a Compliance Form. Additionally, you can view your CE Transcript online at any time and you can request an official transcript. You are entitled to one free transcript each year you pay the CE Registry fee, and any additional transcripts are $15 for members and $20 for non-members.  You can sign up for the CE Registry when you renew your ASHA dues annually, online, by phone, or by mail. An ASHA CE Transcript meets all state licensure regulatory requirements. If you have your CCC’s and are ever audited in regards to your certificate maintenance, your ASHA CE Transcript will be considered proof of attendance for the 30-hour requirement.

When it comes to required hours, maintenance period, and costs associated with state licensure, every state is different. If you are unsure of what is required for your specific state, we encourage you to visit your state’s website and verify what you need in how many months/years.

 

 

Flying Solo After Graduation

Flying Solo After Graduation

Nicole Denney, AuD

When I accepted my first job following my externship year, I knew I was in for a very sink or swim life change. I accepted a position in a private practice as the sole provider in a new city right after graduation. I’d have my own office, my own PCC, and all the patients and responsibilities of managing an office would land on my shoulders. However, this is not all that unique in our profession. Many recent graduates choose to start out in a more independent setting rather than a multi provider office. After working at my current practice over a year now as the only provider, I’d like to share some advice on how to swim rather than sink when starting out on your own.

Before you accept, make sure this is right for you. Do a fair amount of soul searching, list making, and talking with mentors. I was fortunate in that my externship experience provided me with a great sense of the type of environment I’d be working in; we were part of a large practice group with typically only one audiologist and one PCC at each location. Knowing how to run an office and manage your schedule is very important and something we don’t exactly learn in school. For me, I spoke to other friends who started out on their own as a first job. They were able to give me a lot of honest pros and cons and it really helped me determine if this was something I could do. Likely, if you are thinking about taking a job being the sole provider, you know someone who has already been through this and would be willing to talk with you about the experience. 

Always have someone you can ask for advice. This was very important to me during my interviews for all jobs. I wanted to make sure that even though I would be 60 miles from the closest practice in our group, I could still call on other audiologists if needed. And let me tell you – I did need this, especially in the beginning! My corporate office is in Lubbock, Texas, and I’m all the way out in Southern Colorado, so there is a huge distance between us. However, I can always call or email the main audiologists there and they get back to me within the day. Besides that, I also use my mentor/externship supervisor for advice when I need it. It was very important to me to be able to talk to someone within the company when needed and also to get an outside opinion. This way, when I first started out in my office, I didn’t feel completely alone, but I also didn’t feel like someone was watching me or holding my hand. It made me really own up to who I am as a provider and still have that comfort of a safety net.

Which leads me to my next point – you have to own it. Being a 26-year-old doctor fresh out of school, we tend to look like our patient’s grandchildren. While the “wow you are so young” comments can throw you off, just remember you know your stuff! Holding yourself to a higher level of professionalism and making honest and educated recommendations and treatment plans for your patients will get you far when you are just starting out on your own. Being on my own actually gave me more confidence that I could not always find in my externship. Decisions are now mine and I know the reasons for why I’m making them. It’s a mental game that personally worked well for me.

While I made sure I still could call on other audiologists through my practice group for advice, I knew in advance it would be hard to not see and regularly discuss topics with peers. For this reason, I chose to involve myself more with the Academy by applying to be on the New Professionals Committee. There is a plethora of engaging committees within the Academy that are always looking for new members. This gives me a connection to collogues with similar interests and a fun way to stay invested. Another way is to become more involved with your state academy group! This one is a little harder for me personally due to where I live but I know they have in person meetings and that the Colorado Academy of Audiology is planning a really impressive conference this year! Being involved at the state level can connect you with audiologists in your area and lead to a rewarding experience.

I am very content and happy with my choice to work in a private practice as the only provider. If you are considering a similar choice, I’d be more than happy to discuss the pros and cons about my own experience. You can contact me via email at ndenn511@gmail.com

We are not the only profession to have new graduates start out solo. A similar advice article was written for law professionals and published on Americanbar.org. The part that I found most influential was, “you are more qualified to practice law than you give yourself credit for.” Same goes for audiology. You know way more than you think you do, and your patients are coming to you because YOU are the expert.