Since the creation of the AuD, many conversations have taken place to evaluate audiology education and the externship, but few of those have included large perspectives from significant stakeholders—students and recent graduates. To address this, the Student Academy of Audiology Education and Externship Survey was disseminated in September 2018 to current graduate students, externs, and new professionals to further investigate areas of strengths and weaknesses in the current education model and the externship process.
With over 1,000 responses from all 75 accredited AuD programs in the United States at that time, this survey successfully captured a meaningful snapshot of contemporary AuD education from a newcomer to these conversations—the student body. Below are the highlights of the main findings and implications of the survey results.
Externship Application Process
Although recommendations for the AuD externship and application process have been made in the past, (Academy, 2006), the process continues to be frustrating and unclear for many students. A previous Student Academy of Audiology (SAA) survey found that more than 70 percent of respondents indicated the lack of uniformity in the application process was the greatest weakness of the externship process (Dubaybo et al, 2015). Our 2018 survey sought to expand on this investigation.
As a part of this survey, respondents were asked to select factors that caused them to feel pressure when accepting an externship offer. Roughly half of respondents (48.1 percent) reported they felt pressure due to fear of not receiving another externship offer (see FIGURE 1). While it is true that this may be reflective of the post-graduation job market, the diversity in the job market should not be a factor when determining the access that students have to education; and the externship is defined as the final, culminating educational experience of the AuD (Academy, 2006). These results suggest a universal acceptance date may decrease stress associated with the externship process and reduce students feeling pressure to accept a placement based on due date, rather than the education offered or their clinical preference.
Externship Financial Considerations
In addition, varied financial compensation adds stress and uncertainty to an already inequitable externship experience. In SAA’s 2015 survey, 72 percent of audiology students reported that financial support affected their decision to accept or reject an offer (Dubaybo et al, 2015). The present survey asked current externs and new professionals how much financial compensation they received from their externship site. As seen in FIGURE 2, compensation varies widely; however, it is notable that 31 percent of respondents reported no compensation or compensation less than $10,000 per year. For comparison, the U.S. Department of Health and Human Services 2019 Poverty Guidelines list a single-person household income of $12,490 as the guideline for eligibility for federal assistance programs.
Considering the wide variations in compensation, respondents were also asked to indicate whether they had a second job during their externship. Results indicated 22 percent of students reported working a second job. Of those who did, 44 percent indicated that this job interfered with their ability to effectively perform the duties of the externship. This is particularly distressing, as further analysis indicated that the largest group of those students who took unpaid or underpaid externships reported a 2017 household income of more than $70,000.
These results suggest that financial burden could negatively affect the quality of education received during an externship. Additionally, household income results indicate disproportionate access of education to students without external financial support, thus introducing inequity, not only to other students in the short term, but potentially to the profession as a whole.
Prior to the 2019 Future of Audiology Summit, students were asked to select the most pressing professional issues that they would like the SAA to address in the upcoming year. Addressing the differences in AuD education was ranked as the number one priority, followed by inconsistency in the externship. This indicates that, although students may be relatively new to the conversation surrounding AuD education, it’s a topic that they are deeply invested in. The SAA has created an education committee to begin addressing these student concerns.
As discussed earlier, the SAA survey findings continue to highlight disparities in externship experiences. The Academy last issued guidance on the AuD externship in 2006, publishing both “Clinical Education Guidelines for Audiology Externships” and a suggested timeline for 12-month externships. However, the profession of audiology has changed immensely since 2006 and a lack of buy-in for externship guidelines continues to be a problem.
Based on the results of this survey and continued national conversation, it may be time to reevaluate these guidelines using input from preceptors, educators, and students. Once new externship guidelines exist, future directions could include a requirement of compliance with these standards to be listed on sponsored engines such as HEARCareers and/or the accreditation of these sites for following best practices.
A significant motivator gleaned from these results is that students had many positive things to say about the profession. The survey reflected that students find value in the externship. It also highlighted areas of concern from the student perspective, and it is the hope of the authors that this perspective will be able to catalyze and support change in this aspect of AuD education.
American Academy of Audiology. (2006) Clinical Education Guidelines for Audiology Externships. Retrieved from www.audiology.org/publications-resources/document-library/clinical-education-guidelines-audiology-externships.
Dubaybo F, Johnson K, Palumbo D, Kadolph A, Milligan C, De La O M. (2017) 2015 Externship Survey Analysis. Retrieved from www.audiology.org/publications/guidelines-and-standards/2015-externship-survey-analysis.
U.S. Department of Health and Human Services. (2019) Poverty Guidelines. Retrieved from https://aspe.hhs.gov/poverty-guidelines.