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Fourth-Year Externships and More: Interview with Ian Windmill, PhD

Fourth-Year Externships and More: Interview with Ian Windmill, PhD

April 28, 2009 Interviews

Douglas L. Beck, AuD, spoke with Dr. Windmill about the AuD educational model and the evolvement of the fourth-year externship.

Academy: Hi, Ian. Thanks for your time today, and congratulations on your new position.

Windmill: Thanks, Doug. It’s great to be in Mississippi.

Academy: Ian, you’ve been very involved in the pragmatic and theoretical aspects of audiology education for decades. Would you please give me a brief review of some of the ways you’ve served the Academy and the profession with specific regard to educational committees and initiatives?

Windmill: Sure. I was the director of the Audiology Program at the University of Louisville for almost 15 years. I served on the Academy’s Professional Education Committee and the Planning Committee for the recent Gold Standards Summit 2009. I was also on the Joint Audiology Committee, which was a group of various professional organizations. I’ve served on the Council of AuD Programs as well as the Council of AuD Program Directors, and I am current Chair of the Accreditation Committee for Audiology Education (ACAE).

Academy: Okay, you’ve convinced me. Looks like you’re certainly “in the know” with respect to audiology education! Ian, I am admittedly in the dark with respect to the fourth-year externship and I was hoping you could shed some light on that?

Windmill: I’d be happy to. Doug, as you know, when you and I started more than 20 years ago, we had master’s degrees and doctoral degrees and we each had to find a clinical fellowship experience to gain practical experience. In the end, we had some people very well trained and some not so well trained, some with expertise in this and some with expertise in that. Our education and our clinical training were somewhat all over the place, and it depended on where you went, when you went there, who was there at the time and other variables, so that wasn’t a great educational model. Now of course, we’ve had the AuD goals in place for 20 years and so the education is becoming uniform and more rigorous. Within the AuD model, the fourth-year was set-up as the Fourth-Year Externship, which is ideally the time when your clinical and academic training come together.

Academy: But the original clinical fellowship year was not part of the “educational” experience?

Windmill: Right. It was not set up to be part of the degree-bearing educational component. That is, in the previous model, the clinical fellowship year happened after the degree was earned. In many people’s minds, however, it was part of the educational experience, even if informal in that regard. The fourth-year externship is part of the formal program of study, and is more in alignment with medical, dentistry, and optometry education. Of course the timelines are different, but the progression is the same from classroom work and study to clinical and professional experiences.

Academy: And speaking of the clinical fellowship year, some of us got paid quite poorly and others were paid reasonably well during the fellowship year, and some worked for free.

Windmill: Exactly. The system has not really changed very much with respect to finances. Some externships do pay a living wage via a stipend, pre-paid housing or tuition benefits, and some don’t. Maybe it’s got to do with competing for the best students or the normal wage relationship in a given area, but as far as the fourth-year externship, the student needs to find the best possible educational and preparatory experience for their needs and interest.

Academy: Unfortunately, I have to agree. I know some students want to practice at the beach or be near the ski mountains, maybe back home or the most convenient place, but the fourth-year externship is the right time to hone your clinical skills and to get the experience that will set you up for a rewarding career.

Windmill: You are so right. While some locations provide financial support, and others don’t, it is more important to find the best clinical and professional opportunity because it will matter a great deal more to them over the years and decades to come.

Academy: Ian, what can you suggest for the student, when a clinic or hospital doesn’t offer support for the fourth-year externship, but they do have an amazing opportunity for the student, or the clinic says they cannot offer support because they cannot bill for the services of the student during the fourth-year externship. What can the student do? 

Windmill: If I were the student, I might try to demonstrate there’s an additional value to them in this proposition if they were to take me on. For example, maybe they cannot bill for my diagnostic services because Medicare says I have to be licensed first. Okay, I understand. However, there are many things that are not covered by Medicare that I can do, such as dispense hearing aids, or maybe work in their aural rehabilitation program, or maybe do auditory processing diagnostics, screenings, and therapy that can bring additional value and revenue to the practice or hospital. In other words, of course, one must practice in accordance with the laws, rules, and regulations, but if I bring additional value to the table, things that we cannot bill Medicare for regardless, maybe that’s an opportunity and maybe we can work out a financial relationship that would be mutually beneficial.

Academy: I like the way you think, Ian.

Windmill: Thanks. Of course, the students cannot bill Medicare nor can the facility bill Medicare for the students work—unless the student is directly supervised, which often means within the “line of sight” of the supervisor. So one needs to develop their clinical skills in alignment with Medicare and other rules and regulations, but there are other clinical situations that don’t involve Medicare and they may be worthy of pursuit during the fourth-year externship negotiations. Such as “self-pay and non-covered” services.

Academy: Interesting point. Therefore, the students may be able to negotiate support based on hearing aid dispensing, hearing aid repairs and consultation, aural rehabilitation classes for individuals or groups, perhaps auditory processing disorder diagnostics and rehab, and there are probably other areas, too, in which Medicare and other insurers won’t be involved anyway?

Windmill: Exactly. Therefore, the thing is to be cognizant of the rules and the regulations and to absolutely work within those rules and regulations and to see if the fourth-year externship might involve some of the areas that can appreciate financial benefit from the students work. Therefore, the bottom line is that these “non-covered” services may help support a small stipend of sorts, or perhaps housing or tuition.

Academy: Excellent points Ian. I’m sure the students will appreciate your thoughts on this.

Windmill: Happy to help, Doug.

Academy: Thanks again for your time and it’s always a pleasure to chat with you.

Windmill: Thanks, Doug. I appreciate the opportunity to address this with you, too.

Ian Windmill, PhD, is the professor and chief of the Division of Communicative Sciences, Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi.

Douglas L. Beck, AuD, Board Certified in Audiology, is the Web content editor for the American Academy of Audiology.

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