Did You Know: What it takes to clinically prepare an AuD student
Did You Know? The Doctor of Audiology (AuD) programs in California require their students to complete specific clinical practicum hours before advancing to their externship.
According to the California Speech-Language Pathology & Audiology & Hearing Aid Dispensers Board (SLPAHADB), applicants for licensure must have completed 300 hours of supervised clinical practicum in three different clinical settings. These 300 hours are usually completed during the initial years of the AuD program. Following this, students undertake a final-year supervised clinical externship. It’s important to note that these requirements are set forth by the SLPAHADB and specific clinical requirements can vary by program.
Additional information regarding the qualifications for audiology licensure and the pathways to licensure in the state of California is available on the SLPAHADB website.
For this month's Did You Know, CAA reached out to the academic program coordinators at each of the six AuD programs in California. Dr. Kristy Kirsch, Audiology Clinic Director and the Director of Clinical Education at San Diego State University and Dr. Margaret Winter, Director of Clinical Education at Cal State Los Angeles both agreed to offer their insight on what it takes to clinically prepare a student for their externship and licensure.
Can you describe your role as a clinic coordinator and how it contributes to the training of Au.D students?
Dr. Kirsch: Our students receive training in on-campus clinics for the first two years of our program – the first year in the Audiology Clinic at SDSU and the second year embedded in a busy ENT practice at UCSD. I direct the clinic at SDSU, so in addition to managing clinic operations, I assign students to preceptors, determine the types of appointments we are able to provide and the types of patients we can serve. The second year clinic is overseen by Dr. Erika Zettner at UCSD; in that capacity she creates the student/preceptor schedule and helps students transition into providing audiologic services in a medical environment. The students return to SDSU for year three and I meet with them to review their interests, their experiences, their gaps in knowledge and skills, their goals, etc. Based on these factors, I place them at 3 different sites in San Diego county over the course of the year, with the goal of obtaining 3 very different clinical experiences (e.g. large hospital clinic, private practice, pediatric population). In order to do this, I have to maintain good relationships with the precepting audiologists in San Diego and I have mechanisms in place to maintain close (virtual) contact with my off-site students.
Dr. Winter: I’m responsible for supervising AuD student clinicians in their first 3 semesters of on-campus clinic, arranging off-campus clinical practicum experiences for second and third year students, assisting 3rd year students with the application process for their RPE, and throughout all the off-campus students’ clinical experiences I receive weekly reports from them so I have a sense of what their experiences are, what they feel their successes to be, where they may be struggling, and how effectively they feel the supervisor interacts with them. I am also in contact with the supervisors through their regular semester student evaluations and in any situation where either the supervisor or the student has concerns.
How do you assess an Au.D student’s readiness for clinical rotations?
Dr. Kirsch: Students receive a full written evaluation following each clinical rotation and I have access to these reports which include both qualitative and quantitative assessments of their ability to complete numerous core clinical tasks. They also have practical clinical evaluations in the first two years of the program, which allow us to assess specific skills throughout the cohort. Our accrediting body requires that we monitor these skills closely to ensure that all students can execute a full set of skills by the time they graduate. Assessing readiness is a combination of scrutinizing student evaluations, factoring student interests and needs, and consulting with the lead site audiologist regarding student requirements and expectations in relation to the opportunities for learning that the site can offer.
Dr. Winter: We have clinical exams at the end of each of their 3 on-campus clinics so that, appropriate to their level of experience, we can evaluate the students’ ability to perform both simple and more complex audiometric tests, immittance, OAEs and the basics of hearing aid evaluation/programming/verification. Their knowledge and application regarding electrophysiologic and vestibular testing is assessed by their professors through labs as part of their coursework.
How do you structure clinical experiences to ensure a well-rounded education for Au.D students?
Dr. Kirsch: During the first two years, our students are paired with audiology preceptors for one on one experiential learning in the clinical environment. Our accrediting body has generated a comprehensive list of knowledge and skills which must be met and this document serves as our guide. During the final two years of the program, the students are in off-campus placements and externships which are vetted by our faculty for the depth and breadth of experiences offered to them, to ensure they meet the requirements of the program.
Dr. Winter: My goal, which is challenging, is to have each student placed in a hospital or large and diverse clinic at least once, in a primarily hearing aid practice at least once, and two placements in which they may have particular interests (pediatrics, cochlear implants, vestibular, educational).
What logistical challenges do you face when coordinating clinical placements for Au.D students?
Dr. Kirsch: Doctoral programs in audiology are dependent upon the willingness of off-campus sites to precept our students. We are very grateful to the audiologists at these sites who are willing to “give back” to the profession by agreeing to supervise students in their clinics and practices. Finding best fits for students and audiologists alike can be challenging if there are not enough sites available locally at any one time to accommodate our students. In fact, this is the number one bottleneck that limits the size of audiology cohorts and the number of new audiologists entering the workforce each year.
Dr. Winter: There are not enough sites accepting second and third year students to make it possible for every student to get a taste of the range of audiologic opportunities (not enough centers doing cochlear implant work or vestibular assessments, for instance) and those that do some of these procedures may not do them often enough to provide 2-day-a-week students with much direct experience. If more large centers offered not only RPE positions but also 2nd and 3rd year positions, it would help students to be better prepared for the 4th year (AND help the clinic be already familiar with some of the RPE applicants when it comes time to choose). Another challenge is distance from the student’s home to clinic—Los Angeles is huge and spread out and the traffic can be a nightmare, so students who hope to get the particular experience they want may have to drive for two hours one way to get it. It’s exhausting and expensive. By the way, though, we really appreciate the wonderful mentors who do take our students, semester after semester, and teach then so many things they can’t learn until they can see it and do it in the real professional world.
What challenges do students typically face when transitioning from the classroom to clinical practice, and how do you help them overcome these?
Dr. Kirsch: Our students start their clinical practicum in the first week of their first year with a LOT of hand-holding. This allows them to integrate the information they are receiving in their academic courses (hearing aids, instrumentation, diagnostics) into their clinical experiences and vice versa. Although this trend continues throughout the first three years of the program, the intention is very thoughtful and measured during the first year - with preceptors and instructors sharing syllabi, observations of student performance, and recommendations for improvement.
Dr. Winter: There is no perfect blend of clinic and academics, so sometimes students will be seeing patients in clinic before they are academically prepared (young and or complex children, for instance, before they have had pediatrics or genetics; patients with complaints of dizziness before they have had vestibular); or sometimes they will have had coursework but it is many months before they see a patient with the particular issues they’ve studied. We try to combine seeing ‘real’ patients with simulated histories and results so students can put together what they learn in class with what it would look like when the patient presents. Clinic is an applied activity; doing well in coursework is important and in the end clinic requires them to put it into practice. So perhaps the biggest challenge is helping students retain information from semester to semester, from patient to patient, clinic to clinic, and to know or at least remember what resources they have when they encounter a new or only vaguely-familiar type of case. Sometimes I have to laugh when a student says they ‘learned’ something in their clinical rotation, and it’s something I’ve been talking about repeatedly since the start of the program. It really sinks in only once they have had the opportunity to see it in action.
How do you handle situations where a student is struggling clinically or not meeting expectations?
Dr. Kirsch: Once we admit a student, we are committed to their successful completion of the program. To that end, we closely monitor their progress in both clinical and academic areas, intervening as soon as a problem is identified. This might take the form of clearly explaining expectations, assigning remedial work, scheduling one-on-one tutoring sessions and/or recommending extra time on clinical/lab tasks. In general, these endeavors result in a successful outcome. On occasion, however, problems persist and the faculty meet together with the student on a formal basis to draw up a plan of action in accordance with the guidelines outlined in the Student Handbook. If this plan cannot be successfully realized for any number of reasons, the faculty and/or student might pursue a leave of absence and/or ultimately a withdrawal from the program.
Dr. Winter: Of course it depends on the particulars. In rare cases, I have worked with the student directly and delayed placement off campus until they are more confident and their skills are stronger. I have addressed some issues by helping the student engage more directly and more effectively with the supervisor, by reminding them that good audiologists do things in different ways and students are obliged to ‘do it their way’ when they are in that clinic. I do intercede if need be, but I want the student to try to address issues first. If the issue is speed, I emphasize to the student the importance of analyzing what’s slowing them down and that there is truly no substitute for practice. If the issue is making mistakes, we talk about where the confusion lies and how to resolve it. I do respond to every report I receive, every week, so I can offer advice about at least some of the concerns a student may have, even remotely.
Dr. Christy Kirsch received her B.A. and M.A. in Speech Pathology & Audiology from San Diego State University and her Doctorate in Audiology from A.T. Still University. She has worked in a variety of settings, including as a senior audiologist (and later manager) at the Speech, Hearing and Neurosensory Center of Children's Hospital (now Rady Children's) in San Diego. She also served as a program manager/Audiologist at Imua Rehab and as a clinical audiologist at Kaiser Permanente, both in Wailuku, Maui. From 2000-2015 she worked as a clinical audiologist in a private practice in San Luis Obispo, CA. Dr. Kirsch now serves as the Audiology Clinic Director and the Director of Clinical Education for the SDSU Audiology Clinic at San Diego State University.
Margaret Winter is the Director of Clinical Education in the AuD program at Cal State Los Angeles. She was formerly the lead audiologist at the USC Caruso Family Center and clinical coordinator at the House Ear Institute Children’s Auditory Research and Evaluation Center. Dr. Winter has presented on cochlear implants in children, speaking to parents and professionals at local and international seminars and conferences She has also published and presented extensively on infant hearing assessment, hearing aid fitting, and auditory neuropathy in children. She is a member of the Los Angeles Pediatric Auditory Brainstem Implant team, providing assessments and programming of ABI devices under an FDA clinical trial, as well as providing clinical services to children who received ABIs overseas.
Additional information regarding the qualifications for audiology licensure and the pathways to licensure in the state of California is available on the SLPAHADB website.
For this month's Did You Know, CAA reached out to the academic program coordinators at each of the six AuD programs in California. Dr. Kristy Kirsch, Audiology Clinic Director and the Director of Clinical Education at San Diego State University and Dr. Margaret Winter, Director of Clinical Education at Cal State Los Angeles both agreed to offer their insight on what it takes to clinically prepare a student for their externship and licensure.
Can you describe your role as a clinic coordinator and how it contributes to the training of Au.D students?
Dr. Kirsch: Our students receive training in on-campus clinics for the first two years of our program – the first year in the Audiology Clinic at SDSU and the second year embedded in a busy ENT practice at UCSD. I direct the clinic at SDSU, so in addition to managing clinic operations, I assign students to preceptors, determine the types of appointments we are able to provide and the types of patients we can serve. The second year clinic is overseen by Dr. Erika Zettner at UCSD; in that capacity she creates the student/preceptor schedule and helps students transition into providing audiologic services in a medical environment. The students return to SDSU for year three and I meet with them to review their interests, their experiences, their gaps in knowledge and skills, their goals, etc. Based on these factors, I place them at 3 different sites in San Diego county over the course of the year, with the goal of obtaining 3 very different clinical experiences (e.g. large hospital clinic, private practice, pediatric population). In order to do this, I have to maintain good relationships with the precepting audiologists in San Diego and I have mechanisms in place to maintain close (virtual) contact with my off-site students.
Dr. Winter: I’m responsible for supervising AuD student clinicians in their first 3 semesters of on-campus clinic, arranging off-campus clinical practicum experiences for second and third year students, assisting 3rd year students with the application process for their RPE, and throughout all the off-campus students’ clinical experiences I receive weekly reports from them so I have a sense of what their experiences are, what they feel their successes to be, where they may be struggling, and how effectively they feel the supervisor interacts with them. I am also in contact with the supervisors through their regular semester student evaluations and in any situation where either the supervisor or the student has concerns.
How do you assess an Au.D student’s readiness for clinical rotations?
Dr. Kirsch: Students receive a full written evaluation following each clinical rotation and I have access to these reports which include both qualitative and quantitative assessments of their ability to complete numerous core clinical tasks. They also have practical clinical evaluations in the first two years of the program, which allow us to assess specific skills throughout the cohort. Our accrediting body requires that we monitor these skills closely to ensure that all students can execute a full set of skills by the time they graduate. Assessing readiness is a combination of scrutinizing student evaluations, factoring student interests and needs, and consulting with the lead site audiologist regarding student requirements and expectations in relation to the opportunities for learning that the site can offer.
Dr. Winter: We have clinical exams at the end of each of their 3 on-campus clinics so that, appropriate to their level of experience, we can evaluate the students’ ability to perform both simple and more complex audiometric tests, immittance, OAEs and the basics of hearing aid evaluation/programming/verification. Their knowledge and application regarding electrophysiologic and vestibular testing is assessed by their professors through labs as part of their coursework.
How do you structure clinical experiences to ensure a well-rounded education for Au.D students?
Dr. Kirsch: During the first two years, our students are paired with audiology preceptors for one on one experiential learning in the clinical environment. Our accrediting body has generated a comprehensive list of knowledge and skills which must be met and this document serves as our guide. During the final two years of the program, the students are in off-campus placements and externships which are vetted by our faculty for the depth and breadth of experiences offered to them, to ensure they meet the requirements of the program.
Dr. Winter: My goal, which is challenging, is to have each student placed in a hospital or large and diverse clinic at least once, in a primarily hearing aid practice at least once, and two placements in which they may have particular interests (pediatrics, cochlear implants, vestibular, educational).
What logistical challenges do you face when coordinating clinical placements for Au.D students?
Dr. Kirsch: Doctoral programs in audiology are dependent upon the willingness of off-campus sites to precept our students. We are very grateful to the audiologists at these sites who are willing to “give back” to the profession by agreeing to supervise students in their clinics and practices. Finding best fits for students and audiologists alike can be challenging if there are not enough sites available locally at any one time to accommodate our students. In fact, this is the number one bottleneck that limits the size of audiology cohorts and the number of new audiologists entering the workforce each year.
Dr. Winter: There are not enough sites accepting second and third year students to make it possible for every student to get a taste of the range of audiologic opportunities (not enough centers doing cochlear implant work or vestibular assessments, for instance) and those that do some of these procedures may not do them often enough to provide 2-day-a-week students with much direct experience. If more large centers offered not only RPE positions but also 2nd and 3rd year positions, it would help students to be better prepared for the 4th year (AND help the clinic be already familiar with some of the RPE applicants when it comes time to choose). Another challenge is distance from the student’s home to clinic—Los Angeles is huge and spread out and the traffic can be a nightmare, so students who hope to get the particular experience they want may have to drive for two hours one way to get it. It’s exhausting and expensive. By the way, though, we really appreciate the wonderful mentors who do take our students, semester after semester, and teach then so many things they can’t learn until they can see it and do it in the real professional world.
What challenges do students typically face when transitioning from the classroom to clinical practice, and how do you help them overcome these?
Dr. Kirsch: Our students start their clinical practicum in the first week of their first year with a LOT of hand-holding. This allows them to integrate the information they are receiving in their academic courses (hearing aids, instrumentation, diagnostics) into their clinical experiences and vice versa. Although this trend continues throughout the first three years of the program, the intention is very thoughtful and measured during the first year - with preceptors and instructors sharing syllabi, observations of student performance, and recommendations for improvement.
Dr. Winter: There is no perfect blend of clinic and academics, so sometimes students will be seeing patients in clinic before they are academically prepared (young and or complex children, for instance, before they have had pediatrics or genetics; patients with complaints of dizziness before they have had vestibular); or sometimes they will have had coursework but it is many months before they see a patient with the particular issues they’ve studied. We try to combine seeing ‘real’ patients with simulated histories and results so students can put together what they learn in class with what it would look like when the patient presents. Clinic is an applied activity; doing well in coursework is important and in the end clinic requires them to put it into practice. So perhaps the biggest challenge is helping students retain information from semester to semester, from patient to patient, clinic to clinic, and to know or at least remember what resources they have when they encounter a new or only vaguely-familiar type of case. Sometimes I have to laugh when a student says they ‘learned’ something in their clinical rotation, and it’s something I’ve been talking about repeatedly since the start of the program. It really sinks in only once they have had the opportunity to see it in action.
How do you handle situations where a student is struggling clinically or not meeting expectations?
Dr. Kirsch: Once we admit a student, we are committed to their successful completion of the program. To that end, we closely monitor their progress in both clinical and academic areas, intervening as soon as a problem is identified. This might take the form of clearly explaining expectations, assigning remedial work, scheduling one-on-one tutoring sessions and/or recommending extra time on clinical/lab tasks. In general, these endeavors result in a successful outcome. On occasion, however, problems persist and the faculty meet together with the student on a formal basis to draw up a plan of action in accordance with the guidelines outlined in the Student Handbook. If this plan cannot be successfully realized for any number of reasons, the faculty and/or student might pursue a leave of absence and/or ultimately a withdrawal from the program.
Dr. Winter: Of course it depends on the particulars. In rare cases, I have worked with the student directly and delayed placement off campus until they are more confident and their skills are stronger. I have addressed some issues by helping the student engage more directly and more effectively with the supervisor, by reminding them that good audiologists do things in different ways and students are obliged to ‘do it their way’ when they are in that clinic. I do intercede if need be, but I want the student to try to address issues first. If the issue is speed, I emphasize to the student the importance of analyzing what’s slowing them down and that there is truly no substitute for practice. If the issue is making mistakes, we talk about where the confusion lies and how to resolve it. I do respond to every report I receive, every week, so I can offer advice about at least some of the concerns a student may have, even remotely.
Dr. Christy Kirsch received her B.A. and M.A. in Speech Pathology & Audiology from San Diego State University and her Doctorate in Audiology from A.T. Still University. She has worked in a variety of settings, including as a senior audiologist (and later manager) at the Speech, Hearing and Neurosensory Center of Children's Hospital (now Rady Children's) in San Diego. She also served as a program manager/Audiologist at Imua Rehab and as a clinical audiologist at Kaiser Permanente, both in Wailuku, Maui. From 2000-2015 she worked as a clinical audiologist in a private practice in San Luis Obispo, CA. Dr. Kirsch now serves as the Audiology Clinic Director and the Director of Clinical Education for the SDSU Audiology Clinic at San Diego State University.Margaret Winter is the Director of Clinical Education in the AuD program at Cal State Los Angeles. She was formerly the lead audiologist at the USC Caruso Family Center and clinical coordinator at the House Ear Institute Children’s Auditory Research and Evaluation Center. Dr. Winter has presented on cochlear implants in children, speaking to parents and professionals at local and international seminars and conferences She has also published and presented extensively on infant hearing assessment, hearing aid fitting, and auditory neuropathy in children. She is a member of the Los Angeles Pediatric Auditory Brainstem Implant team, providing assessments and programming of ABI devices under an FDA clinical trial, as well as providing clinical services to children who received ABIs overseas.