Across many health professions, the important role of counseling within service delivery is increasingly recognized for playing a crucial part in the emotional and psycho-social well-being of patients. How providers communicate with patients and attend to the emotional aspects of care can influence treatment adherence (Med Care. 2009;47:826 http://bit.ly/2uRf3kj), retention and comprehension of information (Med Care. 1988;26:657 http://www.jstor.org/stable/3765489), and the development of trust within the relationship (PEC. 2015;98:1550 http://dx.doi.org/10.1016/j.pec.2015.06.019). Thus, gaining insight into how audiology graduate programs train students in counseling can guide future efforts to enhance preparation of audiologists in this area.
The importance of including counseling training in audiology programs is not a new concept. Two meaningful studies were conducted to describe the status of counseling training in communicative disorder programs (both speech-language pathology and audiology) for students earning a master's degree in the United States (ASHA. 1986;28:49 http://www.popline.org/node/357241;ASHA. 1994;36:65). Both studies found that, while many programs did offer counseling training courses, less than half of those courses were required, and the scope of training, when provided, was unclear. A more recent study gave an updated count of the number of audiology programs offering counseling courses, which indicated that 71 percent of the previous 56 AuD programs did have such a course in their curriculums (Hearing Journal. 2005;58:54 http://bit.ly/2uRpTa5). Since these studies, the field of audiology transitioned permanently from a master's to a doctorate-level graduate program in 2007; further investigation of how patient-centered counseling training is integrated into the current academic structure of AuD programs is needed. Thus, the purpose of this study was two-fold: (1) to investigate the number of programs in the United States that require a counseling course, and (2) to explore the scope of the content covered.
This study conducted a syllabi review to explore the extent and scope of counseling training provided in AuD programs. The study was completed in Fall 2016. Oversight from the Utah State University Institutional Review Board was not required.
Accredited AuD clinical doctoral programs (N=73) in the United States were identified using the EdFind database. Maintained by the American Speech-language and Hearing Association (ASHA), it provides information about academic programs in communication sciences and disorders based on annual surveys. Program directors were contacted via email and/or telephone and asked if their graduate programs required a dedicated counseling course (not embedded in another audiology content course). If the answer was yes, a copy of the course syllabus was requested. Seventy-three percent of the programs responded (N=53).
SYLLABI REVIEW RESULTS
Of those that responded, 76 percent (n=40/53) reported they required a dedicated counseling course in their curriculum, and 30 programs shared their counseling course syllabi. Some of those who declined to share their syllabi noted intellectual property concerns while others did not specify their reason. Twenty-five percent of the programs that responded (n=13/53) said their program did not have a required counseling course or counseling topics were integrated into other courses (such as aural rehabilitation) or clinical experiences. A total of 32 syllabi were obtained from the 30 programs that responded.
Content Areas. Eight content areas were evident in the syllabi (see Table 1). More than half of the syllabi received a level 2 rating (meaning evidence of the topic was found in course/topics schedule or course list of assignments) for one topic area: counseling theories (59%; n=19). Half of the syllabi included cultural sensitivity in counseling (n=16), and 25 percent (n=8) discussed the definitive role of the audiologist in counseling. The least frequently included topics (6%; n=2) were: counseling individuals with otological disorders other than hearing loss (e.g., tinnitus, vestibular), and referral practices and professional collaboration as it relates to counseling and depression, suicide, and self-harm. Two course activities to address counseling skills were evident in the syllabi. Fifty-six percent (n=18) of the syllabi included role-play scenarios. Some syllabi (19%; n=6) included observation assignments.
Additional Course Details. Three additional areas of the syllabi were explored to identify similarities or differences among courses. The questions below were asked to extract additional course details.
Is the course taken by students outside of the AuD program?
Of the 30 programs that shared their syllabi, 10 (31%) reported including students outside of the AuD program as part of the course, and nine (28%) reported those students to be from the speech-language pathology graduate program of the same university. One program (3%) required audiology students to take a counseling course in the university's graduate counseling program with students earning their master's degree in counseling.
What readings and/or textbooks were required for the course?
Most the syllabi (88%; n=28) indicated varied reading requirements including one textbook, multiple research-based articles, and chapters from different textbooks. One syllabus required students to read a novel written by an individual living with hearing loss.
What ASHA Knowledge and Skills Acquisition (KASA) standards are listed in the syllabus as covered?
Less than half (44%; n=14) of the syllabi listed current KASA standards (CFCC, 2012 http://bit.ly/2uR9QJ3). Four KASA standards were reported most frequently: A16 (69%; n=9), A26 (85%; n=11), B4 (92%; n=12), and D2c (77%; n=10).
The scope and depth of the content covered within graduate training play an influential role in students’ subsequent practice patterns. The content covered, as indicated in the syllabi, suggests a wide range of variability in the topics covered among AuD programs. For audiologists to intentionally engage in counseling conversations with patients, they need a foundation in theoretical knowledge (e.g., behavior change theories, family systems). Even though counseling theories was the most frequently covered topic, only 28 (38%) of the 73 accredited AuD programs mentioned it in their syllabus. Other content areas critical to the basic understanding of audiologic counseling were also not broadly represented among the syllabi reviewed (e.g., the definitive role of the audiologist in counseling, referral practices and professional collaboration as it relates to audiology).
Course activities, such as role playing and observation, can provide students with an important opportunity to consider skills needed for effective counseling. The review results, however, indicate that it is unclear how AuD programs and counseling courses provide students with opportunities to develop and improve their counseling skills. Although 56 percent of the syllabi mentioned role-play experiences, they failed to elucidate how role-play scenarios are linked to specific counseling skills, and only a few syllabi (19%) mentioned observation. Although the types of course activities may vary, how students are supported in gaining confidence in using counseling skills is equally important to the content taught. Counseling skill development, like other audiology skills (e.g., audiometry, hearing aid programming), requires scaffolded learning opportunities.
An important factor that may contribute to the variability in topics covered is the lack of structure provided by the current KASA standards (CFCC, 2012 http://bit.ly/2uR9QJ3). Standards A26 and D2c are the only ones that specifically mention counseling in their descriptions, and more than half of the syllabi (56%) did not indicate discussion of KASA standards in the course. The lack of guidance related to counseling in education in audiology can have serious implications for practice, as inadequate counseling (e.g., missing opportunities for addressing patient issues and emotions) may result in negative consequences for patients and their families.
Counseling in audiologic services plays an important role in helping patients accept their hearing disorder, adhere to treatments and recommendation, and adjust to the emotional, social, and vocational changes that come with hearing loss or other otological disorders. As such, audiologist training on counseling patients and their families can have a negative or positive impact on patient outcomes. The findings of this study indicate the variability of counseling courses in AuD programs, and suggest the need for more structured critical content and better counseling skills development instruction to bridge coursework knowledge to practice.