About 40 percent of older adults between 65 and 84 years old have hearing loss, and the prevalence increases to 66 percent for adults over 85 years old (NASEM, 2014 http://bit.ly/2JiFfuT). The prevalence of vestibular dysfunction has also been found to range from 65 to 72 percent in individuals over 70 years old to 85 percent in individuals over 80 years old (Arch Intern Med. 2009 May 25;169(10):938). Again, these demographics are shifting while the supply of audiologists is decreasing (ASHA, 2012 http://bit.ly/2LLdA6O; Audiology Today. 2009;21(6):46; J Am Acad Audiol. 2013 May;24(5):407).
STUMBLING INTO AUDIOLOGY
In a survey of audiology graduate students, Bennett and Steiger found that these students entered college without the intent to pursue a graduate degree in audiology but did so after being introduced to the field through undergraduate academic coursework (Audiology Today. 2010;24(6):52). It follows then that for students to pursue audiology as a career, they must be aware that it exists as a career option.
However, two other studies found that most new college students are not aware of the profession of audiology (Am J Audiol. 2012 Jun;21(1):41; Am J Audiol. 2013;22(2):271). Specifically, Donai, et al., found that students entering college had more accurate knowledge of podiatry and optometry than of audiology (Am J Audiol. 2013). Students were three times more likely to provide an incorrect description of audiology compared with optometry. Given the low awareness of audiology as an option, it is likely that many students suitable for a career in hearing health care progress through college without considering audiology as a career choice, making it important to increase the awareness of audiology among high school students.
SURVEY GOALS AND METHODOLOGY
A survey was conducted to examine the level of awareness of the profession of audiology relative to optometry and podiatry among college students who haven't decided on a major concentration. These two professions were compared with audiology because they are both doctoral-level professions (non-physician) and their population sizes are the most similar to audiology (although optometry's population is approximately 2.5 times larger than audiology). The survey was reviewed by the Institutional Review Board for the Protection of Human Subjects, and classified as exempt from full board review.
This study used a paper-based survey similar to that used by Donai, et al., in 2013, but with some minor modifications and a different dissemination scheme (Am J Audiol. 2013). The survey was pilot-tested with a class of undergraduate students. Results of the pilot study indicated that the survey's revised format was reliable.
The survey instrument was distributed to 256 college students at a state-supported university in West Virginia during their new student orientation in August 2014 and 2015. This orientation was part of the university's institutional support program to assist students who are undecided in their academic major. This program provides students with available resources to explore potential career options. Of note, the survey was distributed before the students received this type of information at the orientation. The survey questions and a tally of the responses are available online (http://bit.ly/2K36F8r).
Completed surveys were received from 251 respondents (of 256), yielding a 98 percent response rate. As expected, all of the respondents were under 25 years old. Slightly more than half of the sample was male (57%). A majority of the respondents were Caucasian (83%), nine percent were African American, and the remainder reported being Hispanic (4%), Asian (2%), or multicultural (2%).
Academic Major/Area of Interest
Respondents were asked to indicate their academic major (or if undeclared, indicate their major area of interest). As expected, all of the students had undeclared majors and indicated their areas of interest instead. The top-rated area of interest was nursing (20%), followed by business (14%), health (10%), and engineering (6%). The other areas of interest were at five percent or less.
Responses to the question, “What made you choose this major/area of interest?” were classified into categories. The most common response was “interest/like/love for the discipline/area of interest” (41%), followed by “helping people” (21%) and “family/friend influence” (10%). Previous experience was reported by approximately eight percent of respondents. Less than two percent reported a market-driven force (e.g., salary, earning potential, job opportunities, etc.) as a reason for their area of interest. When asked about their knowledge of the undergraduate program in communication sciences and disorders (CSD; the undergraduate major that leads to a graduate degree in SLP or audiology), nearly all of the respondents (94%) reported being unfamiliar. Only one respondent indicated a CSD field (speech pathology) as an area of interest. Thus, nine of 10 students were unaware of the academic program that lead to an undergraduate degree in CSD.
Knowledge of the Professions
The responses from questions related to various details of the three professions (questions 8-21) are summarized in Table 1. In this survey, the terms “ear doctor” and “eye doctor” were counted as correct despite being more applicable to the physician specialties of otolaryngology and ophthalmology. Half (50%) of the total respondents said they were familiar with the profession of audiology. Fewer respondents (46%) reported being familiar with the profession of podiatry, while 65 percent reported being familiar with the profession of optometry. Figure 1 shows the respondents’ self-reported awareness of the three professions. Among those with self-reported awareness (“Yes, definitely know,” “Rather sure,” and “Somewhat sure”), 65 percent were able to accurately describe the profession of audiology, 83 percent accurately described the profession of podiatry, and 94 percent accurately described the profession of optometry. Table 2 shows the chi-square analyses comparing the accuracy of the respondents’ descriptions of the three professions. Audiology was the most poorly described and identified among the three professions.
Survey results revealed that undecided college students had poor knowledge of the profession of audiology compared with their knowledge of podiatry and optometry. These results are aligned with those reported by Donai, et al., in 2013, who conducted a similar survey on a large group of college students (603) at a state-supported university in southwestern Pennsylvania. In the 2013 survey, the students described optometry and podiatry significantly better than audiology.
In this survey, nine of 10 students were unfamiliar with the undergraduate CSD program. This poor awareness of undergraduate CSD programs has also been reported in previous studies (Am J Audiol. 2012; Am J Audiol. 2013). The results represent the awareness of students enrolled in one university. Should this be the case in other universities across the country, it would be cause for concern not only to individual CSD departments but also to the professions at large. The following section, while not exhaustive, provides some recommendations to address the issues found in this survey.
Future Supply of Audiology Professionals
Windmill and Freeman raised the salient question of whether there will be enough audiology professionals to meet the future demand for hearing care services (J Am Acad Audiol. 2013 May;24(5):407). Should there be a lack of professionals, as predicted by the Windmill and Freeman's application of the physician supply model, encroachment by professionals from related fields is probable. Thus, it would behoove the profession as a whole (including university personnel, practitioners, and professional organizations) to take a proactive rather than reactive role in addressing this visibility issue and ensuring the vitality of the profession.
One possibility posed by Windmill is to considerably increase the number of students entering audiology graduate training programs (J Am Acad Audiol. 2013 May;24(5):417). However, there are some logistical barriers to pursuing this option, including (1) a limited number of available clinical training sites, (2) specific Medicare supervisory requirements, and (3) issues related to certification/licensure requirements of graduate training programs. These barriers likely preclude academic training programs from increasing the number of graduates to the level that Windmill and Freeman recommended—a 50 percent increase each year over the next 10 years (J Am Acad Audiol. 2013 May;24(5):407). If this fails to come to fruition, the profession should consider a more widespread use of audiology assistants to increase operational efficiency and thus increase the number of patients seen by an audiologist within a given period. This is a plausible option to meet the needs of the hearing services market.
Improving Audiology Awareness
Personal contact. Research has shown that personal contact with an allied health practitioner can be an important factor in student awareness of a profession. For example, Baldwin and Agho examined the motivation of students in selecting an academic major from multiple allied health programs (J Allied Health. 2003 Summer;32(2):65). Results from approximately 1,800 allied health student respondents showed that students were more likely to major in an allied health field if encouraged by a practitioner from that field. Stewart, Pool, and Winn also reported similar findings in that many students enrolled in physical therapy assistant (PTA) and CSD programs first learned of their respective professions through personal contact with the profession (J Allied Health. 2002;31(2):111). Nearly half (48%) of the CSD students in the sample reported initial exposure to the CSD professions in college. More recently, Barfield, et al., sought to identify factors that motivated students to enroll in allied health educational programs (J Allied Health. 2011 Summer;40(2):82). Exploratory and confirmatory factor analyses identified personal influence (e.g., high school teacher/counselor; college teacher/counselor) as a significant factor for students who chose to enroll in allied health programs. These findings suggest that practitioners who have close contact with school-age students (i.e., educational audiologists) and college students (e.g., faculty, clinical staff, etc.) might have a unique opportunity to assist in improving these students’ awareness of audiology.
Professional Organization Involvement
The role of audiology professional organizations (such as the American Academy of Audiology, Academy of Doctors of Audiology, Council of Academic Programs in Communication Sciences and Disorders, and others) and state-level audiology organizations in raising awareness of audiology among students should be substantial to help assure future viability of the profession. Naturally, the question that follows is: What are the most effective means to achieve this goal? A special task force comprised of representatives from the different professional organizations might prove to be a good use of organizational resources. Given that these issues will impact the profession as a whole, audiologists (and students) from all settings (e.g., academia, private practice, military audiology, educational audiology, etc.) should be represented. This strategy may benefit audiology professional organizations at the national level as they represent the collective interests of the profession.
This is the first study to examine the awareness of various doctoral-level professions among college students who were in the process of making important career decisions, making them an ideal group for this survey. Disseminating the survey to students in one university severely limits the generalizability of the results. The ability to administer a similar survey to a representative sample of college students across the nation has not been possible due to logistical constraints posed by different new student orientation processes. It is hoped that additional research of this nature will be conducted at universities with diverse population sizes and student demographics to increase our knowledge of this important issue.
Acknowledgement: Thank you to Gayle Neldon, EdD, for her assistance with previous versions of the manuscript.
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