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AuD Externships

Building, Managing Successful Experiences

Hyfte, Shannon Van AuD, CCC-A

doi: 10.1097/01.HJ.0000579580.83291.b4
Audiology Education
Free

Dr. Van Hyfte is a clinical associate professor, the director of the audiology clinic, and a third-year externship coordinator in the department of speech, language, and hearing sciences at Purdue University.

Clinical externship is a highly prized experience that enables students to refine their clinical skills of testing, decision-making, test interpretation, and counseling. A successful externship experience should lead to positive student growth and provide the supervisors with a sense of pride in contributing to the profession. Also addressed in the June issue's article, “Steps to Develop a Strong Audiology Extern Program,” developing a relationship between a university and an externship site takes time to evolve and to build trust between university externship coordinators and audiology clinical educators. Off-campus clinical educators need time to understand the students’ expectations as well as their own. With the recent changes in supervision requirements, hearing care professionals in university and private practice settings could learn a lot from these tried-and-tested guidelines to build and manage a successful externship program.

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PARTNERING WITH AN EXTERNSHIP SITE

In the Doctor of Audiology (AuD) program at Purdue University, the university externship coordinator first contacts a potential externship site to learn about available clinical experience for students, gauge the interest of potential clinical educators, and discuss the expectations of the site's educator or supervisor. The externship coordinator must establish a good channel of communication with the site while not being too involved. This helps establish trust in the off-campus educator while the coordinator serves as a resource when needed.

Any externship site has the potential to be a beneficial place to enrich a student's experiences. Sites that have multiple audiologists are often more receptive to a student, but in our experience, many sites with just one audiologist have taken a student with enthusiasm. Audiologists who agree to take a student are forward-thinking and service-oriented, and enjoy seeing the clinic through fresh eyes. Go online to find an audiologist in a specific area. However, word of mouth through colleagues is also effective. The audiology community is relatively small, and colleagues often know potential off-campus audiologists who might be interested and willing to serve as an audiology clinical educator.

After identifying the site, establish a mode of communication that is preferable to the clinical educator. This is critical to maintaining an effective relationship that is conducive to the style and needs of the audiologist. In addition, the university externship coordinator should set expectations on the frequency of communication with the off-site clinical educator. For example, the externship coordinator may contact the supervisor prior to the start of the semester, mid-term, and finals, and will respond to any concerns that arise in between. The externship coordinator can minimize confusion and frustration when the communication schedule is clear.

Create a contract to have a formal agreement to basic terms between the university and the externship site. In a basic contract, the agreement simply allows the student to be at the site without obligating the site to take a student. Students have liability insurance of their own, so the site does not assume additional risk. Contracts may become more detailed and specific based on the facility, but the simplest contract sets up a formal agreement of willingness to accept a student.

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ROLES AND REQUIREMENTS

Effective Jan. 1, 2020, students applying for clinical competency certification in audiology (CCC-A) through the American Speech-Language-Hearing Association (ASHA) will no longer need to meet a required 1,820 hours of supervised experience under an audiologist holding CCC-A. Students applying for CCC-A will need to ensure they have met competency standards for the knowledge and skills identified within the ASHA standards. This hour-based requirement may still be in effect for the program and/or state, so audiologists should check with the state licensure board.

In addition to the changes for students applying for certification, all supervising audiologists will need to have a minimum of nine months of experience post-certification prior to supervising as well as two hours of professional development in supervision post-certification before serving as a clinical supervisor. The externship coordinator must communicate this change in requirements to off-campus educators, and ensure that the supervisors have completed the necessary continuing education prior to placing a student at the site beginning January 2020.

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COORDINATION, TIMING, AND PROCESS DETAILS

At Purdue University, AuD students gain clinical experiences on campus for the first two years of the program. During this period, students learn to perform diagnostic assessments of patients of all ages, and gain skills in rehabilitative audiology as well as hearing aid fitting and troubleshooting. Additionally, students get exposure to cochlear implant candidacy evaluations and mapping. From auditory brainstem assessments to comprehensive audiometry evaluations, students learn to test, interpret results, and counsel patients. Upon satisfactory completion of the first two years of coursework and clinical experience, students may begin off-campus placements (for one to two full days a week) in the summer prior to the start of their third year, allowing for three externship placements before beginning their final year in the AuD program.

The externship placement is coordinated in two ways that work simultaneously. The externship coordinator meets with the students in the fall of the second year of the AuD program to explain the externship process and solicit the students’ interests and site preferences. This is approximately nine months prior to the externship start date. Students provide a list of preferences with the understanding that every externship site provides an experience that will allow them to gain knowledge and skills and that the assigned site may not be on the student's list. At the same time, the externship coordinator starts to contact known externship sites to inquire about the sites’ interest and willingness to take a student. Exploring new sites every semester is important to expanding the students’ options and providing a respite to sites that have previously accepted students.

Securing externships should begin early to ensure enough sites. Off-campus clinical educators are more likely to take a student when the start date is far in the future, giving them more time to plan the externship experience. Planning early may help manage other inevitable life factors—of both students and off-campus clinical educators—that may come into play. These unexpected events and circumstances can lead to scrambling for a site placement close to the start of the externship. Overall, placements are more successful when the process starts early.

After the externship coordinator has met with the students and secured the number of sites needed for the cohort, members of the clinical faculty meet to determine the best student and site matches. To make matching decisions, on-campus supervisors discuss a specific student's interests and consider feedback from previous students regarding the externship sites. For example, if a student is highly interested in pediatric audiology and has shown strength in that area, one of the three externship placements will likely be at a facility that will enable the student to gain further knowledge and skills in that area. The other two externship sites will build upon additional skills, providing the student with an experience that will enhance his or her skill set.

The externship coordinator sends confirmation letters of the placement to the off-campus clinical educator and student. The confirmation letter provides the dates of the externship, introduces the student, and provides information about the expectation of the off-campus clinical educator. In addition, the letter requests the off-campus clinical educator to provide updated state licensure information and ASHA license cards (if applicable). Students copy the externship coordinator on all communication with the off-site placement, so the coordinator can provide feedback related to professionalism.

The externship coordinator's role also includes prompting off-campus clinical educators to share any concerns and send reminders for the clinical educators to complete evaluations and conferences with the students in the middle and end of the semester. The evaluations are entered in an online system and reviewed by the externship coordinator for any concerns that should be addressed with the student.

Building a successful externship program takes time, patience, organization, and perseverance. Community audiologists who share their time and expertise help mold future colleagues. Through this important experience, AuD students can begin building professional relationships, which are critical to becoming strong clinicians.

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