Editor's note: This is the last installment of a three-part series. Read part one at https://bit.ly/351Ccok and part two at https://bit.ly/37r2kJ3.
The previous two articles of this series on accessible audiology education discussed hearing loss (HL) terminology and disclosure preferences of Deaf and hard-of-hearing (DHoH) audiology graduate students (Hearing Journal. 2020;73):18,20,21) and their specific challenges and solutions in clinical education settings (Hearing Journal. 2020;73):36-39). In this third article, we investigate the impact of HL on audiology graduate students’ motivations and self-efficacy as future clinicians. Through their lived experience, DHoH students can provide information that may be critical in ensuring the accessibility of audiology education.
Along with academic success, personal experience can influence a student's path through audiology. Personal motivations and interactions with mentors influence a student's self-efficacy and potential for success. Self-efficacy is the belief in one's ability to execute behaviors and control one's motivation despite the situation or condition. Self-efficacy can be influenced by positive experiences Self-efficacy can be influenced by positive experiences that (1) an individual has had or (2) he or she has seen others succeed in doing despite a perceived barrier or challenge. Albert Bandura stated that “a resilient sense of efficacy requires experience in overcoming obstacles through perseverant effort” (Encyclopedia of mental health. San Diego: Academic Press, 1998).
As is evident in the second article of this series, DHoH students face challenges in the clinic due to their HL. A student's high or low self-efficacy can impact his or her ability to succeed in the clinic. Instructors have a role in positively influencing this development through their interactions and responses to these students’ needs. To determine the specific impact of HL on self-efficacy and motivation of DHoH graduate students of audiology, we conducted a survey, which is described in detail in the first article of this series (Hearing Journal. 2020;73):18,20,21). The results shared are part of a broader investigation of the impact of hearing loss on audiology clinical education. For this article, results relating to the impact of hearing loss on self-efficacy and motivation of DHoH students are discussed.
FINDINGS ON MOTIVATION
The survey included a series of open-ended questions. In response to the question, “What motivated you to become an audiologist?” 77 percent of participants reported that they pursued audiology due to their personal experience with HL. One participant shared:
“I always loved the idea of pursuing a profession that I had a personal connection with. This helps me to connect with my patients and allow them to also know that I can relate to some of the struggles they may have.”
Many respondents felt that their firsthand experience with HL will positively impact their interactions with patients. The other 23 percent were motivated to join the audiology profession due to their love of science, interest in technology and problem solving, and the integration of subjects such as acoustics and psychology.
In response to the question, “How has your personal experience with HL impacted your approach to clinical audiology?” almost all participants felt that their HL has positively impacted their counseling skills. One participant said:
“I think it impacts my counseling and the way I think about talking about hearing technology and hearing health. Yes, sales are important, but what is more important is that the decision/purchase/surgery is the right/best option for the patient to hear better… I am not shy about letting them know about the benefits [of hearing technology] and realistic expectations.”
Responses also indicated that their personal experience with HL helped them establish meaningful relationships and rapport with patients and led them to be more empathetic and deliver patient-centered care:
“I think I'm much more attuned to patients’ needs and wants. I think there are times where it's hard to describe the emotions or frustration with hearing aids or hearing loss that I can provide that language/vocabulary for patients.”
One participant also stressed the role of personal experience in understanding the importance of early identification of HL, stating:
“After learning many of the side effects and issues that occur with untreated hearing loss, I have reflected on my own experience growing up with hearing loss and realized how important it is to address HL early on. I use these experiences to encourage my patients (especially my pediatric patients) to become consistent hearing aid users and self-advocates for their hearing loss.”
FINDINGS ON SKEPTICISM & DOUBT
Building self-efficacy requires positive experiences and interactions. While many participants in this study shared that their HL motivated them to pursue audiology, 50 percent responded “Yes” to the question, “Did your HL ever make you doubt your abilities as a clinician?” They cited clinic challenges as the reason for this self-doubt:
“I was nervous about hearing aid checks and completing WRS correctly, especially when I started doing CI evaluations. I was so nervous that I would mishear what a patient said and qualify them. I just had to remember I have excellent word recognition scores myself, and if I truly was unsure, I've gotten in the habit of just asking the patient to repeat themselves. It isn't a big deal and just like I tell patients to advocate for themselves, if I need a repetition I'm going to ask.”
In response to the question, “Did you face any skepticism from outside sources towards your decision to pursue audiology?” 31 percent of participants responded “Yes,” with one participant saying that their own audiologist said they couldn't be an audiologist. Most participants felt supported by family and friends. One participant had a mixed response about outside skepticism, stating:
“Yes, from other audiologists, mainly about communication with the clients and the capability to do hearing and listening checks. No from my family and friends.”
In response to the question, “Did a clinical instructor ever make you doubt your abilities as a clinician because of your HL?,” 75 percent of participants responded “No” while the rest agreed and shared negative interactions with clinical instructors that affected their self-efficacy. For example:
“I have so many stories about this. One of the worst was needing to have the patient write the words for word rec during a clinic practical, and the clinical instructor ridiculed me for making the patient feel as though they were taking a spelling test. Other clinical instructors have interpreted my not hearing or mishearing something as social inappropriateness, and I have been lectured about social skills when in reality, the problem was that I missed what was said. Clinical instructors who have behaved in this way toward me have made me doubt myself at times.”
ADVICE FOR CLINICAL INSTRUCTORS
On the question, “What advice do you have for clinical instructors to help you build confidence in your clinical skills?” respondents shared some advice on providing support and solutions. One respondent said:
“Provide resources for accommodations or help your students come up with the accommodations they need! It was really hard for me to figure some of them out on my own.”
Many participants also suggested that clinical instructors give reassurance and constructive feedback. One provided a script for clinical instructors:
“They could say ‘You did a great job of performing ____. I saw that you had some difficulty doing ___ but you did a great job overcoming that difficulty. Here are some things that might help you in the future.’”
It was also recommended that clinical instructors simply ask the student for their perspective:
“I think that as students with hearing loss, we have a unique perspective of this field and I think if we were reminded of how important that was, it would be great for everyone!”
These results support the notion that DHoH students are often drawn to audiology because of their own experiences with hearing care. These results also bring to light the need for clinical instructors to become more aware of their impact on a DHoH student's self-efficacy. Understanding these students’ experiences is crucial to supporting the development of their clinical skills, ultimately benefiting the students’ belief in their clinical abilities and the clinical instructors’ grasp of the experiences of DHoH students and patients with HL.