An Evaluation of a Continuing Education Workshop for Audiologists on the Assessment and Management of Tinnitus.

INTRODUCTION: Tinnitus assessment and management is an important component of audiology. The benefits of continuing education (CE) workshops in the field of tinnitus have not been published. This study evaluated the outcomes of a workshop centered around a Sound Therapy and Aural Rehabilitation for Tinnitus (START) framework. Our hypotheses were that a CE workshop would (1) be useful, (2) improve clinician's knowledge and willingness to undertake tinnitus practice, and (3) result in learners using knowledge gained in their practice. METHODS: Twenty-five participants attending a 3-day tinnitus workshop were invited to complete an evaluation immediately and 3 months after the workshop's completion. The workshop consisted of seminars and practical sessions. The pedagogical approaches employed were experiential (theory building, reflection, and testing) and community of practice (shared experiences). RESULTS: Participants reported on a 5-point Likert scale (1 = not useful-5 = excellent) a high level of satisfaction both immediately after the workshop (ratings of usefulness: mean, 4.8; SD, 0.4; willingness to practice: 4.6; SD. 0.6; ability to manage: 4.6; SD, 0.5; all "excellent" ratings) and 3 months later (ratings of usefulness: mean, 4.2; SD, 0.9, "very useful;" willingness to practice: 4.6; SD, 0.6, "excellent;" ability to manage: 4.1; SD. 0.5, "very useful"). Open-ended questions indicated participants made changes in their practice that reflected material provided in the CE. CONCLUSION: The workshop was successful in improving knowledge and confidence of audiologists in undertaking tinnitus assessment and management, but the need for ongoing support and supervision was a common theme.

Student perceptions of two simulated learning environments in paediatric audiology.

Objective: To determine audiology student perceptions of two simulated learning environments (SLE) in paediatric audiology.Design: A one-shot case study design.Study sample: Fifteen audiology students who completed questionnaires after participating in two SLEs, one simulating auditory brainstem response (ABR) assessments of neonates in a hospital ward and one simulating visually reinforced orientation audiometry (VROA) assessments of young children in an audiology clinic.Results: The students responded positively to 11/11 areas of audiometric testing and client interaction in both SLEs, to 7/7 aspects of their interactions with the mannequins in both SLEs, and to 8/8 aspects of their interactions with fellow students playing the role of parent in the ABR SLE and 7/8 of these aspects in the VROA SLE. The students reported low levels of anxiety towards both SLEs but rated the ABR SLE more highly than the VROA SLE in areas of preparedness, effectiveness, realism, pre-SLE training, reinforcement of lecture content, and overall usefulness.Conclusions: The participating students responded positively to almost all aspects of both SLEs. Further research is warranted using research designs capable of determining if these SLEs directly improve student abilities as they transition from academic settings to clinical placements in paediatric audiology.

Management of adult patients with tinnitus: Preparedness, perspectives and practices of audiologists.

BACKGROUND: Audiologists, globally, are generally challenged when assessing and creating intervention plans to help patients suffering from tinnitus. Tinnitus is very common among individuals and may significantly affect one's quality of life, especially if not addressed by health care professionals. In South Africa, there seems to be limited published studies regarding the current practices of tinnitus management by audiologists. This is mainly because of limited training and a lack of guidelines and strategies for the management of tinnitus. In particular, some participants reported being unfamiliar on how to approach the identification of tinnitus and difficulty is also encountered when counselling tinnitus patients. AIM: The aim of this study was to describe the preparedness, perspectives and practices of audiologists who manage adult patients with tinnitus. METHOD: Two hundred and forty-three registered Health Professions Council of South Africa (HPCSA) participants were involved in the study by responding to an electronic questionnaire survey. Data were collected online from Survey Monkey and were exported to Statistical Packages for the Social Sciences (SPSS) (Version 23) for statistical analysis. Data were analysed using descriptive and inferential statistics. Closed-ended questions were analysed within a quantitative framework and thematic analysis for open-ended questions that were descriptively quantified. RESULTS: The results of the study are presented according to the objectives. Approximately 44% of participants (44.3%) disagreed that the undergraduate university training had sufficiently prepared them to manage adult patients with tinnitus. Very few (12.3%) had the opportunity to attend specialist training on how to assess patients with tinnitus. Similarly, only 11.6% received any specialist training with regard to tinnitus intervention. With regard to its overall management, 49.4% felt adequately informed in the assessment of patients with tinnitus, while a further 39.2% rated their experience as being limited with regard to tinnitus intervention. There is no statistical significance relationship between participants' years of experience and tinnitus intervention (p = 0.075). Most participants did not follow any standard guidelines for its management. Some participants (26.8%) reported that further education and training are required in the overall management of patients with tinnitus, while a further 17.7% required training in all areas of tinnitus. CONCLUSION: The feedback relating to the study suggests that overall management of tinnitus seems to be a challenge among South African audiologists, irrespective of their years of experience. Audiologists in the study perceived that tinnitus services are limited mainly because of a lack of or limited knowledge, training and guidelines, these being affected by contextual restraints.

Audiologists and Tinnitus.

Purpose Although tinnitus is highly prevalent among patients receiving audiology services, audiologists are generally untrained in tinnitus management. Audiology graduate programs, as a rule, do not provide comprehensive instruction in tinnitus clinical care. Training programs that do exist are inconsistent in their recommendations. Furthermore, no standards exist to prevent the delivery of unvetted audiologic services, which can be expensive for patients. Patients seeking professional services by an audiologist, therefore, have no basis upon which to be assured they will receive research-based care. The purpose of this article is to describe the current status of tinnitus management services that exist within the general field of audiology and to suggest specific approaches for improving those services. Conclusion Audiologists may be in the best position to serve as the primary health care providers for patients experiencing tinnitus. Tinnitus care services by audiologists, however, must achieve a level of evidence-based standardization.

Perceived Gaps in Genetics Training Among Audiologists and Speech-Language Pathologists: Lessons From a National Survey.

Purpose The aim of this study was to assess knowledge, self-rated confidence, and perceived relevance of genetics in the clinical practice of audiologists and speech-language pathologists (SLPs) toward a better understanding of the need for genetics education, given that genetics plays a growing role in the diagnosis of hearing impairment and communication disorders. Method A survey consisting of 8 demographic items and 16 content questions was returned by 233 audiologists and 283 SLPs. Knowledge of applied genetics was queried with clinical scenarios in a multiple-choice format. Self-assessment of clinical confidence and perceived relevance of genetics in one's field was queried with questions and statements rated on 5-point Likert scales. The benefit of additional training in genetics was rated with a yes/no question, and if answered with yes, suggested topics were entered. Results A large significant gap between confidence in one's own genetics skills and the perceived relevance of genetics was evident, regardless of professional group. Over one third of the audiologists and over two thirds of the SLPs indicated low or somewhat low confidence in their own ability to implement principles of genetics, whereas over two thirds of both groups agreed that genetics is relevant for their field. Regardless of group, confidence scores were significantly and positively associated with relevance scores. Over 80% of respondents in both groups indicated that they would benefit from additional training in genetics. Most commonly suggested topics included genetic causes, general information about genetics, and making referrals. Conclusion Both audiologists and SLPs felt that genetics is relevant for their fields and that additional training in genetics would be beneficial. Future studies should evaluate the effect of genetics training on patient outcomes and the need for incorporating genetics more extensively into audiology and speech-language pathology training programs.

Audiologist availability and supply in the United States: A multi-scale spatial and political economic analysis.

This study employs statistical modeling and mapping techniques to analyze the availability and accessibility of audiologists (practitioners who diagnose and treat hearing loss) in the United States at the county scale. The goal is to assess the relationships between socio-demographic and structural factors (such as health policy and clinical programs which train audiologists) and audiologist availability. These associations are analyzed at the county level, via a mixed effects hurdle model. At the county level, the proportion of older adults reporting difficulty hearing is negatively associated with audiologist supply. The findings show that audiologists tend to locate in metropolitan counties with higher median household incomes, younger populations, and lower proportions of older adults reporting hearing difficulty, suggesting an inverse care-type relationship between audiologist availability and need for hearing health services. Notably, neither state legislation requiring insurance plan coverage of hearing services for adults or Medicaid coverage of audiology services were significant predictors of audiologist supply at the county level.

Towards patient-centred communication: an observational study of supervised audiology student-patient hearing assessments.

OBJECTIVE: This study has two interconnected aims. The first was to better understand how audiology students co-construct hearing assessments with patients while supervised by a clinical educator. The second was to investigate how students' communication aligns with principles of patient-centred communication. STUDY SAMPLE: Twenty-three final year audiology students from two Australian universities participated in the study. RESULTS: The supervised student-patient hearing appointments were video-recorded and transcribed. Genre analysis, a form of discourse analysis, was carried out to identify the structure and communication patterns. The six-function model of medical communication was adopted as an analytical framework to map students' patient-centred communication. The findings showed generic structure of the hearing assessments were the main stages of taking a history, providing a diagnosis, and initiating management plans. For patient-centred communication functions, students demonstrated their ability to foster the relationship and gather information. The communication functions of decision-making, enablement, and responding to patients' emotions were rarely observed. A significant relationship was found between clinical educators' interjection as a function of students' patient-centred communication tendencies. CONCLUSION: To enhance students' patient-centred communication, teaching should include explaining and planning as well as addressing additional aspects of patient-centred communication. Support of clinical educators is needed to optimise students' communication skills learning.

Stories From the Webcams: Cincinnati Children's Hospital Medical Center Audiology Telehealth and Pediatric Auditory Device Services.

PURPOSE: The purpose of this manuscript is to describe the regulatory, technological, and training considerations for audiologists investigating telehealth and to offer some examples of audiology services provided through telehealth. METHOD: The authors presented the regulatory components, the technology required for audiology staff and patients, and staff training for the audiology telehealth program at Cincinnati Children's Hospital Medical Center. Four case studies highlighting the successful use of telehealth in providing auditory device services to patients were also presented. RESULTS AND CONCLUSION: The described regulatory, technological, and training hierarchy provides a framework for audiologists interested in starting a telehealth program. The cases presented illustrate that telehealth can be used to provide some auditory device services, such as troubleshooting, mapping, and parent consulting.

How Gender Stereotypes May Limit Female Faculty Advancement in Communication Sciences and Disorders.

Purpose: The field of communication sciences and disorders (CSD) faces a critical shortage of the faculty essential to train the future workforce of speech-language pathologists and audiologists. Despite a predominance of women in the field, men receive doctoral degrees, tenure status, academic leadership positions, and American Speech-Language-Hearing Association awards at disproportionately higher rates than women. The purpose of this review is to explore how implicit gender bias may contribute to female faculty advancement, including current and projected faculty workforce shortages, and to propose tangible solutions. Method: The authors present proportions of men and women who receive doctoral degrees, advance to each faculty rank, receive tenure status, hold department chairs in CSD, and receive American Speech-Language-Hearing Association honors and awards. They review ways in which cultural stereotypes give rise to implicit gender bias and discuss myriad ways that implicit gender bias may influence the decisions of students considering an academic career in CSD and their career trajectories. Conclusions: Cultural stereotypes about men and women lead to implicit gender bias that may have real consequences for female faculty advancement in CSD. Such implicit bias can influence career selection and outcomes within the field in multiple ways. To ensure that CSD continues to attract top talent and maintain a robust pipeline of future faculty in doctoral training programs, the field must recognize the existence of implicit gender bias and implement evidence-based strategies to minimize its potentially damaging effects on the future of the profession.

Practice patterns of South African audiologists in cerumen management: a pilot study.

OBJECTIVE: To determine the training, self-reported competence and practice patterns of South African audiologists (SAAs) regarding cerumen management (CM). DESIGN: Prospective cross-sectional survey. An online questionnaire was completed by SAA between July and September 2016. The questionnaire addressed sections on educational training, experience and practice patterns of SAAs regarding CM. STUDY SAMPLE: Three hundred and fifty-six SAAs responded to an email invitation sent to 382 actively-practicing audiologists. RESULTS: Majority of the participants (85%) were employed for less than 10 years. Forty-nine percent received less than 10 hours of theoretical training while 57% received less than 10 hours of clinical education. A total of 96% of the participants indicated they felt competent to perform CM, with 96% preferring manual, ear syringing, or a combination of the two. Handwashing pre- and post-procedure was the preferred method of infection prevention and control by 87% of the participants with 66% of these indicating they only wore gloves. Majority (85%) of the participants indicated that they always explained the possible complications of CM to their patients. CONCLUSION: Findings from this study indicate that South African audiologists feel that they are adequately trained and competent to perform CM.

Postgraduate training in audiology improves clinicians' audiology-related cue utilisation.

OBJECTIVE: This study was designed to test whether cue utilisation might be employed as a tool to assess the diagnostic skills of audiologists. The utilisation of cues is a characteristic of expertise and critical for successful diagnoses in clinical settings. However, neither in training nor in practice, is there a means by which the diagnostic skills of audiologists can be assessed objectively and reliably. DESIGN: The study comprised a pre-post training evaluation, controlling for prior exposure to the diagnostic testing tool. STUDY SAMPLE: Three cohorts of trainee audiologists were evaluated, one of which was tested prior to, and following a two-year training programme (16 participants), while the other two groups acted as controls (23 participants and 20 participants, respectively). RESULTS: Consistent with expectations, cue utilisation increased from the initial to the final stages of training and this effect could not be attributed to cohort nor learning effects. CONCLUSIONS: At an applied level, the outcomes provide the basis for a cue-based diagnostic assessment tool that can provide both trainee and practising audiologists with detailed feedback concerning their diagnostic skills.

Evaluation of otoscopy simulation as a training tool for real-time remote otoscopy.

OBJECTIVE: Teleotoscopy requires the assistance of telehealth facilitators; but their training requirements remain to be determined. We evaluated the use of an otoscopy simulator to train facilitators to remote otoscopies sent via the Internet using a teleaudiology platform. DESIGN: Neurotologists experts were asked to identify images using the otoscopy simulator and to perform an identification task of significant anatomical landmarks. The experts were asked to repeat those tasks remotely, with the help of facilitators who either received basic training, or no training prior to the experiment. STUDY SAMPLE: Three experts, three trained facilitators and three untrained facilitators participated in this study. RESULTS: The use of an otoscopy simulator in addition to remote otoscopy yielded a good inter- and intrarater agreement (κ between 0.81-1, and 0.80-0.87, respectively). The accuracy of diagnosis was high on-site (11.7% error) and remotely (0% error). The time required for landmark identification task was not increased when performed remotely with a trained facilitator versus on-site otoscopy (9.3 versus 9.2 s/landmark). Conversely, the lack of training of facilitators increased significantly this time (15.6 s/landmark, p < 0.001). CONCLUSION: An otoscopic simulator coupled to teleaudiology software can be used to efficiently train both experts and facilitators to perform remote otoscopy.

Promoting Hearing Health Collaboration Through an Interprofessional Education Experience.

PURPOSE: To enhance audiology and physician assistant (PA) student appreciation for collaboration/team-based care through an interprofessional educational activity focused on hearing assessments. METHOD: A total of 18 students from Louisiana State University Health-New Orleans's audiology and PA programs participated in an optional interprofessional education learning opportunity, which included a demonstration of hearing assessments. To assess student perspectives regarding interprofessional learning, the students completed pre- and post-surveys. RESULTS: Eighteen students completed a survey, including 5 questions using a Likert scale and 1 open-ended question. Both audiology and PA students demonstrated significant statistical improvement in 2 interprofessional competencies: roles/responsibilities and interprofessional communication. Students also reported increased awareness and knowledge in the skills of the opposite professions as related to hearing assessments. CONCLUSION: Integrating interprofessional education experiences within an audiology program promotes collaborative practice patterns and supports new educational accreditation standards. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.5491669.

The practices, challenges and recommendations of South African audiologists regarding managing children with auditory processing disorders.

Audiologists managing children with auditory processing disorders (APD) encounter challenges that include conflicting definitions, several classification profiles, problems with differential diagnosis and a lack of standardised guidelines. The heterogeneity of the disorder and its concomitant childhood disorders makes diagnosis difficult. Linguistic and cultural issues are additional challenges faced by South African audiologists. The study aimed to describe the practices, challenges and recommendations of South African audiologists managing children with APD. A quantitative, non-experimental descriptive survey was used to obtain data from 156 audiologists registered with the Health Professions of South Africa. Findings revealed that 67% screened for APD, 42% assessed while 43% provided intervention. A variety of screening and assessment procedures were being administered, with no standard test battery identified. A range of intervention strategies being used are discussed. When the relationship between the number of years of experience and the audiologists' level of preparedness to practice in the field of APD was compared, a statistically significant difference (p = 0.049) was seen in that participants with more than 10 years of experience were more prepared to practice in this area. Those participants having qualified as speech-language therapists and audiologists were significantly more prepared (p = 0.03) to practice than the audiologists who comprised the sample. Challenges experienced by the participants included the lack of linguistically and culturally appropriate screening and assessment tools and limited normative data. Recommendations included reviewing the undergraduate audiology training programmes, reinstituting the South African APD Taskforce, developing linguistically and culturally appropriate normative data, creating awareness among educators and involving them in the multidisciplinary team.