Major Gap Analysis Reveals Need and Demand for Audiology Supervisor

Competencies 1:15-2:15pm – Thursday, April 16, 2015

Newport Beach, CA – CAPCSD Annual Conference

Torryn P. Brazell, MS, CAEManaging Director

11480 Commerce Park Drive, Suite 220Reston, Virginia 20191 USA

+1.800.881.5410tbrazell@audiology.org

Possesses the ability to coach students and encourage development of skills

Experienced professional with extensive knowledge of the broad field of audiology;may be an expert in a sub-specialty or a variety of sub-specialties

Good communicator

CHIEF COMPETENCIES Clinical Instructor /

Preceptor / Supervisor

KEY FINDINGSABA’s 2014Clinical Instructor Training Needs Gap Analysis: Parts I, II and III

Majority of surveyed clinical instructors overseeing students in clinical placements have completed little – if any – formal training in the specialized skills needed to be effective clinical educators.

Surveyed Clinical Education Coordinators have limited objective criteria on which to base decisions about student assignments to clinical education placements.

Recently graduated audiologists who participated in the survey reported that the lack of standardized preceptor qualifications hampered their ability to evaluate or compare the quality/value of potential clinical educational placements.

Focused on three (3) specific stakeholder groups:

Part I: Experienced Clinical InstructorsAudiologists experienced in supervising audiology students in practicums, externships and other field experiences in various settings

Part II: Clinical Education CoordinatorsFaculty representing audiology doctorate programs who are responsible for facilitating student clinical placements with practicing audiologists

Part III: Recently Graduated AudiologistsAudiologists who have graduated within the last 3 years, who participated in field work and completed externships and internships in various clinical settings

How Was TheGap Analysis Designed?

Survey included 20 questions in four sections: 1) Preceptor Background2) Preceptor Qualification Criteria3) Student Matching Experiences4) Exploring Training Needs

PART I: Experienced Preceptors

Average length of time serving as a clinical supervisor among survey participants was 11 years

Respondents reported supervising students ranging from 3 to 400+ over their professional practice lifetime

FINDINGS

Arizona State University A.T. Still University Auburn University Baylor University Washington University

School of Medicine Central Michigan University Gallaudet University Indiana University Lamar University Michigan State University Minnesota State University Missouri State University

FINDINGS

National University of Singapore Northeast Ohio University Northwestern University Nova Southeastern University Ohio State University Pacific University Purdue University Rush University Salus University San Diego State University Towson University University College of London

Survey respondents reported working with the 43 audiology programs, operating in 22 states and 4 countries.

FINDINGS University of Colorado-Boulder University of Connecticut University of Florida University of Florida (Distance

Program) University Kebangsaan Malaysia-

Bangi Selangor University of Maryland University of Memphis University of Michigan University of Nebraska University of North Texas University of Texas at Dallas University of Texas Medical

University of Washington University of Western

Australia, Perth University of Wisconsin Utah State University Vanderbilt University Wayne State University West Chester University

Respondents from large hospital clinical settings reported having more formalized affiliation agreements in place with educational institutions.

Experienced preceptors who worked in hospitals commented that placement slots at their facilities are in high-demand.

As a result, their organizations can impose competitive candidate screening requirements that draw more consistently well-prepared students.

Highly CompetitiveClinical Placement Sites

The majority of preceptors who participated in the survey reported they had been required to meet one or some combination of the criteria listed. There was no standardization.

Site/Inspection Visits Submission of CVs Letters of Recommendation State Licensure Certificate of Clinical Competence – Audiology Proof of Supervisory Experience Submission of Recorded Lectures Departmental Support Contractual Agreement (to provide a defined number of hours of clinical

experience/training) Completion of a mentorship period working with experienced preceptors

prior to assuming student supervisory duties

What standards were survey participants required to meet to

serve as clinical instructors?

25% of preceptors had been selected to serve as preceptors without being asked to meet any requirements (other than being practicing audiologists)

Interestingly, the two respondents who had served as preceptors and subsequently worked as Clinical Education Coordinators for audiology programs said that they developed more defined criteria and matching tools for prospective preceptors once they found themselves in the position of having to recommend them to students

FINDINGS

The majority of survey participants had not completed structured preceptor training prior to leading students in a clinical setting.

Most who said they’d had no formal training indicated that they’d engaged in self-directed learning to try to close knowledge and skill gaps.

Among the minority of preceptors who reported that training WAS a requirement, the depth and scope of the training varied widely.

FINDINGS

Experienced Preceptors – Training Comments

“I’d had no readings, no discussions on precepting; only my experiences as a student who worked with a preceptor.”

“All I had to reference was how preceptors were to me as a student. I didn’t have any other real guidance in terms of things I was supposed to do or not do. “

“None at all! This surprises me! I took a short course in adult-learning—but that was after the fact, and self-directed.”

FINDINGS

A minority who did complete some form of formal training reported a diverse range of coursework, including:

-- Three-hour preceptor training course-- Six-hour preceptor training course-- A preceptor training course offered “at the hospital level”-- A multi-day preceptor training program modeled on the Credentialed Clinical Instructor Program (CCIP) offered through the American Physical Therapy Association (http://www.apta.org/ccip).-- A preceptor course required to supervise a 4th year/provisionally licensed audiology student

FINDINGS

University administrators played an important role in facilitating student matches for most, although a few said students apply to work with them directly.

A small minority of preceptors reported that their preceptorships are never facilitated by the faculty of university programs.

Student Matching Experiences

Nearly all preceptors had at least one negative experience with a poor student match, for one of the following reasons:

Technical competency levels were inadequate for the setting

Academic program administrators did not provide adequate support to remediate skill issues

The expectations and goals of the experience were unclear to the student, preceptor, or both

There were personality clashes and communication issues. Students demonstrated a lack of professionalism in the

clinical setting Students were matched with clinical settings not aligned

with their interests

Student Matching Experiences

PRECEPTORS: How can the preceptor matching process be improved?

Clearly define and communicate with students regarding goals, the work environment, the types of clinical opportunities available onsite and the methods used to assess the student’s performance and progress.

Discuss upfront the amount of time a preceptor will be able to commit to working with the student.

Consider the student’s ability to function in various clinical settings

Design clinical educational experiences to strengthen areas where the student needs to build competency.

Review the student’s completed coursework to align their clinical experiences with their academic preparation.

Modeling and moving towards coaching Didactic instruction Socratic teaching method One Minute Manager method Student journaling and guided reflections Performance reviews (including regular one-on-one feedback, peer

reviews, etc.) Case presentations, lectures, student projects Physical demonstrations, video, posters, textbooks and internet

resources Provide clinical practice guidelines or pertinent research Team-based learning Role Playing “Student Driving” where the student tells the preceptor what to do

in a given situation

What teaching strategies do surveyed preceptors use?

How to apply adult learning styles How to give effective feedback How to facilitate critical thinking How to ask effective questions Strategies for maximizing acquisition and retention of knowledge Support from an experienced preceptor willing to serve

as a mentor The difference between supervising and

precepting/mentoring/teaching How to calibrate expectations for students as they begin clinical

rotations How to role play How to design an effective learning experience

What did experienced preceptors wish they had known starting out in the role?

Adult Learning Styles Teaching Styles The Preceptor’s Role Formative Student Evaluation Teaching Strategies Managing Challenging Students Giving Constructive Feedback Reviewing Reports (e.g., format, understandability, accuracy) Setting expectations Regulatory Requirements Leadership skills Generating ideas for materials to supplement patient interactions in the

clinic, such as labs, evaluation forms, etc. Guides, chat groups CPT/ICD-9/10 coding and billing pitfalls and practices

Recommendations for topics to include in the new Preceptor Training Program:

Survey feedback from Clinical Educational Coordinators confirmed generally poor access to preceptor training to build skills.

While students are fortunate that many audiologists bring natural teaching instincts – as well as experience – to the preceptor role, being an excellent clinician and an excellent educator are two different areas of expertise.

Audiologists – even the best audiologists, need an educator’s skill sets to develop precepting skills equal to their clinical expertise.

CONCLUSION: Part II

“As an educational institution, we have found it very difficult – if not impossible - to require particular criteria or standards to those interested in working with student clinicians.”

“[We select preceptors] based on their desire to be clinical educators. They must have at least 3 years of experience –though this may be waived … if preceptor-mentors are available... “

“At times, we are approached by audiologist who would like to host students. Sometimes the connection is made by a referral from a current preceptor. And at times, we approach local audiologists to discuss the possibility of hosting students.”

Part II: Clinical Education Coordinators

How do Clinical Education Coordinators determine whether an audiologist is qualified to be a preceptor? A desire to be clinical educator Three years of clinical experience A clinical focus on an area of expertise of interest to students A formal interview with the Clinical Education Coordinator A site visit Positive references/background Survey respondents reported that they often rely on their

professional networks to identify and recruit candidate audiologists to serve as preceptors for their students. Respondents also said that they are sometimes approached by audiologists interested in hosting students, or receive referrals from a current preceptor working with their program.

Only one Clinical Education Coordinator who participated in the survey indicated that her audiology program currently has a formal training program for preceptors. Topics addressed in this preceptor training program include:- Matching preceptor style to student skill- Setting goals & providing appropriate feedback- Difficult conversations- Documentation requirements

What training is in place?

The majority of survey participants did not have a formal training program in place for preceptors, but did offer a range of informal supports: Information packets Ongoing communications Preceptor meetings Monthly “Preceptor Tips” sent via email

FINDINGS

Teaching Skills Communication and Interpersonal Skills Management Skills Task analysis Assessing student skill levels Developing learning objectives

Surveyed Clinical Education Coordinators identified the following skill gaps as areas preceptor training should address:

Developing learning objectives Goal-setting Setting expectations Formative and summative

evaluations Assessing learning styles Observation Fostering critical thinking and

clinical decision-making Dealing with ambiguity

Continued…

The underperforming student Fostering reflective practices Providing written and verbal

feedback Dealing with challenging /

difficult students Generational issues Cultural sensitivity One Minute Manager WWW (What?, So What?,

What Next?) Understanding FERPA

The Clinical Education Coordinators who participated in this survey expressed strong agreement that preceptors and students alike would benefit from the availability of a much more robust and universally available preceptor training program that emphasized the skills listed here.

CONCLUSION: Part II

Part III:Recently Graduated Audiologists

Included 20 questions in four major topic areas:

1) Student Background

2) The Preceptor Selection Process

3) Externship Experiences

4) Exploring Training Needs

Clinical Assignments

AdultsHearing Device Fittings and EvaluationsBalance Testing VeteransHearing Device Fittings and EvaluationsRehabilitation 

Who were the survey participants? PediatricsNeonatal Hearing EvaluationsHearing DiagnosticsCochlear ImplantsDeaf School Assignment 

Clinical SettingsUniversity Clinic HospitalEducational SettingPrivate ENT PracticeHearing and Balance CenterCochlear Implant ClinicVeterans Administration Clinic

40% of respondents graduated from their audiology program in 2012.

60% completed their studies in 2013.

What year did you graduate?

Respondents reported participating in a wide range of clinical placements

Typical clinical rotations began with on-site assignments at university clinics working with adults and children, followed by off-site placements as students progressed through their program.

What field experiences did you participate in during your educational preparation to become an audiologist? Include practicum, internships, externship, other.

Referred to site/preceptor by faculty clinic education coordinator

List of approved sites Preceptor secured directly by student HEARCareers (American Academy of Audiology)

How did survey participants connect with clinical placement opportunities?

The majority said they received limited guidance from their program in finding/selecting a preceptor. Most support was in the form of lists of approved candidates and written materials designed to help compare the value of sites as clinical education opportunities.

If you were connected with a preceptor through a placement coordinator or faculty of your audiology program, did they provide you with any specific guidance in selecting your preceptor?

A majority reported that they received very limited guidance from a faculty placement coordinator during the process of finding their preceptor.

Among those who received assistance from their program, guidance included lists of candidate preceptors and general criteria for comparing the potential value of sites as clinical education opportunities.

Excerpt from Individual Survey Response:“It was important to me to go to a site where I was treated like a student and NOT another set of hands in the office. I wanted to be at a place where I would be challenged and educated every day. I wanted to be somewhere that would prepare me to be competent in the entire scope of practice, and allow me to be confident in my clinical abilities post-graduation.”

What was a deciding factor in selecting an externship site?

Were externships aligned with clinical interests, and were students prepared for their externship by their audiology program?

Survey participants all agreed that their externships aligned with their clinical interests

Most felt generally well-prepared for their externship, although only one reported their program offered a structured, formal program to assist them in preparing

A few indicated that they entered their externship “light” on hands-on experience

Most felt generally well-prepared for their externship, although only one reported their program offered a structured, formal program to assist them in preparing.

A minority indicated that they entered their externship “light” on hands-on experience

The Good News

Pay for time in Clinical Field Experiences The Pay Range Period of Pay Distribution Other Thoughts on Pay for Externships

“You don’t have time to work a part-time job, and it’s not possible to live on the stipend. Most students live off of student loans the last year.”

Pay Questions

All indicated they were paid for their full-time externship assignments in their final year of education.

One individual was not actually paid by the site, however. Rather, this respondent was paid through her post-secondary institution for working at an externship site on a research assistantship, collecting clinical data for a research project on aural rehabilitation.

Were you paid for your time in any of your clinical field experiences?

Responses varied on this question, ranging from $15 per hour to $25,000 per year.

The average pay fell just under $20,000 over the entire course of the final externship, although, as responses to the next survey question explain, the durations of final externships varied.

In addition to monetary compensation, one person said that they had received room and board as part of their externship.

What was the pay range?

Although not all survey participants responded to this question, among those who did, four indicated serving in their externships for a full 12-month period.

Another completed an 11-month externship, and another reported working full-time for a full “academic year”—listed as 10-months.

Respondents described being paid on bi-weekly or monthly schedules.

Over what time period was your pay distributed?

About half reported they’d entered clinical placements with a clear understanding of performance expectations and learning goals.

A majority relied, to some extent, on an informal “follow-by-example” model.

A small minority had performance goals defined by their university program.

Performance Expectations and Learning Goals

The Pluses Valuable exposure to a range of clinical experiences Built professional confidence and moved towards independent practice

Need Improvement Compatibility issues with the preceptor Too many different supervisors The preceptor’s management and organizational skills A fairer wage Better coordinated timing for the externship application process Lack of exposure across the full scope of practice Lack of time learning about administrative operations / billing and

reimbursement.

What did survey participants feel went well in their externships? What needed improvement?

How to interact with patients Independent thinking Independence with basic clinical responsibilities and a

foundation for more advanced practice Well-rounded clinical experiences Exposure to classical as well as unconventional clinical

presentations Time management and troubleshooting Counseling skills for every age group Specific clinical skill sets (ABR; cochlear implants, etc.)

What did survey participants think was critical for them to learn during their externships?

Clinical Skills Has a well-rounded clinical background Is a life-long learner Has a strong understanding of the science that

underpins clinical practices Applies evidence-based practice Is willing to continue learning new and better ways to

do our job Is interested in improving as a clinician; stays current

on new research 

What qualities and behaviors did survey participants attribute to skilled preceptors?

Teaching Skills Enjoys and wants to teach Allows students to try things Provides positive reinforcement Can teaching to a variety of learning styles (visual, auditory,

kinesthetic learners) Treats students with respect Fosters intellectual curiosity Provides a challenging learning environment Provides students with routine evaluations of their

performance Can provide constructive criticism Can let go and give students independence when appropriate Acts as a mentor

Qualities continued…

Professional Leadership Skills Leads by example Behaves professionally with the student and with patients Serves as a professional role model

Management Skills Has good time management skills

Interpersonal Skills Is a good listener Values the student's input Engages in constant communication with student Demonstrates patience and understanding with students and patients Exhibits humility as a clinician 

Qualities continued…

There is a Need for a Foundation for a Standards-driven Training Program

1. VOLUNTARY2. Creates supervisor preparation designed specifically

for audiologists and students with whom they work;3. Improves and enhances the quality and consistency

of student clinical learning experiences;4. Strengthens the field of audiology by promoting best

practices in clinical skills and professional competency among future generations of clinicians

CONCLUSION: Part III

Assessment-Based Certificate Programs Development Provide certificate program developers and certificate issuers guidelines

for quality program development and administration;

Form the foundation…that enable consumers, employers, government agencies, and others who rely upon a skilled workforce to distinguish between qualified workers and those with fraudulent or less-than-quality credentials;

Assist stakeholders in differentiating between certificate programs from personnel certification; and

Assist stakeholders in differentiating certificate programs from other programs that confer certificates, including but not limited to certificates of attendance or certificates of participation.

The ABA Follows ASTM E2659-09e1 Accreditation Standards

Standard 1 – SCOPE (example) 1.1 This practice provides guidance to certificate issuers

for developing and administering quality certificate programs and to stakeholders for determining the quality of certificate programs.

1.2 This practice includes requirements for both the entity issuing the certificate and requirements for the specific certificate programs for which it issues certificates.

1.3 This practice provides the foundation for the recognition or accreditation or both of a specific entity to issue a specific certificate or certificates to individuals after successful completion of a certificate program.

The ABA Follows ASTM E2659-09e1 Accreditation Standards

May 2015 – ABA Office – Reston, Virginia

SME Participants Current and experienced clinical supervisors Recent AuD student graduates ACAE American Academy of Audiology Clinic Educational Coordinators

NEXT STEP: Training Modules Development