The Unholy Alliance Between Academia, Preceptors, AuD Students and the Profession

The current AuD education model is one where the academic training program trains the student, both theoretically and clinically, on campus for the first one to three years.  The student’s clinical education is then relegated, almost completely, to off-campus, volunteer preceptors, who have their own clinical responsibilities outside of student education.  The final year of clinical training, the externship, is again relegated to off-campus, often out of state, volunteer educators,  who we are asking to take on full time clinical and professional education. All the while, academia is the one reaping any and all financial benefit. 

Currently, there is a great deal of finger pointing. Many believe academia does a poor job in teaching theory and evidence based practice, in nurturing and then demanding critical thinking, in weeding out those students who are ill-equipped to become true colleagues, and in providing little if no support, either personal or financial, to off-campus preceptors. Others believe a great deal of responsibility lies with these unpaid preceptors, who provide insufficient support and supervision, who do not consistently illustrate, in their own work, evidence based practice and critical thinking, who see students as nothing more than cheap labor rather than the students they truly are, and who fail to evaluate students by their true capabilities and performance, which results in some students who are enabled to slide through a profession they are ill prepared to work in independently.  Still others, blame this generation of students and see them as entitled, whiny and under prepared. Finally, many blame the profession and our professional associations and accrediting bodies for their significant failures in formalizing and operationalizing the off-campus clinical education component of AuD education, in requiring stricter academic standards and more 21^st century curriculum and educational models, and in closing or forcing consolidation of programs, who do not have the financial or human resources to provide a comprehensive theoretical or clinical education. 

Many of us, including myself, think this current clinical education delivery model is broken and that often the outcomes are not as expected by any of the participants, including the student. How do we change this paradigm and its direction? 

Our approach to change, to date, has solely been top down.  It has been led by associations and accrediting bodies and their insular group of decision makers.  There have been innumerable meetings, task forces, committees, sub-committees, forums, and conferences solely dedicate to AuD education.  I know, I have participated in them and heard about the others. These endeavors have produced, to date, more reports and more meetings but little if no actionable items.  The biggest change we have seen is that where ASHA will begin to allow for a pathway to certification post-graduation in 2020. Outside of this, no real, tangible change has been made.  They seem to lack the political will to make the tough call. Valuable human and financial resources have been continually squandered.

The majority of academia will not change until they are forced by national associations, accrediting bodies and market forces. Students and preceptors, despite their roles and responsibilities, in many situations, have little to no voice.  Most academic programs have no will nor no ability for honest self-reflection or motivation to evolve voluntarily. Their goals, in many cases, are solely self-preservation and “butts in seats”.  Quality and outcomes appear secondary. 

The change is going to have to be grassroots and going to have to come from preceptors and students. First, more audiologists, who provide evidence based practice and patient centered care, need to step up, step in and precept. AuD clinical education cannot occur without you. But, they should ONLY precept for programs that consistently (I stress this because every program, no matter how good, has outliers) produce students with strong critical thinking skills, interpersonal skills, and theoretical knowledge.  We can teach anyone to push the buttons; what is harder is teaching individuals to think and make patient centered decisions. Marginal programs will have to change, close or consolidate if audiologists refuse to precept their students. Preceptors should also grade students fairly and honestly and not push students forward who are ill prepared for the professional and interpersonal demands of audiology. Finally, preceptors need to recognize and accept that AuD students, whether in their first year or fourth, are STUDENTS! These students need you to lead by example, both clinically and personally, every day and with every patient.  They need your commitment to supervision, professional support, and honesty. They need you to let them fly, when they are ready, but to be there with a net. 

Students also have a role in all of this.  In the application and decision process, potential candidates need to ask about student outcomes, resources, course offerings, support systems, and off-campus clinical opportunities.  A lower graduation rate is GOOD thing in a clinical specialty, not a bad thing!  It means the program will not allow a classmate, who is under prepared, to earn the same degree as you! You want to know how many students pass the Praxis, present at state or national meetings, or have leadership positions? What are the depth and breadth of clinical placement opportunities? What courses are available? How many students are still in the profession in five years? Ten years? How many students are in leadership positions in five years? Ten years? 

Students also have to step up and step in.  This is not high school or their undergraduate college experience.  They are now adults in a professional, adult educational setting. Mom and dad have no role or voice here.  The student voice reigns supreme. They need to consistently respond with self-reflection, maturity, initiative, honesty, and professionalism. They need to appreciate and realize that good preceptors are volunteers, committed to audiology and them, who are attempting to build strong colleagues. Students need to demand more and speak up when concerned, but with solutions and not merely with complaints. Students need to push and demand more from the profession they are committing more in time and treasure, than any previous generation before them, to join. 

There are audiologists out there, like myself, that are willing to support change and change agents. I see my responsibility to audiology now as one where I work hard to build a stronger profession and I support those who will lead the next generation forward.  I will be successful only when audiology is successful. Audiology’s future is extraordinarily bright if we have the political and personal wills to put egos and self-interests aside, push up our collective sleeves, and dig in to make the critical and difficult decisions to move the needle! Who wants to join the Audiology Revolution?