Home > Audiology Academic/Professional Guidelines .:
If you have any questions, comments, or suggestions related to audiologists with hearing loss, please contact: Sam Atcherson at audiology@amphl.org.
Table of Contents
Before we begin
Considerations for Audiology as a Career
- What is an audiologist?
- Is this really what I want to do?
Academic Evolution of an Audiologist
- Introduction to the Training Models
- Academic Pathway
Getting into An Audiology Program
- Can I meet the technical standards of my field of interest?
- How do I maximize my verbal test scores?
- Disclosing one's hearing loss during the application process
- Program visitation
Audiology Programs
- List of Schools with deaf/HOH student/graduates
- AMPHL's Recommendation
Before Audiology Program Starts
- What Now? Do I need to do anything before school starts?
- Self-introduction
The Classroom Years
- How do I get the information?
The Clinical Training Experience
- Communicating with patients
- Administering speech-based tests
- Checking hearing aids and other assistive listening devices (ALDs)
- Academic or Manufacturer Workshops
- Using the telephone or compensating for the inability to use it
- Acoustic Phones
- Text Phones
- Text Messages (pager, cell phone, or internet messages)
- Interpreters
- The Operating Room
- Research and Externships
Clinical Fellowship or 4th year AU.D. Externship
- The application process
- How to set up a system that will work for you
The First Job
- Applying for that First Job
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BEFORE WE BEGIN
The AMPHL audiology guidelines address a certain group of readers: Individuals with hearing loss who are working in the audiology profession or aspiring to do so. With such an audience in mind, AMPHL addresses "you" as one of these readers and "we" or "us" as the collective group. AMPHL does not exclude those who are interested out of support or curiosity.
The AMPHL audiology guidelines were written based on known experiences of several audiologists and audiology students with hearing loss. Everyone with hearing loss is different. Some have more hearing than others. Some feel more comfortable setting limits for themselves, while others plow headlong into working environments that are extra challenging for those with hearing loss. Most have some hearing and compensate with hearing aids or cochlear implants. Most communicate orally, though some may use sign language. There is at least one case of an audiology student who employs the services of an interpreter for all professional and patient interactions (the audiologist always remains as the professional). All of these differences affect who we are and how we approach challenges. It is important to AMPHL that we respect the feelings and viewpoints of people with different experiences with hearing loss. AMPHL strongly encourages others to share their experiences and to give constructive criticism regarding our audiology guidelines so that we may continually make improvements.
As with most professions, there is a certain degree of demand for the ability to hear and to communicate by spoken language. Technological advances and accessibility have permitted even those with severe hearing loss to perform in their jobs. Audiology is no exception. However, because audiology generally involves the evaluation of hearing abilities in others using acoustic equipment, having the ability to hear as the professional is deemed quite important. This is not to say, however, that an individual who cannot benefit from hearing aids or a cochlear implant cannot be an audiologist. Instead, it means that there may be some unique personal obstacles to overcome or hired assistants may be required to be a fully independent practitioner. Therefore, the most important thing to remember as you read these guidelines is that you can do anything you want to do with appropriate accommodations. Never let anyone else tell you that you cannot do something because of your hearing loss. You should be the one to decide what your limitations are going to be, if any.
We will not mislead you. As individuals with hearing loss working in healthcare fields, our road was not an easy one. It took a lot of courage, perseverance, and strength. Many times we became discouraged and almost gave up. We persevered and we succeeded. Because of this, we have a tremendous amount of pride in what we have accomplished. For us, things turned out to be well worth the effort. We are members of a profession that we love, and we are doing the kind of work that we have always wanted to do. Now we want to help others aspiring to follow in our footsteps and encourage them to follow their hearts and their dreams. We are proof that it can be done, and we want to share our experiences with you in hopes that you can learn from the challenges we faced, the obstacles we overcame, and the mistakes we made. We hope that you will not become discouraged from reading our guidelines. We wish to describe our paths and paint a realistic picture. Rather we hope that you become inspired and even more determined to pursue your goal of entering the audiology profession. Remember you can do anything you want to do!
CONSIDERATIONS FOR AUDIOLOGY AS A CAREER
1) What is an audiologist?
Audiology is a healthcare field devoted to hearing and related processes. It is a clinical profession whose unique mission is the evaluation of hearing abilities and the amelioration of difficulties resulting from hearing disorders. Audiologists are, by virtue of academic and clinical training, and appropriate certification and/or licensure, uniquely qualified to provide a comprehensive array of services related to the prevention, evaluation, and rehabilitation of hearing impairment, its associated sequelae, and balance disorders. A single audiologist may play one or more roles including: clinician, therapist, teacher, researcher, administrator, and consultant. Audiologists may, for example, conduct various diagnostic hearing and balance tests; program and fit hearing aids, cochlear implants, and assistive listening devices. The various tools that audiologists may conduct include behavioral, electroacoustic, and electrophysiological tests. Audiologists may find themselves working a number of other healthcare specialists that treat patients who are at risk for hearing impairment. These specialties include: pediatrics, neonatology, neurology, neurosurgery, oncology, infectious diseases, community and family medicine, and gerontology. Audiologists may work closely with educators, speech-language pathologists, and physical therapists.
2) Is this really what I want to do?
You can do anything you want to do, but are you sure you want to be an audiologist? You need to have some exposure to the audiology profession. You are probably extremely familiar with the work of an audiologist as you might have gone to see one several times in your life. As mentioned earlier, much of what an audiologist does involves the use of acoustic signals whether they are from test equipment or checking hearing aids. Therefore, having the ability to hear or compensate for it using hearing aids or cochlear implants is deemed important. However, it is conceivable that an individual who is deaf may also be successful as an audiologist with appropriate accommodations (e.g., sign language interpreter who serves as assistant). Your primary audiologist may be the best resource for you to ask questions and discuss whether or not you have what it takes to be an audiologist. Paying a visit to a University audiology department may allow you to see the broad scope of practice and you can decide what may be of interest to you. This will help you decide what you want to do and will show the admissions committee that you have tested the waters and are still committed.
ACADEMIC EVOLUTION OF AN AUDIOLOGIST
Introduction to the Training Models
The field of audiology is currently undergoing a major academic training transition that we feel should be addressed at this junction. We feel that it is highly relevant for an individual with hearing loss considering audiology as a career. Take a look at Figure 1. You will notice two different models: Educational Model and Professional Doctorate Model. For many years, audiologists were trained under the Educational Model through which they obtained a Bachelor’s degree and an entry-level Master’s degree followed by a 9- to 12-month clinical fellowship (CF) experience. Audiologists with interest in teaching and conducting research went on to pursue a research Doctor of Philosophy (Ph.D.). When the need for additional clinical training had been realized, the field began moving gradually towards the dissolution of the Master’s degree and the CF and replacing it with Professional Doctorate, the Doctor of Audiology (Au.D.), under a new model. In 2007, the Au.D. (or equivalent doctorate such as clinical Ph.D. or Sc.D.) will be the entry level degree, and many audiology programs will quickly be graduating their last remaining Master’s degree candidates. At this point, many programs will have already upgraded to the professional doctorate or will close due to lack of resources, lack of Regent’s approval, or lack of local clinical training experiences for the students.
Once the professional doctorate is made the entry-level degree, those who are interested in teaching and conducting research will go on to obtain the research Ph.D. It should be noted that with the advent of the professional doctorate, a handful of distance-learning programs are currently available to allow Master’s degree holders an opportunity to upgrade their degrees to the Au.D. However, it should also be pointed out that all of the distance-learning programs will phase out by around 2010.
Figure 1. Audiology Training Models
Academic Pathway
Academic exposure usually begins at the undergraduate level with students majoring in Communication Sciences and Disorders. During the junior and senior years, students take a wide range of course in both audiology and speech-language pathology, they amass 25 observation hours in both fields, and little to no hands-on clinical experience is offered. Master’s degree programs often require appropriate undergraduate education before acceptance into their program. With the advent of the Au.D. degree, however, many professional doctorate programs will accept students from a wide variety of backgrounds. You may need to inquire with the graduate school of interest to be sure this is the case and if not, ask whether you can fulfill any necessary requirements while a student in their program.
At the graduate level, the curriculum is specifically tailored to prepare audiology students for the workforce. The graduate program includes both intense academic coursework and clinical training. Before the completion of the Master’s program, at least 350 clinical clock hours had to be obtained before the CF experience. The professional doctorate program, however, will have students graduating with more than 2000 hours before they enter the workforce. During the graduate training, students will often be trained academically by the research faculty and clinically trained by Masters- or doctoral-level clinical supervisors holding the appropriate credentials. In many cases, faculty members may also serve as clinical supervisors.
Any additional training beyond the Master’s or professional doctorate usually culminates in the form of a research Ph.D. Students enrolled in a research Ph.D. program will select an area of interest that may have a basic and/ or applied (clinical) research approach.
GETTING INTO AN AUDIOLOGY PROGRAM
1) Can I meet the technical standards of my field of interest?
In many healthcare programs, there are "technical" standards that a person must have in order to succeed as a student in the program and as a professional in that field. Examples might include being able to lift at certain amount of weight, have the ability to communicate orally, having correctable vision, and having normal hearing sensitivity. As far as we know, there are no technical standards in audiology, but there may be specific criteria against which applicants may be weighed.
Admissions committees use both technical standard and academic merits to judge all applicants as well as those with disabilities. Some schools are very restrictive, while others are more willing to consider how disabilities can be compensated for by a given individual. Your admissions committee may offer or require an interview at which time you may have to be prepared to explain how you intend to compensate for your disability. At first thought, you may feel that an audiology program will be very accepting of an individual with hearing loss; however, the various admissions committee members may feel differently. The committee may want to know the extent of your communication abilities and skills. For example, is your speech intelligible (can people understand you?), are you technologically savvy (can you use computers, the internet, and employ alternative means of communicating with patients?), and what accommodations will you need to be a successful student in the program? In some unfortunate cases, both the department and the University may not have the means to accommodate a student. You will have to explore what your options are.
2) How do I maximize my verbal test scores?
The Graduate Records Examination (GRE) is a major part of the application process, and it includes a test of verbal reasoning skills. Some individuals are fortunate that these tests do not present a problem. But other individuals with a significant hearing loss occurring at the early stages of language development may not have had exposure to the full range of language complexity. Speech therapy might have trained you to develop strong speaking skills, and your English coursework might have honed your writing skills; but they do not necessarily cover the types of skills being tested on standardized measures. You might need more time to process the verbal reasoning questions. In this case, taking the graduate entry examination, in part or in whole, without time limits is the solution. (The drawback to this is that it will be disclosed to the admissions committee, who may look unfavorably upon it.) For others, an explanation to the admissions committee that the verbal reasoning section does not accurately reflect your language skills would suffice. Have your audiologist or counselor write a letter on your behalf.
3) Disclosing one's hearing loss during the application process
All of us want to be judged on our merits. We do not want hearing loss to be used against us or for it to be a liability issue. By the same token, if we are not honest with the admissions committee, it could backfire. It is very difficult to hide a significant hearing loss. If the admissions committee finds out about your hearing loss from someone else, it may be a negative reflection on you that you were not upfront with them and were not willing to address the issue. In the end, you are your own best advocate.
One option is to include, with your application, an additional letter that describes your hearing loss and how you compensate for it. It may be helpful to have a faculty member, dean, or advisor - someone who knows you well - call those schools and vouch for you. At the very least, talk with the dean of your school about your situation. At the end of your letter, encourage the admissions committee to contact the dean, your advisor, or you with any questions.
The question of disclosing one's hearing loss remains a controversial one. The admissions committee still may wonder if you will succeed in a demanding academic environment. They may feel threatened by the effort and expense of the accommodations you may require. While federal legislation makes discrimination on such grounds illegal, it cannot overturn discriminatory attitudes. The committee may simply bump you down lower on its list of candidates and rank other candidates as being "more attractive."
4) Program visitation
You may be afforded an opportunity to visit the graduate school of the program in which you are interested. The visitation will either be voluntary or mandatory (in the form of an interview). A program visitation will allow to see how receptive the faculty is towards you and you can determine at that time if you think you can be successful in that program with the appropriate accommodations. If an interview takes place, in all likelihood the interviewers will have extensive experience in working with individuals with hearing loss and other disabilities. However, you will need to be prepared to accept that some may not feel comfortable while interviewing you, and they may fail to address their reservations with you. The discomfort or reservation may reflect the committee’s uncertainty about how you will be successful in their program. The interview, therefore, serves as an opportunity for you to put the committee at ease by explaining your previous successes, and how you intend to be successful or what changes may need to be made to be successful in their program.
AUDIOLOGY PROGRAMS
Below is a list of audiology programs that have graduated an individual with hearing loss or a student(s) currently enrolled in their program. This list was compiled by a former committee member of AMPHL who is an audiologist with hearing loss. The programs listed below mostly comprise graduate programs where primary audiology training begins.
:. Arizona State University
:. Brooklyn College of CUNY
:. Ball State University
:. College of New Jersey
:. Dalhouse University - Halifax, N.S. Canada
:. East Carolina University
:. East Tennnessee State University
:. Florida Atlantic University
:. Gallaudet University
:. Hofstra University
:. Kent State University
:. Middle Tennessee State University
:. Montclair State University
:. Northwestern University
:. Nova Southeastern University
:. Ohio State University
:. Stern College for Women
:. Teachers College - Columbia University
:. Texas Tech University Health Sciences Center
:. University of Akron
:. University of Arizona
:. University of Cincinnati
:. University of Colorado
:. University of Florida
:. University of Georgia
:. University of Iowa
:. University of Louisville
:. University of North Texas
:. University of Maryland
:. University of Massachusetts
:. University of Mississippi
:. University of Memphis
:. University of North Carolina at Chapel Hill
:. University of Pittsburgh
:. The University of South Dakota
:. University of South Florida
:. University of Tennesse-Knoxville
:. University of Texas-Dallas
:. Utah State University
:. Vanderbilt University
:. CID at Washington University School of Medicine
If an audiology program is not listed above, please contact the webmaster with the school name, name of student with hearing loss, and the year of graduation.
AMPHL presents this list with several cautions:
- This list is by no means comprehensive. It was compiled by a voluntary survey posted on the listserver NOISE and by other requests. Since not all audiologists with hearing loss are subscribed to NOISE, it is a limited survey.
- Some audiologists that responded to this survey graduated over twenty years ago. Thus, the faculty and services offered have changed dramatically.
- We strongly believe that everyone's educational experience is unique. While one person may have felt a program met all their unique accommodation requests, another may have a vastly different experience. For some, a previously graduated audiologist with hearing loss may help pave the road; for others, it may make no difference in their experience.
- While this list represents programs that have or have had a student with hearing loss, it does not represent an endorsement of the program nor a guarantee that they accommodate hearing losses.
AMPHL's recommendation
Contact the schools in which you are interested based on factors such as quality of program, location, reputation, etc. Then schedule a meeting with the appropriate faculty member or the Disability Office to discuss your needs related to your hearing loss. Apply to the school that feels best to you irrespective of whether they have graduated a previous audiologist with hearing loss.
BEFORE AUDIOLOGY PROGRAM STARTS
1) I’ve been accepted! Do I need to do anything before school starts?
Be prepared. If you want people to be on your side, you may have to reach out to them first. Meet with the school's office of student affairs, with the dean of students, with the office of disability or diversity (usually found at the affiliated undergraduate campus), as well as with the academic and clinical faculty. Introduce yourself and tell them what you need. If need be, write a one-page self-introduction which explains your needs and review this in person with the staff. Even if you do not want any special assistance, you should still introduce yourself and mention a significant hearing loss. Thus, the instructors will not think you are rude for not responding if they talk to you when you are not looking at them, and they know that they need to make a special effort to communicate when they call on you in class, etc. If you use an assistive listening device, or require one, it is the best policy to get one and begin using as early as the first day of classes and in clinic. This way, the academic and clinical faculty can begin making adjustments to their style of teaching and new ways of handling patient communication and testing can be conceived. It may be a good idea to tell the faculty that if they feel something is not working or if you are not performing to their expectations, you want to know right away. You cannot afford to wait until the end of class and find out through a bad evaluation. Likewise, if something is not working for you, you will need to speak up and address those issues as soon as you are able. People do not like to say negative things about others, so you may need to reinforce the idea that you are open to all constructive criticism. As the course or clinical experience progresses, the faculty may have suggestions or ideas for doing things in a better way. Be open to such advice; ask for such ideas if a challenge arises.
2) Self-introduction
At times, you may take courses outside of your department and therefore it becomes even more important that you introduce yourself to your new instructors. Explain to them what you may need to be successful in their course. They will often be open to assertive students who show motivation to succeed in their class. When you begin working with patients (or clients), depending on your level of comfort, you may feel that it fosters better communication if you tell them in advance that you have a hearing loss. You can put them at ease by explaining to them that they are free to ask you questions about your hearing loss, or suggest ideas to them to get your attention when they need it. It has generally been the consensus that audiological patients are thrilled to know that their audiologist (or student audiologist) also has a hearing loss. But be aware that some patients may become more resistant particularly when they do not want to disclose or admit that they have a hearing loss. Either way, your shared experience with hearing loss may be just the catalyst needed to help your patient. It may help to ask your clinical supervisor about what they think as well.
THE CLASSROOM YEARS
1) How do I get the information?
In graduate school, one must absorb a tremendous volume of information. With a hearing loss, there is another challenge: how to listen to a lecture and write down all that information? There are a number of options for note-taking services: (1) copy your classmate's notes (you can obtain carbon-less copy paper to eliminate the hassle of making photocopies); (2) the school or disability services office may hire a fellow student to take notes for you; or (3) your classmates may organize a note-taking service where they take turns taking notes for each class and get reimbursed for a small fee (everybody pays $40-$100 up-front and receives very thorough, typed notes).
What if you cannot follow what is being said in the first place? There are several good options. One involves the use of interpreters: Sign or oral. Oral interpreters silently enunciate by mouth what is being said with only a little lag time, and they may use signs to supplement their transliteration. Sign language interpreter primarily signs, but may enunciate words at the preference of the student (or the interpreter enunciates naturally). Check with your school to see if has worked with interpreters before. Contact the Registry of Interpreters for the Deaf to inquire about interpreter referral agencies. The Alexander Graham Bell Association has a national listing of individual oral interpreters which is not always up-to-date and does not tell you about each person's credentials. At the graduate level, you will want an interpreter who is able to keep up with the demands of learning new vocabulary and has the ability to relay complex and scientific themes as accurately and efficiently as possible.
Another option is use try real-time captioning (also known as "Computer-Aided Real-Time Captioning" or CART) where a stenographer types what is being said into a stenograph machine which is hooked up to a computer, and the computer software transcribes the stenography into English that is scrolled on the screen. The screen may be placed directly in front of you or is displayed on a much larger screen for the whole class to enjoy. The set up can be obvious or discrete. Remarkably, you can read word for word what is being said, with only a little lag time. Because the information is generated digitally using computers, the captionist may be able to supply you with a copy of the entire lecture by e-mail! Check with your school or other students with hearing loss in your area to find out about local CART services. If you do not know where to start, there is a web page for CART reporters, CARTWheel, which may prove to be a valuable resource. Remote captioning is an option for those who train in areas where there are no local services. In this case, the CART reporter and user are connected through computers over two phone lines. The CART reporter "listens" to a lecture with a microphone that is connected to an audio phone line, and his transliteration is transmitted over the modem to the user's computer.
There are challenges to consider when using interpreters or CART services. The quality of service is variable, given differences in training and accreditation. Currently, there is no national accreditation for CART reporting. The numbers of CART reporters (or "captionists") are small as the technology is relatively new. Many are court stenographers who want to expand their businesses. Still fewer are specifically trained and certified for CART services for individuals with hearing losses. The interpreter or captionist may have never encountered such a sheer volume of information and complexity of medical terminology. He will have to read the class syllabus or something comparable before each class. The captionist will need to input all new words into his software dictionary so that whatever he types in steno will automatically be transcribed into English for you. In his two years of medical school, one doctor reported that his captionist amassed over 25,000 words in her medical school dictionary. As you can imagine, few people have the temperament and work ethic to take on that kind of a job! You may have to try out a number of reporters before finding one who works well with you.
THE CLINICAL TRAINING EXPERIENCE
Until recently, most students in audiology had normal hearing or at least good speech comprehension skills with hearing aids. Students with more severe hearing loss generally were not enrolled in audiology programs. The rise of students with all ranges of hearing loss in audiology and other healthcare fields has been clearly evident and is likely related to advances in education, technology, and disability/ accessibility law. The following guidelines reflect the compensatory strategies for students with hearing loss, but may also be useful for currently practicing audiologists with late-onset hearing loss.
1) Communicating with patients
Although the patient base may differ widely from clinic to clinic and locale to locale, most patients communicate through spoken language. For this reason, having the means to communicate with them is important during the taking of case histories, during testing, during interpretation of results, during counseling, and during the fitting of hearing devices. Audiology students with hearing loss may supplement their auditory listening with lipreading or speechreading and they can be quite successful. Equally important is that the student must be clearly understood by the patients. In other words, the student’s own speech must be intelligible. If however, the audiologist or student does not or cannot use their hearing and/ or does not have intelligible speech, an oral or sign language interpreter may serve as a translator in the dialogue between the professional and patient. Other protocols are called for in working with patients who use sign language.
2) Administering speech-based tests
Next to the assessment of hearing using pure tones, the assessment of speech comprehension is also an important component in audiologic testing. Speech testing requires at least two skills: (1) the ability to generate the speech stimuli by live voice or pre-recorded materials on tape or CD and (2) the ability to listen or attend to and record the patient’s verbal or alternative behavioral response. Many audiologists generate the speech stimuli using their own voice, however, this practice is discouraged because no two people have the same dialect and there are distinctive differences between male and female voices. Standardized, pre-recorded material is best and thereby is a unique tool for audiologists with hearing loss, particularly if their own speech is not as clear or intelligible. In recording patient responses, the audiometer’s sound system may be sufficient to allow the student with hearing loss to hear the patient’s verbal responses accurately. If this task proves difficult, the student with hearing loss may use an assistive listening device (ALD) by placing the microphone directly on the shirt or lapel of the patient with the student wearing the receiver. The student therefore will have improved the signal-to-noise ratio of (SNR or S/N ratio) the patient’s voice over any other extraneous noise. If the student with hearing loss cannot use his/her own hearing, an assistant or helper could be selected to record the patient’s responses. Because the clinical training experience involves the gradual progression toward independence, a student who cannot use his/her own hearing may need a hired assistant serves as the audiology student’s “ears”.
3) Checking hearing aids and other assistive listening devices (ALDs)
Most people with hearing aids are able to recall an experience when their audiologist, teacher, or parent put on what looks like a stethoscope (called a stethoset) to conduct a listening check. During the listening check, the quality of the sound generated by the hearing aid is assessed. The listening check is even useful to determine if the hearing aid is operational with a good battery, or is unusually weak in gain. Most people can tell during a listening check when a hearing aid is not working appropriately, but sometimes subtle problems cannot be detected during a listening check alone no matter how much experience one has with hearing aids. The next step is generally to perform an electroacoustic analysis of the hearing aid, which provides an objective look at the frequency response of the output of the hearing aid. One does not to “hear” the frequency response, but “see” it. Generally, after a hearing aid is first programmed, an electroacoustic analysis is performed and the frequency response is printed out for documentation. When the hearing aid malfunctions, an electroacoustic check might show even subtle changes in the frequency response that warrant sending the hearing aid to the manufacturer for repair. Seasoned audiologists with and without hearing loss have learned to identify comments made by their patients to identify and rectify minor problems such as feedback and sound quality (too bassy or too tinny) and adjustments are made accordingly. Bottom line is that one does not necessarily need the ability to hear to work with hearing aids.
If one so desires to “listen” subjectively to hearing aids using their own hearing aid or cochlear implant, a trick has been conceived to permit this task using an assistive listening device (ALD) referred to as an “FM system”. The FM system is simply a two-piece ALD designed for a speaker to wear a microphone and the hearing-impaired person to wear a receiver that connects to their hearing aid or cochlear implant. The trick to “listen” to other hearing aids is to use the FM system microphone is such a way to amplify the sounds from the hearing aid you want to listen to. To make the trick work, one needs to find an old stethoset (Figure 2) and an extra grommet (i.e., the tan colored tip). Looking at Figure 3, one will notice that the stethoset tubing has been cut and the extra grommet attached to the cut end. One of the grommets should be fixed securely to the FM microphone and the other end is free to attach to a hearing aid one wants to listen to. Your audiologist or clinical supervisor can show you how to set this up.
Figure 2. Hearing Aid Stethoset or “Listening Scope”
Figure 3. Stethoset Modification
4) Academic or Manufacturer Workshops
Most individuals with hearing loss know that front-row seating is a priority; however, in some cases, it may be difficult to position yourself close enough to the speaker(s). Assistive listening devices (ALDs) are very helpful, particularly when there is only one speaker speaking at a time. Interpreters and CART reporters are also helpful as well when available upon request (see “The Classroom Years” for more information on interpreters and CART). When workshops call for interactive learning or discussions, a conference microphone assembly could be used with the ALD.
5) Using the telephone or compensating for the inability to use it
Unfortunately for audiologist with hearing loss, the telephone remains a prominent feature in the healthcare setting. It is frustrating to see other people do something effortlessly that is so difficult for us. Technological advances have helped and provide greater alternatives at the sacrifice of speed and time. Several options are available.
Acoustic Phones
If one is able to use the phone, a boost in amplification may be all that they need. There are two routes by which this can work. One is to place the phone directly to the unaided ear or near the microphone of the hearing aid and set the volume control of phone accordingly (provided the phone has a volume control). If the phone is not loud enough, an amplified phone can be used.
The other route is through the hearing aid telecoil (a built-in electromagnetic receiver). We have found over the years some unfortunate cases that some hearing aid users either do not have telecoils or they were never told how to use it. The benefit of the telecoil is that the electromagnetic field of the phone speaker is converted to a signal that the hearing aid can process and sounds not generated by the phone are essentially “turned off”. To enhance the electromagnetic field generated by the phone, assistive devices such as the HATIS or hearing aid silhouette can be placed next to the hearing aid and then plugs directly into the phone. Some hearing aids and some phones may allow for a “direct audio input” (DAI) setup, which is another important option for hearing aid users who use phones and assistive listening devices (ALD).
Text Phones
If one cannot use the phone, request to have a telecommunication device for the deaf (TDD) or tele-typewriter (TTY) placed at suitable locations. Some telephone companies may be willing to cover the cost of one TDD that you select from their regional dealers. A TDD may be utilized in one of several ways. More traditionally, you may type messages back and forth with someone else who also has a TDD. If the other person does not have one, you need to call an operator in your state's Relay system. The operator calls the person you want to contact, transcribes what she is saying to your TDD digital screen, and if necessary, will voice your typed responses. Thirdly, you may use Voice Carry Over (VCO) where you speak for yourself into the headset but the relay operator still transcribes what the other person is saying to your TDD digital screen. If you have access to conference calling, some medical professionals utilize two-line VCO. In this situation, the operator is more of a silent partner. You can hear what the other person is saying and speak directly to the person you called. At the same time, the relay operator is transcribing what the other person says into your TDD digital screen. If you miss hearing a word, you can then glance down and fill in the blank. It should be noted that a number of free online relay services are also available if you have access to the internet at your clinical site. Be sure to check out the “Links of Interest” section of this website.
Communication is slower with the Relay, as you are going through a third party who is unfamiliar with medical terminology. Many people often mistake the Relay for a telemarketer and hang up. Despite this, most people are very understanding about going through the Relay and do not have a problem with it. Explain the Relay to hospital staff and patients/clients ahead of time if you know that you will be giving them a call. You may want to take into consideration that using a TDD may take longer than having someone else make a fast call for you or making a quick dash down the hall.
Text Messages (pager, cell phone, or internet messages)
Another way to deal with communication is through text messages. Short and quick messages can be relayed to you by pager, cell phone, or email to your personal pager or cell phone. You may be required to secure your own personal device, or clinic site may provide one for you.
Interpreters
Interpreters may be able to help you with phone calls too. They may listen for you and interpret what is being said, and you may respond directly into the phone headset if you communicate orally.
 The Operating Room
You may find yourself in the operating room either for surgery observations or for electrophysiologic testing of various cranial nerves. Operating rooms are notorious for being an acoustically-harsh environment because sounds bounce around on the hard floors and walls. Fortunately, ninety percent of what is said in the operating room has nothing to do with the surgery at hand. But the ten percent is important and generally involves the surgeon or colleague teaching the student about the relevant anatomy, disease process, or testing procedures. To reduce the anxiety, the student can be told and shown what to expect before the surgery begins. Other than the placing of dermal needles on the skin and setting up the equipment for electrophysiologic testing, audiologists are not involved in any aspect of the surgery and they are often located at some distance from the surgical field. The audiologist will need to be sure that effective communication can take place between the audiologist and the staff (surgeons, surgical residents, nurses, and anesthesiologists).
Generally, all individuals (other than the patient) wear a surgical mask in the operating room. These opaque masks clearly eliminate our ability to speech read. Sometimes you may be able to get people to briefly lower their masks when speaking to you, but do not count on it. Consider the following accommodations: making a "see through" mask, sign interpreting, writing things down, using a FM system or real-time captioning. Each of these options are enumerated for your consideration. (1) "See-through" mask: Such a mask may restore your ability to speech read. Some clinical students have constructed their own prototypes and mass-produced them (i.e., 50 masks) for the surgical staff. In this case, you will need to demonstrate that your mask does not fog up and is similar to traditional masks in retaining respiratory aerosol of certain particulate sizes. (AMPHL is currently working with the company that holds the patent on a certain "see-through" mask technology to encourage them to pursue it for commercial production.) (2) Sign interpreting: Your interpreter can dress in sterile fashion and work for you at a discreet distance from the surgical field. (3) Writing: Have the surgeon or assistant write things down with a sterile skin marking pen or get someone (a fellow student or staff member) to use a dry-erase board or plain old paper and pen beyond the sterile field. (4) FM System: The surgeon can wear a transmitter looped around his neck and underneath his sterile gown. (5) Real-time captioning: Unlike the FM system, where only the surgeon wears the microphone, CART reporting potentially enables you to follow what everybody is saying. You may read what is being transcribed on the captionist's computer screen or on a large TV monitor. Your captionist would be stationed behind the surgeon, away from the sterile surgical field. Administrators or staff may feel that the captionist or his equipment, being non-sterile, would be inappropriate for the operating room. Reassure them that the sterile field around the patient will not be violated. (The anesthesist's ever-present machine is non-sterile. If anyone gives you a difficult time about bringing in an non-sterile means of accommodation, remind them about the anesthetist.)
Surgeons are famous for mumbling and speaking softly. Remind them, again and again, to speak up so that you and/or your interpreter/captionist will be able to hear. Some surgeons are irredeemably tongue-tied, so you might want to use a microphone system with the interpreter/captionist wearing a receiver unit and the surgeon wearing the transmitter as previously described.
Before you start your surgical rotation, it may help to introduce yourself to the surgeons, surgery residents, and anesthesia staff. Demonstrate your means of accommodation. People tend to dislike the unknown, so it is always the better policy to explain yourself in advance. In fact, you will generate a little fame for yourself and people may take the extra step to help you.
9) Research and Externships
The more experience you have in your field of interest, the stronger you are as a candidate. This is especially true of the more competitive healthcare fields. When you have the time (or make the time), pursue research opportunities or private practice externships. Ultimately, you help yourself by meeting the people you hope to work with professionally. Demonstrate your desire and work ethic so that they want to work with you! Having these broad experiences may help you to tailor your career and chosen specialties.
CLINICAL FELLOWSHIP OR 4TH YEAR AU.D. EXTERNSHIP
1) The application process
Once again, you have to advertise yourself. We have already discussed the pros and cons and "how to’s of disclosing your hearing loss. At this point, you need an advisor with whom you can build a trusting relationship. You need to explain in minute detail the nature of your hearing loss and how you compensate in various situations. Your advisor should help you to select this important training site appropriately. Some training sites may be at a major hospital while others may be at a private practice. Often times, the chosen site ends up being your first career move as an audiologist. Think about what kind of work setting would be best for you. For example, a clinic with higher staff-to-audiologist ratio would allow for more staff availability to you to assist you with client communication. A clinic that has a quieter environment might work better for you as compared to one that is constantly very noisy. Case load is also a big issue. If the case load is tremendous, the senior clinicians will not have the time to slow down for you, whether to teach or to communicate with you more deliberately one-on-one. And yet, you do not want a case load that is too low, because then you will not get enough practice or experience. If possible, visit and spend time at the sites in which you are interested. Your advisor should be your advocate and he/she may be the one to make the first contact with prospective sites.
2) How to set up a system that will work for you
Be assertive and as prepared as you can be. Meet with the clinic director and staff before the start of your training. Train your interpreters if necessary. You might even want to spend the first few days at the site just to get a feel for things and fine-tune the accommodations you have in place. If things are not working, it is up to you to inform the appropriate people and to make changes.
THE FIRST JOB
Applying for that First Job
We already discussed at length the question of whether or not to disclose your hearing loss during the application process. It is understood by the AMPHL directors that there is no one approach to this question. If you have an obvious hearing loss or one that necessitates significant accommodations, you will have to come to a decision on when to disclose this information. Some individuals feel the need to be upfront from the beginning; others will want to avoid negative stereotypes and misconceptions from being formed prematurely. You are to screen potential employers as much as they are screening their applicants. If one does not want to work with you, why work with that person?
During the interview, check out the work environment. Can you comfortably hear in the hallways and in the clinic rooms? Is there technology in place that would make it easier for you to institute your accommodations? How many people will you work with at any given time? Request some time to meet staff that you will work with. How open minded do they appear?
When you have selected a final group of potential employers, get more specific regarding the working details of your job. What will you need to deal with telephone conversations? If you cannot use the phone, can you work out an arrangement that is satisfactory to both you and your potential employer? How will you deal with coverage from home? Can you utilize a text pager? Address as many of the details as possible before you take a job. This makes for better job security later on.
Best wishes in your endeavors![url][/url]
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