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If you have any questions, comments, or suggestions related to physicians with hearing loss, please contact: Chris Moreland at physician@amphl.org.

Table of Contents

Getting into Medical School

• Before we begin
  
• "Is this really what you want to do?”
  
• Can I meet the technical standards of my field of interest?
  
• How do I maximize my verbal test scores?
  
• Whether and how to disclose one's hearing status during the application process
  
• The Interview
  
• If I suspect discrimination, what am I to do?

Medical Schools

• List of Medical Schools with deaf/HOH student/graduates
  
• AMPHL's Recommendation

Before Medical School 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 Years

• Stethoscopes
  
• Patient rounds
  
• Sit-down conferences
  
• Using the telephone or compensating for the inability to use it
  
• Pagers
  
• Interpreting services
  
• The Operating Room
  
• Research and Externships

Internship/Residency

• The internship/residency application process
  
• How to set up a system that will work for you

The First Job

• Applying for that First Job

______________________________________________________________________

Getting into Medical School - Preparation

1) Before we begin

The AMPHL medical school and physician guidelines address a certain group of readers: individuals with a hearing loss who are working in the physician’s 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 medical guidelines were written based on collective experiences of deaf and hard of hearing physicians and medical students. Everyone with a 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 more challenging for those with a hearing loss. Some are very much a part of the Deaf culture, while some have been raised in a strictly oralist fashion. 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. AMPHL strongly encourages others to share their experiences and to give constructive criticism regarding our physician guidelines so that we may continually make improvements.

The most important thing to remember as you read these guidelines is that you can do anything you want to do. 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, if any, are going to be.

We will not mislead you. For those with hearing losses working in health care fields, our road was not easy. It took courage, perseverance, and strength. Many times we became discouraged and almost gave up. We persevered and succeeded. Because of this, we take 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 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 you become inspired and even more determined to pursue your goal of becoming a physician. Remember that you can do anything you want to do!

2) "Is this really what you want to do?”

You can do anything you want, but are you sure you want to be a physician? You need to have some exposure to the profession. Volunteer or find jobs at clinics, hospitals, anywhere you can get valuable hands-on experience. This will help you decide what you want to do and will show the admissions committees that you have tested the waters and are still committed.

3) Can I meet the technical standards of my field of interest?

There are often what are known as "technical standards” among medical schools; these are intended to outline what a person must fulfill in order to succeed as a physician. These usually involve five areas: observation, communication, motor/movement, intellectual/conceptual, and behavioral/social abilities. One can easily find examples from various medical schools online by searching for “technical standards” and “medical school.”

Admissions committees use technical standards to judge applicants with legal disabilities. Some schools enforce very restrictive technical standards.Other programs are more willing to consider how a given individual can compensate for a disability. It could be worthwhile for you to learn about the technical standards of some of the schools you are considering. Be prepared to explain to the admissions committee how you plan to compensate for your disability. The most common concerns that admissions committees have are:

• How you are going to hear heart, lung, and bowel sounds
  
• How you are going to communicate with others in surgery when everyone has a surgical mask on
  
• How you are going to communicate with patients in person and over the phone
  
• How you are going to obtain the information that is presented in the classroom, in labs, and in clinical rounds

Note: Please see our sections on the classroom and clinical years. Answers to these tough questions do exist, even for those with a profound hearing loss.

4) How do I maximize my verbal test scores?

GREs, MCATs, and VCATs are a part of the application process, and they include a test of verbal reasoning skills. Some individuals are fortunate that these tests do not present a problem. However, some individuals with a significant hearing loss occurring at the early stages of language development might 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. Consider asking your audiologist or counselor to write a letter on your behalf.

5) Whether and how to disclose one's hearing status during the application process

We all want to be judged on our merits. We do not want a 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 direct with them and were unwilling to address the issue. Even if they do not find out, the admissions committee may not recognize that you have to work harder than many of your hearing peers and thus fail to give you credit for your work ethic and discipline. In the end, you are your own best advocate.

For most medical school applications, a personal statement or essay is required. Generally, the applicant is given free rein in how to structure the essay; it is here that applicants are given an opportunity to reveal more about their personal aspects which are often not clear in transcripts or a curriculum vitae. One’s motivation to enter the field of medicine is one of the generally expected topics. If you are deaf and would like to disclose it, the essay is an ideal place to do so, as you may explain in detail how you prefer to communicate and possible ideas you may have for how you will carry out your duties as a medical student.

Another 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 rank you lower on its list of candidates and rank other candidates as being more attractive.

6) The Interview

Many interviewers have little or no experience working with individuals who have a legal disability. They may not feel comfortable while interviewing you and may fail to address their reservations with you. By law, a potential employer cannot discriminate against applicants based on disability, so interviewers are discouraged from raising the issue during an interview. But if their concerns are not addressed, their initial bias may lead them away from offering you a position. If you have an obvious hearing loss or one that requires significant accommodations, you might want to set the tone and ask if anyone has any questions related to your hearing. Put them at ease. Describe your hearing in a positive context. Explain how you compensate and how you plan to meet the technical requirements of the program. Keep in mind that your hearing colleagues, during their medical school interviews, usually do not know how to listen to heart sounds or properly interview a patient. You may discuss your options for work in medical school, perhaps using an amplified stethoscope or a visual-display stethoscope. Such discussion would reflect your research into options and thus your motivation. You want to come across as being a determined and confident person who would make an excellent addition to their program.

7) If I suspect discrimination, what am I to do?

Ask your interviewer or admissions committee why you were not selected and what you can do to improve your candidacy for other interviews. You may or may not receive useful information, but at least you have a starting point. Ask your dean or advisor to look into the matter. Go to the Disabilities Office on your campus. Contact professionals in your field of interest who have a hearing loss.

MEDICAL SCHOOLS
Below is a list of medical schools which have graduated an individual with a hearing loss or who have such a student currently enrolled in their program. This list is provided due to interest expressed by pre-professional students.

:. Boston University School of Medicine
:. Case Western Reserve University School of Medicine
:. Dartmouth Medical School
:. Drexel University College of Medicine
:. East Carolina University School of Medicine
:. Eastern Virginia Medical School
:. George Washington University in DC
:. Harvard Medical School
:. Indiana University School of Medicine
:. Mayo Clinic Medical School
:. Medical College of Virginia School of Medicine
:. Mount Sinai School of Medicine
:. Northwestern University Medical School
:. Robert Wood Johnson Medical School
:. Rush Medical College
:. University of Adelaide, School of Medicine (Australia)
:. University of Rochester School of Medicine
:. University of California at Davis
:. University of California at San Diego
:. University of California at Los Angeles
:. University of Nevada-Reno
:. University of Oklahoma
:. University of Tennessee
:. University of Texas- Houston
:. University of Sydney Medical School (Australia)
:. University of Vermont College of Medicine
:. University of Washington
:. Washington University, St. Louis

If you know of any other medical schools not listed above, please contact the webmaster with the school name, the name of the student, and the year of graduation.

AMPHL presents this list with several cautions:

• This list is by no means comprehensive.
  
• Some of the physicians who graduated from these programs, if they are not still students, may have graduated a number of years ago. The programs, faculty, staff, and services may have changed since then.
  
• 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 physician with a 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 a hearing loss, it does not represent an endorsement of the program nor a guarantee that they accommodate hearing losses.

AMPHL's recommendation

Contact 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 regardless of whether they have graduated a physician with a hearing loss.

BEFORE MEDICAL SCHOOL STARTS

What Now? Do I need to do anything before school starts?

Be prepared. If you want people to be on your side, you have to reach out to them first. Meet with the school's office of student affairs, the dean of students, the office of disability or diversity (usually found at the affiliated undergraduate campus, if the program has one), as well as the course directors. Introduce yourself and tell them what you need. If needed, write a one-page self-introduction (see below for an example) which explains your needs; 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 to course directors. Thus, the instructors will not think you are rude for not responding if they talk to you when you are not looking at them; they know that they need to make a special effort to communicate when they call on you in class; and so on.

Show the staff your assistive listening device, if you use one. Microphones may already be used because lecture halls are sometimes big enough to make them necessary for hearing students as well. No matter what special accommodations you use, it is a good policy to introduce that means of communication early on.

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. 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 rotation 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. For example, one person was in a course where two faculty members interacted in front of the audience, and she did not know how to listen to both of them. One of the faculty members helped her to set up two FM systems in a novel way so that she could pick up both of them through one receiver.

Self-Introduction

To: Staff involved with (course/rotation)

From: (your name)

Regarding: Hearing loss

On (date), I will start participating in (course/rotation). As some of you may know, I have a profound hearing loss. I want to make you aware of communication skills which best enable me to interact with others.

1. In order to understand what you are saying, I must be able to see your lips since I rely heavily on speech reading. Please get my attention prior to talking with me so I may be able to fully concentrate on what you have to say.

2. During certain situations, I may utilize an assistive listening device that involves the speaker wearing a small receiver on their belt or pocket with a small attached microphone. This device decreases my need for speech reading and help in situations with large groups and background noises.

3. It is difficult for me to follow group discussions. If you are leading a discussion, rephrasing others' questions or comments is extremely helpful to me since my attention will be primarily on you. Similarly, identifying one person to lead a discussion or give an explanation (rather than several people) is beneficial to me since it takes me a few seconds to locate and reorient on a new speaker. During that lag, I may miss important information.

4. I may need to ask questions of you or my classmates in order to clarify things I have missed. I try to ask such questions at appropriate times.

5. Unfamiliar words are difficult for me to grasp and understand. I may ask you to rephrase the concept with different words or to write the word out for me. Similarly, I will often repeat important information back to you to assure myself that I heard you correctly, such as medication dosages, so that I will not make an inadvertent mistake.

6. In the surgical suite, the surgical masks eliminate my speech reading skills, so I utilize real-time captioning. A stenographer types what is being said, and the transcribed words are then displayed on a computer screen for me to read. The stenographers are professionals, and they may make some requests of you in order to perform their job, such as speaking louder so that they can hear you.

7. Please feel free to approach me with questions or suggestions you may have. This rotation will be an experiment in progress. Several staff members in previous rotations have suggested solutions to problems they perceived that helped immensely and improved my performance/communication ability.

I look forward to this (course/rotation) and working with the staff!




Sincerely,
(your name)

THE CLASSROOM YEARS

How do I get the information?

In medical 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:

Copy your classmate's notes (you can obtain carbon-less copy paper to eliminate the hassle of making photocopies).
The school may hire a fellow student to take notes for you.
Your class 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).
During the classroom years, many course directors develop pre-printed syllabi which are sold to the students for a fee. These syllabi often contain the lecturers’ Powerpoint slides and relevant graphs or text. Such syllabi can be invaluable to any student, hearing or deaf.
What if you cannot follow what is being said in the first place? Sign or oral interpreters are an option. Oral interpreters silently enunciate what is being said with only a little lag time and may use signs to supplement their transliteration. Check with your school to see if has worked with interpreters before. Contact the Registry of Interpreters for the Deaf (RID) 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.

When the lights go out for slide review, the speech readers have lost their ability to follow. The low-tech solution is to get a lamp installed on the lectern. The high-tech answer is real-time captioning (also known as Computer-Aided Real-Time Captioning or CART). A stenographer types what is being said into a stenographer machine which is hooked up to a computer; the computer software transcribes the stenographer language into English that is scrolled on the screen. You can read what is being said with only a little lag time. When you have a good real-time captioner, this can be an incredible experience. Check with your school or other students with hearing losses 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 a phone line in conjunction with either another phone line or an internet connection. The CART reporter listens to a lecture with a microphone that is connected to an phone line and his transliteration is transmitted over the modem or network connection 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 (also known as 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 two years of medical school, one doctor reports 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 ROTATION YEARS

1) Stethoscopes

With a hearing loss, the most obvious issue is whether you are able to appreciate heart, lung, and bowel sounds. Someone with a profound hearing loss cannot hear with a traditional stethoscope, but he can accomplish the desired result in an alternative way. So first ask yourself, "Can I use a stethoscope? If not, what are my options?" Many of us will need to select an amplified, electronic, or special stethoscope. Special stethoscopes include visual display stethoscopes, modified stethoscope setups, and tactile stethoscopes. More information on stethoscopes can be found on the AMPHL stethoscope information pages. It is recommended that you either borrow an appropriate stethoscope or obtain one on a trial basis from a manufacturer so that you can be sure it is going to work for you before you invest a lot of money into it. Go to a medical school or hospital and ask if you can spend time with a cardiologist. Spend a few mornings or afternoons with the cardiologist and practice using the stethoscope. Ask what sounds you are supposed to identify. Remember that it takes years for a hearing medical professional to learn to distinguish and identify subtle sounds.

If you cannot hear with a stethoscope, inquire about other ways to auscultate important sounds. Are there visual and tactile clues on physical examination? Can you use other equipment which might not be used traditionally in this situation? For instance, there is a computer program called Stethographics which converts heart and lung sounds into a visual display; there is also a tactile stethoscope under development. Make arrangements to test these alternative systems on patients at a hospital. Keep in mind that many people reject the possibility of alternatives simply because they cannot imagine a different way of doing things. It is up to you to challenge these assumptions and find solutions.

2) Patient rounds

Every morning, clinical students round with interns, residents, and/or faculty on their team's cases. Typically, the team stands outside of each patient's room. The intern or student responsible for the patient's care will discuss how the patient is and give the latest updates on the case. Everyone has an opportunity to visit each patient. Then a plan for the day for each patient is formulated.

Rounds can be frustrating for those with hearing losses and it is often hard to learn from cases other than your own. The person speaking is not always going to be looking in your direction, even if you repeatedly ask the group to try to face you when they are talking. The group is usually pressed for time and cannot slow down to keep repeating things for you. There is usually a lot of background noise which makes it hard for even hearing people to follow the discussion. To make the most of your experience on rounds, you need to become more assertive. Tell people to speak up, to face you as much as possible, and to slow down when necessary. You are not always going to get what you want, but the more persistent you are, hopefully the more people will remember to do those things which will help you. Sometimes when things are happening too quickly and you are lost, a colleague, if asked, will repeat some major points for you.

An FM/microphone system may be helpful in selectively amplifying the conversation of interest over the incessant background noise. When choosing a FM system, you may want to get one that has the option of "zoom" amplification which focuses on just one or a few speaker(s). Also, in a standing group conversation (as in work rounds), you might like the option of holding the transmitter/microphone yourself instead of having different speakers pass it around. (Check the web links on various FM/microphone systems.)

Sometimes the group is just too large or the dynamics of the conversation are too much of an obstacle. Interpreting services, whether signing or oral, may prove to be the solution. Try to find interpreters who have already worked in a hospital setting or have taken some pre-med or pre-vet courses. The complex medical terminology and the speed of communication are tough for lay persons, let alone for you. If you cannot find someone who qualifies, you may have to do some job training of your own. Another option is to take the time to read patient's charts before and/or after rounds and ask questions about things you do not understand.

3) Sit-down conferences

Once or twice a week (or every day), the senior clinician may sit down with your team and review a patient's history and physical exam. Sometimes a mock case will be presented for teaching purposes, usually to initiate discussion about a particular disease process. Usually, the resident or senior clinician will write down pertinent information on a blackboard as the discussion progresses. If not, have someone do so. At Grand Rounds, when a resident or senior clinician presents a patient's case to the entire department, it is standard to have a slide projector showing this information. Make sure there is a lamp for the lectern so you can speech read. Use a FM system, CART reporter, or interpreter as necessary.

5) Using the telephone or compensating for the inability to use it

A hospital is a big place. The phone system has become crucial, as one needs to be able to contact others (such as radiology, pathology, residents, team members, physicial therapists, other hospitals, ad nauseum) efficiently and effectively. Unfortunately for us, the telephone is a prominent feature in the health care setting. It is frustrating to see other people do something effortlessly that is so difficult for us.

A number of hospitals have phones which are volume-controlled. If not, push for amplified phones in areas where you will be working. You may also need to request telephones compatible with assistive devices such as HATIS or cochlear implant telephone jacks. If you cannot use the telephone, request to have a telecommunication device for the deaf (TDD) 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.

Communication is slower with relay, as you are going through a third party who is unfamiliar with medical terminology. Many people often mistake relay for a telemarketer and hang up. Despite this, most people are very understanding about going through relay and do not have a problem with it. Explain the relay system 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.

Other relay services are available online, including text relay and video relay. Online text relay services can be accessed with a web browser; the process is identical to TTY relay services except that a computer takes the place of the TTY. Those who prefer sign language might prefer video relay services, which require a computer and webcam. By accessing the proper sites with a browser and turning on the webcam, a video relay interpreter can interpret a call for you. Many video relay services now have VCO capabilities as well. (See our relay links for more information.)

Another way to deal with hospital communication is a text pager. That way your teammates or hospital staff will be able to leave messages with an operator who will transcribe them into a digital read-out on your pager. You also can type short email messages on its built-in miniature keyboard. Please see the next section on pagers for more information.

Interpreters may be able to help you with phone calls too. They may listen for you and interpret what is being said; you may respond directly into the phone headset if you communicate orally or sign to them and allow them to translate to spoken English.

6) Pagers

Most hospitals use overhead paging systems. Obviously this may not work for the student with a hearing loss. A possible solution is to use a vibrating pager and have people page you directly. Set up a code beforehand and explain it to the front desk, hospital staff, and your team members. For example, "1" may be "call this number" (followed by the number for you to call); "2" may be "go to the front desk;" and "3" may be "go to ___." Another idea is to set up a code based on the level of urgency, where "1" is urgent and "3" is less pressing.

Current paging technology has evolved to the point where there are numerous options for communication. Some of the latest text pagers on the market (Sidekick II by T-Mobile, Ogo by AT and T, RIM 950 by Deaf Wireless, to name a few) allow you to utilize e-mail, instant messaging, text messaging (cell phone to cell phone messaging) and in some cases, internet-based relay services (essentially the same as using the relay on a TTY) for your communication needs. More advanced devices such as the Blackberry line of PDA’s and the Treo line of “smart phones” combine similar capabilities with the addition of PDA features. Many large hospitals, universities, and organizations contract with companies such as Sprint or Verizon, so you may want to contact the department responsible for coordinating such services and find out which devices are offered through the existing plan before purchasing a pager.

Deaf Wireless offers its clients a voice message service that allows hearing people to call the pager user and leave a message (transcribed to text by the service) on their pager. Communication Service for the Deaf, Inc. (www.C-S-D.org) provides a similar service for virtually any text pager.

7) Interpreting services

Interpreting services can be very helpful and even necessary for many of us. We have already discussed contacting the appropriate officials ahead of time. If you encounter resistance when requesting such services, be diplomatic. Explain how interpreting services help you to learn and work effectively, as well as make things easier on those with whom you work. Point out that interpreters are covered under "reasonable accommodations" as stipulated by the American with Disabilities Act (ADA). You can work with the program in several ways:

Help the program determine the criteria by which your interpreters are selected, if possible. When you can, interview interpreter candidates ahead of time. Traits such as willingness to work long hours, ability to master large amounts of vocabulary, and ability to deal with stressful situations and rapid group conversations can be invaluable in the long run. Consider the overall ability of individual interpreters rather than just looking for the highest credentials. Someone who is enthusiastic and willing to work hard may be easier to train and work with than someone who is set in their ways. Look for interpreters who have a science background or have worked in medical settings before. For those who are interested in oral interpreting services, keep in mind that some nationally-certified oral interpreters offer two- or three-day training programs for relatively new interpreters. Be assertive if an interpreter is not working out; a bad interpreter can be a major liability when you are making decisions that affect patient's lives.

Contact faculty and staff members ahead of time to let them know there will be interpreters present and what their role will be. Ask for copies of syllabi, hand-outs, course packets, and any useful texts for the interpreters so that they know what is going on during a given day and can look for unfamiliar vocabulary ahead of time (or even during a free moment when the medical team stops talking for a few minutes). Buy them a medical dictionary or vocabulary book. Set up a schedule to go over unfamiliar medical terms with the interpreters on a regular basis. This will allow you to come up with abbreviations/signs for those rapid-fire lectures and discussions where fingerspelling every other word becomes logistically impossible, as well as provide a time where you can fine-tune things such as professional expectations (interpreter code of ethics, etc), positioning during rounds and surgery, how to handle radiology readings, etc.

If you are lucky enough to attend a program where interpreters have been used before, ask around and find out if the student(s) or interpreters have any suggestions.

8) The Operating Room

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. The clinical student's main responsibility is to learn from the surgeon and to answer questions about the surgical procedure being done as well as the relevant anatomy or disease process involved. Every night, you are expected to do your homework and study for the next day's cases.

How to prepare? Many clinical students take the "Cliff's Notes" route, using books which highlight key points about different procedures, relevant anatomy, and common disease processes. This route makes sense in that there is only so much time at the end of the day to study, especially after getting up at five in the morning and putting in twelve hours in the hospital. Fortunately, for the clinical student who just wants to do well in his surgical rotation, this is sufficient.

However, this approach is not adequate for the surgeon. He must have a mental check-list of what he must do, step by step, during a procedure. He must be able to anticipate potential complications. For those of you who are interested in pursuing a surgical career, read the surgical textbooks and scrub in on as many cases as possible. You may want to study and continuously review videotapes of different surgical procedures. Such preparation would mitigate your hearing loss and, by being well-prepared, you become a stronger candidate for residency programs.

All individuals (other than the patient) wear a surgical mask in the operating room. These opaque masks eliminate our ability to speech read. 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 listed for your consideration.

• ”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.
  
• Sign interpreting: Your interpreter can work for you at a discreet distance from the surgical field.
  
• 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.
  FM System: The surgeon can wear a transmitter looped around his neck and underneath his sterile gown.
  
• 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 anesthesiologist’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 anesthesiologist.)
  
• Surgeons are famous for mumbling and speaking softly. Remind them, again and again, to speak up so that you and/or your interpreter or captionist will be able to hear. Some surgeons are irredeemably tongue-tied, so you might want to use a microphone system with the interpreter or captionist wearing a receiver unit and the surgeon wearing the transmitter as previously described.

Before you start your surgical rotation, 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.

The critical turning point for the trainee with a hearing loss occurs when a patient's life and limb is entrusted in his care. Can you keep your eyes on the surgical field when necessary? Can you respond rapidly and accurately to an emergency? Ask yourself, "Would I trust someone with my level of hearing loss, similar compensatory abilities, and similar surgical skills to operate on my relative?" For some, the answer is "yes." May all the blessings which come with dedication and hard work be yours. For others, the answer is more equivocal or even "no." In that case, surgery may not be the field for you. Remember that you are not a failure. Some of us have limitations, and it takes strength to accept them. The best specialty from a technical standpoint is what maximizes your strengths and minimizes your weaknesses.

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 fields, such as radiology, orthopedic surgery, or dermatology. When you have the time (or make the time), pursue research opportunities or 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!

INTERNSHIP/RESIDENCY

1) The internship/residency application process

Once again, you have to advertise yourself. We have already discussed the pros and cons and hows 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 your programs appropriately. Think about what kind of work setting would be best for you. For example, a clinic with higher staff:doctor 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 major 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. Yet you do not want a case load that is too low because then you will not get enough practice or experience.

Spend time at the program(s) in which you are interested. You will have the opportunity to do at least one monthlong externship at the program of your choice (usually). This is one whole month to prove yourself. Take the initiative. Present a patient at Grand Rounds. Ask permission to conduct student rounds for one day. Ultimately, you will need to demonstrate that you compensate successfully for your hearing loss. Direct observation goes further than letters of recommendations to allay doubts held by the selection committee.

Your advisor should be your advocate; you may want her to call your top three programs on your behalf or have the dean of students do so. You need all the support you can get. The law says that the selection committee cannot discriminate against you but, unfortunately, attitudes cannot be legislated. Few admissions committee members have had personal experience working with health care professionals with hearing losses.

Please review the section entitled "Disclosing one's hearing loss during the application process." AMPHL suggests that you write a letter to the program director explaining your hearing loss and what accommodations you will need. At the end of your letter, encourage the program director to contact your dean, your advisor, or you with any questions.

2) How to set up a system that will work for you

Be assertive and as prepared as you can be. Meet with the program director and staff before the start of your post-graduate training. Train your interpreters if necessary. You might even want to spend a few days on the wards, 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 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. The AMPHL directors understand 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 screening 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 with whom you will work. How open minded do they appear?

When you have selected a final group of potential employers, become 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!

[zdr81]

There are useful links for those needing more information on stethoscopes in the forum (http://www.amphl.org/forums/viewforum.php?f=6) and for pagers (http://www.amphl.org/forums/viewforum.php?f=12)

[zdr81]

Added University of Washington to the list.

[caveat80]

Added University of Sydney Medical School (Australia) & University of Adelaide, School of Medicine (Australia) to the list.
_________________
Cherylene Lee MBBS (USyd)
AMPHL Director

Deafness plays a part in who you are, embrace it, but don’t let it limit you. Always strive for more, and never give up on your dreams and passions.