Background
Doctor of audiology (AuD) programs work with students for 3–4 years, providing them with the knowledge and skills needed to be successful professionals capable of delivering audiological services across the full scope of practice. Most academic programs developed ways to establish a student’s competence level before embarking on the final clinical externship year; yet, many programs express frustration regarding how to measure these competencies. In October 2016, an AuD Education Summit was sponsored by and held at the headquarters of American Speech-Language-Hearing Association. At the Summit, the Student Readiness Working Group was charged with making recommendations about the level of competence needed for students to undertake an audiology externship. Consisting of representatives from a variety of AuD programs, the group focused its discussion on developing common themes across programs concerning (1) the competencies needed for students entering the externship year and (2) how to most effectively measure these competencies.
Competency Assessment
Variations exist among programs in the procedures used to determine student readiness for the clinical externship year. This variation enables programs to provide unique educational experiences for their students. Common assessment themes and approaches include (1) competency-based evaluations, (2) case studies, and (3) formative and summative assessments. Competency-based evaluations consist of practical exams that evaluate student performance on specific expected behaviors and skills in the areas of assessment, management, and professionalism. Some programs use case studies through weekly presentations; this approach enables students to demonstrate how they are integrating the knowledge they’ve gained and how they are applying it in actual practice. Other programs use formative and summativeassessments such as (a) qualifying exams; (b) yearly written, practical, oral comprehensive exams; and/or (c) presentation of student research experiences. The Audiology Praxis® exam is a formative assessment that is used for assigning students in the final year of clinical placement (FYCE). Many programs use some or all of the above measurement types. These formative and summative assessments focus on measuring students’ strengths and weaknesses, and students typically are evaluated by faculty both on and off campus.
Substantial variation also exists among programs and clinical sites regarding what determines competency. The construct of competency is difficult to define because it varies considerably depending on the student’s level of experience as well as (1) the point of student training at which the competency the review takes place, (2) delineation of the core competencies needed prior to the externship, and (3) what determines competency.
Clinical Skills Assessment (CSA) Form
Some common general standards exist across audiology programs, but there is ample flexibility for program administrators to determine how to meet their program’s needs. It is hoped that programs will move toward developing a more uniform set of knowledge and skills in the future. However, it is important to recognize that programs provide students with different experiences, and, therefore, differences will always exist in terms of student preparedness. The creation of a comprehensive list of practice areas can serve as a general guide for judging a student’s level of experience and readiness for the final year clinical externship (FYCE).
The Student Readiness Working Group from the AuD Education Task Force developed a Clinical Skills Assessment (CSA) Form (n.d.)) for the FYCE as a guide for university programs and clinical sites. This form was disseminated as one of the deliverables at the end of the AuD Education Summit Task Force Report which is housed on the ASHA website. The CSA Form contains a comprehensive list of practice areas divided into three skill areas:
- Assessment Skills
- Management Skills
- Professional Skills
This list of skills is further classified based on the student’s level of development prior to the start of the externship experience. The practice areas are classified into three tiers:
Tier 1: Mastery prior to the externship
Exposure to theory and methods in the classroom, some laboratory practice, and considerable experience with real patients.
Tier 2: More advanced (developing) skills prior to the FYCE.
Exposure to theory and methods in the classroom, some laboratory practice, and moderate experience with real patients.
Tier 3: Advanced/specialty skills (unlikely to be fully established prior to the FYCE)
Exposure to theory and methods in the classroom, some laboratory practice, and limited experience with real patients.
The CSA can be used by university programs to provide an evaluation of individual students’ skills in Assessment, Management, and Professionalism and provide specific information to clinical sites regarding whether those skills have been mastered (Tier 1), are developing (Tier 2), or still require exposure and experience (Tier 3). Students are not expected to have all skills listed in all tiers of the CSA as students will have different levels of experience depending on the program they attend. That said, students should have most of the skills listed in Tier 1 for Assessment, Management, and Professionalism, and some of the skills listed in Tier 2. It is unlikely that a student would have mastery of all advanced/specialty skills (Tier 3) prior to the FYCE. Thus, the CSA can be instrumental in providing detailed information to the clinical site about which skills the student has mastered, which are in development, and which are still needed and expected to develop during the final year of their program.
Conclusion
Complete agreement may be an unrealistic goal in terms of deciding which skills should be included in the CSA form and the most appropriate tiers for given skills. Nonetheless, the CSA Form is a useful and recommended tool that audiology programs and FYCE externship sites can use to assess student readiness and expectations for competence.
References
Student Readiness Working Group. (n.d.) Clinical Skills Assessment Form. https://www.asha.org/uploadedFiles/AuD-Education-Summit-Task-Force-Report.pdf
