Audiology programs across the nation faced the same questions in mid-March 2020: What will we do now? How will we deliver excellent clinical education and serve our patients while conducting clinics and classes virtually? What learning opportunities will the students miss? How can students learn clinical skills best during this challenging time?
Online Clinical Case-Based Learning
Like most audiology programs, Purdue University pivoted online within days of closing all buildings on campus at the beginning of the pandemic. Our clinical faculty team came together quickly to plan the rest of the semester. We were not sure how we could deliver high-quality clinical education without the real-world clinical space full of equipment, supplies, and products. The two student cohorts on campus were at different learning levels: the first-year students were working on basic audiology concepts (e.g., testing adults, understanding masking and immittance); the second-year students were learning about the pediatric population (e.g., visual reinforcement audiometry, auditory brainstem response [ABR] testing, and pediatric hearing aid fittings). Because of significantly different learning objectives, the audiology team split the two cohorts into separate learning groups. We initially used Blackboard as the learning platform and transitioned to Brightspace during August 2020.
First-Year Audiology Students
The first-year students completed written responses and reflections to written narrative cases. Clinical faculty chose some cases from audiology course workbooks, and created other cases. During the first part of the week, the students received case history information and test results; we asked them to respond to the case with specific prompts. We then gave the students our recommendations, and instructed them to reflect on and submit their interpretation of the case. In addition, the clinical faculty asked students whether they would have done anything differently. The clinical faculty used a rubric to easily grade and provide feedback to individual students.
Second-Year Audiology Students
We introduced the second-year students to one of our advanced courses, Audiology Integrative Grand Rounds. This course requires each student to present a case from their off-campus placement and requires all other students to post responses and reflections. This advanced course has been very successful; the students enjoy the online, asynchronous nature of the course and find the cases fascinating. This year, we chose the cases from previous year’s presentations that matched the educational needs of second-year students (e.g., infant ABRs, hearing loss and toddlers, complex medical histories, and cochlear implant cases). We uploaded these cases onto our learning platform for students to work through, and we used online discussion boards to facilitate communication and learning. Students received prompts for their posts, and professors utilized rubrics to assess independent thinking and learning.
We also hosted weekly virtual clinical meetings with each cohort to thread together important audiology concepts, best practices, and guidelines for ethical decision making. During that time, students shared what they learned, discussed important aspects of the cases, asked questions, and shared ideas. Clinical faculty attended these sessions to offer perspectives on cases and to clarify difficult concepts.
Reflection on Spring Semester
The 6 weeks of case-based learning in the spring were successful; students learned and met the faculty’s expectations related to learning and refining clinical skills. Yet, the overwhelming feedback from students was that they missed the personal contact—not only with their patients (of course) but also with the clinical faculty. So, we refined our virtual programming for the summer semester—by incorporating telepractice into our students’ learning experiences.
As soon as we realized that this teaching platform was going to be in place through the summer, we discussed how to improve student learning and patient care. During the summer courses, we included telepractice—using both actual patients and fictional cases created by faculty. The faculty cases allowed students to role-play the part of a patient or parent on a one-to-one basis. We continued the weekly meetings, creating a learning community in which students and faculty shared thoughts and discussed cases in depth.
We implemented telepractice using secure WebEx virtual meeting rooms. The secretaries prepped patients, making sure that they signed consent forms and that they could log onto the platform prior to the scheduled appointment. We offered our patients appointments that included communication counseling, referral counseling related to infant testing, hearing aid troubleshooting, and remote programming of hearing aids. All of our students were able to complete several of these appointments throughout the summer.
Audiology Telepatient Case Bank
If students did not have a telepractice patient on their assigned schedule, clinical faculty accessed the case bank and role-played a patient during the clinical session. We created cases in sections, as follows:
- Case history form. We gave the student the completed case history form and allowed them to work on it for several minutes, deciding upon the questions that they as clinicians needed to ask. The student then asked the “patient” (i.e., the clinical faculty member) their questions using a script provided by the case creator.
- Test results. Next, the student selected the battery of tests, providing a rationale for each. The student then reviewed the prepared test results (audiogram, ABR, etc.) and interpreted the findings. The student then shared the results with the “patient” (i.e., the clinical faculty member who was playing the role of either patient or parent).
- Recommendations. Student clinicians then shared their recommendations, and the clinical faculty member asked questions as the “patient” or “parent.”
Discussion/reflection. The student and the clinical faculty member then reflected on the case. Students shared their self-reflective thoughts—using evidence-based practice to (a) identify what they missed, (b) indicate language that they should have used to describe test results, and (c) determine whether the recommendations were appropriate.
Reflection on Summer Semester
Feedback and reflections showed that students and faculty enjoyed the telepractice appointments and learned a lot about remote programming and counseling. Patients also appreciated the access to audiology care. Students unanimously agreed that the live role-playing improved their ability to learn audiology concepts compared with the written case-based learning activities.
Forward Thinking: What Will Fall Bring?
We encourage the audiology clinical faculty and students to begin their clinical experiences immediately. First-year students would be expected to engage in hands-on experiences as early as possible. Second-year students would be assigned patient populations that they have not yet experienced. We will record each session with our new observation recording system—knowing that we could use these recordings as examples for online clinical learning at a later date, if needed. Students could review, discuss, and reflect on these sessions with their clinical faculty member. And, we would continue to build and use our audiology telepatient case bank.
When we eventually stay on campus for long periods of time, it is very likely that we’ll continue to use some of these innovative methods to supplement clinical education and serve our patients. Specifically, current and new patients who wear hearing aids will be able to receive care via telepractice and case based learning will continue to be used to solidify foundational concepts. But, as we anticipate being back on campus, interacting with one another again, we will use every opportunity to evaluate patients in our on-campus clinic, teaching students the foundational skills needed to be independent, successful audiologists.