Education of audiologists to maximise hearing aid outcomes

 (A paper first presented as a poster at IHCON, 2014)

Elaine Saunders, Sarah Bellhouse and  Peter Blamey

This study aimed to investigate the postgraduate education programs available to meet the needs of audiologists in 2014 in five English speaking countries, including Australia.  The paper was an independent study, and was triggered by my interest in audiological standards, competencies and training, which varies between Universities and countries.

Introduction: Hearing aids are the major tool available for rehabilitating people who have mild to severe hearing loss.  The outcomes achieved depend on many factors, including the severity of hearing loss; the quality of the hearing aid’s sound processing; the adjustment of the hearing aid parameters to the needs and the preferences of the user; previous hearing aid experience; the user’s attitude, and the quality of informational counselling.  In addition, it is obvious that hearing aids can have no benefit to the owner if they are not used, as is the case up to 24% of hearing aids owned in the USA3,4.  Evidence supports that many hearing aids in 2014 will give improved benefits compared with hearing aids in 20041.  Whilst there is a need for counselling with some clients, this is not true for the majority of people with mild to moderate loss2.  However, audiologists in clinical practice need to be able to evaluate recent developments in hearing aid technologies, pre-fitting and post fitting measures of both validity and verification, and rehabilitative techniques, including counselling techniques.

Methods:  University and course selection: Data were collected from the websites of 50 English speaking universities offering postgraduate (Master’s degree and Professional Doctor of Audiology) courses delivered in English.  The countries selected were Australia, Canada, New Zealand (NZ), the United Kingdom (UK) and the United States of America (USA).  The rationale for using the website as the primary data source was that this is the primary information source for students selecting an academic program in audiology.  Information was collected on course fees; advertised course features; and time spent on hearing aid related studies (hearing aid units including topics on auditory rehabilitation). 

Course fees: All course fee information was converted to USA dollars (converted May 2014), and is taken for the 2013-2014 study period.  Course fees are listed for domestic student total fee costs, and exclude residential costs.  Course fees, listed in the results, are approximations and may vary depending on an individual’s education history and the electives selected.

 Advertised course features: Where available, advertised course features were recorded from course curricula webpages.

 Time spent on hearing aid related studies: Modules/units of study listed on curriculum webpages were examined to determine the overall percentage of time dedicated to the study of hearing aids in each course.  Where units contained some information about hearing aids, the entire unit value was included in the percentage calculation. The minimum, mean and maximum total percentage of coursework dedicated to hearing aid related studies was then calculated for each of the five surveyed countries.

Hearing aid units including content on auditory rehabilitation: Where available, hearing aid related module/unit descriptions on curricula webpages were examined to determine the advertised content of these units of study. Each module/unit was then recorded as either including content on auditory rehabilitation or as purely focusing on hearing aid technologies. The overall percentage of hearing aid related units that did or did not contain information on auditory rehabilitation was then calculated for each of the five surveyed countries

Results from the website review:

There was variation in both the average duration (Figure 1) and average cost (Figure 2) of post graduate audiology courses between the five countries surveyed.

Figure 1. The average duration of post graduate audiology courses in years, in universities in Australia, Canada, New Zealand, the United Kingdom and the United States of America.
Figure 1. The average duration of post graduate audiology courses in years, in universities in Australia, Canada, New Zealand, the United Kingdom and the United States of America.

 The cost of the courses varied from the lowest in the UK, to the highest in the USA.  This does not account for the different entrance requirements, and the differing incurred costs.

Figure 2. The price range between minimum, mean and maximum cost, in USD, of post graduate audiology courses in universities in Australia, Canada, New Zealand, the United Kingdom and the United States of America.   In the UK many MSc places are “in service” and thus paid for by the NHS.
Figure 2. The price range between minimum, mean and maximum cost, in USD, of post graduate audiology courses in universities in Australia, Canada, New Zealand, the United Kingdom and the United States of America. In the UK many MSc places are “in service” and thus paid for by the NHS.

Of the surveyed curricula webpages containing advertised course features, 37% listed clinical practice as the main focus of the course. The second most highly advertised course feature was research (21%), followed by “a broad curriculum” (15%). No course advertised a focus on hearing aid studies as a feature of the curriculum (Figure 3.).

Figure 3. The percentage of website advertised features of post graduate audiology courses in universities in Australia, Canada, New Zealand, the United Kingdom and the United States of America.

Figure 3. The percentage of website advertised features of post graduate audiology courses in universities in Australia, Canada, New Zealand, the United Kingdom and the United States of America.

On average 11% of coursework was specifically designated to hearing aid related studies across all universities surveyed.  Universities in NZ displayed the highest average hearing aid specific coursework, followed in decreasing percentage order by the UK, Australia, Canada and the USA (Figure 4).

Figure 4
Figure 4

Within most of the surveyed countries there was considerable variation in the amount of total coursework dedicated to hearing aid specific studies between individual universities (Figure 4). The greatest variation was found in universities in the USA where hearing aid specific coursework varied from 2.3% of total coursework at one university to 29.3% of total coursework at another university.  The UK courses appear to offer a number of options in their courses.

Each of the five surveyed countries showed variation in the content of hearing aid related units. While the focus of some units was entirely on hearing aid technology, maintenance and use, other units included rehabilitative information, primarily that of auditory rehabilitation. Of the hearing aid related units advertised on website curricula, Canada and the USA showed the highest percentage of units dedicated entirely to the study of hearing aids.

In Australia and NZ the majority of hearing aid related units also include information about auditory rehabilitation, and in the UK 100% of hearing aid related units included information on auditory rehabilitation (Figure 5.).

Figure 5. Percentage of post graduate audiology hearing aid related units containing information about auditory rehabilitation in addition to hearing aid specific content. From universities in Australia, Canada, New Zealand, the United Kingdom and the United States of America
Figure 5. Percentage of post graduate audiology hearing aid related units containing information about auditory rehabilitation in addition to hearing aid specific content. From universities in Australia, Canada, New Zealand, the United Kingdom and the United States of America

Discussion:

The results indicate that there are considerable inconsistencies in many aspects of post graduate audiology training between the five counties surveyed and between individual universities within each of these countries.  For students choosing a university to attend there are many factors worthy of their consideration, including the coursework covered, the cost of the course, the length of the course and the relevance of their final qualification to their likely workplace.  The variation seen in both course duration (Figure 1) and cost (Figure 2) would presumably make it difficult for students to make qualitative comparisons between the courses offered.  This is especially confusing given that the outcome of all these courses (combined with any national accreditation requirements) allow students to practice as audiologists.

Where available, students may in part base their university selection upon the advertised features of a course. The most highly advertised course feature was clinical practice (Figure 3): However in all of the five countries surveyed, clinical practice was either a mandatory part of the coursework or was required to be completed after graduation.  With such structures in place to ensure the compulsory completion of clinic placement, the advertisement of this aspect of study as a ‘feature’ seems redundant.  It would seem more advantageous for universities to distinguish themselves by advertising a non-compulsory but highly desirable course feature such as a focus on hearing aid technologies, with a specified goal of understanding emerging technologies, and simply indicating compliance.

This study highlighted the fact that on average a low percentage of coursework is dedicated to hearing aid specific study (Figure 4). Data suggest that most audiologists spend part of their time in their career fitting hearing aids2 and it would therefore seem beneficial for students to graduate from university with both a sound understanding of current hearing aid technologies and the skills and aptitude required to embrace emergent technologies as they arise.

Research for this study also highlighted a lack of readily available online information on university curricula.  Many universities listed units by name but gave no further description of the unit content and a small percentage of universities surveyed had no online information available on course content. This lack of transparency on course content would make it difficult for prospective students to identify where the focus of their study would be.  This is confusing for a prospective student interested in hearing aid technologies or in auditory rehabilitation, from the psychosocial and counselling perspective.

We recommend that course curricula in the countries studied have a greater focus on hearing aid technologies, with a specified goal of understanding emerging technologies, and that curricula specify clearly the skills required for auditory rehabilitation,  including effective hearing aid fitting to meet the individual needs of hearing aid users.

It is also recommended that universities improve the curriculum information available on their websites. Doing so would both allow students to identify the university most suited to their interests and promote any universities that are taking the lead in providing high quality post graduate audiology education.

References:

  1. Kochkin, S. (2010). MarkeTrak VIII: Consumer satisfaction with hearing aids is slowly increasing. The Hearing Journal63(1); 19-20.
  2. Hearing The Need:  Audiology and Primary Health Care Reform, Audiology Australia November  2010
  3. Hougaard S., Ruf S.(2011) EuroTrak 1: A consumer survey about hearing aids in Germany, France, and the UK. Hearing Review;18:12–28
  4. Hartley D., Rochtchina E., Newall P., Golding M., Mitchell P. (2010) Use of hearing aids and assistive listening devices in an older Australian population. J Am Acad Audiol;21:642–653..

Acknowledgements

This research was financially supported by Blamey Saunders hears

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