Survey of AuD students confirms need for counseling as part of audiologistʼs training

Abstract

While the importance of counseling is well recognized within the profession of audiology, it is still not a required subject in most training programs. Crandell reported in 1997 that a survey of graduate audiology programs found that only 27% of responding institutions required a counseling course.1 He noted that graduate programs expect their students to learn counseling skills in practicum, where the supervisors were unlikely to have had sufficient training themselves. Despite this, a majority of respondents were satisfied that their students were trained well enough to counsel effectively. This expectation of “on-the-job training” was not supported by a recent study of practicing audiologists, who did not demonstrate basic counseling skills prior to taking a counseling course.2 It was expected that the AuD movement would mandate formal counseling coursework. However, a February 2000 survey of current AuD programs found that fewer than 30% require counseling courses at this time (Table 1).Table 1: Response of AuD programs to a survey asking if they required counseling coursework.Patient dissatisfaction with amplification has resulted in smaller sales of hearing aids than anticipated.3 Sweetow contended that, with the introduction of personal adjustment counseling, a decrease in the return of hearing aids and an increase in positive patient-clinician relations should occur.4 Erdman suggested that by using effective counseling methods and empathic listening, along with formal assessments or inventories to monitor patient benefit and compliance, successful rehabilitation would occur.5 Yet, a Hearing Journal survey of dispensers found that as many as two-thirds of respondents did not use standardized self-assessment tools.6 The advent of distance-learning AuD programs for practicing audiologists has created an opportunity to examine if audiologists enrolled in such programs want to improve their counseling skills. The purpose of the study reported here was to answer the following questions: ❖ Do current practitioners, regardless of academic background, believe their counseling skills are adequate? ❖ Would they choose to take a counseling course if it was elective? ❖ Are they already using inventories to monitor patient benefit and compliance? METHODS Subjects Twenty master's-level audiologists (17 female, 3 male) participated in this study. All were enrolled in the counseling course offered by the Central Michigan University/Vanderbilt Bill Wilkerson Center (CMU/Vanderbilt) AuD distance-learning program. Subjects had an average of 12.9 years in the profession, an average age of 38.5, and all but one were currently employed. Procedures A five-item survey was sent via e-mail to each of the 26 students enrolled in the counseling course before the term began. Twenty students (77%) responded. After the course was over, a second survey was sent to the 20 people who responded to the first survey. (See Appendices A and B.) RESULTS OF PRE-COURSE SURVEY Background and interest in counseling Fifteen of the 20 respondents had taken no counseling classes; two students had taken graduate counseling classes; one had taken an undergraduate counseling class. Three students had participated in some kind of counseling workshops, and one other mentioned obtaining continuing education units in counseling. Minimal readings on counseling were reported by 30% of the students. In summary, only 40% of the respondents reported having any background in counseling. Requirement of this course Eleven of the students said they would have taken the CMU/Vanderbilt course even if it had not been required, while 8 said they would not have and 1 was unsure. Among those who would have elected to take the course, a typical statement was that counseling is “an area in which I need improvement. I believe that the future of audiology is largely dependent on our rehabilitation role. This is what differentiates us from other hearing healthcare providers.” One student who would not have taken the course as an elective and who had only read one book on counseling, explained, “I feel I do an adequate job counseling; skill in counseling is experience-dependent and I have developed my own techniques.” Use of inventories Ten respondents said they were not using inventories prior to taking this class. Seven of the audiologists said they used one inventory: four the Abbreviated Profile of Hearing Aid Benefit (APHAB),7 and one each the Client Oriented Scale of Improvement (COSI),8 the Fisher Auditory Problems Checklist,9 and selections from the Denver Scale of Communicative Function.10 One of the three students using multiple inventories worked in a pediatric setting, where she used the Hearing Handicap Inventory for Adults (HHIA)11 on the initial visit and a modified APHAB. She indicated no rationale for using the HHIA with children. Anticipated impact of course The majority of responses to the question about expectations centered on the concrete. Subjects expressed a desire to learn new tools to guide the decision-making process in amplification (N=4), to improve history taking (N=2), to understand how to provide better hearing aid fittings or recommend school placements (N=5), or to learn about new trends in the field (N=3). One student explained that she wanted the class to “change the way I practice. I am guilty of placing technology as the top priority and I can already see that counseling may need to be number one.” RESULTS OF POST-COURSE SURVEY Interest in counseling After completing the class, nearly all the respondents (N=19 or 95%) said that it had changed their level of interest in counseling. The only respondent who did not said that she was very interested in this subject even before taking the course. She commented, “It is hard to imagine now how we could properly manage a patient without dealing with their emotional side.” Another student said that previously something that she could not identify was missing from her practice. Now she “…identified what my weaknesses are and can focus on improving them.” She added, “Taking this course was one of the best things I have done to improve the care I give my patients.” Requirement of the course All respondents agreed that a counseling course should be required for every audiologist. Responses ranged from the simple such as “how information is presented will influence success” to a strongly worded demand for the profession to require training in counseling as a prerequisite for entering practice. Said one student, “Doing a poor job at counseling can result in permanent damage to the rehabilitation process.” Another stated, “Rehabilitation is the future of audiology. If we want autonomy, this is where we will find it.” One student said that most of what she had learned before taking the course was through “trial by fire.” Another acknowledged having felt unprepared for counseling. “They just throw you in and expect you to learn by doing. Both audiologist and patient suffer.” One student who acknowledged having no experience and initially no desire to take this course wrote, “As a group we audiologists are poorly trained in this area and, more importantly, are unaware of our own ignorance.” Use of inventories With the exception of one audiologist employed by a hearing aid manufacturer who had no personal need for inventories and one who was already using two inventories, all the respondents said they were or would shortly be increasing or changing their use of inventories. Not only were they using more inventories after taking the class, but most (13 of 20) stated they were using them differently. As one respondent explained, before the class, she used the APHAB only to adjust hearing aids. She is now looking at it to help see the patient as a person. The desire of respondents to expand their use of inventories seemed to be a direct result of taking the class. They found that the counseling course took them away from the simple question, “How is your hearing aid working?” toward such issues as defining areas in which the patient perceives a problem or in which the family feels help is indicated and documenting that some of these problems have been resolved. Actual impact of class In their comments on how the course had changed their practice, respondents included listening more; no longer talking about the audiogram as intensity/frequency but instead discussing its impact on communication; encouraging the patient to be in control; communicating more with families; and looking at patients differently. One audiologist stated that she no longer defines the patient by the hearing loss. Although she had always known better, she said that in the past she had “a tendency to assume certain difficulties were global for a given loss.” Another said she no longer bombards patients with data and materials, but bases what she presents in each case on the particular patient. For one of the students who works in a pediatric setting, the biggest change was that she stopped talking so much. She wrote, “I feel less stressed about letting parents guide the process. I acknowledge the patient and parent as being in charge. I am a resource.” Satisfying pre-course goals All 20 respondents reported that the course had exceeded their expectations. Indeed, many of them described the counseling class as the most important in the whole AuD program. DISCUSSION The findings of this survey suggest that a course in counseling is essential to professional growth and should be a required part of every AuD program. Making counseling an elective does not appear to be an acceptable option since, based on the results of this survey, a large percentage of respondents will elect not to take counseling. Typically, those students entering the CMU/Vanderbilt class expressed rather concrete desires; only after completing the course did they see the value of empowering patients, encouraging patients to make their own decisions, using empathic listening, or even seeing the patient as an individual rather than as a pair of ears. It would behoove the profession to require courses in counseling in order to help the practitioner best manage the psychosocial needs of the patient and also to encourage patients to select an audiologist to manage their hearing healthcare needs. While the numbers in this study are small, when the results are combined with data from other investigations, it becomes increasingly clear that audiologists need training in counseling to help their patients adjust more efficiently to their hearing loss.1,12 Without formal training in counseling, they miss what may well be the most important aspect of their profession. Many years have passed since the first calls for counseling courses were sounded, yet the inclusion of such coursework has not resulted.13 Now is the time to heed those calls and ensure that the profession of audiology moves forward on its path to autonomy, empowering not only the patient, but also the audiologist to handle the communicative needs of the patient. ACKNOWLEDGMENTS Appreciation is extended to Dan Konkle, PhD, and Gerald Church, PhD, Central Michigan University/Vanderbilt Bill Wilkerson Center, for their help in developing this study as a capstone experience. Thanks also to the distance learners who served as subjects for this study.