Get Those Phones Out!

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1 Get Those Phones Out! This is an interactive presentation. Throughout our presentation we will have various polls, you will submit your response to the code number listed on the slide. You will be givien 15 seconds to answer Ready? Standard text messaging fees apply

2 Being a Clinical Preceptor in 2014: The good, bad, and the ugly! Hillary Snapp, AuD Kari Morgenstein, AuD University of Miami, Department of Otolaryngology AudiologyNOW 2014, March 26, 2014

3 Disclaimer Our goal is to create awareness of what we do at the University of Miami and start a discussion on how we can make the overall externship process better. We know a lot of these topics can be controversial, and we hope to have this presentation include some professional debate and to obtain your feedback. We will not solve everything today, but hopefully we can open the doors of making our profession, in particular the externship year, better. There are several current limitations in our system, but how can we make things better next week when we go back to our clinics?

4 OBJECTIVES Evaluate the current preceptor student relationship and its potential impact on the future of our profession Analyze the current standards for teaching AuD students throughout the AuD program Define the current opportunities available to strengthen AuD clinical training.

5 Disclosure We do not have any relevant financial / non-financial relationships with any proprietary interests.

6 How many AuD programs are a) 45 b) 62 c) 74 d) 109 there currently?

7 How many AuD programs are a) 45 b) 62 c) 74 d) 109 there currently?

8 a) I am currently a preceptor b) I am not a preceptor c) I am interested in becoming a preceptor d) Who has time for that? I m just here for the CEU

9 What is your clinical setting? a) Hospital/Medical Center b) University c) ENT clinic d) Private practice e) Other

10 a) 1:1 b) 1:2 c) 1:3 d) 1:4 What is your preceptor to student ratio?

11 How many of the following clinical experiences do you provide for students? a) 1-5 b) 6-10 c)11-15 d)16-21 Hearing Screenings Pediatric evaluations: infant/toddler Pediatric evaluations: school-age Adult hearing evaluations Tympanometry Acoustic Reflexes Auditory processing evaluations Evoked potential assessments Intra-operative monitoring cases Otoacoustic emissions Industrial/hearing conservation Vestibular assessments Vestibular rehabilitation Hearing aids dispensed Hearing aid selection/fitting Audiologic rehabilitation (group or individualized) Cochlear implant evaluations Cochlear implant rehabilitation Tinnitus assessments Tinnitus rehabilitation Cerumen management

12 Council on Academic Accreditation (CAA), ASHA Academic and clinical education prepares students in the full breadth and depth of the scope of practice in audiology. Program s responsibility to design, organize, administer, and evaluate the overall clinical education of each student clinical program of study Equivalent access to all courses, clinical practicum opportunities and supervision Clinical education in external placements is monitored by program Ongoing evaluation of external facilities, procedures for selecting and placing students in external clinical sites Standards for Accreditation (01/2014)

13 Six Essential Components Administrative structure and governance Faculty Curriculum (academic and clinical education) Students Assessment Program resources

14 CAA All faculty, including all individuals providing clinical education, are qualified and competent to provide academic and clinical education. Sufficient number of full-time doctoral-level faculty is sufficient to meet needs of the program Does not state how this is determined No guidelines Who checks this for externship sites? Clinical teaching?

15 Accreditation Commission for Audiology Education (ACAE), AAA High quality performance in Au.D. educational programs through a rigorous verification process. Evidence that Au.D. programs have prepared graduates who are qualified to be doctoral-level audiologists. Graduates will be able to function according to the national scope of practice, as defined by the profession. Descriptions of all off-campus clinical sites including qualifications of preceptors Varied clinical environments and populations

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17 Accreditation Commission for Graduate Medical Education (ACGME) Oversees the CLINICAL component of education residency Liaison Committee on Medical Education (LCME) oversees the academic component medical schools Basic standards that every resident program must meet Monitors hours worked (what they did during these hours) and cases seen for every resident Individual from ACGME goes out to all resident sites each year to check that overall systems are in place National database

18 ACGME Sites Rigorous application process Determines which sites can take residents and how many Number of patients seen Patient population Academic and clinical curriculum Strict faculty requirements Board certification, scholarly activity, minimum # hours per week dedicated to resident education activity

19 Jul y Sept Assistant Surgeon Resident Surgeon R esident Supervisor Assistant, Intern? Independent, Extern? Intern Preceptor J J Oc No a Fe M Ap 2012 ul Sep Oc No De Ja Fe Ma Ap Ma t v Dec n b ar r May June MED y Aug t t v c n b r r y June Jul Au Sep Oc No De Ja Fe Ma Ap Ma MIN MED y g t t v c n b r r y Head & Neck Parotidectomy Neck Dissection (all types) Thyroid/Parathyroid ectomy Glossectomy Otology/Audiology Tympanoplasty (all types) Mastoidectomy (all types) Stapedectomy/Ossic uloplasty FPRS Rhinoplasty Mandible/Midface Fractures Flaps General/Peds Airway Pediatric and Adult Congenital Neck Masses Ethmoidectomy Bronchoscopy June 2012 MED Total Procedures

20 This or that? Cleans and straighten clinic Supplies clinic at end of day OR Carrying out professional responsibilities, ethics, sensitivity Evaluate d through: responsibility in carrying out their professional duties (continuity, responsiveness, availability, and self-sacrifice), following ethical principles, and sensitivity to diverse patient populations.

21 This or that? Cleans a nd straighten clinic clinic at end of day Supplies OR out professional responsibilities, ethics, sensiti Carrying d through: vity responsibility in carrying out their Evaluate professional duties (continuity, responsiveness, availability, and self-sacrifice), following ethical principles, and sensitivity to diverse patient populations.

22 Competencies: Grading Scale 4 Independently effective, takes initiative 3 General direction from supervision needed to perform effectively 2 Specific direction and/or demonstration from supervisor needed to perform effectively 1 Specific direction from supervisor does not alter unsatisfactory performance

23 Inherent Biases Halo Effect: A learner receives an assessment (usually positive) based on previous performance or an overall preconceived impression of the learner s abilities/skills. Range Restriction Error: Failure to utilize the entire range of the scale. Faculty may only use the upper end of the scale.

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27 Externship Timeline July-October: Students/faculty investigate program opportunities, requirements, deadlines; September/October: Extern sites accept applications October 31 st : Final date for sites accepting applications November 15 th : Applications Files Completed December/January: Externship interviews scheduled and completed; February 1 st : Offers Made Accepted Round 1: Offers accepted by students within 2 weeks March 31 st : Process completed June 1st to July 1 st : Externship begins

28 The UM Experience One extern per year Externship Registry - Updated late summer Application deadline- October 31 st 2 Letters of Recommendation Resume/CV Transcript **Blinded Committee review Skype interview for top 5 candidates Offer made by January 1 st..

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30 Regularly Regularly Rarely Regularly Everyday Rarely Regularly Everyday Rarely Regularly Everyday Everyday Regularly Everyday Everyday Regularly Everyday Everyday Regularly Never Rarely Regularly Everyday Rarely y Regularly Rarely Regularl Everyday Never Rarely Regularly Rarely Everyday Rarely Everyday Regularly Never Regularly Everyday Never Regularly Everyday Everyday Regularly Everyday Everyday Regularly Regularly Everyday Regularly Regularly Never Regularly Regularly Never Regularly Regularly Regularly Regularly Hearing Hearing Screenings Hearing Screenings Screenings Pediatric Pediatric evaluations: Pediatric evaluations: infant/toddler evaluations: infant/toddler infant/toddler Pediatric Pediatric evaluations: Pediatric school-age evaluations: school-age school-age Adult Adult Adult hearing Adult hearing evaluations hearing evaluations Tympanometry Tympanometry Acoustic Acoustic Reflexes Reflexes Auditory itory Auditory processing proces processing evaluations sing evaluations sing ev aluat aluat io io ns ns Evoked Hearing Hearing potential Screenings Screenings assessments Evoked Evoked potential potential assessments assessments Otoacoustic Intra Intrā Intra-operative op emissions erati ve ve monitoring mon itor cases itori ng ng ca ca se se s s Otoacoustic Otoacoustic emissions emissions Vestibular Industrial/hearing assessments conservation Vestibular Vestibular Vestibular rehabilitation assessments assessments Vestibular Vestibular rehabilitation rehabilitation Hearing aids dispensed Hearing aids dispensed Hearing Hearing aids aids dispensed dispensed Hearing Hearing aid Hearing aid selection/fitting aid selection/fitting aid selection/fitting Audiologic rehabilitation (group or individualized) Audiologic Audiologic rehabilitation rehabilitation (group (group or or individualized) or Cochlear Cochlear Cochlear implant implant implant evaluations evaluations evaluations Cochlear Cochlear Cochlear implant implant implant rehabilitation rehabilitation rehabilitation Tinnitus Tinnitus Tinnitus assessments assessments assessments Tinnitus Tinnitus Tinnitus rehabilitation rehabilitation rehabilitation Cerumen Cerumen management management

31 UM Externship Quarter 1 Quarter 2 Quarter 3 Quarter 4 General Diagnostics: Comprehensive Audiometry Neurodiagnostic ABR Electrocochleography Electroneuronography Otoacoustic Emissions General Diagnostics Pediatrics Auditory Processing Hearing Aids General Diagnostics Cochlear Implants Vestibular Tinnitus General Diagnostics Cochlear Implants Vestibular

32 Bridging the gaps Between schools and sites Sites and the extern(s) Site and other preceptors Recommended Communication: Extern coordinator must make first contact Weekly meeting with extern Mid and final quarter meeting with preceptors and extern Quarterly meeting with extern coordinator and site Quarterly meeting of the preceptors

33 Goals What are the competencies you expect the student to attain? What is the knowledge base you expect them to have? How will you facilitate achieving competencies? How will oversight of this be handled?

34 The Perfect Externship Integrate new ideas with existing knowledge Build on existing knowledge and previous experience Enables a student to apply didactic information to clinical practice

35 Keys to successful precepting: Time management Set structure and expectations early Provide a challenging learning environment Foster intellectual curiosity and critical thinking Provide appropriate, frequent feedback Establish a respectful adult relationship Know your extern/student- cannot educate all students the same way

36 Learning Styles Visual learners: Written instructions Graphs, images Auditory learners: Meetings Journal clubs, grand rounds Interviewing Kinesthetic learners: hands-on approach-practicing skills demonstrating skills to others (teaching interns)

37 Keys to a successful experience Create an environment that is professional and collegial Maintain a student/teacher relationship Should be built on respect These are adult learners Be open to criticism yourself and direction from your extern These will soon be your colleagues

38 Preceptor Development Monitor your preceptor skills Know who your student is Extern preceptors have arguably the biggest influence on the type of professional the student will become Our externs are our future preceptors Find time towards end of year to teach extern how to precept (Resident Supervisor) Externs are up to date on the latest research and clinical care

39 Be a Learner Learning doesn t stop at graduation Great resource for evidence based practice Ask their opinion, ask them to educate you on new concepts or theories Builds trust that you respect them as an adult Value their intellect and it still places you as the educator/authority

40 Feedback Often perceived as uncomfortable and therefore avoided Students like feedback, and often identify it as one of the most important characteristics of a good preceptor Should be positive yet constructive What went well today What needs improvement Use self assessment The student should identify how to execute the change

41 Giving Feedback: Provide feedback on a routine basis Make sure the message has been clearly understood Honesty is the best policy Don t generalize. Discuss specific examples Be transparent Assess skills frequently. Time flies by for everyone

42 Tools AAA 4 th year clinical educational guidelines Clinical Skills Evaluation Form Learning Style Assessment IDA Tools Reflection Preceptor meetings Preceptor Mini Trainings Onsight preceptor mentoring

43 So much more Teacher Role model Facilitator Mentor

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45 YouTube Video Not Available

46 Questions & Answers 1 of 2

47 Questions & Answers 2 of 2

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