Clinical Experiences and Dress Code

Clinical Component

During the four-year graduate program, students receive intensive and broad based clinical training in a variety of clinical settings. Students are exposed to a diverse group of clients across the life span with diverse ethnic, cultural, linguistic and multiple disabilities. Major emphasis will be focused on learning state of the art techniques, grounded in evidence-based practice, to meet the current challenges and standards in diagnostic and rehabilitative care of patients with auditory and vestibular disorders. Through the clinical practicum experiences, students learn to apply much of what they have learned in classes, as well as develop additional skills. Students will learn to:
• Identify, assess, diagnose, interpret, and manage test results related to disorders of hearing, balance, and other neural systems.
• Conduct and interpret behavioral, electro-acoustic, and electrophysiological tests used to assess hearing, balance, and neural system function.
• Perform otoscopic examinations for cerumen in order to evaluate its effects on hearing test results, hearing aid use, and/or making ear impressions, and to make appropriate referrals if needed.
• Perform tinnitus evaluations and make appropriate recommendations regarding its treatment.
• Select, evaluate, fit, and facilitate adjustments to hearing aids and other assistive hearing devices.
• Evaluate and manage children and adults with central auditory processing.
• Conduct newborn hearing screenings.
• Observe/participate in electrodiagnostic tests for the purposes of neurophysiologic intraoperative monitoring and cranial nerve assessment.
• Assess candidacy of clients with hearing loss for cochlear implants, perform CI programming and audiological rehabilitation to optimize device use.
• Counsel clients for psychosocial adjustment to hearing loss for persons with hearing loss and their families/caregivers.
• Identify practice patterns in educational audiology, classroom acoustics, and use of FM systems and other assistive devices with school age populations.

The clinical practicum experience is designed to be commensurate with the level of training. Students are only allowed to perform specific clinical tasks after a period of observation and demonstration by their preceptor. As the student progresses from one semester to another, the intensity of the clinical experiences and the demands of the setting develop into more challenging experiences and a greater degree of independence.

The clinical portion of the Program is designed to begin with 100% supervision and progressively build toward more independence. However, for all clinical experiences, there must be a supervisor on-site and readily available to provide direction and to approve clinical reports. All supervisors are aware of the need to be able to adjust the amount and quality of supervision based upon the demonstrated skills and experiences of each student. The Audiology Clinic Director monitors this process to ensure adequate supervision, based on feedback obtained from the student and the supervisor. Supervision will be done by persons holding ASHA certification (CCC-A) for at least 1,820 hours of clinical practicum (the minimum number of hours required by the Standards); however, some experiences, e.g., intra-operative monitoring, facial nerve monitoring, cerumen management, ENGs, and some off-campus settings may be supervised by non-ASHA certified professionals (up to 400 hrs of the approximate 2500 cumulative hours).

During the first year of the Program, students are placed only in the SDSU Audiology Clinic and receive 100% direct supervision for all activities from a program faculty with ASHA certification. During the first year, the preceptor demonstrates and/or performs any procedures that the first year student is not familiar with or is not comfortable in doing. As the student gains more knowledge and experience, they are encouraged to perform the procedures with guidance from their mentor and/or preceptor. Students must achieve competency levels as indicated on the Clinical Skills Inventory Tracking Form for Year 1. Competency levels are tracked by the clinical preceptors. In addition, the student's competency levels are assessed by a practical component of the Year 1 Exam (beginning of August). Each student should have approximately 200 hours of direct patient contact (with 100% supervision) during the first year.

During the second year of the Program, students receive most of their clinical experience in the UCSD clinic with 100% direct supervision for all activities from a program faculty with ASHA certification. As the student gains experience, and as appropriate skills are demonstrated to the preceptor, the direct supervision may be reduced, but not less than 50%. The experiences will include diagnostic procedures to evaluate auditory and vestibular disorders, hearing aid fitting and dispensing. Students will also observe oto-neurology clinics as well as surgeries of the ear. Students must achieve competency levels as indicated on the Clinical Skills Inventory Tracking Form for Year 2. The student's skills are also again assessed via the practical portion of the Year 2 Exam (middle of June). If needed, the student will remain in the on-campus clinics until skills reach the target levels for Year 2 and the Audiology Clinic Director determines that the student is ready for off-campus placements. Qualified students are assigned an off-campus placement in the summer of year 2, where they are supervised at a level appropriate to their abilities, but not less than 25%, and a preceptor is to be on-site and available at all times. Students must achieve competency levels as indicated on the Clinical Skills Inventory Tracking Form for Year 2. Each student will receive at least 75 hours of clinic experience at the UCSD clinic during the second year and at least 125 hours of clinic experience at an off-campus site during the summer of the second year.

During the third year of the Program, each student is placed in three or more off-campus sites (20-24 hrs/wk), where they are to be supervised at least 25% of the time, and a preceptor is to be on-site and available at all times. Students must achieve competency levels as indicated on the Clinical Skills Inventory Tracking Form for Year 3. The student's skills are again assessed via the practical portion of the Year 3 Exam (middle of June). Each student should receive at least 500 hours of clinic experience during the third year.

During the fourth year of the Program, each student is to be placed in a Clinical Externship and is to be supervised by an ASHA certified audiologist, who is on-site and available at all times. Initially, the student should receive at least 25% supervision. The level of supervision during the externship is to be adjusted by the preceptor and must be commensurate with the skills of the student, but must be no less than 8 hours/month of direct observation of patient service delivery (5% supervision). The Clinical Externship should culminate in complete independence, equipped to enter the profession with all expected entry-level knowledge, skills, and confidence. The Clinical Externship will be evaluated using methods and instruments similar to the Clinical Fellowship Year. During the Clinical Externship, students will be engaged in a clinical agency for full-time (52 weeks x 35 hours/week). Note: The Program is not yet at its 4th year.

Essentially there are four stages of clinical preparation in the Program:

Stage I (Sept Year 1-Aug Year 1):

Basic Level (100% supervision). Students spend 6-8 hours per week in the SDSU Audiology Clinic, all three semesters. They gain experience in basic diagnostics and hearing aid fittings, mostly with adult clients. Ample time is allowed for each patient (1-2 hours). Students learn: a) appropriate safety and infection control procedures, b) how to review patient charts/relevant information and obtain a case history, c) diagnostic equipment operation and how to perform the basic audiometric tests, d) electroacoustic hearing aid checks, ear mold impressions, hearing aid selections and fittings (real ear probe), e) report writing, and f) recommendations (generally made by the preceptor). All students attend a Clinical Cases Studies and Staffing Course (AUD 721) to discuss some of their cases and clinic issues. Students should accumulate approximately 200 hours during Year 1.

Stage II (Sept Year 2-June Year 2):

Intermediate Level (100%-50% supervision). Students spend at least 4 hours per week in UCSD Otology and Audiology Clinic (Perlman Center), two of the three quarters. In addition, they spend one quarter in Otology Preceptorship where they shadow an otologist during their clinics and surgeries. The foci in Year 2 are to get exposure to a wide variety of interesting medical cases, review and write in medical charts, and increase speed of evaluations. Students also spend time in the Neurophysiology Clinic participating in ABR, OAE, ENG, and Facial Nerve monitoring. All students attend a Clinical Case Studies and Staffing Course (SURG 274) and attend the Chairman's Conference and Neurotology Conference, where cases are discussed among residents, staff, and community physicians. Students should accumulate at least 75 hours at the UCSD clinic and 125 hours at an off-campus site during Year 2.

Stage III (July Year 2-June Year 3):

Intermediate Level (25% supervision). Beginning in the summer of Year 2 and continuing through June of the third year, qualified students are assigned to off-campus clinic sites where they receive at least 25% supervision. Students spend about 20-24 hours per week in off-campus agencies. Students will demonstrate more independence on basic and advanced audiometric assessments and hearing aid fittings, and will develop skills in cochlear implants, pediatrics, and intraoperative monitoring, electrophysiological assessment, and vestibular assessments. All students enroll in a Clinical Cases Studies and Staffing Course (AUD 821) and are required to present some of their cases for discussion. Students should accumulate at least 500 hours during Year 3.

Stage IV (July Year 3-June Year 4):

Advanced Level (25%-5% supervision) from preceptor with CCC-A, which can be adjusted based on demonstrated competencies. Students compete for a full-time clinical placement (Clinical Externship) for 12 months (July-June) at a variety of interested sites associated with the program or at an approved site selected by the student. Students should gain independence and confidence in a wide variety of clinical skills. All students will participate in an On-line Integrative Seminar, where interesting cases and issues are discussed. Students should accumulate at least 1,820 (52 wks x 35 hrs) during Year 4.

THE DRESS CODE APPLIES TO ANYTIME YOU ARE IN THE CLINIC FOR MORE THAN 10 MINUTES WHETHER OR NOT YOU ARE SEEING PATIENTS. THIS INCLUDES STAFFINGS, LABS, RESEARCH, MEETINGS, ETC.

THIS DRESS CODE IS ALSO THE MINIMUM REQUIRED FOR OFF-CAMPUS CLINICAL PLACEMENTS. INDIVIDUAL PLACEMENTS MAY HAVE MORE STRINGENT RULES.

1. Shoes worn during clinic should look nice. Open-back shoes such as clogs and mules are acceptable. No flip-flops or athletic shoes are allowed during the provision of clinical services. Hose are optional for women. Off-campus sites may have different dress code requirements.

2. Any pants/skirt/shirt combination must cover the midriff when your arms are raised and also cover the back when bending over. No excessively baggy pants (crotch of pants to the knees, or riding excessively low on the hips).

3. Skirts should be of reasonable length, e.g., no more than 4 inches above the knee.

4. No denim jeans, shorts or jackets. All pants must be in good condition

5. Low-cut tops, tube tops, or shirts that show-through are not allowed. All tops must have straps that are at least 3" wide. Tops should not be too tight so as to gap in the front.

6. Shirts for men must have collars. No Hawaiian or other "loud prints. Ties are recommended when seeing patients. Shirts must be tucked in.

7. Any visible or potentially visible body art needs to be removed or covered. Oral or facial piercings (tongue, lip, eyebrow, nose) must be removed. Any arm/shoulder/neck tattoos must be covered with long sleeves or a high collar. Any leg and/or ankle and/or foot tattoos must be covered with dark tights or pants. Using Band-Aids to cover tattoos is unacceptable.

8. Clinicians must wear their identification badge while providing services to patients.
As needed, your supervisor will help you to appear professional in the clinic environment.