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OBSERVATION, PRACTICUM AND EXTERNSHIP HANDBOOK
Washington University School of Medicine Program in Audiology and Communication Sciences (PACS)
Doctor of Audiology (AuD) Program
2018-19 Academic Year
Updated August 22, 2018
1
TABLE OF CONTENTS
General Requirements and Philosophy 2
Course Requirements 2
Minimum Clinical Hour Requirements 3
Practicum Coordination, Meetings, and Staffings 3
Practicum Sites 4
Practicum Placements 4
Practicum Schedules 5
Practicum Attendance 5
Practicum Evaluation and Grading 5
Practicum Progression 6
Documentation of Hours 6
Requirements for Supervision of Practicum 6
Employment and Payment 7
Student Titles 7
Professionalism 7
Course, Practicum, and Externship Evaluations 7
Observation and Practicum: First-Year Students 8
Practicum: Second-Year and Third-Year Students 8
Fourth-Year Externship 9
Locating and Securing the Externship Site 9
Paperwork 10
Student Feedback and Evaluation 10
Contacts 11
Appendix A: Suggested Timeline: Securing an Out-of-Town Summer Practicum Placement
Appendix B: Clinical Site Form
Appendix C: CALIPSO Practicum Evaluation
Appendix D: Grading Scale
Appendix E: CALIPSO Clock Hour Form
Appendix F: Student Non-Patient Clinical Activities: Sample 1
Appendix G: Student Non-Patient Clinical Activities: Sample 2
Appendix H: AAA Externship Timeline Guideline
Appendix I: Externship Summary (Blank Sample)
2
GENERAL REQUIREMENTS AND PHILOSOPHY
It is the philosophy of PACS that AuD students should begin supervised hands-on clinical training immediately upon
matriculation, in the first year. Students may begin actual patient contact, or practicum, after 25 hours of supervised
clinical observation in audiology and/or speech-language pathology have been completed. Students who have not
previously completed these observation hours will have the opportunity to complete this requirement through PACS.
Students who have previously completed these observation hours are asked to submit official documentation of such to
PACS and may receive credit for up to 25 clinical observation hours completed in audiology and/or speech-language
pathology prior to matriculation. Similarly, AuD students may receive credit for up to 100 clinical practicum hours
completed in audiology and/or speech-language pathology prior to matriculation; official documentation of completion of
these hours must be submitted to PACS for review and approval before being credited to the student’s hours.
The AuD program involves a heavier course load and lighter observation and practicum load in the first year and gradually
progresses toward a lighter course load and heavier practicum load in subsequent years, culminating in a full-time
externship experience in the fourth year. The curriculum evolves from year-to-year, but every effort is made to ensure that
students have had, or concurrently have, the coursework applicable to the practicum experiences.
COURSE REQUIREMENTS
Students earn academic credit for observation, practicum, externship, and staffings through the following courses:
Year: Semester Course Number Course Name Credit Hours
Year One: Fall PACS 460 Staffing 1
Year One: Fall PACS 4611 Observation and Practicum in Audiology 1
Year One: Spring PACS 460 Staffing 1
Year One: Spring PACS 4612 Observation and Practicum in Audiology 1
Year One: Summer PACS 4613 Practicum in Audiology 4
Year Two: Fall PACS 460 Staffing 1
Year Two: Fall PACS 4621 Practicum in Audiology 2
Year Two: Spring PACS 460 Staffing 1
Year Two: Spring PACS 4622 Practicum in Audiology 2
Year Two: Summer PACS 4623 Practicum in Audiology 4
Year Three: Fall PACS 460 Staffing 1
Year Three: Fall PACS 4631 Practicum in Audiology 2
Year Three: Spring PACS 460 Staffing 1
Year Three: Spring PACS 4632 Practicum in Audiology 2
Year Three: Summer PACS 4633 Practicum in Audiology 6
Year Four: Fall PACS 4641 / Clinical Externship 9
3
4651
Year Four: Spring PACS
4642/4652
Clinical Externship 9
TOTAL 48
CLINICAL EXPERIENCE REQUIREMENTS Students must complete all required practicum courses and placements, as outlined above, prior to beginning the fourth-
year externship. In addition, all students will complete some observation experience prior to beginning practicum, as well
as some clinical experiences in an SLP and/or deaf education setting. A minimum of 12 months of full-time equivalent
clinical experience is required for ASHA certification in audiology, though the focus of PACS is on measurable outcomes, as
related to clinical competencies across the scope of practice, rather than clock hour minima. Students must continue in
full-time practicum rotations through the spring semester of the third year, and full-time in the externship year, even if
competencies have been met or exceeded. In addition, students are expected to be proactive in making certain they are on
target for accrual of clinical experiences across the scope of practice.
A clinical competency checkpoint is required for AuD students in their first year. In years 2-4, students will gain experience
across the scope of practice via practicum placements and the externship year, with competencies evaluated at end-of-
semester checkpoints via a combination of performance evaluated completed by the supervisor in CALIPSO and evaluations
of performance during clinical experiential labs. If a student is not meeting minimum competency standards, the student
will be referred to the CAPES for consideration of a remediation plan or other outcome, as appropriate. In some cases,
clinical practice exercises or extended clinical practicum experiences may be required, which may extend the student’s
length of study.
If admitted to a formal summer research training program, this experience may be substituted for one summer practicum
rotation (typically completed in the summer following the first or second year).
These experiences meet and exceed the requirements of ASHA for certification in audiology. Exceptions to these
requirements may only be granted by the Committee on Academic and Professional Evaluation of Students (CAPES).
PRACTICUM COORDINATION, MEETINGS, AND STAFFINGS
The Director of Audiology Studies serves as the Practicum Coordinator and works in close collaboration with the WUSM
Clinical Audiologist at WU/CID. This arrangement helps to ensure consistency and carry-over across academic and practical
experiences, and provides an opportunity to observe students’ abilities to apply the knowledge base under actual
conditions of professional practicum.
4
A member of the practicum team will conduct an annual informational meeting during orientation to outline practicum
expectations and procedures. One or more members of the team will also teach the weekly audiology staffing course
during the fall and spring semesters. Attendance at these staffings is required for all AuD students in the first, second, and
third years.
The Externship is coordinated by the Director of Audiology Studies. Please see the Fourth-Year Externship section for
information.
PRACTICUM SITES
There are approximately 50 affiliated sites within the St. Louis metropolitan area and over 100 additional sites around the
country. Students who are interested in exploring the opportunity for placement at an out-of-town site for the summer
rotation should do so in close consultation with the Practicum Coordinator. (At this time, international placements cannot
be pursued.) A suggested timeline for arranging such an out-of-town practicum rotation is included here as Appendix A. A
Clinical Site Form must be submitted when requesting a new site; a copy of this form can be found here as Appendix B.
Students should note that the Affiliation Agreement and any other necessary paperwork must be complete and fully
approved for new sites no later than April 1st to facilitate summer placements. The student should keep this in mind when
making summer living plans. Once initial agreements are in place, a formal Affiliation Agreement must be developed
between PACS and the site. All practicum sites must have an Affiliation Agreement in place before a student can be placed
at that site and begin observation, practicum, and/or the externship.
Copies of affiliation agreements for their current placement site(s) are available to students upon request. In addition, for
the fourth-year externship, once the Externship Summary has been finalized, students will receive a copy and are strongly
encouraged to familiarize themselves with the terms of the document. Please see the “Fourth-Year Externship” section for
complete information on Affiliation Agreement and Externship Summary requirements during the externship.
PRACTICUM PLACEMENTS
To the extent possible, observation, practicum, and externship placements are made to accommodate individual student
interests, abilities, availability, and needs. This includes, but is not limited to, ensuring each student engages in a variety,
depth, and breadth of experience; to meet the needs and interests of sites; and student requests. However, PACS reserves
the right to determine all final observation, practicum, and externship placements for all students, without exception.
Placements are not elective and students are expected to complete all placements, as made, or in the case of the
externship, as agreed upon (verbally and/or in writing) by the student.
If a change is requested, a written request must be submitted to the Practicum Coordinator (1st through 3rd-year AuD
students) or Externship Coordinator (4th-year AuD students) as soon as possible after the placement is known, and prior to
the first day of the rotation. Students should not communicate and/or negotiate with the site directly on these matters.
5
Only under extreme circumstances will an alternate placement be considered, and assuming an alternate option is
available. Failure to follow these policies and procedures may result in a lowered or failing grade, rejection of the request,
and/or referral to the CAPES.
In the event a student encounters difficulty during a rotation, students should report these issues to the Practicum
Coordinator and/or Externship Coordinator immediately so that problem-solving steps can be taken.
PRACTICUM SCHEDULES
Practicum schedules follow the published program academic calendar, including scheduled holidays. Observation and
practicum start and end dates for each semester will be published on the PACS Academic Calendar. Once a practicum
assignment has been made, it is the student’s responsibility to contact the site supervisor to make arrangement for the
practicum schedule and other details. All students are encouraged to work cooperatively with practicum placement sites
regarding specific schedules, including days, times, and locations. Occasionally, students may be asked to complete
practicum hours on scheduled academic holidays (including spring break, fall break and similar days of clinical operation),
weekends, evenings, or at alternate locations. In addition, students may be expected to make up days missed.
While summer rotation schedules will vary from site to site, students are expected to complete a minimum of six weeks of
full-time effort (240 hours), or the equivalent, during each summer rotation. The more practicum experience, the better;
therefore, exceeding the minima will serve to enhance learning.
PRACTICUM ATTENDANCE
Please refer to the attendance policies outlined in the PACS Student Handbook for complete information. Students are
expected to attend practicum experiences, as assigned. Any absence or other professionalism concern may negatively
impact grading and/or result in disciplinary action by the CAPES.
PRACTICUM EVALUATIONS AND GRADING
The practicum team will work together to ensure that all students are achieving the requisite clinical competencies. These
competencies will be evaluated through formative and summative feedback and in-person competency exams. The
evaluative input from the practicum supervisor is one important factor considered in determining the final semester grade
(see Appendices C and D). Additional factors that may be taken into consideration include overall progress/improvement,
communication between coordinator and practicum supervisor, and participation in other required activities related to
observation, practicum or externship.
6
A member of the practicum team will meet individually with each student (1st, 2nd and 3rd-year) near the end of the
semester to review the student’s evaluation(s) and discuss his/her performance. When possible, students will be notified
of the final semester grade at this time.
Grades during the fall and spring semesters of the first year are on a Pass/Fail basis. Letter grades are assigned in the
summer semester of the first year and in subsequent years. Practicum grades may not be reported until hours and
evaluations have been submitted. Copies of practicum evaluations are kept on file in the PACS Office as well as in CALIPSO;
students may review their evaluation within CALIPSO once it is finalized by the practicum supervisor.
PRACTICUM PROGRESSION
Decisions about a student’s progression from one course/placement to a subsequent course/placement during the first
three years are made by the Practicum Coordinator. He/she will consult, as necessary, on such decisions with the Director
of Audiology Studies and/or the Committee on Academic and Professional Evaluation of Students (CAPES). A student may
not be permitted to progress unless satisfactory performance and progress has been demonstrated.
DOCUMENTATION OF HOURS
Students are responsible for documenting clinical practicum hours in our web-based clinical practicum tracking platform
called CALIPSO, as appropriate. Each student will be given a private and unique CALIPSO account at orientation as well as
all instructions for using the web-based application. All of our approved clinical preceptors have a unique CALIPSO account
so that they can approve submitted hours and submit student evaluation forms. An example of the CALIPSO Clock Hour
Form can be found as Appendix E. Any miscellaneous hours (i.e., SLP hours, screening hours) should be recorded via
CALIPSO. For transfer hours, appropriate documentation must be submitted to the PACS Office before the student’s record
will be credited.
The PACS Office will maintain an official record of each student’s practicum sites, supervisors, and accrued hours in
CALIPSO. Students will have access to an updated copy of this record following each completed rotation via their CALIPSO
account. Other forms and documents related to practicum can also be found on the CALIPSO website.
Clinical practicum is defined by ASHA as “hours spent in direct patient/client contact, consultation, recordkeeping, and
administrative duties relevant to audiology service delivery.” Hours recorded in CALIPSO must follow the guidelines above,
as well as ASHA requirements for supervision.
Please note that current AuD students may not use the practicum hours completed and/or supervision received, in whole
or in part, during a practicum rotation completed in PACS toward Hearing Instrument Specialist (HIS) licensure.
Furthermore, PACS does not support either the obtaining of licensure prior to the student’s graduation or the earning of a
7
master’s degree for the sole purpose of licensure and/or billing. See “Certification and Licensure” in the PACS Student
Handbook for more information. On rare occasion, a student may require provisional licensure for fourth year students.
When this occurs, the student must be fully supervised and paperwork / costs absorbed by the site/students. Advance
approval by PACS is required.
REQUIREMENTS FOR SUPERVISION OF PRACTICUM
Requirements of ASHA for supervision of practicum and qualifying practicum hours are strictly followed. Complete
information is available from the ASHA website at www.asha.org. Students are trainees, not employees of the site, and
may not replace any site staff.
EMPLOYMENT AND PAYMENT
Students may not accept any employment or position in which they are expected to fulfill the role and/or duties typically
reserved for fully certified and/or licensed professional without receiving authorization from PACS in advance. This
includes, but is not limited to, maternity leave coverage or other substitute coverage for a fully certified and/or licensed
professional. Furthermore, any AuD student offered a paid position in any facility providing audiology services must first
obtain the authorization of PACS before accepting the position. The student and/or facility may be asked to provide specific
details on the position, such as the types of activities in which the student will be engaged, payment rate, and supervision.
No student is exempt from this requirement; for students in the fourth year, a completed and signed Externship Summary
generally serves as the document authorizing such payment. Students completing the fourth-year externship who are
receiving payment of any kind must report complete and accurate information to the Office of Student Financial Planning
and such payments may reduce or eliminate eligibility for financial assistance.
STUDENT TITLES
During practicum experiences, and in this handbook, the student completing observation and/or practicum will be referred
to as the “student clinician”. Students may not use the term “candidate,” as this title may only be used by doctoral
students under special circumstances and after all requirements for the degree have been completed.
PROFESSIONALISM
From the first day of training, students are considered members of our professional community. As such, they are expected
to exhibit professional behavior at all times. Students must demonstrate the highest standards of professionalism, ethics,
judgment, and responsibility. Students are expected to follow the guidelines in the PACS Student Handbook, which includes
more detailed information on issues such as attendance, cell phone use, code of ethics, confidentiality, feedback,
complaints, and dress. Student professionalism will also be evaluated on a regular basis by the Committee on Academic
and Professional Evaluation of Students (CAPES), as described in detail in the PACS Student Handbook.
8
COURSE, PRACTICUM, AND EXTERNSHIP EVALUATIONS
Students are expected to participate in regular evaluation of observation, practicum, and externship experiences. These
processes provide PACS faculty and staff with the opportunity to identify areas of strength, identify areas needing
improvement, and to implement changes that will improve the processes and experiences for everyone. These evaluations
are completed at the end of every semester; the primary evaluation mechanism is an on-line course evaluation, which
provides general feedback on the observation, practicum, and/or externship experience and the weekly staffing course.
Students will have an opportunity to evaluate the site via the Supervisor Feedback form found within CALIPSO.
OBSERVATION AND PRACTICUM: FIRST-YEAR STUDENTS
First-year AuD students are assigned during the fall and spring semesters to the Spencer T. Olin Clinic, a satellite clinic of the
Washington University School of Medicine (WUSM), Department of Otolaryngology, Division of Adult Audiology. The Olin
Clinic is located in the Central Institute for the Deaf (CID) building near the PACS administrative offices, classrooms, and
student lounge. During these placements, students complete approximately one-half day per week of clinical practicum
under the supervision of a fully certified and licensed audiologist. Placements are scheduled around students’ class
schedules, and students are often grouped in pairs for these experiences. When patients are not being seen, students are
expected to practice techniques on each other and attain additional experience with the equipment, either through the
Olin Clinic or the PACS Lab. Examples of suggested student activities from two current practicum sites have been included
as Appendices F and G. To further enrich first-year students’ experiences, students may also be assigned additional
observation experiences within the WUSM complex or St. Louis community during the fall or spring semester. When the
program is in place, each student will be assigned to an observation experience at one of our affiliated sites here on campus
or within the metropolitan St. Louis area.
By the end of the spring semester of the first year, the goal of these experiences is to have prepared students to begin their
first external rotation, which is typically scheduled for the summer following the first year. Summer academic courses are
generally scheduled as intensive experiences ranging from one to three weeks that immediately follow the spring semester.
This allows students to focus their efforts for the remainder of the summer on the summer practicum rotation, which may
take place locally or out of town.
PRACTICUM: SECOND-YEAR AND THIRD-YEAR STUDENTS
Following the first-year summer rotation, there are five additional semester-long or summer rotations during the second
and third years. Students are expected to complete a minimum of 2 days of practicum per week during each rotation, with
emphasis upon gaining as much valuable experience as possible. These take place as follows:
1. Year Two: Fall Semester
2. Year Two: Spring Semester
3. Year Two: Summer Semester
9
4. Year Three: Fall Semester
5. Year Three: Spring Semester
These experiences are varied, so students will gain extensive experience across the lifespan and across the scope of
practice. This provides students with an excellent foundation that is further fortified during the fourth-year externship
experience.
Students are expected to be self-motivated and use “down” time to assist the site and/or improve upon their own
knowledge and skills. Examples of suggested student activities from two current practicum sites have been included as
Appendices F and G.
FOURTH-YEAR EXTERNSHIP
Locating and Securing the Externship Site:
The student should begin to explore possible fourth-year externship sites as he/she approaches the third year of study, at
the latest. Close mentoring is provided by the Director of Audiology Studies, Practicum Coordinator, Externship
Coordinator, and/or other members of the faculty and staff who have nation-wide contacts.
During the course PACS 470: Practice Management, students will learn enhanced skills for professional cover letter and
résumé writing. Assistance is available from PACS faculty, and students may also utilize University resources, such as the
Career Center.
Students will also gain exposure to researching various sites via regular meetings with the Director of Audiology Studies and
support from other PACS faculty members. Potential sites may be located via a variety of avenues, including networking
with area audiologists; experience with previous practicum sites; discussing possible sites and resources with faculty
members; information-gathering at professional meetings; and on-line research. There are also a number of
“clearinghouse” avenues developing professionally, such as through the Externship Registry of the American Academy of
Audiology (AAA) at www.audiology.org/education/academia/externship/ and through Audiology Online’s Career Center at
www.audiologyonline.com/careers/.
If a student is interested in an externship opportunity, the recommended procedure is for the Director of Audiology Studies
to make the initial contact, either by e-mail, phone call or letter. The student may then send a cover letter of inquiry and
résumé, followed by a personal phone call. The Director of Audiology Studies, student, and potential site will remain in
close contact throughout the process. The timeline recommended for this process by the American Academy of Audiology
(AAA) is included here at Appendix H, and this timeline will be followed as closely as possible. Students should know that
variability does exist during the interview and offer phase of the externship search.
10
During the seeking and interviewing processes, each potential site should know that the student is exploring a number of
opportunities for his/her fourth-year externship. The Director of Audiology Studies is closely involved in negotiations and
plan-making with the site. The final placement requires approval of the Director of Audiology Studies. Emphasis will be
upon quality, depth, and breadth of the experience.
Paperwork
To finalize the fourth-year externship placement, certain paperwork must be completed between PACS and the site. This
includes the Affiliation Agreement and the Externship Summary. Additional paperwork may also be required by the site.
Students may share a copy of the sample Externship Summary prior to accepting an offer, included here as Appendix I, but
should do so for informational purposes only and to ensure that the sites understand that the sharing of these documents
should not be interpreted as a definitive commitment.
Once the student has secured the offer and required approvals from PACS, the PACS Office will negotiate with the site to
complete the required paperwork. The student will be asked to provide the details to be included in the Externship
Summary to the PACS Office during this process. Completion and approval of this paperwork generally takes several weeks
to several months, but can often take longer. However, students should be aware that there may be instances where the
site and the University cannot come to mutually-agreeable terms. In such cases, negotiations will be terminated and an
alternate externship must be located by the student. Students may not begin the fourth-year externship until all required
paperwork has been completed, signed, and returned to the PACS Office. The student should keep this in mind when
making relocation plans. Once the Affiliation Agreement and Externship Summary have been finalized, students will receive
a copy of the Externship Summary and are strongly encouraged to familiarize themselves with the terms of the document.
Copies of documents are also available to students upon written request.
In addition, once the paperwork has been finalized, it is important to exert the utmost in professionalism in letting other
sites know of your decision in a timely manner.
In addition, the policies and procedures outlined in the “Practicum Placements” section of this Handbook must also be
followed. Students should pay special attention to the information in this section on verbal and written agreements,
requests for changes, and communication with sites. The student should keep in mind that verbal and written
agreements are commitments that should be honored.
Student Feedback and Evaluation:
• The student should maintain regular communication with the Director of Audiology Studies regarding the student’s
perception of how the externship is progressing. This communication should be at least monthly, and may be by
phone and/or e-mail. For this purpose, and for general updates and inquiries from PACS, students should check
their student e-mail accounts regularly.
11
• The Director of Audiology Studies will be in (at least) quarterly contact by phone and/or e-mail with the preceptor
regarding his/her perception of how the student is progressing within the externship experience.
• An evaluation form will be sent to the preceptor at the beginning of each fall and spring semester for a formal
evaluation of the student’s performance. This should be completed by the preceptor, reviewed with the student,
and submitted to the PACS Office at the end of the semester via CALIPSO. Students will have an opportunity to
evaluate the site via the Supervisor Feedback form found within CALIPSO.
• Semester grading will follow the same process as during the first through third years, as detailed in the “Practicum
Grading” section above.
• Documentation of practicum hours should follow the same process as during the first through third years, as
detailed in the “Documentation of Hours” section above. As a reminder, semester grades may not be submitted,
including final grades and paperwork required for graduation, certification, and/or licensure, until hours and
practicum evaluations are submitted. Due dates will be communicated by PACS.
• Local sites will be visited by a member of the PACS faculty at least once during the externship experience. Efforts
will be made to also visit sites in other cities, as schedules and budgets allow.
CONTACTS
Questions should be addressed to the following key contacts within PACS:
Amanda Ortmann, PhD, CCC-A Director of Audiology Studies (Interim) [email protected] Voice: (314) 273-1221 Fax: (314) 747-0105 L. Maureen Valente, PhD, CCC-A Externship Coordinator [email protected] Steven Smith, AuD CID Clinical Audiologist [email protected] Voice: (314) 747-7190
Beth Elliott, MAT, Director, Finance and Student/Academic Affairs [email protected] Voice: (314) 747-0102 Beth A. Fisher Administrative Professional [email protected] Voice: (314) 747-0108 Rene’ P. Miller, Academic Records Assistant and Coordinator [email protected] Voice: (314) 747-0103
APPENDIX VI-A: AUDIOLOGY CLINICAL POPULATION
Name and type of facility (e.g., hospital, school, industry, government agency, private practice, college/university, research/
science/lab, etc.) and site contact information:
Location/distance from campus:
Indicate which modality this site is used for - residential (Re),distance education (DE) and/or satellite (S):
Academic and clinical prerequisites for student placement at thisfacility:
Estimated number of students per supervisor:
Number of terms your program has used this facility in past twoyears:
Type of activities students typically engage in:
Culturally and linguistically diverse populations served:
CATEGORY TOTAL NUMBER OF CLOCK HOURS PER LAST 2 YEARSTotal Children* Adults*
Auditory DisordersPrevention & IdentificationEvaluationTreatment
Vestibular DisordersPrevention & IdentificationEvaluationTreatment
Related Communication DisordersPrevention & IdentificationEvaluationTreatment
* Age range for adults: , children:
Appendix B
CA
LIP
SO
Prac
ticum
Eva
luat
ion
You
ng C
hild
(0-
5)
Chi
ld (
6-17
)
Adu
lt (1
8-64
)
Old
er a
dult
(65+
)Pe
rfor
man
ce R
atin
g Sc
ale
1 -
Una
ccep
tabl
e6
- Pr
esen
t
2 -
Dev
elop
ing
Und
erst
andi
ng7
- Pr
esen
t Con
sist
enty
3 -
Ear
ly E
mer
ging
8 -
Dev
elop
ing
Mas
tery
4 -
Em
ergi
ng9
- G
aini
ng I
ndep
ende
nce
5 -
Em
ergi
ng C
onsi
sten
tly10
- I
ndep
ende
nt/O
utst
andi
ng
Clie
nt(s
)/Pa
tient
(s)
Mul
ticul
tura
l Asp
ects
(ch
eck
all t
hat a
pply
)C
lient
(s)/
Patie
nt(s
) L
ingu
istic
Div
ersi
ty (
chec
k al
l tha
t app
ly)
Eth
nici
tyE
nglis
h
Rac
eE
nglis
h L
angu
age
Lea
rner
Cul
ture
Prim
ary
Eng
lish
dial
ect
Nat
iona
l ori
gin
Seco
ndar
y E
nglis
h di
alec
t
Soci
oeco
nom
ic s
tatu
sB
iling
ual
Gen
der
iden
tity
Poly
glot
Sexu
al o
rien
tatio
nG
ende
r id
entit
y
Rel
igio
nSi
gn L
angu
age
(ASL
or
SEE
)
Exc
eptio
nalit
yC
ogni
tive
/ Phy
sica
l Abi
lity
Oth
erO
ther
Foun
datio
ns o
f Pr
actic
eSc
ore
1. U
tiliz
es u
nive
rsal
pre
caut
ions
and
infe
ctio
us/c
onta
giou
s di
seas
e co
ntro
l pra
ctic
es (
std
IV-A
21, s
td 3
.1.1
A)
2. D
eter
min
es w
heth
er in
stru
men
tatio
n is
in c
alib
ratio
n ac
cord
ing
to a
ccep
ted
stan
dard
s (s
td I
V-A
25, s
td 3
.1.2
A)
3. D
emon
stra
tes
know
ledg
e of
equ
ipm
ent o
pera
tion.
Use
s in
stru
men
tatio
n ac
cord
ing
to m
anuf
actu
rer's
spe
cifi
catio
ns/r
ecom
men
datio
ns (
std
IV-A
24, s
td 3
.1.2
A)
4. A
pplie
s pr
inci
ples
and
app
licat
ions
of
coun
selin
g to
pat
ient
s, f
amili
es, a
nd o
ther
app
ropr
iate
indi
vidu
als.
Use
s co
unse
ling
that
eff
ectiv
ely
com
mun
icat
es r
esul
ts/r
ecom
men
datio
ns a
nd a
ddre
sses
con
cern
s in
an e
ffec
tive
and
cultu
rally
sen
stiv
e m
anne
r. (
std
IV-A
26, I
V-D
2c, s
td 3
.1.4
A)
5. U
nder
stan
ds a
nd f
unct
ions
with
in th
e po
licie
s, p
roce
dure
s, p
roto
cols
and
bus
ines
s pr
actic
es o
f th
e cl
inic
al f
acili
ty in
clud
ing
prom
pt c
ompl
etio
n of
all
billi
ng, i
nclu
ding
ass
igni
ng c
orre
ct C
PT a
nd I
CD
cod
es,
trac
king
for
ms,
dat
a en
try
and
othe
r do
cum
enta
tion
as r
equi
red
(std
IV
-A28
, std
3.1
.4A
)
6. C
onsu
lts/c
olla
bora
tes
as a
ppro
pria
te w
ith in
terp
rofe
ssio
nal t
eam
s in
ass
essm
ent a
nd in
coo
rdin
atio
n of
car
e w
hile
mai
ntai
ning
a c
limat
e of
mut
ual r
espe
ct a
nd s
hare
d va
lues
. Mai
ntai
ns o
r es
tabl
ishe
s lin
ksw
ith e
xter
nal p
rogr
ams
(st
d IV
-A29
, IV
-F6,
std
3.1
.1A
, 3.1
.4A
, 3.1
.6A
)
Num
ber
of it
ems
scor
ed:
0N
umbe
r of
item
s re
mai
ning
:6
Sect
ion
Ave
rage
:0.
00
Prev
entio
n an
d Id
entif
icat
ion
Scor
e
1. I
mpl
emen
ts p
roto
cols
, act
iviti
es, a
nd s
cree
ning
mea
sure
s th
at a
re c
linic
ally
app
ropr
iate
, cul
tura
lly s
ensi
tive,
age
- an
d si
te-
spec
ific
to p
reve
nt a
nd id
entif
y he
arin
g an
d co
mm
unic
atio
n dy
sfun
ctio
n FO
RC
HIL
DR
EN
(i.e
., ne
wbo
rn h
eari
ng s
cree
ning
/fol
low
-up
and
scho
ol s
cree
ning
s). (
std
IV-B
1, I
V-B
2, I
V-B
3, s
td 3
.1.3
A)
Page
1/4
Appendix C
Prev
entio
n an
d Id
entif
icat
ion
Scor
e
2. I
mpl
emen
ts p
roto
cols
, act
iviti
es a
nd s
cree
ning
mea
sure
s th
at a
re c
linic
ally
app
ropr
iate
, cul
tura
lly s
ensi
tive,
age
- an
d si
te-
spec
ific
to p
reve
nt a
nd id
entif
y he
arin
g an
d co
mm
unic
atio
n dy
sfun
ctio
n FO
RA
DU
LTS.
Adm
inis
ters
pro
gram
s de
sign
ed to
red
uce
the
effe
cts
of n
oise
exp
osur
e, ti
nnitu
s, a
nd to
xic
agen
ts to
the
audi
tory
and
ves
tibul
ar s
yste
ms
(i.e
., co
mm
unity
& o
ccup
atio
nal c
onse
rvat
ion
prog
ram
s). (
std
IV-B
1, I
V-B
2, I
V-B
3, s
td 3
.1.3
A)
3. S
cree
ns in
divi
dual
s fo
r sp
eech
and
lang
uage
impa
irm
ents
and
oth
er f
acto
rs a
ffec
ting
com
mun
icat
ion
func
tion
usin
g cl
inic
ally
app
ropr
iate
, cul
tura
lly s
ensi
tive,
and
age
- an
d si
te-s
peci
fic
scre
enin
g m
easu
res
(std
IV
-B4,
std
3.1
.3A
)
4. E
duca
tes
indi
vidu
als
on p
oten
tial c
ause
s an
d ef
fect
s of
hea
ring
loss
, los
s of
ves
tibul
ar s
yste
m f
unct
ion,
dev
elop
men
t of
tinni
tus,
and
dev
elop
men
t of
com
mun
icat
ion
diso
rder
s. (
std
IV-B
5, s
td 3
.1.3
A)
5. I
dent
ifie
s in
divi
dual
s at
ris
k fo
r ba
lanc
e pr
oble
ms
and
falls
who
req
uire
fur
ther
ves
tibul
ar a
sses
smen
t and
/or
trea
tmen
t or
refe
rral
for
oth
er p
rofe
ssio
nal s
ervi
ces
(std
IV
-B1,
IV
-B6,
std
3.1
.4A
)
Num
ber
of it
ems
scor
ed:
0N
umbe
r of
item
s re
mai
ning
:5
Sect
ion
Ave
rage
:0.
00
Ass
essm
ent
Scor
e
1. O
btai
ns a
cas
e hi
stor
y fr
om a
ppro
pria
te s
ourc
es to
fac
ilita
te a
sses
smen
t pla
nnin
g. D
eter
min
es c
onte
xtua
l fac
tors
by
aski
ng a
ppro
pria
te a
nd in
vest
igat
ive
ques
tions
in a
cle
ar a
nd o
rgan
ized
man
ner.
Adm
inis
ters
clin
ical
ly a
ppro
pria
te a
nd c
ultu
rally
sen
sitiv
e sc
ales
of
com
mun
icat
ion
func
tion
to c
omm
unic
atio
n pa
rtne
rs o
f th
e in
divi
dual
bei
ng s
erve
d. (
std
IV-C
2, I
V-C
3, s
td 3
.1.4
A, 3
.1.5
A)
2. P
erfo
rms
audi
olog
ic a
sses
smen
t usi
ng c
linic
ally
app
ropr
iate
and
cul
tura
lly s
ensi
tive
beha
vior
al, p
sych
ophy
sica
l, an
d se
lf-a
sses
smen
t mea
sure
s FO
R C
HIL
DR
EN
(st
d IV
-C2,
std
3.1
.3A
, 3.1
.4A
, 3.1
.5A
)
3. P
erfo
rms
audi
olog
ic a
sses
smen
t usi
ng c
linic
ally
app
ropr
iate
and
cul
tura
lly s
ensi
tive
beha
vior
al, p
sych
ophy
sica
l, an
d se
lf-a
sses
smen
t mea
sure
s FO
R A
DU
LTS
(std
IV
-C2,
std
3.1
.3A
, 3.1
.4A
, 3.1
.5A
)
4. P
erfo
rms
an o
tosc
opic
exa
min
atio
n. D
emon
stra
tes
prof
icie
ncy
in r
ecog
nizi
ng n
orm
al la
ndm
arks
, oto
scop
ic a
bnor
mal
ities
, and
the
need
for
med
ical
ref
erra
l. (s
td I
V-C
4, s
td 3
.1.4
A)
5. R
emov
es c
erum
en, w
hen
appr
opri
ate
(std
3.1
.4A
)
6. D
emon
stra
tes
abili
ty to
acc
urat
ely
dete
rmin
e A
ir C
ondu
ctio
n &
Bon
e C
ondu
ctio
n th
resh
olds
usi
ng a
ppro
pria
te te
chni
ques
(st
d IV
-C2,
IV
-C5)
7. D
emon
stra
tes
prof
icie
ncy
in d
eter
min
ing
the
need
to m
ask
whe
n pe
rfor
min
g pu
re to
ne a
ir/b
one
cond
uctio
n te
stin
g. D
emon
stra
tes
prof
icie
ncy
in p
erfo
rmin
g m
aski
ng p
roce
dure
s us
ing
acce
pted
pra
ctic
ete
chni
ques
(st
d IV
-C5)
8. D
emon
stra
tes
abili
ty to
adm
inis
ter
and
accu
rate
ly in
terp
ret s
peec
h te
sts
incl
udin
g th
resh
old
and
supr
athr
esho
ld te
sts
in q
uiet
and
in n
oise
(st
d IV
-C5)
9. D
emon
stra
tes
prof
icie
ncy
in d
eter
min
ing
the
need
to m
ask
whe
n pe
rfor
min
g th
resh
old
and
supr
athr
esho
ld s
peec
h au
diom
etry
. Dem
onst
rate
s pr
ofic
ienc
y in
per
form
ing
spee
ch m
aski
ng p
roce
dure
s us
ing
acce
pted
pra
ctic
e te
chni
ques
. (st
d IV
-C5)
10. D
emon
stra
tes
abili
ty to
eff
icie
ntly
and
acc
urat
ely
com
plet
e th
e ba
sic
audi
olog
ical
test
bat
tery
in a
tim
ely
man
ner
(std
IV
-C2,
IV
-C5)
11. P
erfo
rms
acou
stic
imm
ittan
ce te
sts
effi
cien
tly a
nd a
ppro
pria
tely
for
dif
fere
ntia
l dia
gnos
is o
f si
te o
f le
sion
. Acc
urat
ely
iden
tifie
s an
d in
terp
rets
tym
pano
gram
type
s an
d ac
oust
ic r
efle
x co
nfig
urat
ions
(st
dIV
-C2,
IV
-C7)
12. D
emon
stra
tes
the
abili
ty to
per
form
and
inte
rpre
t Oto
acou
stic
Em
issi
ons
(std
IV
-C2,
IV
-C5,
IV
-C7)
13. P
erfo
rms
audi
tory
evo
ked
pote
ntia
ls f
or n
euro
diag
nost
ic a
pplic
atio
ns a
nd e
stim
atio
n of
per
iphe
ral h
eari
ng s
ensi
tivity
. Dem
onst
rate
s pr
ofic
ienc
y in
wav
efor
m a
naly
sis
and
inte
rpre
tatio
n (s
td I
V-C
1, I
V-C
2,IV
-C5,
std
3.1
.4A
)
14. D
emon
stra
tes
the
abili
ty to
per
form
a v
estib
ular
ass
essm
ent a
nd d
eter
min
e th
e ne
ed f
or v
estib
ular
reh
abili
tatio
n. I
nter
pret
s te
sts
of b
alan
ce f
unct
ion
(std
IV
-C2,
IV
-C6,
std
3.1
.4A
)
15. D
emon
stra
tes
abili
ty to
per
form
ped
iatr
ic b
ehav
iora
l aud
iolo
gica
l ass
essm
ent.
Sele
cts
appr
opri
ate
test
s an
d te
stin
g te
chni
que
(VR
A, C
PA, o
r ot
her)
(st
d IV
-C2,
IV
-C5)
16. D
emon
stra
tes
abili
ty to
per
form
and
sel
ect b
ehav
iora
l and
ele
ctro
phys
iolo
gica
l tes
ts o
f au
dito
ry p
roce
ssin
g. D
emon
stra
tes
appr
opri
ate
anal
ysis
of
test
bat
tery
res
ults
for
dif
fere
ntia
l dia
gnos
is a
ndm
anag
emen
t str
ateg
ies
(std
IV
-C2,
IV
-C8)
17. D
emon
stra
tes
abili
ty to
per
form
aud
iolo
gica
l reh
abili
tatio
n as
sess
men
t (us
e of
sel
f-as
sess
men
t mea
sure
s, s
peec
h re
adin
g as
sess
men
t, ai
ded
test
ing)
to e
stab
lish
func
tiona
l use
of
hear
ing
(st
d IV
-C9,
IV
-C
2, s
td 3
.1.4
A)
18. P
repa
res
a re
port
, whi
ch in
clud
es e
valu
atio
n pr
oced
ures
, int
erpr
etat
ion
of d
ata
to e
stab
lish
type
and
sev
erity
of
diso
rder
, sum
mar
izat
ion
of f
indi
ngs,
gen
erat
ion
of r
ecom
men
datio
ns a
nd r
efer
rals
, and
deve
lopm
ent o
f an
aud
iolo
gic
trea
tmen
t/man
agem
ent p
lan
(std
IV
-C10
, std
3.1
.4A
)
19. C
omm
unic
ates
res
ults
and
rec
omm
enda
tions
ora
lly a
nd in
wri
ting
in a
cul
tura
lly s
enst
ive
and
age
appr
opri
ate
man
ner
to th
e in
divi
dual
bei
ng s
erve
d an
d ot
her
appr
opri
ate
indi
vidu
al(s
) (s
td 3
.1.4
A, 3
.1.6
A)
Num
ber
of it
ems
scor
ed:
0N
umbe
r of
item
s re
mai
ning
:19
Sect
ion
Ave
rage
:0.
00
Inte
rven
tion
(CFC
C I
V-D
)Sc
ore
1. E
valu
ates
nee
d fo
r an
d se
lect
ion
of h
eari
ng a
ids,
sen
sory
aid
s, h
eari
ng a
ssis
tive
devi
ces,
ale
rtin
g sy
stem
s an
d ca
ptio
ning
(st
d IV
-D1,
IV
-D2a
, std
3.1
.6A
)
2. U
ses
veri
fica
tion
and
valid
atio
n m
easu
res
to e
valu
ate
effe
ctiv
enes
s of
hea
ring
aid
s an
d ot
her
assi
stiv
e de
vice
s (s
td I
V-D
1, I
V-D
2a, s
td 3
.1.6
A)
Page
2/4
Inte
rven
tion
(CFC
C I
V-D
)Sc
ore
3. T
roub
lesh
oots
and
adj
usts
hea
ring
aid
s an
d ot
her
assi
stiv
e de
vice
s (s
td I
V-D
1, I
V-D
2a, s
td 3
.1.6
A)
4. D
eter
min
es c
andi
dacy
of
pers
ons
with
hea
ring
loss
for
coc
hlea
r im
plan
ts a
nd o
ther
impl
anta
ble
sens
ory
devi
ces
(std
IV
-D2b
, std
3.1
.6A
)
5. F
its, m
aps,
adj
usts
, and
trou
bles
hoot
s co
chle
ar im
plan
ts a
nd o
ther
impl
anta
ble
sens
ory
devi
ces
(std
IV
-D2b
, std
3.1
.6A
)
6. E
duca
tes/
orie
nts
cons
umer
s, f
amily
and
car
egiv
ers
in th
e us
e of
and
adj
ustm
ent t
o he
arin
g te
chno
logy
(st
d IV
-D1,
IV
-D2a
, std
3.1
.6A
)
7. C
ouns
els
patie
nts,
car
egiv
ers,
and
oth
ers
rega
rdin
g pr
ogno
sis
and
trea
tmen
t opt
ions
, psy
chos
ocia
l asp
ects
of
hear
ing
loss
& o
ther
aud
itory
dys
func
tion,
and
pro
cess
es to
enh
ance
com
mun
icat
ion
com
pete
nce
(std
IV
-D2c
, std
3.1
.4A
, 3.1
.6A
)
8. P
rovi
des
com
preh
ensi
ve a
udio
logi
c tr
eatm
ent f
or p
erso
ns w
ith h
eari
ng lo
ss o
r ot
her
audi
tory
dys
func
tion,
incl
udin
g bu
t not
exc
lusi
ve to
com
mun
icat
ion
stra
tegi
es, a
udito
ry tr
aini
ng, s
peec
h re
adin
g, a
ndvi
sual
com
mun
icat
ion
syst
ems
(std
IV
-D1,
IV
-D2d
)
9. D
eter
min
es c
andi
dacy
for
ves
tibul
ar a
nd b
alan
ce r
ehab
ilita
tion
ther
apy
to p
erso
ns w
ith v
estib
ular
and
bal
ance
impa
irm
ents
(st
d IV
-D3,
std
3.1
.6A
)
10. P
rovi
des
trea
tmen
t and
aud
iolo
gic
man
agem
ent o
f tin
nitu
s (s
td I
V-D
1, I
V-D
4, s
td 3
.1.6
A)
11. P
rovi
des
trea
tmen
t ser
vice
s fo
r in
fant
s an
d ch
ildre
n w
ith h
eari
ng lo
ss; c
olla
bora
tes/
cons
ults
with
ear
ly in
terv
entio
nist
s, s
choo
l bas
ed p
rofe
ssio
nals
, and
oth
er s
ervi
ce p
rovi
ders
reg
ardi
ng d
evel
opm
ent o
fin
terv
entio
n pl
ans
(i.e
., in
divi
dual
ized
edu
catio
n pr
ogra
ms
and/
or in
divi
dual
ized
fam
ily s
ervi
ce p
lans
) (s
td I
V-D
1, I
V-D
5)
12. P
artic
ipat
es in
the
sele
ctio
n, p
urch
ase,
inst
alla
tion,
and
eva
luat
ion
of la
rge-
area
am
plif
icat
ion
syst
ems
(std
IV
-D6)
13. D
evel
ops
cultu
rally
sen
sitiv
e an
d ag
e ap
prop
riat
e m
anag
emen
t str
ateg
ies
and
impl
emen
ts tr
eatm
ent p
lans
usi
ng a
ppro
pria
te d
ata
(std
3.1
.6A
)
14. M
onito
rs, s
umm
ariz
es a
nd d
ocum
ents
trea
tmen
t and
out
com
es (
std
IV-D
7, s
td 3
.1.6
A)
15. E
ncou
rage
s ac
tive
invo
lvem
ent o
f th
e in
divi
dual
in h
is o
r he
r ow
n ca
re (
std
3.1.
1A)
16. E
ffic
ient
ly a
nd e
ffec
tivel
y m
akes
ear
mol
d im
pres
sion
Num
ber
of it
ems
scor
ed:
0N
umbe
r of
item
s re
mai
ning
:16
Sect
ion
Ave
rage
:0.
00
Prof
essi
onal
Ski
llsSc
ore
1. I
nter
acts
eff
ectiv
ely,
usi
ng a
ll fo
rms
of e
xpre
ssiv
e co
mm
unic
atio
n, w
ith in
divi
dual
s se
rved
, fam
ily m
embe
rs, c
areg
iver
s, a
nd o
ther
s in
volv
ed in
the
inte
ract
ion
to e
nsur
e th
e hi
ghes
t qua
lity
of c
are
deliv
ered
in a
cul
tura
lly c
ompe
tent
man
ner.
Use
s in
terp
rete
rs, t
rans
liter
ator
s, a
nd a
ssis
tive
tech
nolo
gy a
s ne
eded
(st
d IV
-A22
, IV
-A27
, std
3.1
.1A
)
2. D
emon
stra
tes
activ
e/re
flec
tive
liste
ning
ski
lls, a
ppro
pria
te e
mpa
thy
and
care
/com
pass
ion,
and
the
abili
ty to
ada
pt in
tera
ctio
ns to
mee
t the
nee
ds o
f th
e in
divi
dual
, fam
ily m
embe
rs, c
areg
iver
s, a
nd o
ther
sin
volv
ed in
car
e (s
td I
V-A
26, s
td 3
.1.1
A)
3. D
emon
stra
tes
open
ness
and
res
pons
iven
ess
to c
linic
al s
uper
visi
on a
nd s
ugge
stio
ns. E
ngag
es in
sel
f-as
sess
men
t to
impr
ove
his
or h
er e
ffec
tiven
ess
in th
e de
liver
y of
ser
vice
s (s
td 3
.1.1
A)
4. D
ispl
ays
orga
niza
tion
and
prep
ared
ness
for
all
clin
ical
ses
sion
s
5. A
ssum
es a
pro
fess
iona
l lev
el o
f re
spon
sibi
lity
and
initi
ativ
e in
com
plet
ing
all r
equi
rem
ents
6. A
ppro
pria
tely
ref
ers
to a
nd c
olla
bora
tes
with
oth
er p
rofe
ssio
ns, a
genc
ies,
and
/or
cons
umer
org
aniz
atio
ns (
std
IV-C
11, s
td 3
.1.1
A)
7. U
ses
self
-ref
lect
ion
to u
nder
stan
d th
e ef
fect
s of
his
or
her
actio
ns a
nd m
ake
chan
ges
acco
rdin
gly
(std
3.1
.1A
)
8. M
aint
ains
rec
ords
in a
man
ner
cons
iste
nt w
ith le
gal a
nd p
rofe
ssio
nal s
tand
ards
(st
d 3.
1.4A
, 3.1
.6A
)
9. A
dher
es to
fed
eral
, sta
te, a
nd in
stitu
tiona
l reg
ulat
ions
and
dem
onst
rate
s kn
owle
dge
of le
gal a
nd e
thic
al p
ract
ices
, con
tem
pora
ry p
rofe
ssio
nal i
ssue
s an
d ad
voca
cy (
incl
udes
tren
ds in
bes
t pro
fess
iona
lpr
actic
es, p
riva
cy p
olic
ies,
mod
els
of d
eliv
ery,
and
rei
mbu
rsem
ent p
roce
dure
s/fi
duci
ary
resp
onsi
bilit
ies)
(st
d IV
-A19
, std
3.1
.1A
, 3.1
.6A
, 3.8
A)
10. A
dher
es to
the
ASH
A C
ode
of E
thic
s an
d Sc
ope
of P
ract
ice
docu
men
ts a
nd c
ondu
cts
him
or
hers
elf
in a
pro
fess
iona
l, et
hica
l man
ner
(std
3.1
.1A
)
11. U
nder
stan
ds th
e ef
fect
s of
cul
tura
l and
ling
uist
ic d
iver
sity
and
fam
ily s
yste
ms
in p
rofe
ssio
nal p
ract
ice
(Std
IV
-A16
, std
3.1
.1A
)
Num
ber
of it
ems
scor
ed:
0N
umbe
r of
item
s re
mai
ning
:11
Sect
ion
Ave
rage
:0.
00
Adv
ocac
y / C
onsu
ltatio
n (C
FCC
IV
-E)
Scor
e
1. E
duca
tes
and
advo
cate
s fo
r co
mm
unic
atio
n ne
eds
of a
ll in
divi
dual
s th
at m
ay in
clud
e ad
voca
ting
for
the
prog
ram
mat
ic n
eeds
, rig
hts,
and
fun
ding
of
serv
ices
for
thos
e w
ith h
eari
ng lo
ss, o
ther
aud
itory
dysf
unct
ion,
or
vest
ibul
ar d
isor
ders
(st
d IV
-E1,
std
3.1
.6A
)
2. C
onsu
lts a
bout
acc
essi
bilit
y fo
r pe
rson
s w
ith h
eari
ng lo
ss a
nd o
ther
aud
itory
dys
func
tion
in p
ublic
and
pri
vate
bui
ldin
gs, p
rogr
ams,
and
ser
vice
s (s
td I
V-E
2)
Page
3/4
Adv
ocac
y / C
onsu
ltatio
n (C
FCC
IV
-E)
Scor
e
3. I
dent
ifie
s un
ders
erve
d po
pula
tions
and
pro
mot
es a
cces
s to
car
e. U
nder
stan
ds th
e ro
les
and
impo
rtan
ce o
f pr
ofes
sion
al o
rgan
izat
ions
in a
dvoc
atin
g fo
r th
e ri
ghts
of
acce
ss to
com
preh
ensi
ve a
udio
logi
cse
rvic
es. (
std
IV-E
3, s
td 3
.1.1
A)
Num
ber
of it
ems
scor
ed:
0N
umbe
r of
item
s re
mai
ning
:3
Sect
ion
Ave
rage
:0.
00
Edu
catio
n / R
esea
rch
/ Adm
inis
trat
ion
(C
FCC
IV
-F)
Scor
e
1. M
easu
res
func
tiona
l out
com
es, c
onsu
mer
sat
isfa
ctio
n, e
ffic
acy,
eff
ectiv
enes
s, a
nd e
ffic
ienc
y of
pra
ctic
es a
nd p
rogr
ams
to m
aint
ain
and
impr
ove
the
qual
ity o
f au
diol
ogic
ser
vice
s in
bot
h as
sess
men
t and
trea
tmen
t (st
d IV
-F1,
IV
-D7,
std
3.1
.4A
, 3.1
.5A
, 3.1
.6A
)
2. A
pplie
s ac
adem
ic k
now
ledg
e an
d pr
inci
ples
of
evid
ence
-bas
ed p
ract
ice
to p
atie
nt c
are
usin
g cl
inic
al r
easo
ning
whi
le im
plem
entin
g ne
w te
chni
ques
and
tech
nolo
gies
(st
d IV
-F2,
IV
-F3,
std
3.1
.1A
, 3.1
.4A
,3.
1.6A
)
3. U
nder
stan
ds th
e ro
le o
f cl
inic
al te
achi
ng/m
odel
ing.
Adm
inis
ters
clin
ical
pro
gram
s an
d pr
ovid
es s
uper
visi
on o
f pr
ofes
sion
als
as w
ell a
s su
ppor
t per
sonn
el (
std
IV-F
4, s
td 3
.1.1
A)
4. I
dent
ifie
s in
tern
al p
rogr
amm
atic
nee
ds a
nd d
evel
ops
new
pro
gram
s (s
td I
V-F
5)
5. M
aint
ains
or
esta
blis
hes
links
with
ext
erna
l pro
gram
s, in
clud
ing
but n
ot li
mite
d to
edu
catio
n pr
ogra
ms,
gov
ernm
ent p
rogr
ams,
and
phi
lant
hrop
ic a
genc
ies
(std
IV
-F6)
Num
ber
of it
ems
scor
ed:
0N
umbe
r of
item
s re
mai
ning
:5
Sect
ion
Ave
rage
:0.
00
Page
4/4
Performance Rating Scale1
2
3
4
5
6
7
8
Unacceptable: Skill present < 20% of the time. Unacceptable Performance. Skill is not evident most of the time. Student requires direct instruction to modify behavior and is unaware of need to change. Supervisor must model behavior and implement the skill required for client to receive optimal care. Supervisor provides numerous instructions and frequent modeling.
Developing Understanding: Skill present 20-29% of the time with maximum support. Needs improvement/emerging with maximum support. Skill is emerging, but is inconsistent or inadequate. Student shows awareness of need to change behavior with supervisor input. Supervisor frequently provides instruction and support for all aspects of case management and services.
Early Emerging: Skill present 30-39% of the time with maximum support. Needs improvement/emerging with maximum support. Skill is emerging, but is inconsistent or inadequate. Student shows awareness of need to change behavior with supervisor input. Supervisor frequently provides instruction and support for all aspects of case management and services.
Emerging: Skill present 40-49% of the time with maximum support. Moderately meets performance expectations with maximum support. Skill is present and needs further development. Student is aware of need to modify behavior, but does not do this independently. Supervisor provides on-going monitoring and feedback; focuses on increasing student's critical thinking on how/when to improve skill.
Emerging Consistently: Skill present 50-59% of the time with increased support. Moderately meets performance expectations with increased support. Skill is present and needs further development. Student is aware of need to modify behavior, but does not do this independently. Supervisor provides routine monitoring and feedback; focuses on increasing student's critical thinking on how/when to improve skill.
Present: Skill present 60-69% of the time with moderate support. Adequately meets performance expectations with moderate support. Skill is developed most of the time and need continued refinement or consistency. Student is aware of behavior in-session and can self-evaluate. Problem solving is independent, however supervisor acts as collaborator to plan and suggest possible alternatives.
Present Consistently: Skill present 70-79% of the time with moderate support. Adequately meets performance expectations with moderate support. Skill is developed most of the time and need continued refinement or consistency. Student is aware of behavior in-session and can self-evaluate. Problem solving is independent, however supervisor acts as collaborator to plan and suggest possible alternatives.
Developing Mastery: Skill present 80-89% of the time with minimal support. Consistently meets performance expectations with minimal support. Skill is consistent and well developed. Student can modify own behavior as needed and is an independent problem-solver. Supervisor serves as a consultant and provides guidance on ideas initiated by student.
Gaining Independence: Skill present > 90% of time with minimal support. Consistently meets performance expectations with minimal support. Skill is consistent and well developed. Student can modify own behavior as needed and is an independent problem-solver. Supervisor serves as a consultant and provides guidance on ideas initiated by student.
Independent / Outstanding: Exceeds performance expectations/independent: Adequately and effectively implements the clinical skill/behavior. Demonstrates independent and creative problem solving.
9
10
Letter Grade Assignments
Letter Grade
10 - 9.01 A+
(reference only)
9 - 8.018 - 7.017 - 6.016 - 5.01
A+
5 - 4.01
A
4 - 3.01
B+3 - 2.01
B2 - 1.01
F1F
3rd Year
AA-B+BB-
CC-F
2nd Year
A+AA-B+
B-CF
1st Year Summer
A+AA-
BCF
1st Year Fall/Spring
PP
PFF
PB+BC+
Appendix D
CALIPSO Clockhour Form
Child Adult Total
Total Observation Hours:
Observation
Evaluation
Treatment
Prevention & Identification
Hearing Screening
Hearing Conservation
Noise Measurements
Evaluation
Behavioral Assessment of Hearing
Cerumen Management
Electro-Physiological Assessment of Hearing
Tinnitus Evaluation
Assessment of Balance
Treatment
Selection, Verification, Use of Amplification
Selection, Verification; use of ALDs
Selection, Verification, Use of Implants (cochlear, brainstem,baha)
Perceptual Training (auditory and/or visual)
Counseling
Vestibular Therapy
Other
Administration
Consultation/Staffings
Speech and Language
Evaluation/Screening of Speech Disorders
Evaluation/Screening of Language Disorders
Treatment of Speech Disorders
Treatment of Language Disorders
Total Hours 0:00 0:00 0:00
Page 1/1
Appendix E
Last updated 11/30/12 by BC
Prior to your first day:
Read the orientation packet
Consider the areas we will be grading on your competency forms
Read or re-read your school information on adult and pediatric testing(including Conditioned Play and Visual Reinforcement Audiometry)
On your first day:
Wear your school badge (above the belt)
Dress appropriately (see orientation packet)
Bring:
a record of a TB test in the last 12 months
a record of CPR certification
a copy of your orientation packet
Appendix F
Last updated 11/30/12 by BC
GRADUATE STUDENT ORIENTATION
Locations and General Clinic Hours: We have three primary locations: Medical Tower A Suite 385 Audiology clinic, Medical Tower
A Suite 398 Audiology Administrative Offices and the Mercy Children’s Hospital/MCH Audiology clinic. Our clinic hours are officially 8:00am to 4:30pm. You will need to be in the appropriate office at approximately 7:45 or 7:50am. Our last patient is generally gone by 4:30pm. Most patient related administrative tasks are easily completed between patients, but we do occasionally need to stay after 4:30pm. Please check with the Audiologist(s) that you have been working with during the clinic day before you leave. Assignments for which office you’ll be working in each day will be provided by your supervising audiologist.
Craniofacial Team is at the Child Development Center (CDC) on some Fridays. If you are assigned to those clinics, you will meet there at 8:00am and return to campus after team is finished, generally around lunchtime. The office is at 641 N. New Ballas Rd., between Ladue and Olive, North of St. Louis Bread Co. and the Post Office. It has a “Mercy Blue” sign out front and a small blue entranceway.
Lunch Time: You are welcome to have lunch with us in the Admin Office lunch room in Suite 398. Should a
hearing aid rep come and visit our office while you are here, please join us. Feel free to keep your lunch in the refrigerator. There is a microwave available in the lunch room and in the cafeteria. Purses, briefcases, etc., can be stored in the “Staff” office (398.4) located within Suite 398. Additionally there is a cafeteria in the main hospital and a small café in Medical Tower A where you can buy drinks, snacks and lunch.
Attendance: Please submit all time off/vacation requests prior to your rotation start date. Academic
and religious holidays are not necessarily clinic holidays. If you have to be out of clinic during any of your scheduled clinic times, please let us know well in advance. Our schedule assumes you will be available in the Audiology clinic and may need to be adjusted if you will be absent. Attendance and reliability are aspects of a competent professional and numerous unscheduled absences will adversely influence your grade for the semester.
In the case of illness, car trouble or bad weather, call us as soon as possible (Not only to adapt the schedule, but because we get worried if you don’t show up). If you will be late or absent, contact Dr. Cristel at 618-910-2664 as soon as possible, and leave a voicemail. Please do not email. You may also leave a message at the main number (314) 251-5850 and follow-up in the morning to make sure the message was received. It is best to think of your time with us in the same way you would a paying job. We consider your practicum here on par with your coursework and just as important. We expect a professional attitude toward attendance, it reflects on your reliability and future conduct as a certified and licensed Audiologist.
Last updated 11/30/12 by BC
Transportation to and from our offices is your responsibility. If your mode of transportation begins to cause frequent tardiness or absences during the semester you will be expected to find another means of transportation.
Clinical Conduct: HIPAA: All conduct must adhere to HIPAA guidelines. If you are unfamiliar with HIPAA guidelines,
please contact your direct preceptor prior to your start date. It is necessary and required that all professionals at Mercy maintain privacy and confidentiality while interacting with patients.
Dress: Most of you will have had experiences in a patient clinic at some point before your first day at
Mercy, so please follow similar guidelines. Closed toe shoes are JCAHO compliant. (Flip-flops and athletic shoes are not acceptable.) Clothing should be neat, ironed, and conservative with regard to coverage. Excessive cleavage, visible undergarments, mid-thigh skirts and flashes of midriff while bending over to perform otoscopy are unacceptable. If you have long hair, please keep it from falling on patients. It is not hygienic for you or the patient.
Supervision: We expect that if you have any questions or concerns that you address these with your direct
preceptor or an available staff audiologist – no question is stupid if you are unsure of the answer. We were all students once and we understand that you may not yet have experienced a similar clinical situation prior to coming here.
As students in a professional program, it is up to you to make sure you obtain the skills needed to function once you are out on your own. Take initiative to ask for exposure on things you need to work on a bit more. Let us know if there is an area in which you are already confident and hopefully competent. You may not always get to see the patients you want to see, but we try to accommodate your educational needs as much as possible. Once you are assigned to a clinic for the day we expect you to help out with that clinic. Should there be something else happening that you are interested in, you can speak to your direct preceptor to see if it is a possibility to let you float during that time, but you must ask permission before leaving a current assignment.
Downtime: During downtime in the clinic, there are a number of things you can do (Please see the next
page). Please understand that the Audiology staff often have projects they need to work on between patients and may need that time to concentrate on phone calls or computer work. Please bring some of your class work or reading assignments to work on during downtime in case we have no precepting experiences for you. Looking up syndromes or other medical issues that you encounter in the clinic is another great down-time activity that can help you with possible case-studies for school. Please do not bring novelty reading or personal tasks as these activities greatly reduce your appearance of professionalism.
Everyone really enjoys having you here. The semesters seem to fly by far too fast. Remember that this is a learning experience and ask questions.
Last updated 11/30/12 by BC
GRADUATE STUDENT PROTOCOL
Mornings
Turn on / Log on equipment in both booths and the HA labs and perform listening check. Determine your location and audiologist for the day.
During and After Test Session
Be ready for the patient. When patient is registered, be ready to interact with thepatient and the audiologist.
Discuss your role with the audiologist. Complete chart note in Microsoft Word at discretion of Audiologist. Review with Audiologist. Fill out fax cover sheet Fax/mail report to appropriate referral sources. Restock any missing materials. Organize test area for next patient.
During Slow or Free Time
Check with your scheduled preceptor for the day. Prepare clinic/test area for next patient. Perform biologic calibrations on audiometers. Change ultrasonic fluid. (1 to 2 times per week) Look up any syndromes or conditions you have come across in histories. Read articles or study for school.
Before Leaving
Check with Audiology staff. Refill any supplies that are low. (case history forms, tips, etc…) Straighten hearing aid lab, test booths, fitting rooms for next day. Restart NOAH computers and shut down all other equipment and computers. Turn off lights in testing areas.
Appendix G
July
Aug
Sep
Dec
Apr
May
June
Stud
ent/F
acul
ty S
earc
h Pr
oces
s
App
licat
ion
Perio
d O
pen
App
licat
ions
Sub
mitt
ed
App
licat
ion
File
s C
ompl
eted
Inte
rvie
ws
Offe
rs M
ade
Offe
rs A
ccep
ted
(Rou
nd 1
)
Pape
rwor
k Fi
naliz
ed B
etw
een
PAC
S an
d Si
te
Adap
ted
from
the
Exte
rnsh
ip T
imel
ine
Gui
delin
e pu
blis
hed
in A
udio
logy
Tod
ay, J
uly/
Augu
st 2
006,
p. 6
.
MU
ST B
E C
OM
PLET
E B
EFO
RE
EXTE
RN
SHIP
CA
N B
EGIN
Mar
EXTE
RN
SHIP
TIM
ELIN
E G
UID
ELIN
EN
ovO
ctJa
nFe
b
Appendix H
WASHINGTON UNIVERSITY EXTERNSHIP SUMMARY
FOR ITS PROGRAM IN AUDIOLOGY AND COMMUNICATION SCIENCES
Site Name: Student Name: Site Supervisor Name: Site Supervisor
ASHA #:
The above-named student agrees to:
1. Begin the externship placement on (no earlier than May 20, 2019).
2. Complete the placement on (no later than May 6, 2020).
3. Maintain the following hours:
4. Participate in clinical observation as required by the site before beginning to provide clinical services.
5. Complete no less than 36 weeks and 1450 hours of experience within the agreed-upon dates.
6. Be responsible for continuity of care by not canceling or postponing clinical services without prior
consent of the site and/or supervisor.
7. Submit evaluations, progress notes, therapy plans, and other reports within the site’s written
guidelines.
8. Implement decisions regarding evaluation and treatment only after receiving approval from the
supervisor.
9. Abide by all of the rules and expectations of the site, as supplied in writing, including observation of
appropriate dress codes and standards for professional conduct.
10. Recognize that the externship may be terminated anytime in consultation with the site, supervisor, and
Program.
11. Complete and submit the required forms and agreements, including evaluation forms and log sheets.
The above-named site agrees to:
1. Maintain and submit proof, upon request, of the Certificate of Clinical Competence (CCC) in Audiology
from the American Speech-Language-Hearing Association (ASHA) for the individual named as the
supervisor.
2. Provide appropriate supervision of the student, as defined by the Council on Academic Accreditation
(CAA) of ASHA.
3. Provide to the student written guidelines on submission of evaluations, progress notes, therapy plans,
and other reports.
4. Schedule regular meetings with the student to discuss progress and performance, with no fewer than
three such meetings (entrance, mid-point, exit).
5. Provide no less than 36 weeks and 1450 hours of experience within the agreed-upon dates.
FOR REVIEW U
SE ONLY
-
inform
ation
to "fi
ll in th
e blan
ks"
shou
ld be
sent
to the
AuD pr
ogram
,
whic
h will t
ype u
p fina
l
Externs
hip Sum
mary do
cumen
t
for re
view/si
gnatu
res
Appendix I
Updated 6/29/2016
6. Complete and submit the required forms and agreements, including evaluation forms and log sheets.
7. Provide $ compensation to the above-named student.
8. Provide the following types of experiences to the student during the externship:
9. Provide the following additional benefits to the student:
10. Abide by the terms set forth in the Affiliation Agreement.
Program Signatures
Student Date
L. Maureen Valente, Ph.D., Associate Professor Date
William W. Clark, Ph.D., Program Director Date
Site Signatures
Site Supervisor Date
Site Administrator (if applicable) Date
FOR REVIEW U
SE ONLY
-
inform
ation
to "fi
ll in th
e blan
ks"
shou
ld be
sent
to the
AuD pr
ogram
,
whic
h will t
ype u
p fina
l
Externs
hip Sum
mary do
cumen
t
for re
view/si
gnatu
res
