Establishing Global Clinical Training Programs in Audiology Kathleen A. Sco<, Ph.D., Hofstra University Donna Geffner, Ph.D., LI AuD ConsorFum Yula Serpanos, Ph.D., LI AuD ConsorFum Ianthe Murad, Sc.D., LI AuD ConsorFum Rose Valvezan, AuD., LI AuD ConsorFum
Introduc)on Ø Global health educa)on provides competency based field experience to graduate student clinicians in an environment that is interdisciplinary in nature and culturally diverse by defini)on. Ø Global health educa)on occurs not only in the academic classroom, but also in field-based clinical experiences. Such clinical experience increases students’ awareness of cultural differences, and provides opportuni)es to discuss complex ethical issues, and encourages students to adopt new solu)ons when resources are limited (Crowley & Baigorri, 2012; Hickey & GildersleeveNeumann, 2012; Riggsbee, 2015). Ø Exposure to clinical experience in environments where resources are extremely limited provides opportuni)es for students to apply prior academic and clinical training in new ways (Rowden-RaceQe, 2010). Ø Scant literature is available regarding how to best prepare students academically and clinically prior to a global experience and what is available is primarily anecdotal in nature (Hallowell, 2012). Ø Subsequently, for programs that administer such global opportuni)es and clinical supervisors who work in these environments it is unclear what academic, socio-cultural, and clinical training should be required of student-clinicians prior to global clinical experiences. Primary research ques)ons 1) How much clinical experience should a student have prior to a global clinical experience? 2) Should addi)onal academic coursework/workshops be provided to the student-clinicians prior to the experience? Method Ø Six graduate student clinicians par)cipated in a 10-day healthcare mission trip in Southeast Asia. All students had completed 7 semesters of academic work and 4 semesters of clinical work in a clinical doctorate program. Ø The focus of the trip was to provide hearing healthcare to underserved and unserved popula)ons in two major urban ci)es. Students worked alongside audiologists, interpreters, volunteers, and other hearing health trained professionals performing intake, hearing screenings, ear mold impressions, and hearing aid fi\ngs as well as follow-up a]ercare services. Ø Prior to the experience, students were asked to anonymously complete a 10-ques)on survey regarding the clinical experience. At the end of the trip they were asked to complete an exit survey. The students indicated their agreement with the items using a 5point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Ø This study was approved as exempt by the Hofstra University Ins)tu)onal Review Board (IRB). Data analysis A descrip)ve, quan)ta)ve and qualita)ve analysis of the data was conducted to answer research ques)ons regarding level of clinical experience needed prior to global clinical assignments and what, if any, addi)onal coursework would improve the quality of the experience.
Survey Ques)ons Self-Percep)on Ques)ons 1. I understand health care dispari)es across cultures and countries. 2. I understand the mission and goals of this global experience. 3. I see myself par)cipa)ng in future global missions. 4. I have volunteered for a global experience in Audiology to: (check all that apply) a)help unserved or underserved popula)ons; b) gain more experience with culturally diverse individuals; c) gain clinical credit hours; d) fulfill a civic, religious, and/or ethical commitment to helping others; e) travel to a part of the world I haven’t seen; f) other (please specify). 5. (PRE) What were your expecta)ons for this trip? (POST) Were your expecta)ons for this trip met? Why or why not? Knowledge and Skills Ques)ons 6. I am confident working with culturally diverse popula)ons. 7. I am confident working with a translator in clinical prac)ce. 8. I feel clinically competent to contribute to this global experience. 9. I feel informed about the culture and country in which the global experience took place. 10. I feel that a global audiology experience would be most educa)onally valuable in the following year of the program: 1st, 2nd, 3rd, 4th.
Self-Percep)on Pre- Post Experience SUBJ 1 2 3 4 5 6 AVG
Pre-experience Q1 Q2 Q3 4 4 5 5 5 5 3 4 5 4 1 1 3 4 5 4 4 5 3.83 3.67 4.33
Post-experience Q1 Q2 Q3 5 5 5 5 5 5 4 4.5 5 4 5 5 4 5 5 5 5 5 4.50 4.92 5.00
Knowledge and Skills Pre- Post Experience Pre-experience SUBJ Q6
Post-experience
Q7
Q8
Q9
Q6
Q7
Q8
Q9
1
4
5
5
5
4
5
5
5
2
5
5
5
4
5
5
5
4
3
4.5
5
5
4
4.5
5
5
4
4
4
4
5
4
4
4
5
4
5 6
4 5
5 4
5 5
4 4
4 5
5 4
5 5
4 4
AVG 4.42 4.67 5.00 4.17 4.42 4.67 5.00 4.17
Results Ø There was a significant difference (t(2) = -4.47, p = 0.047) in pre- and post survey outcomes on student self-percep)ons of the global training experience. Ø There was no significant difference (p > 0.05) in pre- and post survey outcomes on student knowledge and skills following the global training experience. Student Reasons for Volunteering All students stated reasons for volunteering were a, b, and e. Four students also stated that they par)cipated to fulfill a civic, religious, and/or ethical commitment (d). None of the students reported they par)cipated in the experience in order to acquire clinical hours. Student Expecta)ons (Open ended ques)ons) (PRE-Experience) “Help as many people as possible.” “Have fun.” “Gain a beQer skill set with dealing with popula)ons and cultures different from my own.” “Learn as much as possible in whatever ways possible.” “Experience the culture.” Student Expecta)ons (Open ended ques)ons) (POST-Experience) “Yes! Can we do it again? I learned a lot!” “Exceeded expecta)ons. The hands on clinical experience was amazing. I learned so much about pathologies and how to best handle” “Yes! I feel I was here to make a difference and I know I was able to!” “My expecta)ons were exceeded. Great trip. Can’t express it more.” Discussion Ø All student clinicians provided very posi)ve comments about the experience. Ø The one student who originally stated he/she would not volunteer again, reported that he/she would volunteer again. Ø There was a significant difference in student self-percep)ons about global experiences from pre-experience to post-experience repor)ng. Ø Although no difference was found in the Likert ques)ons of knowledge and skills, when asked open-ended ques)ons all students provided responses, and all students responded posi)vely that they had significant gains in their clinical skills. Conclusions Outcomes reveal that a minimum of four semesters of clinical work prior to a global clinical experience is sufficient for student training. Programs should consider providing seminars that explore the culture and healthcare issues of the country prior to a global clinical experience to maximize the student experience. Pre- and post-experience surveys may be beneficial at the programma)c level. Selected References
Crowley, C., & Baigorri, M. (2012). Interna9onal service that really serves. The ASHA Leader, 17, 30 - 33. doi:10.1044/ leader.WB1.17132012.30 Hallowell, B. (2012). A magnificent new era for global collabora9ons in higher educa9on in communica9on sciences and disorders. Access Academics & Research. Rockville, MD: American Speech-Language-Hearing Associa9on. Retrieved from hTp://www.asha.org/Academic/ques9ons/New-Era-for-Global-Collabora9ons-in-Higher-Educa9on/? utm_source=asha&utm_medium=enewsleTer&utm_campaign=0412AAR Hickey, E., & Gildersleeve-Neumann, C. (2012). SLPs and Audiologists (SLP/A) in Global Se]ngs: Ethical Considera9ons Before, During, and A^er. American Speech Language Hearing Associa9on Na9onal Conven9on, Atlanta, Georgia. Riggsbee, S. (2015). CreaFve Healing: An SLP pracFcing in Nepal tackles language barriers and resource limits, but relishes the universal rewards of helping people in need. The ASHA Leader, October 2015, 20, 40-41. doi:10.1044/leader.WB. 20102015.40 For further informa9on please contact: Kathleen A. ScoT, Ph.D. CCC-SLP (kathleen.scoT@hofstra.edu)