Editor's Note: Although we don't usually publish 'op/ed' pieces as articles, I thought this paper was particularly important at this time. I believe most practicing audiologists are probably not well versed regarding military training of 'audiology assistants.' At least I wasn't! Therefore, I decided to 'air' this paper as these discussions are becoming more important. All responsible viewpoints, opinions and responses will be published online, beginning immediately after this paper. ---Editor.
INTRODUCTION:
With all the attention regarding Audiology Assistants (AA) lately, I thought it would be beneficial for the readers to know about my experience in the military, serving essentially, as an 'Audiology Assistant.'
HISTORY:
I joined the US Army in 1994 to become an Ear, Nose & Throat Assistant. My reasons for joining the Army were simple; I needed money for college! The recruiter offered me this job specialty/opportunity - and I took it. After completing basic training, I went to the US Army Academy of Health Sciences at Fort Sam Houston in San Antonio, Texas. Once there, we began our specialty training.
The first part of my training consisted of 16 weeks of intense medical training. We started with anatomy and physiology of the head and neck. Following that, we studied the physics of hearing. After completing the physics portion, we were taught how to evaluate hearing, including; pure tone audiometry (air and bone), masking, speech audiometry and immittance audiometry (tympanograms and acoustic reflexes). All of our training was 'hands on' training. Upon completion of each section of training, I had to pass a practical test to 'qualify' and to continue my training. I began learning how to take ear impressions. We were initially trained with powder and liquid materials. Again, to continue our schooling, we were given a practical test to determine our ability to take ear impressions. After successfully completing the above sections, we started our CAOHC Hearing Conservation Course. Again, we had to pass an exam in order to document our abilities.
Beyond the audiology-based training, we had practical and written testing in non-audiology areas. For example, we were taught and tested on the proper nomenclature of over 150 surgical instruments and their uses, sterile technique, universal precautions, note taking (SOAP format) and medical-legal documentation. Out training and preparation was intense, comprehensive and thorough.
Those of us who completed the preliminary educational process were sent to various Army Hospitals in the country to work under close supervision.
I was assigned to Evans Army Community Hospital at Ft Carson, Colorado (Colorado Springs). During the first 6 weeks we were closely supervised while conducting all aspects of our job. We were given weekly evaluations by the audiologist and by the otolaryngologist. After successful completion of this second phase of training, we were awarded our Military Occupation Specialty and sent on to our first duty assignment.
DUTY ASSIGNMENT:
My first duty assignment was in the EENT (Eye, Ear, Nose & Throat) clinic at Bayne-Jones Army community Hospital at Fort Polk, Louisiana. Once I got oriented to the new facility, and established a routine, my day-to-day schedule evolved. Basically, the daily course of events, for the first six months included...
- Daily calibration checks of all the audiology equipment.
- Daily check of the hearing conservation equipment.
- Supervised audiometry (air/bone/speech/immittance)
- Supervised earmold impressions.
- Supervised hearing aid repairs.
- Supervised earmold modification.
- Filing appropriate paperwork.
After six months, supervision was in the form of the audiologist being next door (although still in the same office) rather than being on-site and looking over my shoulder!
After a year or so, we were allowed to do perform audiometric evaluations without direct, 'over-the- shoulder' supervision. At that point, if the audiologist was in the office and if they wanted us to, we could do the audiometric evaluation for their patients. Naturally, the patient was informed that a 'tech' would be performing the test, but the interpretation and diagnosis would be performed by the audiologist.
Regarding the otolaryngology aspects, we assisted in minor clinic procedures and worked in the OR under supervision. Much like the audiology clinic, after we had proven our skills, we worked as the sole scrub tech in the OR with the otolaryngologist and we performed cerumen removal in the clinic. As was true of all aspects of our training, the first cerumen removals were performed under direct supervision of the professional, and as we learned and became competent, we were allowed to do 'ear cleanings' as long as the otolaryngologist was in the facility.
I spent almost three years at Fort Polk before being assigned to the Army Community Hospital in Wurzburg, Germany. My assignment in Germany was as an NCO (Non-Commissioned Officer) in charge of the audiology clinic.
The clinic managed the hearing conservation program for 14 outlying Army health clinics. I was responsible for over 21,000 noise-exposed personnel. I traveled weekly to various clinics insuring that Army and OSHA hearing conservation regulations were being administered correctly and adhered to.
Every quarter, the audiologist and I taught a CAOHC approved course to train additional hearing conservationists to work in the outlying clinics and to act as 'subject matter experts' in hearing conservation at the unit level.
Eventually, my 'audiology responsibilities' expanded to include diagnostic audiometry under the audiologist's supervision (in the clinic but not in the booth), newborn screenings (DPOAE), some ABR orientation and even hearing aid selection and fitting. I studied and became familiar with hearing aid fitting theory, practical application of fitting rules and concepts - such as fitting the patient rather than the audiogram - and how to use the computerized hearing aid analyzer.
Although I was not assigned to the ENT clinic during my time in Germany, I was the only ENT tech working in the hospital. Therefore, during surgery days for the otolaryngologist, I worked as his surgical scrub tech. Duties included: OR suite prep, 'back table' set-up, patient prep, direct surgical assistance, and instrument decontamination and sterilization.
PERSONAL REFLECTIONS:
After working as an ENT tech for seven years in the US Army, I've come away with a few ideas and views on this topic.
Many professions use techs. The 'short list' would include...dentists, otolaryngologists, optometrists, ophthalmologists, physical therapists, occupational therapists, nurses, physicians, respiratory therapists and on and on. Many professions have trained and certified 'techs' and assistants, and quite simply, it works. It is efficient and it maximizes personnel and reduces costs.
I've worked directly with 6 audiologists and indirectly with 4 others. Never once did I get the feeling that my training and skills threatened them. I knew what I was capable of, and they did too. I think the audiologists in the military were very able to use my abilities and skills and knowledge to help them accomplish their goals - which was simply to maximally address the needs of the patient!
RECOMMENDATIONS:
I believe a nationally based 'official' training, recognition and documentation for audiology assistants (AA) would significantly benefit the profession and the patients. The time has come. There are not enough audiologists to go around and I believe the audiology profession, as a whole, should embrace this idea.
Conversely, I believe that if audiologists and their organizations do not initiate training, recognition and documentation of AAs, it is probable that the national otolaryngology groups will!
Simply, these are decisions driven by economics and efficiency. If it is less expensive to hire AAs than audiologists, it will probably happen. I understand that some audiologists may feel threatened by additional trained personnel. However, if the audiologists initiate appropriate programs and guidelines, they will assure their position as the 'professional,' in the same way that dentists, otolaryngologists, optometrists, ophthalmologists, physical therapists, occupational therapists, and others have done so, previously.
Audiologists are the profession of choice to manage, administer and regulate the training of AAs. However, if they don't initiate these programs in the very near future, it is likely that others will!
