What I Wish I’d Known About the Externship A recent audiology graduate offers advice to students preparing for their last immersive year. Student's Say
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Student's Say  |   August 01, 2017
What I Wish I’d Known About the Externship
Author Notes
  • Madison Saunders, AuD, CCC-A, is a clinician at Island Audiology, a private practice in Oahu, Hawaii. She received her clinical doctorate from the University of Kansas Medical Center and recently completed her term as the vice president for audiology student state officers on the National Student Speech Language Hearing Association Executive Council. mcmonlezun@gmail.com
    Madison Saunders, AuD, CCC-A, is a clinician at Island Audiology, a private practice in Oahu, Hawaii. She received her clinical doctorate from the University of Kansas Medical Center and recently completed her term as the vice president for audiology student state officers on the National Student Speech Language Hearing Association Executive Council. mcmonlezun@gmail.com×
Article Information
Hearing Disorders / Professional Issues & Training / Student's Say
Student's Say   |   August 01, 2017
What I Wish I’d Known About the Externship
The ASHA Leader, August 2017, Vol. 22, 44-45. doi:10.1044/leader.SSAY.22082017.44
The ASHA Leader, August 2017, Vol. 22, 44-45. doi:10.1044/leader.SSAY.22082017.44
My 22-year academic journey has come to a close.
As graduation approached, I found myself reflecting on this journey, especially on the professional and personal impact of the past year’s clinical immersion. Audiology is one of a few fields that includes this experience in the degree process, rather than after graduation. (This model has presented challenges for many academic programs and students; see the recent ASHA Leader article on this topic.)
For AuD students, this model can create something of a gray area. We are definitely still students: Most are paying full or partial tuition, some are still taking distance-learning classes, and without a doubt, we all lack the experience to handle all the possible cases that could walk through a clinic’s doors.
Externs are doctoral trainees, not doctors of audiology. However, we are ready and capable to practice with an increasing level of autonomy. The struggle is finding where we fit in that range with our clinical site, our own comfort and our clinical goals. I know from talking with other students that the level of extern supervision and support can vary—depending on the site, some externs are treated as clinicians, balancing their own caseload with occasional reliance on preceptors for decision-making, while some externs practice under 100-percent supervision and may take on a more observational role.
What’s key throughout the externship is growth. This year is about developing and fine-tuning our clinical skills and decision-making to a point where we can effectively diagnose and treat hearing and balance disorders. I know that sounds easier than it really is in practice, so I’d like to share some pointers to help others on this journey.

Your academic coursework teaches how to assess and treat in a perfect world—let your externship teach you how to assess and treat in the real world.

Key lessons
I am by no means an expert on all things externship, but as my time in this unique role ends, I have gained important insights into clinical practice. Here’s some of what I’ve learned:
  1. Work with a variety of personality types. Understanding who you are and how you function in different facets of your life is an important step in learning to adjust and work cooperatively with staff in a clinical setting. Take a personality evaluation (I took the R3, the Advanced Multidimensional Personality Matrix, 3rd revision) to understand your own strengths and weaknesses and how you can best work with—and not against—others to reach goals most effectively.

  2. Manage when you think your superior is in the wrong. As students, we learn the newest evidence-based information, guided by best practices, and we use the latest testing procedures and techniques. But what if your colleague or supervisor has not been exposed to recent innovations? An opportunity to educate and strengthen a clinic can easily become a power struggle if not handled properly. My advice is to ground everything in respect. Take the educational approach to any potential difference of opinion. Explain how you learned it at your university or discuss a recently published article. Ask questions instead of making statements about how or why something is done. And be open to evidence and information about approaches that are new to you.

  3. Handle workplace politics. I learned from watching professional interactions and significant structural changes that you need to be flexible and adaptable to whatever arises. We learn in school how to handle patients, but not how to handle, for example, what happens if your clinic is restructured and you are left with responsibilities beyond your skill set. I don’t know the answers for these situations, but just remember that you are first and foremost a clinician, and the patient’s quality of care is the primary goal.

  4. Maintain healthy physician relationships. Having good working relationships with ear, nose and throat doctors is very important, because where our scope of practice stops theirs takes over—and in some aspects, the reverse is true. Some physicians value our expertise and respect our contributions—others do not. You learn when to push and when to fold. Be confident in your knowledge and have evidence for your positions, but also respect the physician’s expertise. The patient should always be the primary focus of any interprofessional interaction.

  5. Advocate for yourself. Learning is the primary goal of your externship. Have clear and outlined goals for your year that guide your growing experience and autonomy. Be respectful, but don’t be afraid to ask for what you need or want.

  6. Expand skills. You will confront new conditions and fine-tune your clinical skills. I saw disorders I had only read about, and I encountered symptoms I had never even heard of. Your academic coursework teaches how to assess and treat in a perfect world—let your externship teach you how to assess and treat in the real world.

  7. Achieve the goal. When you find yourself bogged down with classes, papers, the Praxis, comps, research projects, trying to have a social life or a successful relationship, staying healthy, or even dealing with general self-doubt—remember the struggle is absolutely worth it. You are investing in your future and in the future quality of life of your patients.

If only I’d known
On the other hand, here’s what I wish I knew:
  1. Not everyone is like you or will like you. Being best friends with everyone at work is not the most important aspect of your externship. As long as you are behaving appropriately, ethically, and respectfully, differences of opinion or personality are fine.

  2. Audiology is a very small community. Your reputation—your greatest advantage or detriment—follows you everywhere. Give every professional and fellow student you interact with something to talk about … in a positive way.

  3. Just do your best. You will get out of your experience what you put in. You will not always know the right answers or what to do, but try your hardest.

  4. Avoid burnout. Find ways to keep yourself motivated and excited about your job. We all know ears are awesome, but being an extern is stressful and you may get burned out. Straddling the line between student and doctor of audiology trainee is challenging—so find time to enjoy the fun aspects of your last year in school.

  5. Go beyond your degree. Most conferences and educational opportunities offer discounted student rates or are free to student volunteers. Tap these opportunities to learn, make friends with similar interests, and build your professional network. Also consider becoming a student leader or get involved with national or state advocacy. Even as students, we have the potential to make as big of an impact outside the clinic as within.

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FROM THIS ISSUE
August 2017
Volume 22, Issue 8