Preparing Students for
Post-graduate Audiology Credentialing
Virginia Ramachandran, Au.D., Ph.D.
Brad A. Stach, Ph.D.
Henry Ford Hospital
Wayne State University
Detroit, Michigan
Disclosures
 Virginia Ramachandran is a Member-at-large of the
Executive Board of the Accreditation Commission for
Audiology Education (ACAE)
Your Student …
… and Credentialing
Your Student …
Accreditation
… and Credentialing
Your Student …
Accreditation
AuD Degree
… and Credentialing
Your Student …
Accreditation
AuD Degree
Licensure
… and Credentialing
Your Student …
Accreditation
Licensure
AuD Degree
Certification
… and Credentialing
Credentialing
 Historical Perspective
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–
–
–
The Degree and its role
Accreditation and its role
Certification and its role
Licensure and its role
 What Does this Mean to You?
– Accreditation
– Certification
– Licensure
 Solutions?
Credentials
 Evidence of authority, status, rights,
entitlement to privileges, or the like
 Identifies scope and/or limitations of
practice
 Provides standards for academic programs,
individual practitioners, professional
organizations
Who Cares About Credentials?
 Peers
 Public
 State government
 Third-party payers
Types of Credentials
 Degree
 Accreditation
 Licensure
 Certification
Then & Now
Brad A. Stach
Jennifer Alford
B.A. New Mexico State University 1977
B.A. University of Iowa 1998
M.A. Vanderbilt University 1979
Au.D. University of Texas at Dallas 2013
Ph.D. Baylor College of Medicine 1986
Then & Now
Then
Now
 Clinical education was
incomplete upon graduation;
needed CFY
 Accreditation same for SLP &
audiology
 Obtained CCC-A
 Obtained license to practice
when available
 Discontinued renewal of
CCC-A
 Employed in a large medical
setting
 Clinical education completed
during university program
 Graduated from a program
that is ACAE-accredited
 No certification
 Obtained license to practice
 Employed in a large medical
setting
The Role of the Academic Degree
In the Credentialing Process
Education Model Evolution
– In the old days:
 Model was one of classroom education with studentteaching assignment
 Large chasm between the theoretical and practical
 Clinical education was incomplete upon graduation
 Competency to practice depended on luck of finding a
decent CFY
Education Model Evolution
– What Audiology did:
 Promoted the vision of doctoral-level entry &
single-degree designator
 Completion of degree = prepared to practice
 Single-degree designator promoted recognition of audiology
in the healthcare professions
 Separated research and professional degrees
AuD Progression
1978 ASHA Task Force on Science:
Need a professional doctorate to distinguish the PhD
1986 ASHA Audiology Task Force:
Recommended a professional doctorate
1988 ADA Sponsored Conference:
Recommended a move to the doctorate
1988 AAA is Formed:
Committed to doctoral level entry
1989 American Foundation of Audiology:
Commitment to transform Audiology to the AuD
AuD Progression (cont.)
1996 First AuD Graduating Class:
Residential program at Baylor College of Medicine
1998 Six residential programs establish
1999 First Distance Program Established:
For practicing professionals at Nova Southeastern
2006 No remaining Master’s programs in Audiology
Education Model Evolution
– Today:
 The qualification of competence of an audiologist
is demonstrated by the Au.D. degree rather than
entry-level certification
The Role of Accreditation
In the Credentialing Process
Accreditation
 A formal process of external quality review used by
higher education to scrutinize colleges, universities
and academic programs for quality assurance and
improvement.
 Accreditation is voluntary
 In the U.S., this process is carried out by private, nonprofit organizations designed for this purpose
 “To protect public health and safety and to serve the
public interest”
Accreditation
 Provides protection to
consumers of higher education
– Patients
– Students
– Employers
– Government agencies
Types of Accreditors
 Regional
– Seven U.S. regions - Focus is institutional
 Faith-based
– Religious affiliations
 Private Career
– Most single purpose institutions
 Programmatic or specialized
– Health and professional degrees predominate
Accreditation Progression
1880s First regional accrediting agencies
Focused on standards and admissions requirements
1912 Accrediting Council for Independent Colleges:
23 private professional career schools
1918 American Council on Education:
National association interested in standardization
1930s Accreditation well established for higher ed
Accreditation Progression (cont.)
1965 Department of Education:
Accreditation created by the Higher Education Act
1975 Council on Postsecondary Accreditation:
Established to recognize accreditors
1996 Council for Higher Education (CHEA):
Formed to replace COPA
Accreditor Oversight Today
 Council for Higher Education Accreditation
– Accredits 60 institutional and specialized
accrediting agencies
– Including over 3,000 Colleges and Universities
 U.S. Department of Education
– Ability to be evaluated as an accreditor depends
upon funding mechanism to program through DOE
Audiology Program Accreditation
Accreditation and Credentialing
 Autonomous professions control their own
practice standards and academic standards
 Academic standards are maintained through
accreditation of university programs
The Role of Certification
In the Credentialing Process
On Certification…
There are times in modern history and
experience when the enunciation of even the
most elementary common sense has an aspect
of eccentricity, irrationality, even mild insanity
-John Kenneth Galbraith
Certification and Credentialing
– In the old days:
 Graduation was not the end - degree was
not designed to ensure competence
 Designation of who was an audiologist
followed a compulsory fellowship year
Certification Progression
1952
1954
1965
1970
1993
1997
ASHA began certifying members
Basic and advanced levels; SLP and A separated
Single level; Master’s or equivalent; national exam
CFY supervisor required to be certified
Master’s or doctorate (no equivalent)
New requirements for Audiology, including
doctorate (effective 2012)
1999 Mandatory continuing ed (effective 2003)
1999 American Board of Audiology creates “board
certification in Audiology
Certification
 Voluntary recognition
 No “legal” standing
 Awarded by certifying bodies (professional
organizations)
 Usually awarded once following significant
postgraduate training or accomplishment
Purposes of Certification




Entry-level designator
Demonstration of continued competence
Advanced competence within the broad scope of practice
Advanced competence at the specialist level
Certification and Credentialing
 Certification had value as the profession
evolved and remains important for SLP
 For Audiology, the Au.D. degree has replaced
the competency component of entry-level
certification
 There still may be value for self-governing of
professional activity on a voluntary basis
 Certification has value in other professions
for specialty recognition
The Role of Licensure
In the Credentialing Process
Medical Licensure Progression
1867
1876
AMA calls for examination by State Boards
Texas makes examination compulsory
California requires exam for those without a diploma
1877 Alabama Medical Practice Act
1889 Florida requires diploma and examination
1880s 28 states adopt only registration requirements
1901 AMA creates Committee on Medical Legistation
1900s All but Alaska and Oklahoma have examining boards
1910s Precondition for examination: graduation from stateapproved medical institutions
Audiology License Progression
1969 First audiology license: Florida
1970s 30 more states add audiology licensure
1980s 7 more states add audiology licensure
1990s 9 more states add audiology licensure
2000s Final 3 states add audiology licensure
Licensure Today
 Provides legal right to practice in a state
 Delineates scope of practice
 Consumer protection is the primary purpose
Consumer Protection
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



Louisiana Revised Statutes
Title 37. Professions and Occupations
Chapter 34. Speech-Language Pathology and Audiology
§ 2650. Legislative purpose
The legislature declares that it is a policy of this state that the
practice of speech-language pathology and audiology is a
privilege granted to qualified individuals and that, in order to
safeguard the public health, safety, and welfare, to protect the
public from incompetent, unscrupulous, and unauthorized
persons, and from unprofessional conduct by speech-language
pathologists, audiologists, and speech-language pathology
assistants, it is necessary to provide regulatory authority over
persons offering speech-language pathology and audiology
services to the public.
Status of State Regulation
 50 States and DC require audiology
licensure
> 30 States permit audiologists to dispense hearing aids
under audiology license
Licensure and Credentialing
– Today:
 Audiology has its own designator, the AuD,
that distinguishes who is an audiologist
 Licensure is a reality throughout the country
 Once an AuD is earned and a national exam
is passed, the privilege to practice is granted
through licensure
Certification vs Licensure
 A certificate is usually given to show the achievement
of some defined accomplishment
 A license is a legal right to practice
 In the past certification provided the right to practice
 Education incomplete upon graduation and no
licensure
 Today competence is demonstrated by Au.D. degree,
and licensure provides the right to practice
What does this mean to you?
What Does This Mean to You?
 Accreditation
 Degree
 Certification
 Licensure
Accreditation
 Competition among competing accreditors
drives standards
 Accreditation of programs becoming marketdriven
 Programs have to decide how to respond to
these effects
Degree Challenges
 Historical aspects of clinical education are
driving the current model rather than current
needs
 This causes some problems
– Barriers to recruiting and maintaining clinical
educators
– “Fourth-year”/“externship” problems
– Location of programs within institutions
Clinical Education Needs
– Audiology students need substantial clinical training to become
competent across the scope of practice
– What are the qualifications and training of clinical educators?
 Certifications, licensure, etc.
 CAPCSD, ABA
– What are barriers to recruiting the best clinical educators?
 Volunteers
 Reimbursement
 Supervisory licensure requirements
 Program certification requirements
ASHA Certification as a Credential for
Clinical Education
“Applicants for
certification must
complete a program of
study that includes
academic course work
and a minimum of 1,820
hours of supervised
clinical practicum… The
supervision must be
provided by individuals
who hold the ASHA
Certificate of Clinical
Competence (CCC) in
Audiology
CAA
Standards
CFCC
Standards
University
Standards
“The program
must ensure that
students…qualify
for state &
national
credentials…”
Therefore, the
university program is
compelled to provide
clinical education by
those who hold the
CCC-A, unless CCC-A
certification is not a
stated goal of the
program
What do Certification Requirements Mean
for Clinical Education?
2011 survey data
Responses were obtained from 35 individuals (49% response rate)
Are you concerned about maintaining or obtaining sufficient access to
quality external clinical education placements for your students in the
near future?
Have you noticed any relatively recent changes in the quantity of
external clinical education placements available to your students?
Are there external clinical placement sites that you feel would provide
fruitful learning experiences for your students, but which you do not
utilize SOLELY due to a requirement for ASHA-certification of clinical
education supervisors?
What do Certification Requirements Mean
for Clinical Education?
 “More and more audiologists are dropping the CCC, making it harder to
get our students enough hours with ASHA-certified audiologists.”
 “We lost 3 sites last semester alone one because person dropped CCC”
 “Over the past 10 years there have been fewer and fewer placements with
audiologists because they have dropped annual dues to ASHA”
 “I am using 15 sites/term, and could easily have 50 sites available if the
CCC requirement were not so restrictive”
 “Not enough sites that have audiologist with CCC within "reasonable"
driving distance. Students currently driving up to 90 miles one way to get
to sites and some are less than ideal because of practice policies or types
of services available”
“Externship Year”
– Unaligned expectations among programs, students,
and clinical educators
– Lack of guidance for students and clinical educators
– Timelines
– Payment
– Licensure
– Solutions???
 Keep an open mind to other models
Program Location
– Liberal arts/sciences/education
 Focus on academic/didactic content
 Don’t understand professional doctorate
 Ph.D. emphasis
– Medical/professional/allied health
 Focus on clinical outcomes
 Understand needs for entry-level competencies
 Professional doctorate common
Clinical Education Solutions?
 Consider other options for the fourthyear/externship experience
 Advisory Groups
– Solicit input of clinical educators
 Meaningful training of clinical educators
– CAPCSD, ABA
 Change program goals to state licensure rather
than certification
Certification
 ASHA
– General
 ABA
– General
– Specialty
Certification in Audiology
Certificate of Clinical Competence in Audiology
 Developed by ASHA/CFCC
 Requirements
• Graduating from program accredited by CAA
• Completion of 1,820 hours under supervision of CCC-A
audiologist
• Passing national exam adopted by ASHA
 Recertification requirements
• 30 hours CEUs every 3 years
• Annual recertification
Certification in Audiology
“Board” Certification in Audiology
 Developed by AAA/ABA
 Requirements
• Graduating from accredited program
• Completion of 2,000 hours under supervision of licensed or
ABA-certified audiologist
• Passing a national exam
 Recertification requirements
• 45 hours CEUs every 3 years, including
• 15 hours of Tier 1
• 3 hours in Ethics
Certification in Audiology
Specialty certification
 Developed by ABA
• Cochlear implants
• Pediatric audiology
 Other specialty certifications
Benefits & Costs of Certification
 Benefits
– Prestige & public confidence
– Employability
– Representation
 Costs
–
–
–
–
Direct financial
Potential unwanted representation
Masks the need for meaningful certificate
Potential impact on clinical education
Do Your Students Need Certification
to:
 Get licensed?
– 5 states require either ABA or ASHA
– 1 state (NM) requires ASHA
 Get a job?
– No (but some employers may require it)
 Get payment from third-party payers?
– No
 Supervise students?
– No (but some programs may require it)
Certification Solutions?
 Develop a long-term vision for board
certification
 Develop a long-term vision for specialty
recognition
Current Licensure Mandates


Your Students Must Have a License to Practice
What are the requirements for licensure in your
state and region?
 Accreditation?
 Degree?
 Certification?
 Other?
Licensure: Laws vs Rules
 Laws (Statutes)
– Passed by legislature and can
only be changed by legislature
 Rules
– Interpretations of the law
– Developed by the Board
Licensure Boards
 Board Types
– Audiology only
– Audiology & SLP
– Audiology, SLP, & Hearing Aid Dispensers
 Board Composition
–
–
–
–
–
–
Generally appointed by the governor
Audiologists
SLPs
Hearing aid dispensers
Physicians
Consumers
Aspects of Licensure
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Definition of audiology
Scope of practice for audiology
Academic requirements
Clinical education requirements
Examination
Certification
Ethical requirements
Academic Requirements
 Level of preparation
– Master’s
– Doctoral degree
 Accreditation
– Regional
– Program
Clinical Education Requirements
 Master’s degree
– Generally requires evidence of post-graduate clinical training
 Doctoral degree
– May or may not require evidence of clinical training
 In either case, may require specific breakdown of hours in certain
experience areas
 Reciprocity
– State may allow option of using ASHA- or ABA-certification requirements
as a means of documenting clinical education
– State may allow option of using licensure in another state as a means of
documenting competency.
National Examination
 Examination
– Educational Testing Service (ETS)
National Examination or
– Unspecified
 May include passing score in
licensure law or rules
National Exam Stats
Ethical Obligations
 Ethical Requirements
– States may or may not have their own code of ethics
 Failure to adhere to ethical requirements may result in a
board:
– Permanently revoking a license
– Suspending a license
– Censure or reprimand
– Limitations on license that may include:
 Peer review
 Remediation of education
– Probation
– Civil fines
Special Licensure
 Temporary licensure
 Clinical training registration
Audiology Assistants
 Educational background
 Supervision plan
Hearing Aid Dispensing
 Some states require an additional license to
dispense hearing aids
 Some states permit dispensing under audiology
license
– May or may not require additional criteria
(e.g. education, examination, etc)
 May have specific rules regarding hearing aid
sales
Continuing Education
 Hours vary (some may have none)
 May require specific content areas
 States may audit licensees
Other Licensing Issues
 Fees
 Other examination
requirements
(e.g. hearing aids,
jurisprudence, medical
errors, communicable
disease prevention)
 Citizenship requirements
 Fingerprinting,
background check
 Owing money (child
support, taxes)
 Malpractice insurance
requirements
 Displaying your license
Licensure Solutions?
 Systematically fix every state license to:
– Add AuD as the credential that defines entry-level
audiologists
– Remove or neutralize reference to certificates
– Remove or neutralize reference to specific
accreditation bodies
– Neutralize reference to national exams and scores
Conclusions
 Current state of credentialing is based on
historical context
 Credentialing is continuously evolving
 Academic programs play an important role in
decision-making regarding credentials
 Academic programs are impacted by the
credentialing decisions of consumers