CLINICAL INTERNSHIP HANDBOOK - audiology.asn.auaudiology.asn.au/public/1/files/Members only/Clinical Internship... · Audiology Australia Ltd I Suite 101, 13 Cremorne Street, Cremorne,

Audiology Australia Ltd I Suite 101, 13 Cremorne Street, Cremorne, 3121 P: 03 9940 3900 E: [email protected] W: www.audiology.asn.au

CLINICAL INTERNSHIP

HANDBOOK

Information for Clinical Interns, Supervisors

and Employers

Audiology Australia | Clinical Internship Handbook | 2

Contents ............................................................................................................................................................................................................................................... 1

CLINICAL INTERNSHIP HANDBOOK ....................................................................................................................................................................... 1

Information for Clinical Interns, Supervisors and Employers ........................................................................................................................ 1

Section 1 - Overview of the Clinical Internship Program .......................................................................................................................... 4

Clinical Internship Program Timeframe....................................................................................................................................................... 4

What is a 'Clinical Intern'? ................................................................................................................................................................................. 5

When does the Clinical Internship start? .................................................................................................................................................... 5

When does the Clinical Internship end? ..................................................................................................................................................... 6

What are Audiology Australia's supervision requirements? ............................................................................................................... 6

Types of Supervision Recognised .................................................................................................................................................................. 7

Section 2 - Audiology Australia Clinical Internship Documentation .................................................................................................... 9

Within two weeks of supervision commencement ................................................................................................................................. 9

At end of Quarters 1 and 2 ........................................................................................................................................................................... 10

At end of Quarter 3 .......................................................................................................................................................................................... 10

At end of Quarter 4 .......................................................................................................................................................................................... 10

Section 3 - Clinical Internship timeframes and Processes ..................................................................................................................... 11

Sample Time Frame ......................................................................................................................................................................................... 12

Section 4 - Information for Clinical Interns ................................................................................................................................................. 13

Responsibilities of a Clinical Intern ............................................................................................................................................................ 13

Supervision Diary Entries ............................................................................................................................................................................... 13

Knowledge & Skills Matrix ............................................................................................................................................................................ 13

Tips for Clinical Interns ................................................................................................................................................................................... 14

Section 5 - Information for Supervisors ........................................................................................................................................................ 15

Audiology Australia Requirements for Clinical Intern Supervisors: Responsibilities and Expectations: ......................... 15

Role of the Clinical Intern's Supervisor..................................................................................................................................................... 15

Characteristics of a Great Clinical Supervisor ........................................................................................................................................ 17

Programming your Clinical Intern's Development Program............................................................................................................ 18

Assessing the Abilities and Skills of the Clinical Intern ...................................................................................................................... 21

Principal and Secondary Supervisors ........................................................................................................................................................ 22

Changing Supervisor ....................................................................................................................................................................................... 23

Assessing their Competence ........................................................................................................................................................................ 23

CPD Points for Supervision ........................................................................................................................................................................... 24


Tips for Supervisors .......................................................................................................................................................................................... 24

Section 6 - Information for Employers .......................................................................................................................................................... 26

Ideas for Creating a Great Audiologist ..................................................................................................................................................... 26

Appointment programming: ........................................................................................................................................................................ 26

Support your Supervisor: ............................................................................................................................................................................... 27

Audiology Australia Clinical Internship and paperwork: ................................................................................................................... 27

Section 7 – Support during internship .......................................................................................................................................................... 28

Appendix A: Characteristics of a Great Supervisor ................................................................................................................................... 29


Section 1 - Overview of the Clinical Internship

Program The Clinical Internship aims to achieve two goals:

1. to facilitate the supervision process, so a Clinical Intern receives the appropriate level of direction, training and

support to steadily develop their clinical skills and apply the knowledge acquired in their Master of Clinical

Audiology course, and

2. to support the Supervisor to develop a structured approach to developing their Clinical Intern's skills, monitor

their progress and provide feedback.

The supervision process used in the Audiology Australia Clinical Internship program is ‘a formal process of professional

support and learning which enables the individual practitioners to develop knowledge and competence, assume

responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations’.

The Clinical Internship is a program that employs an apprenticeship style supervision for Novice/Developing, a more

collegial style preceptorship for Consolidating/Competent and allows for a mentoring relationship for the competencies

eventually assessed as Independent.

Clinical Internship Program Timeframe

• The Clinical Internship program extends over a minimum of 48 weeks EFT (equivalent full time).

• The 48 weeks includes clinical training and supervised clinical contact. This means any structured clinical training

that is provided in the early days of a Clinical Intern’s employment can be counted in the 48 weeks.

• If annual leave, extended sick leave, maternity leave, leave without pay, etc. are taken during this 48-week period,

the time taken must be recorded in the diary and added to the supervision completion date.

• The program is divided into four quarters of approximately three months each.

• The earliest commencement date for supervision of a new graduate is the first week of January.

• The earliest completion date for supervision of a new graduate is the first week of December in the same year.

See Section 3 for more detail regarding internship timeframes and processes.


What is a 'Clinical Intern'?

Only full members of Audiology Australia and student members who are transferring to full membership are eligible to

register for the Clinical Internship.

An Audiology Australia member registering for the Clinical Internship may be:

• a graduate of an Australian Masters of Clinical Audiology university program,

• an Audiologist who has lost and wants to regain their status as an Audiology Australia Accredited Audiologist -

formerly known as the Certificate of Clinical Practice (CCP), or

• an overseas trained Audiologist who has passed the Audiology Australia exam, has been offered and taken up

membership, and wishes to become an Audiology Australia Accredited Audiologist (formerly known as CCP) to

practice in Australia.

If you have any questions about your eligibility, please contact Audiology Australia.

When does the Clinical Internship start?

• If the initial Clinical Internship documentation is submitted promptly (i.e. within two weeks or ten working days

of starting your supervision), the Internship will be recorded as commencing the date supervision actually

commenced, as recorded on the registration form. Any delay submitting the paperwork will delay the Clinical

Internship commencement date.

• A graduate of an Australian Master of Audiology course can apply to commence the Clinical Internship at any

time of year BUT the earliest commencement date for supervision of a new audiology graduate is the first week

of January.

• Please note that Graduates must have finished and passed all components of their Masters course before they

can register for the Clinical Internship program.

• Audiologists who wish to regain their status as an Audiology Australia Accredited Audiologist (formerly known

as the CCP) or who have obtained their audiology qualification overseas can commence their Clinical Internship

at any time of the year.

NOTE:

The Clinical Internship is for members of Audiology Australia and as such no supervision undertaken prior to becoming

a member will be recognised retrospectively.

If you have any questions about the Clinical Internship timeframe or are a member who has previously held the CCP and

wishes to regain it, please call Audiology Australia to discuss your situation on 03 9940 3900.


When does the Clinical Internship end?

The end of the Clinical Internship is calculated as 48 weeks from commencement (accounting for any leave taken during

this time). This means if a new graduate starts work as a Clinical Intern in January, their earliest completion date is the

first week of December in the same year (i.e. 48 weeks later).

Some Clinical Interns require longer than 48 weeks to acquire the level of competence and confidence required to work

independently. The focus is on achieving this high level of competence, not time elapsed, so a Supervisor must not sign

off on their Intern’s Clinical Internship until they are satisfied that they have achieved ‘Independence’ in all of the

Knowledge and Skills Matrix (KSM) competencies listed as Priority 1 and Priority 2.

What are Audiology Australia's supervision requirements?

• Supervision in the Audiology Australia Clinical Internship program is “a formal process of professional support

and learning which enables the individual practitioners to develop knowledge and competence, assume

responsibility for their own practice and enhance consumer protection and safety of care in complex clinical

situations”.

• The level of supervision and support a Supervisor provides for different tasks should be related to their Clinical

Intern’s competency levels (as assessed and noted in their KSM).

• Clinical Interns will progress more quickly in some clinical areas – thereby requiring LESS supervision in some

KSM Clinical Elements – while requiring higher levels of oversight in others. Supervisors may wish to introduce

some Priority 2 clinical elements early if their Clinical Intern is ready to extend their skills and their clinic can

continue to offer adequate support.

• Clinical Interns should not move between the supervision levels or have standard appointment times until they

are meeting the standards for each level as specified in the Audiology Australia KSM.

• Clinical Interns must be assessed as Independent in all Priority 1 and Priority 2 clinical elements before they can

complete their Clinical Internship.

NOTE:

If a Clinical Intern is required to work remotely from their Supervisor before the end of Quarter 1, they can do so only

under the following conditions:

• They are assessed as Independent for all Priority 1 elements.

• Their Supervisor submits a Supervision Diary and KSM to Audiology Australia for review as soon as this

assessment has been determined.

• The Supervisor provides a case for why their Clinical Intern should be granted Independent status prior to the

completion of Q1.

Audiology Australia will acknowledge receipt of the documents, and the Clinical Internship Committee will review

them. Supervisors will be advised within two weeks of receipt if the documentation is satisfactory. If it is, a Clinical

Intern is allowed to work in another location with indirect supervision.


Types of Supervision Recognised

Supervision of an audiologist must entail the personal and direct involvement of the Supervisor in any and all ways

that will permit the Supervisor to attest to the adequacy of the intern's performances in the clinical training experience.

Audiology Australia prefers that supervision is carried out in-house, especially for a Clinical Intern in the early months

of their internship. However, in circumstances where this is not possible, details of the proposed supervision should be

submitted to Audiology Australia for approval. The following guidelines are provided for the advice of Clinical Interns

and their proposed supervisors, and employers.

In-house Clinical Supervision

In-house clinical supervision applies to those Clinical Interns working in the same establishment and therefore in daily

contact with their Supervisor. In-house supervision also covers circumstances where the Clinical Intern works off-site

for short periods of time to see cases such as home visits or to work in another centre for a period of time no greater

than 20% of the work week and where the case load is judged by the Supervisor to be appropriate for the Clinical

Intern without the immediate support of a more experienced audiologist.

The Supervision Agreement

A formal (i.e., written) supervision agreement helps to facilitate the negotiation of the structure and content of the 12-

month clinical development period for the Clinical Intern and is a requirement for Audiology Australia members

undertaking their Clinical Internship. The supervision agreement gives a framework against which both parties can

judge progress. It should be done as soon as the intern asks you to take on supervision of them for their Clinical

Internship. Both parties should sign the agreement and both should have copies of the agreement. The agreement

should be reviewed periodically throughout the 12 months, and at a minimum every 3 months.

Questions to be addressed when negotiating the supervision agreement include:

1. How much observation does the Clinical Intern do of other staff? What types of clients are observed? Note:

Observation and discussion of what was learned should continue throughout the 12 months, with the Clinic

Intern gradually moving into more complex areas of practice.

2. How much observation will you do of the Clinical Intern with the client? When will this occur? How will this

occur? ('at elbow' supervision, through observation mirror, video tape of client (remember to have the client

sign permission for this to occur)). How will you select clients to directly observe? Who will decide the need for

observation? Remember that the Clinical Intern is skilled to work with non-complex clients in a wide range of

areas. However, direct observation enables you to identify areas where further mentoring would benefit the

professional development of the Clinical Intern.

3. How will you interrupt a session if you feel there is need to redirect the Clinical Intern's work with a client?

4. How will feedback be given? When? Will the Clinical Intern be expected to self-evaluate? In what ways will the

Clinical Intern self-evaluate?

5. How will you provide a summative assessment to the Clinical Intern? Remember, Audiology Australia requires

the Supervisor to sign a document to indicate that the Clinical Intern is capable of competent, independent

work.

6. When and how will the Clinical Intern move on to the management of more complex clients?


Fostering clinical independence

One of the goals of the Clinical Internship year is to develop highly competent, independent clinical skills in the intern.

Unfortunately, the word ‘independence’ can convey to the Clinical Intern the impression that they should not ask

questions, should not consult their Supervisor and they should manage things on their own. As a Supervisor your role

is to encourage ‘independence’ through consultation that develops true independent competence in the Clinical

Intern. You can do this by:

1. Encouraging questions that are enquiring and challenging. Discourage questions that seek ‘the answer’.

2. Don't provide answers to questions. Instead, ask them how they might find that out? Or ask them to self-

evaluate before you discuss it.

3. Reward the Clinical Intern for consulting appropriately. Make comments that indicate you appreciate them

consulting with you about their clients.

4. Model appropriate consultation with colleagues and other professionals.


Section 2 - Audiology Australia Clinical

Internship Documentation

Within two weeks of supervision commencement

At the beginning of the first quarter (Q1) of the Clinical Internship – i.e. within 2 weeks or 10 working days after the

Clinical Intern commences their internship, please follow these steps:

Step 1. Complete Clinical Internship Registration Form

• The applicant and the Supervisor must each complete the relevant sections of this form.

Step 2. Complete Knowledge and Skills Matrix (KSM)

• This identifies the key Learning Goals which have been selected by the Supervisor as being offered to the Clinical

Intern, and then allocated a priority. The KSM includes a Learning Plan, description of the Assessment Process

and strategies to be employed to meet the Learning Goals.

• Refer to the instructions at the front of the KSM when completing this form.

Step 3. Complete Joint Supervision Agreement (JSA)

• This document confirms in writing the supervision process being implemented to support the Clinical Intern

towards competence and the ultimate goal of independent practice.

• The JSA must be signed by the Clinical Intern and their Supervisor. It must also be signed by the clinic manager

if he/she is not the Clinical Intern's Supervisor.

Step 4. POST to the Audiology Australia Office in hard copy (no faxes please)

• Clinical Internship Registration Form

• Knowledge & Skills Matrix

• Joint Supervision Agreement

Clinical Interns and Supervisors will receive a letter confirming registration and the supervision completion date within

two weeks of receipt. If you do not receive this, please contact Audiology Australia.

Step 5. Clinical Intern & Supervisor commence making entries in the Supervision Diary.


At end of Quarters 1 and 2

Within 10 working days from the end of each of the first two quarters (Q1, Q2), these two documents must be sent to

[email protected] from the Supervisor's email address:

(1) Updated KSM

(2) Supervision Diary, which will include the Supervisor Summary/Progress Report for that quarter. The Supervisor's

summary report should briefly describe how the Clinical Intern is progressing, any difficulties that may have

arisen and/or any particular successes achieved. This summary should include any relevant information not

contained in the other documents.

At end of Quarter 3

Within 10 working days from the end of the third quarter (Q3), the following documents must be sent to

[email protected] from the Supervisor's email address:

(1) Updated Knowledge & Skills Matrix

(2) Balance of Supervision Diary which includes:

a. Option A (supervision diary) or B (case studies)

b. Supervisor’s Comments

At end of Quarter 4

After a minimum of 48 weeks OR when a Clinical Intern has been assessed as capable of working as an Independent

clinician in all Priority 1 and Priority 2 elements (whichever is later), the following must be emailed to Audiology Australia

by their Supervisor:

(1) Completed Knowledge & Skills Matrix

(2) Balance of Supervision Diary which includes:

a. Option A (supervision diary) or B (case studies)

b. Intern’s Reflective Statement

c. Supervisor’s final evaluation

(3) Intern & Supervisor Declaration


Section 3 - Clinical Internship timeframes and

Processes The Clinical Internship runs over a minimum of 48 weeks. The end of the Clinical Internship should be calculated as 48

weeks from commencement (accounting for any leave taken during this time), or when the Clinical Intern is deemed

competent enough to work independently, whichever is the later date.

Assessment of the Clinical Intern will occur at the commencement of the program and at the end of each quarter.

Audiology Australia expects all relevant paperwork to reach the office within two weeks of the completion of each

quarter (i.e. 10 working days). Any delay in submitting documents may delay the completion date of the Clinical

Internship.

Audiology Australia will acknowledge that the documentation has been received.

• The Supervisor will receive an auto reply when they have submitted documents electronically. They should

forward this acknowledgement to their Clinical Intern for their records.

• When documents are posted to Audiology Australia, an acknowledgement email will be sent to the Clinical

Intern and their Supervisor within 10 working days.

• If an acknowledgement email is not received, please contact Audiology Australia to ensure the documents

arrived.

This process does not require Audiology Australia to 'sign off' on the work that has been undertaken nor is there a need

to wait for Audiology Australia approval to move on with the Clinical Internship. The Supervisor makes this decision.


Sample Time Frame

As a guide to the timeframe of the Clinical Internship program, where it starts in the first week of January

Stage of Internship What When How

Initial Clinical

Internship Paperwork

Clinical Internship Registration Form

Knowledge and Skills Matrix (KSM)

Joint Supervision Agreement (JSA).

Paperwork to arrive at

the Audiology Australia

office by mid January

Hard copy posted to

Audiology Australia

office

Quarter 1 - January to

the end of March

Supervision Diary (SD) with Supervisor's

comments & progress report Updated

Knowledge and Skills Matrix (KSM).

Submissions due by mid

April

Electronic copy -

emailed by Supervisor

Quarter 2 - April to

end of June

Supervision Diary (SD) with Supervisor's

comments & progress report. Updated

Knowledge and Skills Matrix (KSM).


July

Electronic copy -


Quarter 3 - July to the

end of September

Supervision Diary (SD) OR 2 Case Studies with

Supervisor's comments & progress report.

Updated Knowledge and Skills Matrix (KSM).


October

Electronic copy -


Quarter 4 - October

to December

Supervision Diary (SD) or 2 Case Studies with

Supervisor's final evaluation report.

Updated KSM.

Clinical Intern's reflective statement.

Audiology Australia Accredited Audiologist

Application Form.

Submissions due within

two weeks of completion

of the minimum 48

weeks of the

Internship. Please note,

this is the minimum time

frame and submissions

must not be submitted

prior to the completion

date as advised by the

Audiology Australia

office.

Electronic copy -


* See Summary of Clinical Internship Documents and Submission Dates for more information. We suggest Clinical Interns and

Supervisors print out this summary, write in the table the dates when the documents are due and keep this somewhere handy with

their other Clinical Internship documents. This does not get sent to Audiology Australia.


Section 4 - Information for Clinical Interns

Responsibilities of a Clinical Intern

Audiology Australia expects each Clinical Intern to be responsible for:

• Showing evidence of steady development of your skills, knowledge and confidence.

• Being open and responsive to feedback and direction.

• Proactively seeking information and opportunities to learn and develop, taking responsibility for your own

learning.

• Collaborating with your Supervisor about your learning needs.

• Being realistic about your abilities and limitations, and ready to ask for assistance from your Supervisor or other

experienced clinician when faced with a situation out of your range of skills.

• Openly communicating with your Supervisor and manager.

• Writing regular (three entries per week in the early weeks) entries in your Supervision Diary.

In collaboration with your Supervisor, completing Clinical Internship paperwork and ensuring all required documents

are submitted to Audiology Australia on time each quarter.

Supervision Diary Entries

As a guide, you should be writing three entries per week in the early weeks and months. The number and detail of

entries can reduce over time, to two entries per week in the second quarter and down to no less than one per week in

the latter quarters.

An example of a Supervision Diary is available on the Audiology Australia website. To view this click here or you will

find them under Clinical Internship Documents – Examples of Completed Documents - to give you an idea of the kind

of entries you (and your Supervisor) should be making.

Some entries are more detailed than others. The important thing is that your diary tells a story about your learning

and progress over time, demonstrating to Audiology Australia that you are developing your skills and becoming a

competent, confident clinician who delivers excellent audiological services to their clients.

Knowledge & Skills Matrix

The goal of the KSM is to help you and your Supervisor identify the 'core' clinical elements you can expect to be

developed in at your clinic, prioritise the focus of your training, plan your development and discuss learning strategies

that will best work for you and your Supervisor, and provide a tool to assess your progress and provide you with

feedback.

In the first and probably the second 3 months of working, the focus will be on the Priority 1 clinical elements.

As your skills develop, and as the needs of your clinic change, training in Priority 2 elements will be introduced, probably

in Q3 or Q4.

Priority 3 clinical elements are considered 'enhancements' to the Clinical Intern's development. They may not be required

for your everyday work, but they are things that you would benefit from being exposed to and having some experience

with. It is not mandatory for you to become competent in these elements before being signed off.

http://audiology.asn.au/index.cfm/members/clinical-internship/clinical-internship-documentation/


Your Supervisor is required to undertake an initial assessment of your skills and then at the end of each quarter. We

recommend you also assess your skills, independent of your Supervisor and then compare notes. Do you agree on your

competency levels? If not, why not? Why are your perceptions different? What can you do about it?

Discuss your needs with your Supervisor – maybe for more feedback, some structured learning activities, attendance at

workshops, observation of them or other clinicians, etc.

There is an example of a completed KSM on the Audiology Australia website.

Tips for Clinical Interns

The following tips were offered by former Clinical Interns and Supervisors:

• If it is not booked, ask for some 1:1 time with your Supervisor regularly.

• Ensure the process is discussed and commenced as soon as possible, that you take personal responsibility for

the Clinical Internship process & paperwork, and ask your Supervisor if not sure.

• Request 15-20 mins a couple of times a week to be blocked out for diary entries in the early weeks/months.

• If you have a shared computer drive in your workplace/organisation, store the Supervision Diary there so you

and your Supervisor can work on the same copy, and your Supervisor can easily check if you are managing to

keep it up to date.

• Be active in seeking extra experiences in your workplace.

• Your supervision diary is a great learning and feedback tool for Clinical Interns and Supervisors, especially later

in the year when the Supervisor is no longer at your elbow.

• Ask your Supervisor to check your diary regularly.

• Write down a quick note about interesting patients when you see them that will jog your memory later when

you are writing up your diary. You easily forget.

• Write down key dates (e.g. end of Q1, 2, 3, 4) in your diary so you know when to have everything in by. Each

Clinical Intern starts at a different time so you need to keep track of your own Clinical Internship.

• Read back over your diary entries from time to time, to see how far you have come.

• It does get easier with familiarity. Do not hesitate to ask questions.

• Do not rely on your Supervisor, especially for dates when things need to be submitted by.

• Have one or maximum two Supervisors as it gets confusing when you start and have everyone telling you

different things.

• Keep good clinical records.

• Take note of how your Supervisors perform tasks.


Section 5 - Information for Supervisors

Audiology Australia Requirements for Clinical Intern

Supervisors: Responsibilities and Expectations:

Audiology Australia has set the following criteria for Supervisors of Clinical Interns:

• All Supervisors of Clinical Interns must be Audiology Australia Accredited Audiologists (formerly known as the

CCP).

• Supervisors must not accept any remuneration from the clinical applicant. This does not preclude provision of

travelling expenses or of Supervisory allowances by the employing authority, where appropriate. (Refer

Audiology Australia – Code of Conduct – Standard 17).

• The supervision process used in the Audiology Australia Clinical Internship program is "a formal process of

professional support and learning which enables the individual practitioners to develop knowledge and

competence, assume responsibility for their own practice and enhance consumer protection and safety of care

in complex clinical situations".

• The Clinical Internship is a program that employs apprenticeship style supervision for Novice/Developing, a

more collegiate style preceptorship for Consolidating/Competent and allows for a mentoring relationship for

the competencies eventually assessed as Independent.

• Supervision of the Clinical Intern must entail the personal and direct involvement of the Supervisor in any and

all ways that will permit the Supervisor to attest to the adequacy of the Clinical Intern's performances in the

clinical training experience.

• Since the purpose of the Clinical Internship program is to evaluate the clinical effectiveness of the Intern, the

Supervisor should provide opportunities for the Intern to share his/her ongoing evaluation, and to discuss with

him/her any areas of deficiency, and ways in which these areas may be made good.

At the conclusion of the period of the Clinical Internship, the Supervisor is required to submit to the Membership

Committee a signed report, certifying that to the best of the Supervisor’s knowledge and belief, the Clinical Intern has

(a) met both the spirit and the letter of the Audiology Australia Clinical Internship program, and (b) has in the opinion

of the Supervisor, reached a level of professional preparation such that the Clinical Intern may be expected to perform

clinical services in audiology competently, without supervision by persons with more education and/or experience.

Role of the Clinical Intern's Supervisor

The influence of the clinical Supervisor is considerable. In most cases a Clinical Intern will be a recent graduate, but this

influence impacts on new audiology graduates as well as more experienced clinicians who do not have current clinical

certification. They will base much of their own clinical practice on your example and training.

The role of a Supervisor is to:

http://audiology.asn.au/public/1/files/Code%20of%20Conduct%2020170119.pdf

http://audiology.asn.au/public/1/files/Code%20of%20Conduct%2020170119.pdf


• Facilitate their Clinical Intern's growth and development to independent practice in a range of generic and

professional skills including professional and ethical practice, critical thinking and analysis, clinical skills and

communication (verbal and documentation).

• Model how an ethical, professional and caring clinician behaves and works with clients, focused on their clients'

outcomes and best interests.

• Model best audiology clinical practices using an evidence-based approach.

• Encourage honest self-appraisal and provide timely, constructive feedback.

• Promote necessary administrative skills, including effective record keeping and report writing.

The responsibilities of a Supervisor include:

• Discussing Audiology Australia Clinical Internship paperwork requirements and clarifying who is responsible for

doing what.

• Continually monitoring and observing their Intern's development and progress, providing the appropriate level

of supervision and guidance based on developing competence.

• The KSM is a great tool for measuring progress. Although Audiology Australia requires a report at the end of

each quarter, Supervisors should refer to it frequently in the early stages (e.g. once a week) to document the

Clinical Intern's rapid competency development, highlight issues to focus on and encourage their growth.

• Discussing cases regularly during a booked time period each week (5 hours per week is recommended by

Audiology Australia in Q1).

• Allocating appropriate time and opportunities to learn (e.g. extended appointment times in the early weeks).

• Reviewing their Clinical Intern's case notes and checking clinical reports and letters.

• Ensuring their Clinical Intern provides their Supervision Diary for sign-off - ideally three (3) times per week at

first and at least weekly later on - and writing constructive feedback in the Diary.

• In collaboration with their Clinical Intern, ensuring required Clinical Internship paperwork is completed and

posted or emailed on time to Audiology Australia.


Characteristics of a Great Clinical Supervisor

Supervisors of Clinical Interns ideally should have at least three years of clinical experience. With this level of experience,

the expectation is that you are competent and confident in the skills you are teaching and developing in your Clinical

Intern. Below are some key characteristics of a Supervisor that Clinical Interns are most likely to learn from and enjoy

working with. This list has been compiled from ideas offered by several Clinical Interns.

Patient, calm and encouraging.

Good sense of humour.

Enthusiastic about their work, helping clients and supervising a Clinical Intern.

Knowledgeable, confident and competent.

Good at explaining things in a simple, logical manner using terms they can understand.

Knows when to take over and when to leave the Intern alone.

Allows their Clinical Intern to find their own way of explaining or demonstrating things.

Does not get annoyed when a Clinical Intern asks lots of questions.

Connects well with people.

Gives constructive feedback at the right time e.g. writes notes for discussion afterward so there aren't too many

interruptions in the appointment, doesn't correct the Clinical Intern too much in front of the client, suggests

ways to improve.

Gets other clinicians involved (e.g. asks other audiologists if the Clinical Intern can sit in on some of their more

unusual clients or check out an interesting ear).

Does not undermine decisions made by the Intern.

Makes it look more like a casual ‘sit in’ on the appointment rather than watching intently everything the Clinical

Intern does.

Offers advice on whether the Clinical Intern is spending too much or too little time on certain tasks of the

appointment.

Explains why, not just how.

Consistent in their clinical practice – does not keep changing the way they do things.

Open to questions and happy to answer questions as they arise (even during appointments).

Checks what the Clinical Intern knows and what they do not know – does not make assumptions.

Provides additional information about related topics e.g. articles, websites, research papers.

Takes time to explain things and encourages discussion and reflection.

Open to feedback themselves

NOTE:

Generally, Clinical Interns do not like a Supervisor who…

Rushes the Clinical Intern.

Gets irritated if they are asked the same question several times.

Interrupts and takes over the appointment (makes Clinical Interns look and feel like a fool and a failure).

Is not prepared to do the extra work to get the best out of their Clinical Intern.

Is critical without being able to explain what went wrong or offering suggestions on how to improve.

Tries to amaze the Clinical Intern with their knowledge rather than asking their opinion.

Cuts corners, shortens appointment times and squeezes in extra clients, increasing the pressure on the Intern.

Criticises the Clinical Intern in front of clients.

Is unable to explain things in simple terms.

Is unsure of what they are talking about.

Is set in their ways of doing things.


Is cynical, short tempered, impatient.

Is arrogant and bosses the Clinical Intern around.

Tries to fit too much in the appointment so is always rushed.

How do you think you rate? Go to Appendix A for a self-assessment checklist. Print it out and examine your strengths

and weaknesses. If you are game, after a few weeks of working together, ask your Clinical Intern to assess you as well.

No-one is perfect, and often we can be blind to our areas of growth. Inviting feedback from your Clinical Intern and

being open to learning and change is also a great model for them now and in the future.

Programming your Clinical Intern's Development Program

If you have never supervised a Clinical Intern who is a recent graduate, and/or your company does not have a structured

training program, the following suggestions might be helpful.

• If you have a clinic manager, it is important that they understand and are supportive of whatever program you

design for your Clinical Intern. Discuss it before your Clinical Intern commences. Book some time in the first

week for the three of you to discuss the Clinical Intern's development program and agree on the short and long

term time and support they will need.

• On their first day or two of work, book time to sit with your Clinical Intern for establishing rapport, clarifying

expectations (e.g. workplace code of conduct, responsibilities of Clinical Intern and Supervisor), requirements of

the Audiology Australia Clinical Internship program, begin completing Audiology Australia paperwork, etc.

• During their first couple of weeks, book time for your Clinical Intern for reading workplace related documents

(policies, HR regulations and requirements, etc.) and observing you performing a range of clinical tasks (and

other clinicians if available).

• In their first 1-2 weeks, try to spend as much time as possible providing 100% 'at elbow' supervision of all your

Intern's cases. This will give you the best understanding of their strengths, weaknesses and development needs.

It will also make completing the KSM much easier.

During Quarter 1:

• Focus on the clinical elements you have identified as Priority 1 in the KSM.

• The level of supervision and support for different tasks should be related to their competency levels (as assessed

and noted in their KSM). Your Clinical Intern will need a high level of direction and support during their first

three months as they learn to apply the knowledge they acquired during their university training.

• Allow extended appointment times (maybe 25-50% longer than usual) while your Clinical Intern develops their

skills. It also allows time for instruction and discussion of issues when they arise; the best way to learn quickly.

• Ensure time is booked each week with your Clinical Intern for case discussion and feedback. A suggestion is 5

hours minimum in first few weeks, reducing over time only as their confidence and competence increases.

• You should review and co-sign 100% of your Clinical Intern's files.

• You should check all clinical reports and letters before they are sent.


• You should check all or most of their ear impressions.

• Also check completion of all important forms (e.g. Hearing Service Program claims, refit requests, etc.).

• Ensure they make regular entries in their Supervision Diary – three times per week in their first weeks, reducing

over time. Ensure you add comments as well.

• Although the KSM does not have to be submitted until the end of the quarter, refer to it often. It is an excellent

tool to monitor your Clinical Intern's progress and provide them with feedback, and the end-of-quarter

assessment will take a lot less time.

• Book time to complete the KSM assessment in the last week of Q1/first week of Q2. (Tip: Invite your Clinical

Intern to assess themselves as well, and then compare both of your assessments to see how closely you agree).

During Quarter 2:

• As your Clinical Intern's competence and confidence increases, the amount of direction they need will diminish

on their KSM Priority 1 and possibly 2 elements. They will also need less extra time to complete appointments,

and your proximity should become more distant.

• You may be adding KSM Priority 2 elements to their development activities in this quarter.

• Refer to Q1 (updated) KSM for their competency levels and adjust your supervision style according to their

competence.

• You do not have to wait until the end of the quarter to make notes in the KSM.

• Your Clinical Intern should still have a few hours of at-elbow supervision per week, focusing on skills which they

are still developing and need coaching in.

• Ensure time continues to be booked each week with your Clinical Intern for case discussion and feedback (at

least 1-2 hours).

• Review and co-sign at least 25% of your Clinical Intern's files.

• You should check most clinical reports and letters before they are sent.

• You should check most of their ear impressions.

• Check completion of all/most important forms.

• Ensure that they continue to make regular entries in their Supervision Diary, and make sure you add comments

as well.

• Book time to complete the KSM assessment in the last week of Q2/first week of Q3.

During Quarter 3:


• Early this quarter, discuss whether they wish to continue filling in their Supervision Diary or write up two case

studies. If they choose the case study option, remind them to keep an eye open for any interesting cases over

the next couple of months they could write up.

• As your Clinical Intern's competence and confidence increases, your proximity should become more distant and

amount of direction you offer should diminish. Refer to updated KSM for their competency levels. You

may/should be adding Priority 2 learning goals (skills) to their clinical experience.

• Ensure time continues to be booked each week with your Clinical Intern for case discussion and feedback (at

least 1-2 hours).

• Review and co-sign at least 10% of your Clinical Intern's files.

• Check most clinical reports and letters before they are sent.

• Check most of their ear impressions and important forms.

• Encourage them to continue to make regular entries in their Supervision Diary OR complete 2 Case Studies, and

ensure you add comments as well.

• Book time to complete the KSM assessment in the last week of Q3/first week of Q4.

During Quarter 4:

• Early this quarter, discuss whether the Clinical Intern wishes to continue filling in their Supervision Diary or write

up two case studies. If they choose the case study option, remind them to keep an eye open for any interesting

cases over the next couple of months they could write up.

• Check KSM for tasks (learning goals) that you should focus on in the last three months.

• By now your Clinical Intern should be Independent in most or all Priority 1 and 2 learning goals. Focus on any

that are not ‘Independent’ as all must be assessed as Independent before their Clinical Internship is complete

and they can become an Audiology Australia Accredited Audiologist.

• Priority 3 learning goals are considered 'enhancements' to the Clinical Intern's development, but not mandatory

for their everyday work. You may wish to work on these during this quarter.

• Still book some time each week with your Clinical Intern for case discussion and feedback.

• Review and co-sign at least 5-10% of your Clinical Intern's files.

• Check most clinical reports and letters before they are sent.

• Check some of their ear impressions and important forms.


Assessing the Abilities and Skills of the Clinical Intern

A Supervisor is responsible for mentoring and assessing a range of generic and professional skills in the intern. The

areas covered include:

Professional and Ethical Practice

A Supervisor should ensure that the Clinical Intern:

1. Practises in accordance with the profession's code of ethics and engages effectively in ethical decision-making.

2. Ensures confidentiality of information.

3. Has knowledge of and acts to ensure that rights of individual clients or client groups are not compromised.

4. Accepts accountability and responsibility for their actions in client management.

5. Recognises the limits of their own knowledge base and scope of competence and consults with an

experienced audiologist when client care requires expertise beyond their scope of competence.

6. Refers clients appropriately when the client's needs fall outside the scope of audiological practice.

Critical Thinking and Analysis

A Supervisor should ensure that the Clinical Intern:

1. Acts to enhance their professional development and self-evaluates effectively.

2. Uses the Professional Practice Standards to assess their own performance.

Clinical Skills

A Supervisor should ensure that the Clinical Intern

1. Uses a structured approach in the process of assessment.

2. Carries out tests appropriately.

3. Analyses and interprets test results accurately.

4. Formulates a plan of care in collaboration with the client.

5. Identifies expected outcomes including a time frame for achievement in collaboration with the client and

monitors these outcomes effectively.

6. Organises workload to facilitate planned care for individuals and groups.

7. Collaborates with other members of the health care team.

Communication

A Supervisor should ensure that the Clinical Intern

1. Communicates effectively with individuals and groups.

2. Ensures documentation is accurate and maintains confidentiality.

Problems with progress and outcomes in the Clinical Intern's skills

If the Supervisor has concerns about the Clinical Intern’s skill development, the Supervisor should document these

early and work with the Clinical Intern to develop a program to address these concerns. If the Clinical Intern agrees,


the Supervisor should consult with Audiology Australia about options for the Supervisor and the Clinical Intern. It is

also recommended that the Supervisor consult with the head of clinical education at the university that has graduated

the Clinical Intern. In general, the Supervisor who is not satisfied that the Clinical Intern has reached a satisfactory level

within the 12 months can recommend

1. Extension of the period of supervision and

2. Nominate specific areas to be addressed prior to the Clinical Intern applying to become an Audiology

Australia Accredited Audiologist

The Membership Committee of Audiology Australia will make a determination about the requirements for the Clinical

Intern to become an Audiology Australia Accredited Audiologist based on submissions from the Supervisor and

Clinical Intern.

Principal and Secondary Supervisors

Audiology Australia recommends that each Clinical Intern has a single Supervisor throughout their entire Clinical

Internship program. However, Audiology Australia recognises that for some workplaces this arrangement is impractical.

Generally, the following guidelines apply:

• A Principal Supervisor is nominated and assumes responsibility for the design, implementation and oversight of

the supervision requirements of the Clinical Intern.

• The Principal Supervisor needs to specify how they will monitor the Clinical Intern's development needs and

communicate with other supervisors. This should include a minimum of quarterly meetings of the Clinical Intern

and all supervisors (this can be by phone); and

• Supervision must be continuous and documented in the Clinical Internship Supervision Diary.

If it is not possible for a single supervisor to work with the Clinical Intern (e.g. if the Principal Supervisor works part-

time), then the Clinical Intern and the Principal Supervisor can apply to the Audiology Australia office for approval of a

Secondary Supervisor under the following circumstances:

• The Principal Supervisor and Secondary Supervisor keep each other updated and discuss the Clinical Intern’s

progress.

• The Principal Supervisor takes responsibility for ensuring that comments and progress reports are completed.

Note that the Secondary Supervisor may fill in the comments and progress report sections of the documentation, so

long as their entries are reviewed by the Principal Supervisor.

The Clinical Intern, Supervisor and Employer should each keep copies of the Supervision Diary and KSM. Clinical Interns

should take these documents with them if they change employers.

Multiple Principal Supervisors

If a Clinical Intern has more than one Principal Supervisor because they are working for more than one company or

organisation, each Principal Supervisor must submit a KSM and Diary each quarter.


Changing Supervisor

When there is a change of supervisor, a Change of Supervisor Notification Form must be completed and submitted to

Audiology Australia.

In addition to this form, the following documentation is to be submitted in the case of:

1. Change of Employer

a. Newly completed Joint Supervision Agreement

b. Newly completed Knowledge & Skills Matrix (including the Learning Strategies)

2. Change of Supervisor (same location)

a. New Joint Supervision Agreement (only if current JSA is not available)

3. Change of Supervisor (different location)

a. New Joint Supervision Agreement (only if current JSA is not available)

b. Amended Knowledge & skills Matrix - only if there is a need to change any element

When there is a change of Supervisor, it is important for the Clinical Intern's development that the transition to a new

Supervisor is as smooth and seamless as possible. Here are some ideas for achieving this:

• If the change happens during a quarter, complete a skills assessment and ensure the Clinical Intern has a copy

of the updated KSM to give to their new Supervisor.

• Meet with or call the new Supervisor to discuss where the Clinical Intern is up to: their strengths and areas of

development, their learning style – anything that will assist them to pick up where you are leaving off.

• Pass on any documents or notes that will assist the new Supervisor with their role.

• Check the new Supervisor is aware of their responsibilities as a Clinical Intern's Supervisor. Direct them to the

Audiology Australia website for the documentation and information they may need.

Assessing their Competence

There are a number of ways you can assess your Clinical Intern's knowledge and skills such as:

observing them working with clients.

asking questions.

reviewing their file entries and reports.

setting up clinical roleplaying to explore their understanding of and approach to a clinical situation.

completion of training modules.

participation in training events.

short quizzes and tests.

case discussion.

case presentations.

formal assessment tools.

Remember, the Clinical Internship is a minimum 48 weeks EFT – assuming no leave or extended absences occur during

this time. The focus is on COMPETENCE, not elapsed time. For a variety of reasons, some Clinical Interns will require

longer than 48 weeks before they are competent in all Priority 1 and 2 clinical elements in the KSM. You must not sign


off their paperwork until you are completely satisfied that they are ready, competent and confident to work

independently in all Priority 1 and 2 elements.

CPD Points for Supervision

Supervisors may claim CPD points for their work with a Clinical Intern. Points will be accrued at 2.5 points per quarter.

Tips for Supervisors

The following tips were offered by former Clinical Interns and Supervisors.

Keep daily notes to help with the diary entries.

Make sure you check your Clinical Intern's Supervision Diary on a regular basis.

Book regular 1:1 time with your Clinical Intern.

Ensure that you understand the Audiology Australia paperwork and process for the Clinical Internship and be

ready to discuss this with the Clinical Intern on commencement.

If you have a clinic/hearing centre manager, discuss your Clinical Intern's training and supervision needs early

with them, preferably before your Clinical Intern commences. Ensure you have their full support in the short and

longer term, as your Clinical Intern will need time to develop their skills (extended appointment times important

in early stages), discuss cases and complete the Audiology Australia paperwork.

Ensure the paperwork is up to date and submitted on time as it affects how quickly Clinical Interns can get their

QP number (and possibly a pay rise).

Actively seek opportunities for expanding the perspective of Clinical Interns.

Involve other clinicians in your Clinical Intern's learning experience. For example:

• If they have an interesting case, invite the Clinical Intern to sit in on the appointment.

• Involve other clinicians in case discussions about a tricky client to get broader ideas and experience.

• Book the Clinical Intern to sit in with all other clinicians if possible. They will learn a lot from watching what

and how other audiologists work.

Make sure you are well prepared and have a good understanding of all the Audiology Australia documents e.g.

put everything into a folder and work out what you have to do for each quarter.

Write down key dates to match Clinical Interns. Put your quarterly reminders into your email calendar.

Encourage open dialogue as it is a very steep learning curve juggling the Hearing Services Program, technology

and best practice.

Provide your Clinical Intern with proper support and clinical training.

It is sometimes good to step aside, challenge the Clinical Intern and throw them in the deep end. I know for me,

I began to surprise myself, I learnt quicker and faster from my mistakes, and had to step up a fair bit in the

process. It was certainly a good learning experience for me.

Three years’ experience is required for Supervisors. If this is not feasible, a senior audiologist should be

appointed as a Secondary Supervisor and communicate with the Clinical Intern at least once a month.

Sit down regularly with your Clinical Intern to discuss their progress and the Clinical Internship documents. Do

not just quickly do it so the documents are in on time and leave your Clinical Intern with no review of information

or document content.

Remember that you were once a Clinical Intern too.

Initially limit the number of Supervisors to one or two as it gets confusing when Clinical Interns have everyone

telling them different things.

Ensure you know what needs to be completed and when.

Do not assume anything! Many problems can be avoided by setting the ground rules and expectations early,

and ensuring you share a common understanding about what will happen.


"A supervisor gains respect through

honest, clear, direct self-expression - the

assertive approach to communication."

Burley-Allen - Managing Assertively


Section 6 - Information for Employers Graduate audiologists leave their university course full of enthusiasm, knowledge and a desire to apply that knowledge

in the real world with real clients. Their course covers a diverse range of topics and in various depths. The number of

practical clinical hours they do is considerable, but still only enough to introduce them to the complexities of working

in an audiology clinic and dealing with diverse personalities, experiences and motivations–in their work colleagues as

well as clients!

So what is your role in creating an audiologist who will deal with each client with care and skill and achieve excellent

outcomes for your clients and your clinic/business?

Ideas for Creating a Great Audiologist

There are a number of ways you can help create an audiologist who will deliver excellent service to your clients.

• If possible, allocate a Supervisor for your new Clinical Intern that is experienced, patient, competent, a good

teacher, and who is keen to undertake this important role.

• Before your Clinical Intern commences work, meet with the Supervisor to discuss and design a development

program that will help the Clinical Intern learn and grow effectively and efficiently.

• Make sure you are familiar with the requirements of the Audiology Australia Clinical Internship and the

implications for both your Intern and Supervisor.

• Use the Audiology Australia Clinical Internship documents as tools to help you develop a structured training

program for the Intern and keep check on their progress.

Appointment programming:

• The Supervisor is required to assess their Clinical Intern's competence against a number of clinical elements in

the KSM. The easiest way for them to do this – and to understand their Clinical Intern's strengths and weaknesses

- is to work alongside them for the first 3-5 days.

• Book extended appointment times in the early weeks for your Clinical Intern to gradually improve their ability

to do the myriad clinical tasks each interaction involves. As a guide, allow 25-50% extra time for each

appointment for the first month at least, depending on the competence of your Clinical Intern. The return on

this time investment in the early days can be considerable as the Clinical Intern has time to be taught and receive

immediate feedback and direction from their Supervisor. They will more quickly increase their speed and

confidence, meaning more satisfied clients, better outcomes and improved throughput sooner.

• Time should also be booked for the Intern and Supervisor to discuss the day's cases. In the first weeks, the

recommendation is 30 minutes per day. This can reduce as the Clinical Intern's competence and confidence

increases, but some time every week or two should be booked with the Supervisor until the end of the Clinical

Internship.


Support your Supervisor:

• Supervising a Clinical Intern can be very rewarding, but also very demanding, tiring and stressful. Regularly check

your Supervisor is managing their role and offer whatever support you can.

• It may help to occasionally share the supervision load with another willing clinician in your clinic or company, if

one is available.

• Keep the lines of communication open with their Supervisor. Check on their progress and whether amendments

need to be made to the development program you agreed to initially.

• If possible, provide an independent person for Clinical Interns to contact with any issues they may feel

uncomfortable discussing with their Supervisor. Of course, Audiology Australia staff are always ready to offer

help and advice.

Audiology Australia Clinical Internship and paperwork:

• Please allow time for the Clinical Intern to fill out their Supervision Diary, particularly in the early days when

three entries per week are required (10-15 mins a day should be enough).

• Their Supervisor will also need time allocated during each week to add comments to the Diary as well as review

the Intern's files (they must sign off every entry), reports and letters. 1-2 hours a week would be ideal, but

depends on the clinic and Clinical Intern.

• Although the Audiology Australia Clinical Internship is nominally a 48-week program, the focus is on

COMPETENCE, not time elapsed in their job. Supervisors are instructed to not sign off their Intern's

documentation unless they are entirely satisfied that the Clinical Intern is fully competent and confident and

ready to work independently.

Refer to ‘Programming your Clinical Intern’s development program’ in Section 5 for more ideas and information.


Section 7 – Support during internship If you have any questions and/or need support, contact

Audiology Australia

Suite 101, 13 Cremorne Street, Cremorne, Vic 3121

Telephone: +61 3 9940 3900

Email address for submission of Clinical Internship documents: [email protected]

Email address for other enquiries: [email protected]


Appendix A: Characteristics of a Great

Supervisor How do you think you rate?

Below are 25 characteristics of a Supervisor who is most likely to create a positive learning environment and be

effective in helping their Clinical Intern develop into a competent, confident audiologist.

• Rate yourself against each item. Be as honest as you can. Look at your areas of weakness and see what you

can do to improve your approach.

• In a couple of months, consider giving this sheet to your Clinical Intern and ask them to rate you as well to

check your perceptions. If you are open to their feedback, they are more likely to be open to yours.

Characteristics of a great supervisor…

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1. Is patient and calm

2. Has a good sense of humour

3. Takes time to explain things and can do it in a way the

intern can understand.

4. Knows when the Clinical Intern is out of their depth and

when to take over.

5. Is open to questions and happy to answer questions as they

arise, does not get annoyed when Clinical Intern asks lots of

questions.

6. Is encouraging (even when the Clinical Intern makes a

mistake).

7. Writes notes for discussion afterward so there are not too

many interruptions in the appointment.

8. Suggests ways to improve.

9. Is knowledgeable and up to date.

10. Is consistent in their clinical practice-does not keep changing

the way they do things.

11. Explains why not just how.

12. Able to ‘connect’ with Clinical Intern and clients.

13. Gives constructive feedback

http://audiology.asn.au/public/1/files/Application%20Forms/Clinical%20Internship/APPENDIX_A_ClinicalInternship.pdf

http://audiology.asn.au/public/1/files/Application%20Forms/Clinical%20Internship/APPENDIX_A_ClinicalInternship.pdf


Characteristics of a great supervisor…

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14. Is enthusiastic and positive about their work.

15. Wants to supervise the Clinical Intern.

16. Genuinely interested in the Clinical Intern.

17. Is able to realise when the Clinical Intern does not quite get

it.

18. Gives the Clinical Intern a chance before they interject- lets

them find their own way of explaining or demonstrating

things to the client.

19. Confident in their own ability and the ability of the Clinical

Intern.

20. Does not correct the Clinical Intern in front of the client.

21. Makes it look like an informal “sit in” on an appointment

rather than a “tester”.

22. Offers advice about how to spend time on tasks in

appointments (too little, too much).

23. Checks what the Clinical Intern knows and what they do not-

does not make assumptions.

24. Provides articles and written information to help the Clinical

Intern learn.

25. Ensures there is time for questions, discussion and reflection.