Tinnitus qualifications

[lux]

Does anyone know if the B.Sc Audiology degree allows graduates to become a Hearing Therapist or a Tinnitus therapist or is futher trainning needed?

[RiderFan]

Maybe I'm missing something in the overseas translation, but is it not a requirement to be Masters of Audiology in your country? And if you have your Masters, why would you want to call yourself something other than audiologist. I have not heard of hearing therapist or tinnitus therapist. As audiologists I believe we are the professionals that would be the most qualified to be working with tinnitus patients. Is tinnitus therapist a protected title like audiologist is? If not, what would be stopping anyone from calling themself a tinnitus therapist? I guess I don't understand what the basis for your question is. Are their individuals in your country calling themselves tinnitus therapists? If so, they shouldn't be misinforming the general public that they have the background knowledge of the auditory system to be able to manage an auditory system based problem?

[mancie]

Hi RiderFan you have indeed missed the point a little bit. Things have changed a lot in the UK over the last couple of years. Let me fill you in.

I think Lux's question was probably around competence to practice certain clinics and procedures.

There is NO requirement to have an MSC in the UK. In fact the qualification route is now a 4 year BSC (three years uni (including clinical placements) + 1 full year clinical training).

I think audiologist is a protected title as is audiological scientist. One means BAAT (old training route) or BSC and the other is an MSC + clinical training. So before the BSC started the training routes were BAAT for audiologist or MSC + CAC for audiological scientist. BAAT audiologists do further post qualification training to do vestibular and paediatric work.

Audiological Scientists are registered with the HPC, audiologists are registered with the RCCP but this is still currently a voluntary register but is soon to also come under the HPC.

The main reason for the clinical differences is that the MSC students complete a CAC whereas the BSC complete a CCC. These are the clinical parts of the courses, the CAC has to be done after the 1 year MSC, whereas the CCC is included inside the 4 year BSC. The MSC is a conversion course from a science first degree whereas the BSC is a full degree in audiology.

The CAC more extensively tests your clinical work in paediatrics and vestibular work. The CCC (done in the BSC) doesn't require you to be able to do vestibular or paediatric (infant age) on your own. You mearly have to be competent in assisting in vestibular and paeds, whereas the CAC has practical exams in these two areas. The CCC practically examines you in many areas and has a log book for many different tests/clinics etc. The paediatrics and vestibular is mostly all assist level competency signatures.

At the moment there are only two years worth of BSC graduates in audiology as the BSC is quite new. I don't think anyone really knows exactly what the BSC scope of practice actually is. I know new BSC graduates doing paediatric and or vestibular work but probably not on their own to start with. The whole thing is changing again when another qualification (two year foundation degree) comes on line.

BSC audiology does contain a great deal of skills training needed for things like tinnitus therapy and hearing therapy. I suspect that the MSC course may not actually cover these counselling skills in as much depth?

In the UK there was a separate hearing therapy course, (not sure if this was a protected title or not). I've not personally heard of anyone calling themselves tinnitus therapists specifically, but I do know that generally there are tinnitus specialists in many UK NHS audiology departments who have done extra training on tinnitus.

Tinnitus was covered extensively in the BSC. In an advanced studies topic etc etc. However, I wouldn't call myself a tinnitus expert. I've never actually done seen a full tinnitus assesment/therapy patient journey on my own but I have experience of this in my training observing others. I suspect this is where Lux's question originates from, there is no "competency" signature for tinnitus work in the BSC. I don't think there is for the MSC either?

I think the answer from the BAA (British Academy of Audiology) about if the BSC qualifies you for a "hearing therapy" role was that is is up to the individual heads of departments to decide if you a competent or not. I suppose this is all covered under the NHS clinical governance rules.

I hope that fills you in a bit.

[mancie]

I should also point out that you still can do the MSC + CAC route in the UK. I heard rumours that the CAC was going to stop meaning MSC + CCC and then further advanted modules for paediatric and vestibular work.

However, this hasn't happened yet and I don't know any more on this. There are other people on this board who are more qualified to speak on this.

[RiderFan]

Yes, thanks that helps to fill me in. It just seems strange from the outside looking in that their isn't a standardized qualification process that would entitle and educate all those working in this hearing health field (am I allowed to say audiology?) to the same level of competence. Sounds to me though from Guy's response to my similar question in another thread that this is changing, with consideration of a doctorate even. I think that's positive. I would imagine there are varied opinions about that over there in the U.K. though? By the way, about two years ago now I was considering coming over and working there for a couple of years while leaving the previous private clinic I worked at before opening my own. I find it interesting to hear what others like myself are doing in other parts of the world.

[lux]

Thanks for the answer Mancie. It is quite unclear what the scope of practice for a B.Sc. graduate is when it comes to outside Adult Rehab. From what I understand the Hearing Therapy (HT) trainning course has already stoped so I am assuming B.Sc. will be the only way that HT can come from. It would be a shame that the B.Sc. graduates are only restricted to HA fittings and hearing tests.

[Maz]

i think it would be a big shame if after doing a 4 year long BSc course all we could is be a hearing aid dispensor...it would be nice to be able to do abit of hearing therapy as well.

[brightspark @]

i think it would be a big shame if after doing a 4 year long BSc course all we could is be a hearing aid dispensor...it would be nice to be able to do abit of hearing therapy as well.

That would be a terrible thing wouldn't it? Fitting your patients' choice, top quality hearing instruments in your own dispensing practice with the best equipment commercially available. AND able to offer a standard of aftercare that the patient wants.

Glass half full or glass half empty ?

[sue]

Hi,
There is no way to train as a Hearing Therapist in the U.K. anymore we are all audiologists under the skin now
The idea is that a BSc graduate would use the Higher Training Scheme and post graduate study courses to specialise in the area/areas they are interested in. This may or may not involve an MSc such as the Rehabilitation MSc at Aston university. It may also involve individual modules at M level rather than a full MSc. Tinnitus therapy has been classified as a higher skill level that should be undertaken by experienced audiologists and is therefore not really in the scope of practice of a new BSc graduate.
I hope this helps

[mancie]

In my humble opinion. The BSC Audiology course at Manchester university (don't know about the others), extensively includes a lot of theory in tinnitus and rehab, and we do a short externally run counselling course as part of a larger rehab module. I know that the BSC graduates may be exempt from some of the theory side of M level modules for example paediatric and vestibular theory). I don't know if this could also apply to rehab/tinnitus work since the BSC is supposed to cover this really isn't it?

However, since the rehab and tinnitus side is not compulsory on the CCC log book it isn't a skill that we have officially been practically examined in. Therefore most people won't have much practical experience in tinnitus work for example. In that sense BSC graduates are a sue says not really able to immediately run tinnitus clinics for example. However, I think with a bit of post qualification supervised experience we could easily and quickly get up to speed on this. I guess the problem is finding a department that wants to hold your hand whilst you gain this experience.

Also, the way audiology services are going "one stop shop" hearing aid assessment and open fitting appointments I suspect that there isn't the demand for this kind of work?

There are some crazy things going on too. For example where I work, if during the course of the hearing aid route we discover the patient needs some tinnitus therapy. Instead of just directly referring the patient to the audiologist in the department who runs the tinnitus clinic, you have to send the patient back to their GP to be referred to ENT, who refers them back to the person in the office next to you. Net result, they probably never get to see the very person who can help them the most. Very inefficient use of a GP and ENT consultants time too! (unless of course there is some other referable reason).

[sue]

personally as an Audiologist and Hearing Therapist I think it was very wrong that more tinnitus and adult rehabilitation work was not included in all the BSc courses. This appeared to back the governments need at the time to have more unqualified people fitting adult hearing aids rather than a need for well rounded graduates, and allowed Assistant practitioner level to be acceptable for adult services - (very much my own opinion)
I do think if tinnitus is an area that interests you it will not be hard to find ways to get experience and build on any existing knowledge.

Tinnitus clinics will become very much a specialised service in the future as hearing aid services are provided in more streamlined ways.
Although Hearing Therapy qualified as an independent sector provider I offer only basic tinnitus advice within the confines of a fitting and assessment appointment and refer on as my funding does not cover the additional time I need to give appropriate support to a tinnitus patient.
The reason you have to refer back to GP is a funding issue and paying for a hearing aid service of 2/3 appointments but getting an extensive tinnitus one would not be in the spirit of payment by results we are now working towards. Each patient journey requires specific GP funding - but the patient should not see that process it should be seamless at the point of delivery in an ideal world

[Maz]

That would be a terrible thing wouldn't it? Fitting your patients' choice, top quality hearing instruments in your own dispensing practice with the best equipment commercially available. AND able to offer a standard of aftercare that the patient wants.

Glass half full or glass half empty ?

Glass is very full when you look at it like that!

[brightspark @]

Glass is very full when you look at it like that!

Forgive the facetiousness of the earlier post but it's a bit of a simplification to say that 'just fitting hearing-aids' isn't that appealing. I'd agree with you, if you thought that churning out instruments to patients was the norm, but things are very different in independent practice.

I'm not saying for a minute that it's all fantastically interesting and you never have a bad day, but there's a bit more to it when you are dealing with five or six different suppliers: each with their own range of models.

At the top of the scale, Adam Schulberg at Cubex in New Cavendish Street recently fitted an Epoq system to Rocco Forte. At the other end I fit a variety of RITE/RIC models to my clients. You could sit anywhere in that scale and enjoy your own challenges and opportunities.

Make the most of what you have

[lux]

Maybe Sue can help with this question. Does anyone know that the B.Sc covers the pre-requisits for the tinnitus module? I've checked on the BAA websites and its not entirely clear on whether it does or not. I would be grateful for any responses.

[RiderFan]

I think there can be a demand for the audiologist to have the therapy available for both hearing and tinnitus. At least I should believe this because this is how I built my clinic. Eastside Audiology and Rehabilitation inc. Note the acronym.

I do provide TRT and dispense hearing aids both and my process runs quite smoothly. I think the process can seem a little disjointed (is that a word) when it is a patient with hearing loss and tinnitus if the therapy is not in the same setting. A hospital in a northern city in my province offers TRT, but when the hearing aid or sound generator or tinnitus instrument needs to be fit, they must go to a dispensing clinic to get that done.

Having to get another referral to get that TRT done when it is someone within the same clinic must be quite annoying. One thing that we are trying to accomplish in this province is that referrals to ENTs can come directly from the audiologist, and not have to go to the GP first. Perhaps something like that could save one step.