The Certificate of Clinical Practice is recognised by the Audiological Society of Australia (ASA) as the benchmark for undertaking the clinical practice of audiology in Australia. Only Full Members or Fellows may hold a Certificate of Clinical Practice. The Certificate of Clinical Practice is valid for 2 years from the date of issue. The date of validity of the CCP is clearly printed on the certificate. Renewal of the Certificate of Clinical Practice is based on you remaining a financial Full Member or Fellow of the ASA and meeting the ASA's Continuing Professional Development (CPD) requirements which include

• Working in audiology for the equivalent of 12 weeks fulltime during the preceding 12 months or an average of 6 hours/week over this time, and
  
• Completing the CPD point requirements of 50 hours professional development over the 2 years

To obtain the CCP, a Full Member must participate in a supervised 12-month equivalent full-time clinical practicum. This is called a (Graduate) Clinical Internship ((G)CI). Supervision must be carried out by a Full Member or Fellow Member of ASA who holds a current CCP. As such, the shortest period required for an Australian graduate to achieve Full Member status and be awarded the CCP would be 12 months from the date of their graduation and award of the Master of Audiology degree. The ASA recognises the Certificate of Clinical Practice as the benchmark for clinical practice in Audiology in Australia.

Required Procedures for ALL Applicants for (Graduate) Clinical Internship ((G)CI)

In addition to and separate from standards required for Full Members of the ASA, a (Graduate) Clinical Internship is in operation. This is a 12-month program and is available upon application to all Full Members of the ASA who can demonstrate appropriate professional preparation and supervision that meet the requirements as laid down by ASA. Once a (G)CI has been completed satisfactorily, a Certificate of Clinical Practice can be awarded.

1. You may submit an application for participation in the (G)CI at the same time as you submit an application for Full Membership. You need to complete a "(G)CI Program Application and Approval Form" (Form A).
   
   
2. The (G)CI applicant needs to be employed in an audiology clinic, with a supervisor who is a Full Member of ASA and who holds a current CCP. It is the responsibility of the applicant to obtain the agreement of an audiologist holding a CCP to act as their supervisor.
   
   
3. To ensure that the (G)CI program of clinical supervision provided to applicants meets the expectations of all stakeholders, applicants wishing to undertake a (G)CI program leading to award of the ASA Certificate of Clinical Practice MUST register their program with the ASA Office at its commencement. This registration will specify the details of the Supervisor, and the program of supervisory activities to be undertaken. The (G)CI Program Application and Approval Form (Form A) must be signed by the Member and Supervisor.
   
   
4. On completion of the (G)CI, the Intern and their Supervisor must sign a "Certificate of Clinical Practice Award Application Form" (Form B) declaring that the (G)CI, as registered with the ASA, has been duly and fully completed and that the applicant has attained the required standards of clinical practice.
   
   
5. Upon satisfactory completion of all requirements for the clinical certification program the applicant will be awarded a CCP provided they are a current Full and financial member of the Society.
   
   
6. After the applicant has been awarded the CCP they will be enrolled in the Society's Continuing Professional Development program and will be advised by the Society of the requirements of this program.

Requirements for Clinical Supervisors of (Graduate) Clinical Interns

• All clinical supervisors must be holders of a current Certificate of Clinical Practice.
  
  
• 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.
  
  
• Supervision of an audiologist must entail the personal and direct involvement of the supervisor in any and all ways that will permit him/her to attest to the adequacy of the Intern's performances during the internship. Knowledge of the intern's clinical work may be obtained in a variety of ways such as direct observation, clinical conferences, written reports, staff meetings, and discussions with other persons who have participated in the intern's clinical training. It is expected that the supervisor will use a range of these methods to mentor the clinical development of the intern.
  
• Since the purpose of the (G)CI program is to evaluate the clinical effectiveness of the intern, the supervisor must provide opportunities for the applicant to share his/her ongoing evaluation, and to discuss with him/her any areas of deficiency, and ways in which these areas may be improved.
  
  
• At the conclusion of the 12-month equivalent full-time internship, the supervisor will be required to submit to the Membership Committee
  
  
  • A signed report, certifying that to the best of his/her knowledge and belief, the intern has met both the spirit and the letter of the ASA's (G)CI program, and has in the opinion of the supervisor, reached a level of professional practice such that s/he may be expected to perform clinical services in audiology competently, without supervision by persons with more education and/or experience.
    
    
  • A copy of the supervision diary, detailing the nature of the supervision and the times spent in supervisory processes.

Types of Supervision Recognised for the CCP

Supervision of an audiologist must entail the personal and direct involvement of the supervisor in any and all ways that will permit him/her to attest to the adequacy of the intern's performances in the clinical training experience. ASA prefers that supervision is carried out in-house, especially for an 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 the ASA for approval. The following guidelines are provided for the advice of interns and their proposed supervisors, and employers.

In-house Clinical Supervision

In-house clinical supervision applies to those interns working in the same establishment and therefore in daily contact with their supervisor. In-house supervision also covers circumstances where the 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 intern without the immediate support of a more experienced audiologist.

Remote Clinical Supervision

Remote clinical supervision applies when an intern is working in a different clinic to the supervisor. The ASA may approve remote supervision under exceptional circumstances. The ASA classifies supervision as remote if the supervisor and the intern are not working in the same clinic for a minimum of 20% of the intern's work time. Where an intern proposing remote supervision, it is the responsibility of the supervisor and the intern to provide details to the Society regarding:

1. The precise nature of the supervision proposed.
   
   
2. The procedures by which the supervisor will obtain sufficient knowledge of the intern's clinical knowledge, skills and abilities to meet the Society's requirements for demonstrated professional competency.
   
   
3. Reasons why on-site supervision cannot be met.
   
   
4. The duration of the proposed remote supervision and when it will occur in the (G)CI year.
   
   
5. Procedures available to ensure appropriate professional development support for the intern.
   

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 intern and is a requirement for ASA members undertaking their (G)CI. 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 (G)CI. 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 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 intern gradually moving into more complex areas of practice.
   
   
2. How much observation will you do of the 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 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 intern.
   
   
3. How will you interrupt a session if you feel there is need to redirect the intern's work with a client?
   
   
4. How will feedback be given? When? Will the intern be expected to self-evaluate? In what ways will the intern self-evaluate?
   
   
5. How will you provide a summative assessment to the intern? Remember, the ASA requires the supervisor to sign a document to indicate that the intern is capable of competent, independent work.
   
   
6. When and how will the intern move on to the management of more complex clients?
   

Fostering clinical independence

One of the goals of the (G)CI year is to develop highly competent, independent clinical skills in the intern. Unfortunately, the word "independence" can convey to the 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 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 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.

Assessing the Abilities and Skills of the (Graduate) 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 intern

• Practises in accordance with the profession's code of ethics and engages effectively in ethical decision-making.
  
• Ensures confidentiality of information.
  
• Has knowledge of and acts to ensure that rights of individual clients or client groups are not compromised.
  
• Accepts accountability and responsibility for their actions in client management.
  
• 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.
  
• 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 intern

• Acts to enhance their professional development and self-evaluates effectively.
• Uses the Professional Standards of Practice to assess their own performance.

Clinical Skills

A supervisor should ensure that the intern

• Uses a structured approach in the process of assessment.
  
• Carries out tests appropriately.
  
• Analyses and interprets test results accurately.
  
• Formulates a plan of care in collaboration with the client.
  
• Identifies expected outcomes including a time frame for achievement in collaboration with the client and monitors these outcomes effectively.
  
• Organises workload to facilitate planned care for individuals and groups.
  
• Collaborates with other members of the health care team.

Communication

A supervisor should ensure that the intern

• Communicates effectively with individuals and groups.
  
• Ensures documentation is accurate and maintains confidentiality.

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

If the supervisor has concerns about the intern's skill development the supervisor should document these early and work with the intern to develop a program to address these concerns. If the intern agrees, the supervisor should consult with the ASA (Membership Portfolio Chair) about options for him/her and the intern. It is also recommended that the supervisor consult with the head of clinical education at the university that has graduated the intern. In general, the supervisor who is not satisfied that the 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 CCP being granted
    

The Membership Committee of the ASA will make a determination about the requirements for the intern to be granted a CCP based on submissions from the supervisor and intern.

What are the Expected Competencies of a New Graduate in Audiology?

The university programs and the ASA have developed the following Position Statement to describe the abilities of a new graduate at the beginning of their professional practice of audiology. This document describes the areas in which a graduate may be expected to carry out work with some autonomy, and the role of the supervisor is to develop and mentor these skills through review and feedback. These guidelines are provided as information to employers to ensure that they provide an appropriate environment for the employment of new graduate audiologists.

Audiological education in Australia has the following aims:

• To produce a graduate with the knowledge, skills and attitudes to be a competent beginning practitioner of clinical audiology .
• To produce a health professional who is familiar with general issues relating to health care and education for special groups .
• To produce a graduate who can function effectively in a range of health care settings, both metropolitan and rural, including practising audiology with minority and disadvantaged groups .
• To produce a graduate with skills in acquiring and appraising scientific and clinical information and foster an attitude towards the maintenance of professional currency which will assist their further professional development.

Abilities of New Graduates

The following abilities apply to a new graduate

• From a Master's program in audiology at an Australian university.
  
• Taking up a first position in clinical audiology (working under supervision).

The core abilities should be seen as applying to non-complex cases in generalist clinics.

Core Abilities of New Graduates:

Theoretical Knowledge Abilities

1. Auditory pathology
   Graduates should be able to identify and describe conditions that cause hearing loss, tinnitus, vertigo, ear pain or discharge, and other auditory symptoms. They should be able to relate this knowledge to a client's audiological history and findings and identify situations where urgent medical follow-up is required.
   
   
2. Acoustics and instrumentation
   Graduates should have a working knowledge of the physics of sound transmission and measurement and instrument calibration and should know where to find appropriate acoustical standards.
   
   
3. Auditory physiology
   Graduates should be able to describe and explain the anatomy and physiology of the auditory system and auditory neural pathways.
   
   
4. Psychoacoustics and psychology
   Graduates should be able to describe and explain the processing skills of the normal auditory system and relate these to known physiological mechanisms.
   
   
5. Tests and measurement
   Graduates should also be able to select and evaluate audiometric test procedures according to the basic principles of test development and selection (e.g. reliability, sensitivity, etc.).
   
   
6. Speech, language and communication
   Graduates should have a working knowledge of acoustic phonetics, language development, audio-visual speech reception, and speech production. They should be able to apply this information to assess or estimate the impact of hearing loss upon the perception and production of speech, and upon language development.
   
   
7. Medical background for audiology
   Graduates should be able to identify and describe the basic principles underlying otological conditions, such as the effects of ototoxic agents, the pathology and natural history of infectious disease, basic genetics, and embryological development of the auditory system. They should also be able to describe some common treatable conditions affecting the auditory system and the usual medical or surgical interventions for these.
   
   
8. Critical literature review skills
   Graduates should be able to evaluate research studies in audiology and related fields and assess their scientific merit and applicability to clinical practice.
   
   
9. Professional practice
   Graduates should demonstrate knowledge of the ethical practice of audiology and be familiar with the codes of ethics of the relevant professional associations. Graduates should also be familiar with the broad areas of expertise and practice of other health and related professionals - e.g. speech pathologists, general and specialist medical practitioners, clinical psychologists, occupational therapists, special education teachers - sufficient to refer their clients appropriately to these professionals.
   

Core Abilities of New Graduates:

Theoretical knowledge and demonstrated clinical competence sufficient for independent application to a non-complex case load.

1. Hearing aids
   Graduates should be able to recommend, fit and evaluate appropriate amplification and monitor and document outcomes. It is expected that they should be able to take into account factors including the type and degree of hearing loss, use appropriate prescriptive techniques and modify their approach according to client variables such as age and communication needs.
   
   
2. Diagnostic audiology and otoscopy
   Graduates should be able to recognise the presence of conditions of the external ear preventing accurate threshold audiometry and refer appropriately for management. Graduates should be able to obtain accurate pure tone air and bone conduction thresholds, using appropriate masking techniques, for most hearing loss configurations. They should be able to take account of subject variables, such as age, motivation, tinnitus, and intellectual ability, and modify or simplify procedures in an appropriate way. They should also be aware of tester variables, which could affect results, such as rate of presentation and additional cues, and be able to modify their technique when necessary. They should be aware of the effects of calibration errors and be able to take account of such errors with unfamiliar equipment. They should be able to practise identification audiometry according to the principles of screening.
   
   
3. Paediatric audiometry
   Graduates should be able to select and/or modify procedures for the assessment of hearing thresholds in children of all ages; carry out these procedures in children over three years, developmentally, in a manner likely to obtain accurate results; interpret results appropriately, and recommend follow-up assessment that is likely to provide accurate diagnosis of hearing loss as early as possible.
   
   
4. Impedance (immittance) audiometry
   Graduates should be able to recognise conditions of the external ear and canal preventing tympanometry and refer appropriately for management. Graduates should be able to obtain accurate tympanometry and acoustic reflex results under most clinical conditions with all age groups. They should be able to assess impedance results against audiometric findings and evaluate their consistency.
   
   
5. Speech audiometry
   Graduates should be able to select appropriate speech audiometry measures for clients and carry out such testing in a manner likely to give reliable results. They should be able to assess speech results against audiometric findings and evaluate their consistency.
   
   
6. Evoked potential testing
   Graduates should be able to recommend the use of suitable evoked potential testing in the diagnosis of hearing loss (e.g. ABR, ERA, ECochG). In particular, the applications of Auditory Brainstem Response (ABR) audiometry to identifying retrocochlear pathology and to the assessment of hearing in infants and other difficult-to-test clients should be thoroughly understood. Graduates should be able to carry out ABR assessment, interpret results appropriately and integrate these with other audiological findings.
   
   
7. Integration of audiological results
   Graduates should be able to form reasonable conclusions about the likely type and site of pathology in patients with auditory symptoms based on case history and interview, behavioural audiometric information and electrophysiological measures. In particular, graduates should be able to analyse the results for consistency and recommend further action that is likely to resolve inconsistencies. They should also be able to evaluate results to recommend medical and/or other follow up.
   
   Graduates should be able to produce clear and concise reports on audiological findings and their interpretation for clients, parents, and other health and education professionals, and to write clear and concise referrals to other professionals.
   
   
8. Communication assessment and intervention
   Graduates should be able to assess a client's communication needs and formulate an appropriate management plan. Graduates should be able to provide basic advice on hearing re/habilitation options and services to the client and relevant others.
   
   
9. Informational counselling
   Graduates should demonstrate the basic communication skills required to impart useful information about audiological results and management to clients.
   
   
10. Standards and procedures
    Graduates should be able to perform simple electro-acoustic measures of audiometer output and of sound-field acoustics. Graduates should be able to describe and apply local standards of workplace safety, including infection control.

Core Abilities of New Graduates:

Theoretical knowledge and awareness of practical applications

1. Otoacoustic emissions
   Graduates should be able to explain the principles of otoacoustic emissions and their application to the description of auditory function. They should be able to recommend OAE testing and interpret the results appropriately and integrate them with other audiological findings.
   
   
2. Vestibular assessments
   Graduates should be able to explain the principles of electro-nystagmography and caloric testing and be able to recommend vestibular tests appropriately for clients with balance disorders. They should be able to interpret results from these assessments appropriately and integrate them with other audiological findings.
   
   
3. Central auditory function assessments
   Graduates should be able to explain the principles of central auditory function and assessment and be able to recommend tests of central auditory function for clients with auditory disorders. They should be able to interpret results from these assessments appropriately and integrate them with other audiological findings.
   
   
4. Sensory devices
   Graduates should be able to describe the principles of cochlear implant and other sensory device technology (e.g. vibrotactile aids, implantable hearing aids) and their application to assist people with severe and profound hearing loss. They should be able to interpret audiological results and histories in relation to candidacy for sensory devices for adults and children and advise clients on their suitability.
   
   
5. Assistive listening devices
   Graduates should be able to describe the principles of assistive listening device technology (e.g. alarms, telephone devices, FM devices) and their applications to assist people with hearing loss. They should be able to interpret audiological and communication assessment results and recommend appropriate devices for adults and children, which are compatible with their personal device use.
   
   
6. Tinnitus assessment and intervention
   Graduates should be able to recommend assessment and management strategies for clients with tinnitus and to advise of their effectiveness. They should be able to make appropriate referrals to specialist tinnitus services and interpret the information thus acquired.
   
   
7. Educational audiology
   Graduates should be aware of the range of educational options available to hearing-impaired children and be able to provide descriptions and information about these to parents and to other professionals.
   
   
8. Occupational hearing loss
   Graduates should be able to explain the principles of hearing conservation and describe the legislation, which applies in their state. They should have the skills to advise employers and employees of their rights and obligations under the relevant sections of their state Occupational Health and Safety Act.
   
   
9. Deafness studies
   Graduates should understand the needs and aspirations of the Deaf community. They should have an understanding of the variety of non-verbal communication systems used by members of Deaf communities and be able to recognise and describe these.
   
   
10. Intra-operative monitoring
    Graduates should demonstrate an understanding of common situations in which audiologists may use electro-physiological tests to monitor cranial nerve function during surgery.
    
    
11. Practice management
    Graduates should demonstrate an understanding of a range of issues relevant to the conduct of an independent audiological practice; e.g. business, legislative, management, ethical, promotional and marketing issues.

Abilities of New Graduates:

Additional skills, knowledge and attitudes

1. Research design skills
   Graduates should demonstrate research design and statistical analysis skills, which would be sufficient to carry out simple studies in audiology or related fields.
   
   
2. Research report-writing skills
   Graduates should demonstrate adequate scientific writing skills to assemble a coherent report on an area of audiological research.
   
   
3. Professional development
   Graduates should demonstrate a positive attitude towards continuing professional development.