Managing your practice: Continued learning beyond CEUs

When I hear the term “practice management,” I often think about a private practice audiologist up to their ears in paperwork work, juggling hearing aids, and audiograms, often with a pencil tucked behind their ear and glasses askew. However, I really think “practice management” not only deals with how to manage one’s private practice, but also how one copes with change and growth professionally, or manages how they practice. Audiologists are confronted with needing to learn a new skill on the job, and learning it quickly. This may mean working with pediatrics again after working solely with adults for a few years, or maybe always having an interest in specialized testing (i.e., tinnitus assessment, vestibular assessment), and then being presented with the opportunity to actually get to perform that test.

So, what do you do when you are expected to learn a new test or procedure? In grad school this is easy, right? You simply ask a professor or a mentor! Problem solved. But what happens when you are someone’s mentor, or there’s no one else to ask?

I love the vestibular system. I find it fascinating, exciting, and for me, performing a vestibular assessment is one of the most intimate patient experiences we have as an audiologist. However, until the job I held before joining Otometrics, I had not had the opportunity to work with dizzy patients; I spent 2-3 years in pediatrics, and then I was at a VA for another 2 years where I primarily fit hearing aids. At this last job, the person performing our vestibular testing retired, and since I had a clear passion and interest, I was an obvious choice to tackle this project. Which was great; I was finally getting to do what I wanted to do, but I had a small problem: I was seriously out of practice and feeling like a fish out of water. I thought to myself: how am I going to do this? Was I crazy to say yes to this? Is my boss sure I should be the one? Then I realized that I can do this, I have done this before, but most of all that I would regret it more if I didn’t take on this challenge. I also knew that this was going to take some serious time and self-motivation to get through. I looked around at my coworkers who were also tackling some big projects. When I saw what they were doing to continue to learn or enhance their learning, I knew it was time to model after them. These professionals were doing the following: 1) studying up on what they wanted to know; 2) consulting with other professionals; 3) becoming more familiar with their equipment; and 4) actually getting out there and doing the darn thing.

1) Study Up

One thing that my colleagues were doing was reading up on what they were learning. I started by reviewing my notes and other information I had held onto from grad school. I also knew that for this type of test, I needed to have a protocol in place, and it needed to be a protocol that was well researched and followed a general method employed by most other practitioners. I looked through all of my notes, and made a guideline of what I should do. Looking through my notes helped to jog my memory and get my thoughts moving in the right direction. From reviewing my notes, I realized there were things I didn’t know, and things I wanted to know more about. For example, I knew that my knowledge of anatomy was lacking. I also knew that since about 6 years had gone by since acquiring this task and the time I had done my last VNG, so I suspected that testing trends had likely changed. To conquer this, I looked in text books and looked for journal articles (and actually read the articles). Sometimes, this meant that I locked myself away in my local coffee shop on a Saturday afternoon, but it was exciting for me to learn this information again.

2) Professional Outreach

My coworkers would also reach out to other professionals who were familiar with the testing they were doing. My boss at the time had actually been one of my teachers in grad school, and it was good to go through this with him because he had done this testing in the past, and his feedback provided me with more insights. If I didn’t have him, I would have reached out to another professional just to get that reassurance and feedback. I also got to take a day and go to another clinic to watch what another professional was doing. Having this model in my mind assisted me in framing what I wanted to do.

3) Equipment Knowledge

It’s important to know as much information as you can about your equipment. Since the person doing the testing before me had used very old equipment, our clinic acquired new equipment at the same time that I was preparing myself. I attended the installation of our equipment, paying close attention to which piece plugged in where, and any general service that needed to occur (this was especially helpful when we moved the equipment, and times I had to troubleshoot). Once the equipment was installed, I blocked time on my schedule to go in, set-up my protocols, and get familiar with the equipment. I would actually stand in the room alone, press the buttons, and practice what I would say to a patient. It felt silly at times, but it helped me to rehearse the steps I would take for the day I tested an actual patient.

4) Do the Test (and then keep looking up what you still do not know . . .)

So then, I started testing patients. Sure, it was bumpy the first few times, but the more I did the test, the more I was able to refine my routine and get better at what I was doing. I got comfortable with the knowledge, the equipment, and even performing the test, but then it was time to analyze a test. As I came to this point, I realized there were still many things that I just didn’t know. Even though I had prepared thoroughly, I think sometimes you do not know what you do not know until you’re in that situation. For this, I resorted to my notes, and books. I would also from time to time look something up online- it was surprising to me how many resources from universities and key opinion leaders are available, and once I knew of what more to look for, how much more I could find.

As time went on, and I did more and more testing, my fears subsided and I really began to feel confident. I relied on my notes less and less. I think the best thing was to get out there and just start doing it, and to look-up what I didn’t know. In some ways I wish I had someone there to just tell me what to do, but I feel like it made me a stronger clinician to look it up on my own, and integrate what I had learned with what I had to accomplish. I had learned to mentor myself through this by modeling after the strong professionals around me. As we think about what we want to do as audiologists, versus what we know and what we are doing, it can be scary to make the jump to our goal. For me, following the above steps got me from being a fish out of water, to swimming in the deep sea of vestibular assessment.



Maggie Boorazanes, AuD, FAAA
Board Certified in Audiology
Clinical Support Specialist II



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