At the beginning of my teaching career at Central Michigan University (CMU) some 15 years ago, I taught students the way I was taught. Class consisted of evidence-based didactic instruction without benefit of transparencies, slides, PowerPoint, the Internet, Blackboard or significant hands-on experience.

Today's educational approach looks much different-we offer hands-on education, and both the patients seeking treatment and our students are benefiting.

A decade ago, students significantly relied on their externship and/or on-the-job training to be able to interpret the zigzag lines and rolling eyeballs. At the conclusion of the vestibular course, I remember students writing on opinion surveys that they understood vestibular anatomy and theoretical concepts of testing but felt insecure about interpreting actual raw data, making recommendations and-God forbid!-initiating treatment. Comments from practicing clinicians returning to school for their AuDs indicated that most of what they currently knew about vestibular testing was learned while on the job.

Data collected from a survey of audiologists in 2002 (n=901) indicated that most audiologists felt unprepared to conduct vestibular assessments (69 percent) or vestibular rehabilitation (90 percent). Only 50 percent conducted testing at all, probably because of the perceived lack of training. Surprisingly, no particular vestibular protocol was being followed anywhere.¹

CMU has invested heavily in the vestibular components of its AuD program to ensure that, in addition to a solid theoretical foundation, students have access to the state-of-the-art CMU Audiology Clinic and Fall and Balance Center, which is where they receive those important hands-on lessons.

The following educational components have been critical to student learning of vestibular assessment and treatment techniques:

Theoretical foundation-There is no substitute for evidence-based empirical data and a great vestibular textbook, which often helps students distill difficult concepts. Peer-reviewed articles help students become critical consumers of literature. Professors shepherd students through information, highlighting what
is important.

Laboratory assignments-CMU ensures its students learn clinical software through direct experience. Students in the residential AuD program are required to complete at least two laboratory assignments for each test. The assignments are completed on non-patients prior to real testing in the audiology clinic. Current laboratory assignments include:

• Videonystagmography (water and air);

• Electronystagmography (water and air);

• Sinusoidal rotational testing (two separate chairs);

• Computerized dynamic posturography;

• Testing and treatment for BPPV;

• Dynamic visual activity test;

• Subjective visual vertical test;

• Vestibular myogenic potential test.

Clinical Practicum-Residential students evaluate vestibular patients in the CMU Audiology Clinic and Fall and Balance Center. Students are part of an interdisciplinary team that includes a physical therapist specially trained in vestibular rehabilitation and other professionals, such as a dietitian. In this setting, students can integrate the information from classroom and laboratory experiences and apply their knowledge to "real" patients.

Multimedia learning-Online CMU-produced how-to videos provide immediate instruction for routine vestibular assessment techniques and treatment. Students access and use these videos in the classroom when rehearsing for a practicum exam, preparing for a patient, brushing-up at an extern site, and in practice after graduation. These videos are available at cmich.edu/cmuvestibular.

Case review-CMU maintains a library of de-identified, real clinical vestibular cases that are reviewed with students throughout all stages of their training. These cases contain raw history and raw clinical data (including squiggly lines and zigzags). During these sessions students must analyze the data on the spot, draw a conclusion and make appropriate recommendations.

Off-campus sites-During the academic year, students gain vestibular clinical experience in CMU's in-house clinic and in Michigan-based hospitals and facilities. It is routine for fourth-year students and summer externs to travel around the country.

Audiology students need to be prepared for the changing face of medicine, to be familiar with what other professionals bring to the balance table and to be equipped to be a vital part of the balance team. As their instructors, we need to do our best to prepare our students. With newly emerging educational tools and opportunities available, we can do just that.

Reference

1. Nelson, MD, Akin, FA, Andresen, K. (2005). [A Survey of Vestibular Clinic Practice and Opinion]. Unpublished paper.

M. Dawn Nelson, PhD, is associate professor at Central Michigan University, The Herbert H. and Grace A. Dow College of Health Professions, Department of Communication Disorders, AuD program.