provider

CHRIS COX: RILEY, do you remember when you started your externship?

RILEY BASS: I do remember that.

CHRIS COX: How did that go?

RILEY BASS: Well, it was terrifying but it went pretty well.

CHRIS COX: I know exactly that feeling. Mine probably wasn’t as terrifying as yours. I heard some stories about yours, mainly stories that you told me.

RILEY BASS: Yeah.

CHRIS COX: I was hoping maybe you could share that today.

RILEY BASS: Yeah. Well, my externship itself wasn’t actually scary. It was the whole idea of getting to my externship that was a little bit scary.

CHRIS COX: Oh yeah? How so?

RILEY BASS: Oh, well, I chose to do my externship in not only in another city, but another state than I lived in. And I actually went in sight unseen. I had done all of my interviews over the phone. And I actually signed a lease on an apartment without looking at it in person either. So I made the drive from Springfield, Missouri to Phoenix, Arizona, and that was the first time I ever set foot in Arizona, was when I was moving there.

CHRIS COX: Wow, that’s pretty adventurous.

RILEY BASS: I guess you could say that, yeah.

CHRIS COX: So how did that work out?

RILEY BASS: Well it worked out really well. I don’t know if it was just luck or if it was coming into it with an open mind and ready to learn that I had a really great experience. I had some really awesome preceptors there, other great externs that were all on the same page as me. We were ready to learn. We got to see a lot of patients. So it overall was a really great experience.

CHRIS COX: That’s awesome. And hopefully everybody has an awesome and great experience with their fourth year externship or third year externship, depending on where you go. What we want to talk about today is something that has come up many, many times in discussions that we’ve had with students. And it’s just this, that transition from going from a student to being an extern, or even into being a full time provider and having starting off your career that way.

We come across this so often in the questions that we’ve gotten, we decided we wanted to dedicate three episodes of the podcast to covering some of these topics. And it’s not all of the topics that are ever going to come up, but we figured these are the top three that are probably going to be the most discussed.

RILEY BASS: Chris, what would you say is the number one component in success, transitioning from student to provider?

CHRIS COX: The number one is probably going to be confidence, just being confident in yourself. Having spent all this time in the classroom, and now you’ve actually got to see patients for real.

RILEY BASS: Scary.

CHRIS COX: It is kind of scary.

RILEY BASS: It’s not. As long as you act like you know what you’re talking about, right?

CHRIS COX: So it’s not scary then?

RILEY BASS: It is scary. I’m just kidding.

CHRIS COX: It’s not scary. It’s what you make of it. And hopefully, through our talk today, we’ll be able to make it a little bit less scary for you.

RILEY BASS: Absolutely. With that confidence, then it will not be scary for you.

CHRIS COX: The next thing I would say would be value and really trying to pull out that value in what you offer to the patients and what you offer to the rest of your team.

RILEY BASS: Right. As long as you’re in school, especially in that college and graduate program year, you’re paying them to be there but once you transition into being an extern or even being an audiologist, they’re paying you to be there. So you more or less have to earn that value. You have to earn that spot on the team.

CHRIS COX: Yeah. And that third one’s probably going to be that integration with the team and how you can go from just being someone who’s been focused on themselves and maybe the team that you’ve been working with in school, to actually working with a real team that has many different backgrounds and have many different functions and feel confident and feel the value within that and how to interact within that team. So there are our next three episodes– confidence, value, and teamwork.

RILEY BASS: So stay tuned, because it’s going to be really awesome.

CHRIS COX: Stay tuned, don’t go away. And right now, we’re going to start on the first point, confidence.

RILEY BASS: Chris, did you feel confident when you started your externship?

CHRIS COX: You know, it was a little shaky. I will have to say, it was a little shaky. As much as I felt strong in my abilities clinically, there’s still that component of oh no, I’m going to be releasing the guardrails.

RILEY BASS: I was going to say the Kracken.

CHRIS COX: Maybe the Kracken is coming after me if I didn’t do it right. Yeah, it was just a very– it was one of those things where you kind of knew it. It was like when you took off the training wheels on your– or your parents took off the training wheels on your first bicycle. And it’s like you kind of knew that you were going to be able to do it, you may have a little bit of issue there at the very beginning but once you got it, you’re good. And it felt good to be almost there. And we had a good supportive team around to help with that growth, especially in the first few weeks of being in the externship.

RILEY BASS: Were you familiar with the location that you did your externship before you actually started there?

CHRIS COX: I did, actually. It was a rotation that I got to go through a few semesters earlier. And so I already had an idea of what the dynamics were there. And one of the reasons that I chose that as an externship site was because of that prior experience. So, for me, it was a little bit easier then it was for you, going from middle of nowhere Missouri to the desert and a place that you’ve never seen before, never stepped foot in before, and having to start from absolute scratch there. So two contrasting, two different experiences.

RILEY BASS: Right. And one of the things that took a little while to adjust to was just the way that everything was done and the way that every step along the way was just a little bit different than anything I had done before, starting with just the equipment was different. The audiometers were different, the tympanometers, the real ear measurement systems were ones that I had not been introduced to previously.

So everything was a little bit different. I was learning sort of the way that we did everything, even down to the audiogram. The paper was different than I had ever used before. And I don’t know. I’m sure that you guys have seen an audiogram come over from a referral from another clinic and you look at it and think what are they thinking, looking at this paper?

CHRIS COX: Where did this come from?

RILEY BASS: Right. What is this? You get so set in your ways with what you do wherever you are that, when you’re looking at a different places, it takes a little while to adjust to where do I write this? How do I do this? How do I do that? So there was definitely a little bit of a learning curve coming into it, of just getting used to looking at everything and using everything a little bit differently.

CHRIS COX: Yeah, because not even just with the equipment, but just where everything is, like all the supplies. Like where are the domes and where’s the ear mold impression material? Where do they keep this and do they even have one of these things that I’ve used in my past rotation?

So it’s kind of, that in and of itself is a little unnerving, no matter where you are and who you are, just not knowing where those things are.

RILEY BASS: Have you ever walked into like a hearing aid lab and opened every single drawer and cabinet, looking for a certain type of dome?

CHRIS COX: Yeah, basically like the first month anywhere that you work, that I’ve worked has been that. Where’s this?

RILEY BASS: Yeah and if you have not done that, then you’re lying to yourself because every single–

CHRIS COX: No, no, I just said that I did.

RILEY BASS: No, I’m talking to our listeners. Every single person has done that. Every single audiologists has walked into a lab, looking for some tool or some piece and opened every single drawer and cabinet trying to find it, because you’re not familiar with where things go.

CHRIS COX: Yeah. And I actually do lie to myself about other things, not just that. Not that though. So we’ve got the kind of the logistical things, like the lay of the land, so to speak, of wherever you’re going to be starting. And that’s a real basic piece that can really hurt your confidence getting started. And it’s something that can be really easily mastered, just finding out where all the right domes and supplies are.

And along with that are those protocols, like you were talking about, there are different ways of doing things and some of your preceptors are going to want you to do things their way. And we had several different preceptors in my externship, and they all did things slightly different. So the other piece of that is trying to remember which preceptor likes doing word rec first, for instance, or SRTs first or who likes doing temps first or who doesn’t do temps at all, and making sure that you’re not just doing it the way they want it, but also understanding the why behind why they do those things.

RILEY BASS: Right. Report writing was the big one for me with my preceptors.

CHRIS COX: Oh yeah, huge.

RILEY BASS: Every different preceptor wanted reports written slightly different. So I had to kind of remember and make templates for each different preceptor.

CHRIS COX: Yeah. You’d think they’d get on the same page at one point.

RILEY BASS: They work in the same office, but to each their own.

CHRIS COX: So the thing that comes to mind with this, and this is, like I said, one of the basic pieces of being in a new place, in a new office, is that you can learn these things. You can learn where the domes are, you can learn the different procedures. You can learn how the audiometer works.

And that’s just going to take some time, but until that point, you’re what I call fumbly, bumbly, and dumbly. You fumble around and you get kind of bumbly, especially if you’re with a patient and you’re looking for that impression material or whatever it is and it’s not around. The worst is when someone takes the otoscope and puts it in another room and you didn’t know about that. And so you’re just kind of fumbling around for the otoscope and then you’re bumbly to the patient. Well, I know it’s around here somewhere. And then you kind of have to walk out dumbly and act like this is how it’s supposed to be.

So it’s all about that confidence in the beginning and making sure you know where everything is. And that’s pretty easily overcome.

RILEY BASS: Right. I still feel like those should be names for some of the seven dwarves, but that’s just me.

CHRIS COX: Yeah. What would it be, 10 dwarves then?

RILEY BASS: Yes.

CHRIS COX: That might be too much of a handful.

RILEY BASS: Poor Snow White.

CHRIS COX: Or was it Sleeping Beauty?

RILEY BASS: No, it was Snow White.

CHRIS COX: I’ll take your word for it. I’m not into the Disney princesses yet.

RILEY BASS: Yet.

CHRIS COX: So the next part of it that I think is probably a little harder to overcome is getting that confidence with patients. And for me, and I know I’ve spoken with a lot of students that have talked about this, is confidence in front of somebody, especially somebody who has a very strong personality. It can be a little bit unnerving to sit across the table or across the desk from somebody who’s a little more pushy or a little more inquisitive about what’s going on.

And a lot of times, if you’re not feeling secure in your knowledge, you kind of fold up, fold up like a paper napkin. Is that how you say it? Fold up like a table? Fold up like a–

RILEY BASS: I mean, you can fold up a lot of things. You fold the laundry, you can fold a chair.

CHRIS COX: Fold up like a Japanese origami swan. That sounds good. In fact, that’s beautiful. You kind of fold up on the floor, feel what happens. So maybe the laundry one is better.

There comes to mind a story of a friend of mine. He was just out of school, he had just graduated and he had a high powered lawyer come in and very flashy and very loud personality. And came in, sat across the desk from him, and really just kind of made his presence known in that office.

And my friend was a little taken aback by it, and it really did change the tone of the whole appointment. And he was feeling more and more submissive, I guess you could say, in the presence of this guy. And as more and more went on, he started realizing that this lawyer, this attorney, is somebody who doesn’t know anything about what we know, which is hearing and how hearing can impact quality of life. And for him, it was a switch in his mind of understanding and gaining that confidence that this person may be very boisterous, may be very loud, but when it comes down to it, having the confidence in yourself and knowing that you can provide a solution and know that is the right solution, is huge, even in the face of somebody who’s going to bowl you over, as it were.

So with that, by the time the end of the appointment came around, he had kind of settled himself and righted the ship and got back on the horse, so to speak.

RILEY BASS: That’s a lot of euphemisms in one sentence. He righted the ship and got back on the horse.

CHRIS COX: It was a seahorse. Sorry.

RILEY BASS: He did not meet the same fate as Jack on the Titanic.

CHRIS COX: Again, I don’t know about your Disney princesses.

RILEY BASS: That’s Titanic. That’s not even a Disney movie. Come on, now. I do get what you’re saying, Chris, and I can relate to that. Not necessarily your story but in being a female and being pretty young to the field, I’ve had patients say you don’t look old enough to be a doctor. You look younger than my grandkids.

And I may be younger than their grandkids, but I do also have that degree and I have that piece of paper on the wall. I have the training and the knowledge necessary to treat every patient that comes in the door. And I had to learn that confidence and I had to learn how to approach these patients confidently and be 100% in my recommendations and know what I’m talking about.

And actually, you can use that I just graduated and I’m young to your advantage, because you are up to date on all the latest technology, all the latest research. Sometimes, when you’re out in the field for a long time, you stop being so interested in all of the innovation that’s happening in the industry. And, as you guys know, it’s changing very quickly and very rapidly and we’re learning new things and getting new types of technology every day. So being up to date on that and being up to speed is definitely an advantage that you can use for being young.

CHRIS COX: Right, and you bring up a great point about the age difference. That’s always been a huge deal and if you’re not confident, and what you can do with, then, that whole old age interaction can be a big factor in how you come across to that patient, as well as gender. And in a predominantly female dominated profession like audiology, I imagine there are a lot of people like you, I mean women, who have experienced that exact same thing that you have with the patients, even in a few rotations here and there, if you’ve interacted with any patients in that manner.

So there’s the age and the gender differences that can sometimes start to hit you in the confidence area and, if you’re not confident, if you’re not sure in what you’re doing, then that can really bring down that interaction with the patient.

RILEY BASS: Right. But just know that you have that knowledge and you have that expertise. So use it to your advantage.

CHRIS COX: Absolutely.

RILEY BASS: The other thing that can be really intimidating and can damage your confidence is that relationship that you’re building with those preceptors and audiologists that are already in the practice. You might feel intimidated or like you don’t know what you’re doing compared to them, especially if they’re observing you, which oftentimes they are, especially when you’re first starting out on your externship. I know, Chris, do you ever feel like you can’t type whenever somebody’s sitting there with you?

CHRIS COX: All the time. It’s the worst. It’s like I can type a million miles a minute, but actually I think my best was 80 words a minute on Type a Shark. You ever play Type a Shark?

RILEY BASS: I did, like in middle school.

CHRIS COX: Awesome game. Anyway, pretty well with that but then if somebody’s standing over my shoulder, then all of the sudden, I can’t type.

RILEY BASS: It’s letter, backspace, letter, backspace, letter, backspace.

CHRIS COX: The whole time, it’s horrible. So imagine having to do that. You don’t have to imagine, you know what it’s like to have someone over your shoulder while you’re testing somebody or while you’re doing a temp, which is the worst, whenever you’re trying to get the seal and that person behind you is like come on. And then the patient’s like what’s going on? Why is this taking so long?

So, yeah, absolutely. It’s one of those things where, if you’ve got someone looking over your shoulder, that’s also one of those things that can deflate your confidence really quickly, especially if things aren’t going as well as you’re hoping it would be.

RILEY BASS: Absolutely. And just being new and feeling like you know what you’re doing, you feel like you have to show that you’re excellent and you’re smart and you’re fantastic when you’re an extern. And it’s OK that you are still kind of picking up and learning things, and your supervisors are going to be more apt to teach you when you come to them with these questions and with these concerns than if you just try to pretend like what you’re doing.

CHRIS COX: So how do we get that confidence, RILEY? What got you to that point to where you could sit across from a patient and feel comfortable in your recommendations and the way that you’re steering that conversation?

RILEY BASS: Well, I’m very much a hands on learner, so I think just actually doing it and practicing and seeing patient after patient after patient gave me that confidence to do exactly what I needed to do every time.

CHRIS COX: That is definitely the best way to do it, just to get in there and do it. Another thing you can do is practice, practice the protocols that you have and ask for the protocols if you’re in whatever your placement is. Ask for the protocols, wherever your placement is, and hopefully they have something that you can study and go over.

Practice those procedures, practice the different instruments and the equipment that you’re going to be using, especially if it’s one of those tympanometers like one that I saw, where you hand crank it with the dial on the front to pump up the air pressure. That was the weirdest thing and it took like two hands to do. But once I got it down, it was kind of funny.

And then, of course, with fitting instruments and fitting those hearing devices, a huge thing for you to be able to practice is the fitting software for the different manufacturers that you’re going to be using, and being able to not take too much time in fitting those hearing devices.

RILEY BASS: Right. Most of the hearing aids have some sort of demo mode on them, where you can practice with there being no changes saved to the device itself. So it’s just kind of a risk free ability to see all the different programming changes you can make.

CHRIS COX: The sooner that you can get all of this down, the better it is going to be for you to be able to gain that confidence in other things and start working on those other parts of being an audiologist, like talking with the patient and talking with the rest of the people on your team. Get these down. This is the easiest of them to do.

RILEY BASS: Something that I personally struggle with is asking questions when you don’t know things. I’ve always thought that asking questions and not knowing the answer was going to harm me, but it’s actually the other way around. Asking questions shows that you’re engaged and you want to learn more and you want to refine your skills and not that you don’t care.

But if you do ask and you get a good answer, make sure you remember it so you’re not asking the same question again and again. Write it down if you have to. Keep a notebook, keep those hot questions top of mind so that you’re constantly seeing them and, at some point, you could be the one to answer those questions, not the one asking them.

CHRIS COX: Yeah, the worst is whenever you’re training somebody or you’re working with somebody and they ask you a question and you answer it and then, two days later, they come up and ask the same question, as if they’ve never ask it before. And you answer it patiently and then, two days later, they came back and ask the same question. You’re like, “Were you not paying attention?”

RILEY BASS: Right.

CHRIS COX: So don’t be that guy or girl. 000 The next thing I would say is, if you aren’t feeling confident in certain things, not just ask a question of them but tell them as a whole or tell your preceptor that, in general, you’re having a difficult time with this specific concept or this specific protocol and let them know that that’s a focus point for you, so they can support you in that and they can come in and check in on and say, how are you doing in this situation? You communicated to me before that you were having difficulty, for instance, introducing yourself to a patient, which probably isn’t a big deal for most people, but that’s a that you had you told me that you were having trouble with because you don’t know how to communicate that you’re a student but you also don’t want them to think that you’re a doctor, but you also don’t want them to lose any confidence in you.

So that’s one of those ones where some people have an issue at the very beginning of the consultation with the patient. So communicating those to your preceptor lets them know that that’s a sticking point for you and that you would like a little more guidance, a little bit more help in that situation.

RILEY BASS: Right, absolutely. And going along with that, make sure you are communicating with them when you do understand something and when you do overcome one of those areas that you had been struggling in. Make sure you’re letting them know, I figured a great way to do this and I figured it out and I’ve overcome this obstacle I was facing.

So just stay in really good communication with your supervisor. They should be somebody that you can go to to ask these questions and to have as someone that’s really advising you through this whole process of getting this Aud degree.

CHRIS COX: And they could probably pick up a few things for you, too, once you figure some things out.

RILEY BASS: Absolutely.

CHRIS COX: The other thing you have to really be careful about is to not overdo it. No one likes a cocky jerk.

RILEY BASS: Right. We’ve been preaching and preaching about being confident and we definitely want everyone to be confident, but there’s also something to be said about humility and being gracious and being willing to accept help and advice from others. So confidence with humility is key here and being the best self you can be, but always being willing to learn and to improve.

CHRIS COX: My favorite of all these is celebrating your successes.

RILEY BASS: Woo-hoo. Party time.

CHRIS COX: Party time. Don’t just focus on what you’ve done wrong. It’s great to be good at self-reflection and part of that is to not just look at where you could improve, but also what you’ve done well and how you’re improving. And you will see, over the first few months of your externship or your first job, that there’s going to be a lot of growth there. And acknowledge that.

RILEY BASS: Right. I know I feel like I’m occasionally one of those people that will lay in bed at night and think about something embarrassing I did five years ago. I just think, oh my gosh, I can’t believe that happened.

CHRIS COX: I can’t believe it happened either.

RILEY BASS: But you really have to think about it. Most people have probably forgotten about it, if not every person, has forgotten that that’s happened. So nobody else really cares, just you. So focusing on what you did wrong is not going to get you anywhere but a negative attitude. Focusing on those things that you’re doing really well and that you’re succeeding in are going to get you a lot further in your Aud career and in your success and in your personal satisfaction. You’re going to be a lot happier of a person if you’re looking at the positive.

CHRIS COX: So, in summary, looking over what we’ve talked about today, this is part one of our three part podcast series on this transition from student to provider. This one was about confidence and learning how to be more confident, both in the new lay of the land of wherever you’re going to be working with those patients that are going to be sitting in front of you, whatever type they may be, and also working with the preceptors and other professionals that are within your practice.

These tips that we’ve talked about hopefully are going to go far for you and help you gain some of that confidence in these new environments where you can practice everything, where you’re able to ask questions and feel confident about those answers, being able to communicate with your preceptors and not being a jerk.

RILEY BASS: Being humble.

CHRIS COX: Being humble. And, number one–

RILEY BASS: Celebrate your successes.

CHRIS COX: So thank you for tuning in.

RILEY BASS: Yeah, thank you guys for listening. Please subscribe to our channel on iTunes. Give us some feedback so we can get a little more popular. Please share this with your friends, your colleagues, your cohort at school. We would love to talk to all of you guys about what we have learned and impede our knowledge on you.

Please tune in next week, when you’re going to be talking about the number two thing in transition from student to provider, which is value. My name is Riley Bass.

CHRIS COX: And I’m Chris Cox.

RILEY BASS: And this is the podcast. See you next week, guys.