Audiology education:
Recommendation for a possible setup in Romania
Introduction
The background is well-known to all parties: Romania is a big country in the EU, with a population of 22 million people. Although the economic situation is difficult, the country still reports a GDP of over 12,000$, which is better than e.g. that of Poland.
Romania has a good academic tradition, there are relatively many young people who speak good English and – when it comes to the topic of audiology, there has been a tradition of good craftsmanship and even a college of audiology in Bucharest. Therefore, there are quite a number of talented people “on location” who could cooperate to shape a new future for hearing healthcare in Romania.
Furthermore, the market for hearing aids is one that presents challenges, but also tremendous potential.
Challenges
There is no reason to hide that my four days of meetings in late April with key stakeholders showed a lot of disagreement and especially lack of trust among the many parties.
Twenty years of uncertainty has left the Romanian hearing healthcare “system” in near-chaos with most players mistrusting each other, some actively fighting each other in various ways.
Therefore, a key idea in the following is the concept of a fresh start, a new beginning, or – to steal Obama’s phrase: Change we can believe in.
To achieve this, all the work ahead must be done in an open, transparent way which slowly builds up trust and confidence. Many pointed out that EHIMA may have a unique opportunity in this respect.
In order to cut as many ties to the past as possible, I would suggest that we work through the new generation of ENT doctors/audiologists in Romania.
Establish New Institution
Also, to avoid ties to the past, we need to establish a new institution which could be called something like The Romanian Hearing Healthcare Association (better ideas hereby invited. And it must of course be in Romanian language).
The AFPAR could have been used as this vehicle, but it doesn’t seem to be functional in a way which would be necessary to carry this responsibility. In order to signal change, we must create something new.
The Romanian Hearing Healthcare Association (RHHA) should have as its members all players involved: ENT doctors, University professors, teachers and industry people (preferably a representative from all hearing aid manufacturers represented in the Romanian market).
It could have an executive committee of e.g. 3 people (elected on a rotation basis) and should ideally be headed by a neutral person.
RHHA tasks:
· Main driver in establishing a college for audiology education (complete with location, facilities, curriculum, standards)
· Becoming the official “monitoring institution” for this education
· Marketing the education to young people in high school
· Possibly (long-term) take over the approval and certification of private dispensers
For EHIMA it is important that discussions about standards and curriculum are based on the upcoming EU Standard, CEN 380.
My suggestion would be to start up, possibly September 2011, in Bucharest where all the facilities are available at the hospital, with Dr Madalina Georgescu in charge.
If the RHHA agrees that the need for audiologists is not covered by one college, and if there is a political interest in a geographical spreading, then in September 2012, the education could start up in Iasi, possibly headed by Dr Sebastian Cozma.
One could also imagine a college in – for example - Cluj.
That would cover the country geographically, and a very practical rotation could be established:
Bucharest start 2011 Graduates 2014
Iasi start 2012 Graduates 2015
Cluj start 2013 Graduates 2016
Bucharest start 2014 Graduates 2017
Iasi start 2015 Graduates 2018
Cluj start 2016 Graduates 2019
Etc etc etc
In this way there would be one class graduating every year (15 – 20 students?)
Class size would depend on the agreed need.
Important: Getting the first location up and running is the top priority. Establishing a second or third location must follow later on, according to need.
One should expect a certain drop-out rate, possibly biggest the first years, until it becomes generally known that the audiology profession is a good, interesting and rewarding career opportunity.
When we contact the University and not least the relevant ministries, and we describe to them the college, the curriculum and the RHHA, then the notions of neutrality and quality should be stressed.
Further, we should stress that in this way, Romania would be joining the “mature mainstream” of European audiological education by
1. Having an official, independent education
2. Meeting EU standards (CEN 380)
If the RHHA could also serve as the official certification/approval institution, this would mean that they assumed responsibility for
1. Education (curriculum, diplomas, teachers…)
2. Hardware (incl. calibration)
3. Set up of dispensing offices (à la DELTA in Denmark, Hearing Aid Council in U.K. etc)
It may well be that this certification authority should be given to the RHHA as a second step in a process which begins with the establishing of the education college.
Theory and practice
A natural “division of labor” could imply that the hospital staff are responsible for the theoretical part of the education, and skilled and interested staff from the hearing aid manufacturers teach about hearing aids technology and fitting. Industry members should meet and decide on who they could suggest for these tasks. A rotation principle could also be discussed.
If we look at the model used at the Lübeck Academy in Germany, students spend approximately 25% of their time at the Academy (theory) and 75% working with an authorized hearing aid dispenser (Hörgeräteakustiker-meister). Applied to Romania, this could work in different ways:
1. Students work 3 days per week in the shop, 2 days in the college
2. Students work around 35 weeks in the shop, 11 weeks at the college.
I do not know which option will be most practical and desirable. Option 2 will imply the least travelling, for which reason it may be preferred.
Framework for cooperation
A project like this will demand good cooperation among the individual hearing aid suppliers. This will be a quite new situation for most players. For this reason, I would suggest that the industry members meet to establish a “Framework for cooperation” which has to be accepted by all parties.
It is in the interest of everybody that this project succeeds. It cannot be jeopardized by single members going for short-term gains. It will therefore be in the interest of EHIMA – and EHIMA member headquarters – to make sure all parties follow the guidelines established in the “Framework”.
EHIMA could offer to participate in the process to establish this “Framework for cooperation”.
Marketing the new education
Both in Iasi and in Bucharest there is negative experience with student interest in audiology. Students do not know what it is and strongly doubt that it could be a way of living.
All parties therefore pointed out, that an efficient information campaign to potential students would be necessary.
I would suggest that the RHHA is responsible for this, but with the industry members making the biggest contribution. This could work in two ways:
1. Local dispensers and/or wholesalers advertise locally to recruit new staff who will work in the shop, thereby making some money, and at the same time study 2 days at the college, getting their Bachelor’s Degree after 3 years.
2. An RHHA campaign could be assisted by industry marketing people. There are several “education fairs” in Romania where high school students can show up to get information about future career opportunities. We should be present with booth, info material, and some exciting ideas for catching young people. (interactive CDs? Social media? Dedicated web site? Competitions?). We could also send info material to all high schools. In the information, we should stress that in Europe in general, the career of audiologist/hearing aid specialist is a truly meaningful one (helping people) and generally an economically attractive profession. These marketing activities could be financed by the Romanian representatives of the hearing aid manufacturers.
Existing staff
It will be important not to create a new confrontation line between the new graduates and the existing staff in the present shops. This group should not become the losers in this project. So the RHHA should come up with an idea for “upgrading” this group by offering to all those who are interested the opportunity to attend courses which would de facto upgrade them to a level comparable to the Bachelor Degree. Within a transition period of e.g. 3 years, they should perhaps also be awarded with a Diploma corresponding to the one the new Bachelors get. After 3 years, this window closes.
Communication with ministries
We should be careful to follow a logical timeline:
1. Agreement on the EHIMA proposal among the key players visited. This includes industry giving its estimate on the need of graduates in the market.
2. Meetings to establish a kind of Romanian Hearing Healthcare Association
3. RHHA briefs University rectors about the project. It was recommended that this includes Soeren Hougaard to stress the neutrality and the European scope.
4. And THEN we could contact the ministries (Health and Education). It is probably wisest to do this through the University rectors in Iasi and Bucharest. EHIMA supplies RHHA with all the ammunition we have regarding the potential (economic and social) benefits for the State. Important that the ministries are informed about the CEN 380, so they understand the need for an official monitoring to verify that requirements are being met.
Possible timeline
Costs
This is obviously a sensitive issue, but I can only see the project working if there is a kind of cost-sharing. I could imagine the following:
1. The Ministry of Health and/or Education pays for the theoretical part of the education, i.e. rooms, equipment, teachers’ salaries and administration costs. (In Bucharest, rooms and equipment are already available. In Iasi, they will be available in a few months). The alternative is that these costs are paid for by the hospital in Bucharest (Institute of Phono-Audiology…) and the University of Medicine and Pharmacy in Iasi.
2. The private companies pay for the practicum period (e.g. 3 days per week) by offering the student for example 50% of a normal start-salary. In return, the student signs an agreement to stay with the private manufacturer for an agreed period (2 years? 3 years?)
3. The private companies pay for student recruiting activities
4. Student transport and accommodation costs: this must be discussed. If the students get a salary, they could perhaps pay this themselves? Or their employer must pay. Open for discussion.
Postscript
This is my proposal!
It does address all the various input I received during my fact-finding tour, but I am aware that not everybody gets exactly what they were hoping for. However, that is the nature of cooperation and compromise, and I sincerely hope – for the sake of all the hearing impaired people living in Romania, and for the sake of those working with hearing healthcare – that we can reach an agreement along the lines suggested above.
Fortunately, this will also benefit the Romanian Government long-term, as independent research has documented that governments and healthcare authorities stand to benefit also financially from investing in hearing healthcare. In other words, we have a potential win-win-win situation.
June 22, 2010,
Soeren Hougaard
Secretary General, EHIMA