There are many different ways to become an audiologist throughout the world and it is interesting to see how different some of the training routes can be. In this issue Dr Cherilee Rutherford, a lecturer in audiology at the University of Cape Town, provides an overview of the profession in South Africa.
Audiology training programmes are delivered through five accredited universities in South Africa (RSA) and these are typically associated with programmes in speech-language pathology. The programmes are usually housed within the faculties of health sciences, or located within the education department of the respective institutions.
Audiology as a healthcare profession is governed by the Health Professions Council of South Africa (HPCSA) and, in order to practise as an audiologist, students and graduates must register with the HPCSA and adhere to its requirements for clinical and professional practice. The HPCSA is the professional board for most healthcare professions in RSA and each profession is represented by its own professional board who is responsible for registration, the quality of education and training, ongoing professional development, ethical guidelines and practice, and compliance with professional standards. Professionals who work within the stated scope of practice are required by law to register with the HPCSA and failure to do so is considered a criminal act.
‘Welcome!’ Students from University of Cape Town do a one year course in South African Sign Language.
Audiology programmes in RSA are delivered in the format of a four-year undergraduate course. Historically, audiology courses were offered alongside speech-language pathology and graduates were dually trained and able to qualify as both audiologists (AUD) and speech-language therapists (SLT). After 1998, many university programmes started to separate the programmes into single-profession tracks, leading to qualification as either an audiologist or speech-language therapist.
“Most courses in RSA continue to have some joint teaching and shared modules between SLT and AUD students, allowing for the development of strong interprofessional links.”
Today, the majority of universities offer these courses separately, with the exception of WITS University and Sefako Makgatho University, who currently still offer a joint programme. WITS University is in the process of splitting their programme and plan to offer separate courses from 2018. The entry requirements for audiology training in RSA typically involve matriculation endorsement (a final high school pass rate that is the minimum entry level for studying a bachelor’s degree at university) with completed subjects like Maths / Maths literacy, English, and Physical / Life sciences.
Most courses in RSA continue to have some joint teaching and shared modules between SLT and AUD students, allowing for the development of strong interprofessional links that are important for children and adults with hearing, balance and communication difficulties. At the University of Cape Town, first, second, and third year SLT and AUD students have joint modules in child language, paediatric aural rehabilitation, sign language, isiXhosa / Afrikaans (languages), linguistics, early communication intervention, speech and hearing sciences, human communication development, anatomy, psychology, becoming a health professional, and research methods and statistics.
In addition, students are also required to work together in fourth year on advanced seminars, writing and presenting on topics that are relevant to both professions e.g. managing difficult clinical encounters, provision of culturally sensitive services, attributes of the successful clinician etc. Table 1 provides an overview of the six universities who offer training in audiology and hearing therapy in RSA.
Clinical training of audiologists typically starts early in the degree programme (second year) and increase over the course of the programme. Students are required to obtain 400 hours of clinical work, which is carefully planned and monitored, to ensure that they are able to register with the HPCSA at the end of their final year of study. Clinical hours are recorded for assessment, intervention, observation and case discussions. Of the 400 clinical hours, 375 must come from clinical contact, and 25 from observations. Students are exposed to a variety of clinical audiology functions throughout their four-year training, including community clinics, hospital clinics, university clinics, simulation clinics, schools for the deaf, and institutions like DeafSA.
Clinical training is provided in all areas of diagnostic audiology, rehabilitation, and vestibular management. Several universities offer postgraduate qualifications in audiology via a research-based Masters or PhD programme.
Once students have graduated from an audiology programme, they are required by law to complete one year of paid (salaried) community service before practising in the field. Community service is mandatory for all healthcare professionals and the programme is run and managed by the Department of Health (DoH) who is responsible for applications and placements throughout the country. Students send in their applications for community service and are then allocated to a site anywhere in the country where there is a need for services. Often these placements may be outside the province where students lived or studied. Community service posts exist in healthcare sectors throughout the country and can be based in the community or in secondary / tertiary hospital settings.
UCT Students supporting the Special Olympics by providing free hearing checks.
There are currently no educational audiology placements for community service audiologists, as these do not fall under the remit of the DoH, but rather that of the education department. Once community service has been completed, students are free to apply for any position in the sector of their choice and, from this point, they then take ownership for their further career paths. Nuha Khatib, a 2016 audiology graduate from the University of Cape Town, is currently doing her community service year at The Carel du Doit Centre for Hearing Impaired Children, and describes her experience here:
“My community service year so far has honestly been an incredible learning experience for me. I am very lucky to have two amazing, experienced supervisors. It is also so gratifying to provide a service that is appreciated and, unlike during my studies, I am able to build a long-term relationship with my patients and be on their journey with them.”
“The training, education and clinical practice of audiologists in RSA is challenging given the rich cultural diversity and 11 official languages of the country.”
In RSA, registration with professional organisations is done on a voluntary basis. There are currently two professional organisations that audiologists are able to join: South African Association of Audiologists (SAAA) and South African Speech-Language-Hearing Association (SASLHA). The role of these organisations is to promote the professions of audiology and speech-language pathology, offer opportunities for further professional development, publish a peer-reviewed academic journal (South African Journal of Communication Disorders), and provide guidelines for professional and ethical practice.
The training, education and clinical practice of audiologists in RSA is challenging given the rich cultural diversity and 11 official languages of the country. Geographic and socio-economic differences also add to the complexity of hearing health service delivery in a developing world context. Students typically graduate with a deep appreciation of cultural diversity, as well as the ability to creatively apply their theoretical knowledge to the local needs and context.
My thanks to Dr Leigh Biagio and Prof Alta Kritzinger (University of Pretoria), Dr Lavanithum Joseph (University of Kwazulu-Natal), Katerina Ehlert (SMU), Dhanashree Pillay (WITS), and Lucretia Petersen (UCT) for their input.
South African Association of Audiologists:
South African Speech, Language & Hearing Association:
South African Journal of Communication Disorders (Open Access):
Health Professions Council of South Africa:
Declaration of competing interests: None declared.