Hello. Welcome everyone to the IHS webinar, Elevated Learning with the 2022 IHS Distance Learning Course and Trainer Manual. I'm your moderator, Sierra Sharpe, IHS's Director of Professional Development. Thank you so much for joining us today. Before we get started, I just want to share a few housekeeping items. Note that we are recording today's webinar, so it can be offered on demand through the IHS website in the future. Closed captioning is also available and can be turned on using the Zoom toolbar as shown on your screen. Also, this webinar is available for one continuing education credit through the International Hearing Society. The CE quiz and information about how to receive credit can be found on our website, ihsinfo.org. Click on the webinar banner on the homepage or choose webinars from the navigation menu. A link to that page has been added to the chat. The slides for today's presentation can be downloaded from that same page. Feel free to take a moment now to do so if you'd like to follow along. Tomorrow, you will receive an email with a brief survey about this webinar. Your feedback is incredibly helpful as we continue to create valuable content for you moving forward. And now onto our speakers. IHS has just released the new edition of our distance learning course and trainer manual. To share what's new and some insight behind the development of the course and trainer package, our IHS subject matter expert, Pat Connolly, and IHS senior project manager, Michelle Weiss. Pat graduated from Rutgers University with an undergraduate degree in speech pathology, Wayne State University with a master's degree in audiology, and Michigan State University with a PhD in audiology and minors in neuroscience and speech science. Her vast clinical experience as an audiologist ranged from adult and pediatric testing and hearing aid fittings to hearing evaluations and amplification management on infants and toddlers. Although she's retired from clinical pursuits, Pat has been busy working on the 2022 edition of the distance learning course for the past two years and loving life in Tennessee with her husband, Tom Higgins, and Jack Russell Terrier, Lucy. Michelle Weiss has been at the International Hearing Society for over three years and is the professional development senior project manager. She has an MA in theater education and has taught adults and in a variety of school settings. Her educational experience was put to very good use as she managed the development of this new edition of the IHS distance learning course. As you can see on the screen, our expert speakers have much to cover today. At the end, we'll move on to a Q&A session. On your bottom menu, you'll see icons both for chat and for Q&A. Try to keep general conversation in the chat box and any and all questions which you can send at any time in the Q&A box. And now let's get to our presentation. Take it away, Michelle. Thank you, Sierra. All right, let's go ahead and get started with the new features and benefits of the 2022 edition distance learning course. I'll cover the topics listed here. Then I'll hand it over to Pat to discuss the clinical updates. First, some background. This project would not have been possible without our amazing volunteers. Thank you to everyone who has worked on this edition. This photo here is from our item writing workshop in March of 2022. And from top left to right, we have Ed Leibarger, Tim Strong, Jean Duncan and Sierra Sharp on the screen, then Jeanette Call and Dan Davis. And of course, that's me taking the selfie. For the materials for this course, we have a new streamlined look and high quality printed and digital materials. The online learning system is on a new platform called Achieve, which is more modern. And the newest offering with this edition is the option to add ebooks. Why ebooks? We are responding to customer demand. We've especially heard from people who work in multiple offices that having an electronic version of the course would be really helpful. The ebooks are available as an add on when purchasing the course, the trainer package or the full kit. Ebooks do not provide access to the online learning system and don't replace the physical books. But when you do purchase them, you get an access code for each book. We recommend that the student uses the codes for the textbook and workbook and the trainer uses the code for the trainer manual, but it's up to you. On the next slide, we'll get a preview of how the ebooks work. All right, let's take a look. First, open the main menu to see the options. Go to any section from the links in the table of contents, or you can search for a term that you're looking for. Once you find it, you can highlight something to add a note or create a flashcard. So I've got my note. I'll create a flashcard. Then go back to the menu to find all of your notes and flashcards in one convenient location. You can even use the different colored highlight options to create categories for yourself to keep things organized. Plus the flashcard function helps you quiz yourself. And these are flashcards that you can make in addition to the ones included in the online learning system. Pretty cool if you think if I don't say so myself. And for more ebook help, you can click on this link to find tutorials from Red Shelf, the site that hosts it. And this link is found on our website in the help section. Let's talk about course organization. The content is broken into units to help both the trainer and the trainee understand which topics relate to one another and at which point the trainee should be moving on to more advanced tasks. In the trainer manual, there are training milestones on the right side there that should be met by the completion of each unit. While the training milestones aren't new, they've been updated and their alignment with the content covered in each unit has been verified by our subject matter experts. For this edition, the textbook is the anchor of the course and provides the higher level theory and conceptual knowledge. In the workbook, topics are broken down into smaller sections with more practical application. The workbook is also where a lot of the new learning tools are located, including the key terms, updated learning objectives, and brand new exercises. The trainer manual covers the information from both the textbook and the workbook so that trainers are fully prepared to discuss the content with their trainees and help them through the learning process. So how do students use the course? For each unit, there's one or more textbook chapters, and for each textbook chapter, there's one or more associated workbook lessons. After completing the last workbook lesson associated with a chapter, students should take that chapter's test, then move on to the next chapter. Of course, that's if their trainee trainer has deemed them proficient and the skills covered in that section. For the trainer, it's a little bit more in-depth because it contains an overview of both books and includes lists of tasks for the trainer to complete as they're going through. Let's take a look at some of those. The trainer tasks are listed at the beginning of each lesson, as shown on the left-hand side, and throughout the lesson, there are additional tips, discussion questions, and suggestions for addressing specific trainer tasks, as shown on the right. The trainer task in that box directly relates to the second to last task in the list on the right. At the end of each lesson, the trainers also have a tool to track the completion of the tasks, including how long they've spent on them, and whether or not the trainee has achieved proficiency. We are really excited about the exercises that are included in this 2022 edition. They are brand new, and let's take a little bit of a deeper dive into them. Some of the exercises are printed in the workbook, as shown in this image here. Some of them, and this is the trainer view of the exercises printed in the workbook, the trainers see the exercises plus the answers, often discussion questions as well. And then some of the exercises are digital, so this is what a digital exercise would look like in the workbook, and this is what it would look like for a trainer. So what do digital exercises look like? Let's see some examples. So first, we're going to do some bridging and bracing. Let's get started. Why don't we start with otoscopes? So here I'm determining whether or not this is bridge or brace acceptably. Okay, I got it right. Look, there's lots of information that pops up on the screen there to explain why that is or isn't the correct answer. Okay, oh, I got it right again. Let's look at the next one. Not so sure. Okay, so that's what it looks like when it gets wrong, pops out with that red, so now we can see the correct. Pretty cool, really in-depth and a great way to practice with bridging and bracing. How about another one? Here's another example. In this one, I'm labeling the parts of the pinna. Okay, as we all know, I'm not a clinician, so I hope I'm doing all right. Keep going here. All right, just pop these in. Okay, I'm going to check answer at the top right now to see if I got it right. Okay, it turns out not correct. You see that red box around the center, and then the feedback on the right-hand side, it says something about the triangular fossa. Oh, okay, I think I see what I did, so I'm going to hit try again, switch those around, and check the answer again, and yes, I got it correct. There are quite a few exercises in the online learning system that are this labeling style, so I hope this gives a good taste of what's included. What about the exercise answers? There is an answer key included in the workbook, and as you can see, between the left and the right, there's a big difference in the amount of information that's included in the workbook and in the trainer manual. Students can go to the answer key in the workbook to learn whether they got the answer right or not, but for more information about why they got it right or not, they'll need to go back to the text, or even better, to their trainer who's equipped with the trainer manual. These are some of the other features of the lessons, and it's by no means comprehensive, but in particular, I want to call out that last bullet point. We've gotten a lot of questions from customers about whether there are videos associated with the course. Well, our team of subject matter experts have now reviewed numerous videos and linked them to the appropriate lessons in the course. They help provide trainees with additional insight into given topics and present the information in a new way. There's no need for you or your trainees to scour the internet for good videos because we've compiled them for you. Next is assessments. For each lesson in the trainer manual, there are a series of assessments and evaluations. The first is the practical training assessment, which gives the opportunity to categorize the trainee as beginning, developing, proficient, or advanced in each of the learning objectives covered in that lesson. There's also additional space to give an overview There's also additional space to give an overall evaluation, list specific areas that need work, and set a date for follow-up review. Plus, have the trainee comment and keep track of their test scores. The trainer's role is really important here. By keeping track of the trainee's progress and competency levels, you're creating less work as you move from training into studying for the licensing exams. We've always encouraged trainers to reuse the trainer manual for multiple trainees if they have them, and now that's easier than ever because these evaluation pages are included as downloadable PDFs in the trainer toolbox, so if you forget to make a copy, we got you. We had a dedicated team of item writers who are subject matter experts create or update all 350 of the test questions that are included in the 2022 edition of the course. One key difference between the chapter tests and the final exam relates to the answers. On the chapter tests, trainees get to see their results and know which questions they got right and wrong, as well as a reference for each question so they can go back to the books and find the reasoning for the correct answer. For exam security reasons, trainees can only see their score on the final exam, not whether they got a question right or wrong. The final exam is fully mapped to the ILE, the International Licensing Examination for Hearing Healthcare Professionals, which is the professional licensing examination managed by IHS and used in 44 states and five Canadian provinces. This means that the final exam has questions on the same topics as the ILE in the same proportion. By changing the chapter tests for this edition, each test is able to ask questions about a larger number of topics, which means that there are a mix of memorization type and higher level questions on the chapter tests. All of this information together means that this course is better preparing trainees to take their licensing examinations. Let's take a look at some of those question examples. This question is asking for one piece of information. What is the average adult ear canal length and diameter? There isn't a lot of interpretation required. Go ahead and type your answer in the chat if you'd like. Do you think it's A, B, or C? Give you a second. All right. If you guessed A, you're correct. To answer this question correctly, you just had to remember that fact. Pretty simple. Now, let's take a look at a higher level question. This is an example of a question on a chapter test. So, we're referring to the exhibit, which ear requires masked testing for accurate bone conduction threshold determination? Go ahead and put your answer in the chat. A, B, or C? Here we go. A is the correct answer. In this higher level question from one of the chapter tests, there's several factors at play. The trainee has to be able to read the audiogram, understand the process for determining air and bone conduction thresholds, and know the masking rules. They're applying their knowledge to the scenario to get the correct answer. In addition to the final exam, the whole course is mapped to the ILE. The document showing which chapters and lessons apply to which topics on the ILE is included in the trainer manual. This can be really helpful as trainees are going through the course and identifying which areas they may need additional study or practice in. The trainer manual also has documents to evaluate and assess the trainee's performance as it aligns with the ILE. The competency-based performance evaluation gives an in-depth rubric for each of the tasks listed. It's a really granular way to determine whether the trainee is ready for independent professional practice. Then on the right, the final competency assessment is a higher level look at the trainee's overall competence in the five larger topic areas. These assessments are also included as PDFs in the trainer toolbox. That sums up my overview of the features and benefits for the course. I'm now going to hand Okay, thank you so much, Michelle. Today, I'll present seven content expansions featured in the new edition of the distance learning course that represent added benefit when training students on hearing aid testing and the recommendations process. In addition to the training, I'll also present seven content expansions for the distance learning course that represent added training students on hearing aid testing and the recommendations process. In addition to the seven areas noted on the previous slide, there are guidelines of significant clinical importance in the new learning materials that will be presented in detail. We'll start with the content that provides added benefit. Most of the patients who seek hearing care tend to be older citizens who are often at high risk from the longer term effects of COVID infections. Given that auditory and cognitive symptoms have been identified in some infected individuals, it is advisable that questions specifically related to a COVID infection are explored during the case history. Another area is an expanded infection control chapter. Standard precautions represent the minimum infection prevention and control practices that must be used for all patients in all situations, whether there is evidence of infection or not. This set of precautions can prevent the spread of infection among healthcare providers and patients. They recommend common sense practices and they prescribe the use of personal protective equipment or PPEs to prevent the spread of disease. The Spalding classification system is another value-added feature of the new learning materials. It classifies all medical devices into critical, semi-critical, and non-critical categories based on patient safety and the risk of contamination by that device. It also establishes three levels of processing clinical items for decontamination, including sterilization, high-level disinfection, and low-level disinfection. This table shows how the Spalding classification is utilized in hearing aid dispensing practice, notably under the semi-critical items section. Further, this chapter provides in-depth information directly applicable to infection control policies and procedures for dispensing practices. The CDC has also provided guidance on infection control training and retraining, including when a staff member fails to meet the practices, policies, and procedures. There's a new chapter and workbook lesson dedicated to the central auditory pathways. Knowledge of anatomy and physiology and disorders of the central auditory pathways go a long way to convincing the learner that we truly hear with our brains. The electroacoustic analysis or ANSI testing of hearing aids is an important step in verifying and documenting their function and quality. Hearing aid candidacy is not solely determined by a patient's audiometric results or lifestyle, be it sedentary or active. Rather, many factors enter into the professional's recommendation for amplification. So, the new edition offers expanded guidance to trainees through textbook chapters and workbook lessons that can be applied to the decision-making process. Technology levels such as basic, standard, advanced, and premium with loosely corresponding lifestyles are presented to anchor the trainee in the factors that contribute to a recommendation. However, keep in mind that a technology level should be selected that meets the listening and operational needs of the patient, regardless of their perceived or self-described lifestyle. A comprehensive needs assessment must be part of every patient's evaluation. Another topic of benefit is behavioral verification of a fitting. Functional gain measurements are a behavioral fitting verification method for patients with implanted devices that do not let themselves to real ear measurements and for difficult to test individuals who cannot cooperate with probe tube insertion for real ear verification. We have included the referral criteria for cochlear implantation as an important consideration when hearing aids aren't enough for individuals with severe hearing loss or poor speech discrimination. We'll now move on to the three substantive features that introduce new information or procedures. The three areas that are covered are medical referral criteria, expanded bone conduction testing and word recognition and testing and interpretation. It is mandatory that hearing aid specialists adhere to their current state or provincial licensing or registration requirements regarding medical referrals which typically include the first nine items listed here. This new edition of the course also includes the conditions listed in red as important to consider when deciding if a medical referral is indicated. Item number 12 is in green to highlight its importance of word recognition scores to making a medical referral and will be covered in just a few slides. Measuring the bone conduction thresholds in each ear is typically taught with a parallel to air conduction testing. That is each year is always tested. This encourages the trainee to practice the bone conduction threshold determination procedure. However, in the interest of saving clinical time and effort we are now encouraging mentors and trainers to teach the exceptions to testing both ears by bone conduction. These exceptions are one, no air bone gaps in the first ear tested and the air conduction thresholds are symmetrical. Number two, no bone conduction response at the limits of the audiometer. And number three, air conduction thresholds in the severe to profound range which prevent the application of sufficient masking. These exceptions to testing bone conduction thresholds of both ears should not be considered shortcuts in the testing procedure. Rather, they are evidence-based recommendations that result in greater clinical efficiency without impacting test validity and reliability. Finally, always follow your jurisdictions rules and regulations regarding bone conduction testing in case the testing of both ears by bone conduction has been legislated. This slide shows the significant issues with word recognition testing that have been amplified in this new edition. In the following slides, I'll introduce PBMAX as the gold standard of word recognition testing, how the validity and reliability of PBMAX is impacted by the presentation intensity and list length. And finally, the tools available for making evidence-based interpretations of word recognition scores. This next slide shows nothing new but it's often overlooked during hectic schedules when shortcuts can compromise the accuracy of word recognition measurement. Speech audiometry must be completed using recorded and calibrated word lists and sentences. I'm sorry, sentences. Live voice testing significantly compromises test validity and reliability and is indefensible. Word recognition testing requires that PBMAX be measured. From this point forward, I will use the terms word recognition score and PBMAX interchangeably. Your trainees and in your practices, the terms can be considered equivalent if you follow the procedures outlined today. Regarding item number one in the slide, PBMAX is the metric that designates the patient's optimum performance for word recognition under controlled and standardized conditions, thus making it a valid and reliable measure of auditory function. We often use PBMAX to guide the patients when setting reasonable expectations for their benefit and success with amplification. Item number three indicates that PBMAX scores can be monitored over time. If a statistically significant change is found, a medical referral is indicated. Word recognition scores can change even when the pure tone thresholds are stable. When considering PBMAX scores in the decision to make a medical referral, we must ask the following questions. Are the word recognition findings consistent with the pure tone measures? And is there an unusual asymmetry that is not predicted by the hearing levels? We must consider the presentation level or intensity of the word recognition lists and the number of words presented for the determination of PBMAX. When reported to a physician, asymmetric word recognition scores can trigger a comprehensive investigation of a possible retrocochlear lesion, which might include an MRI. This scenario has the potential to cause distress to a patient thinking there might be a tumor, there might be expense from an MRI and or exposure to potentially unnecessary radiation. Further, measuring PBMAX at intensities that are too low can lead to erroneous results, conclusions and recommendations. On the other hand, a presentation level that is too high can cause significant listening discomfort for individuals with low tolerance levels. The common practice is to obtain one score at a single presentation intensity in each year. Historically, word recognition has been tested at the most comfortable listening level or MCL or at SRT plus 30 or 40 dB. However, there is no way to tell if that intensity level is adequate to measure PBMAX. The intensity level shown must increase the probability that the word recognition score obtained is a reasonable estimate of the true PBMAX. Therefore, it's essential to consider the need for intelligibility of the speech signal for measuring PBMAX. A presentation level that includes the air conduction threshold of 2000 Hertz is necessary given that this frequency contributes the most to the intelligibility of speech. The acoustics at 2000 Hertz contribute 33% of the intelligibility of speech, the highest contribution of any frequency. The recommended approach seen on the next slide for determining presentation levels for PBMAX emphasizes speech intelligibility without being uncomfortably loud. The recommended presentation level for the measurement of PBMAX is based on the hearing level at 2000 Hertz. This slide shows that it is an evidence-based recommendation for the presentation intensity for the measurement of PBMAX. So when the 2000 Hertz air conduction threshold is below 50 dBHL, add 25 dB to the threshold at 2000 Hertz. That will be your presentation intensity for the word lists. If the threshold at 2000 Hertz is 50 to 55 dB, add 20 dB to the threshold at 2000 Hertz. I'll skip and say that if the threshold at 2000 Hertz is 70 to 75 dB, add 10 dB to the threshold at 2000 Hertz. Here's an example of a sloping modern to severe sensory neural hearing loss with 2000 Hertz while recommendation is applied. The air conduction thresholds at 2000 Hertz are 50 and 55 dBHL. The rule for these thresholds states that 20 dB is added to the thresholds at 2000 Hertz. So the presentation levels for PBMAX testing are 70 and 75 dBHL. This method for selecting a presentation level based on the 2000 Hertz threshold is an evidence-based approach to PBMAX measurement. There are two exceptions to the 2000 Hertz guidance. The first is for those patients with 2000 Hertz thresholds greater than 75 dBHL. In this situation, follow the rule for a 2000 Hertz hearing level of 70 to 75 dBHL. You can complete additional word recognition testing at increased intensity levels to determine if you have reached PBMAX. An alternative to this rule or this exception is simply to measure the loudness discomfort level for speech and measure word recognition at LDL minus 5 dB. Bear in mind that as the high frequency hearing levels get progressively worse, word recognition ability is also affected and PBMAX may be quite low. The second exception is for patients with an audiogram that has an atypical configuration. In this case, follow the recommendation for word recognition testing for their category of 2000 Hertz threshold. Additional testing at higher presentation levels can be completed to search for PBMAX. The use of a 50-word list is the best practices recommendation for the measurement of PBMAX because it provides a more reliable measure of PBMAX than a 25-word list. Recorded 50-word lists improve test validity and reliability when compared to a 25-word list. Consequently, the risk of coming to an inaccurate conclusion regarding the patient's word recognition ability is reduced, which is particularly important when applying this information to the need for a medical referral prior to the hearing aid fitting. There is an expedited word recognition test that identifies patients who do not require a 50-word list test to reliably measure PBMAX without sacrificing test reliability and validity. To perform expedited word recognition, you must use Autotex recorded NU6 ordered by difficulty word lists. It was found that ordered by difficulty lists differentiated listeners who had impaired word recognition and required the administration of a full 50-word list to determine PBMAX. Briefly, 10 words are presented first. If the patient misses two words or more, then continue presenting words until you have presented 25. If they miss four words or more on the 25-word list, then a full 50-word list is required. The expedited word recognition test is evidence-based to provide PBMAX. In summary, the use of the patient's 2,000 hertz air conduction threshold to determine the presentation intensity of the word recognition lists and use the recorded Autotex recording of the ordered by difficulty lists requires time and effort in an evidence-based process. There is a difference between categorizing and interpreting PBMAX scores. The scale on the next slide is a generalization that applies to the patient's monaural performance in quiet using high quality equipment. It is a meaningful metric to share, especially when combined with the pure tone results, speech intelligibility index, the count the dots audiogram, or speech and noise results. It's certainly a convenient tool. However, medical referral decisions are made when the three questions on the next slide are considered. Number one, are the scores symmetrical right and left? Number two, have the word recognition scores changed over time? Number three, is the measured word recognition score or PBMAX within the expected range for a particular level of hearing loss? The research of Thornton and Raffin provided practitioners with statistically equivalent 95% variability ranges for all possible values of word recognition scores. They displayed the ranges in a chart that is referred to as the Thornton and Raffin chart. This chart is used to determine if word recognition scores are equivalent, which answers the questions, are the scores symmetrical, and have the scores changed over time? To use the table, the two PBMAX scores are compared. The comparison may be right versus left word recognition score, or the same year score from this year versus last year. First, find the patient's score on the chart. Then examine the normal variability range for that score. If the second score is outside the range, then the two scores are different enough to be statistically different. It doesn't matter which score you select first. In this example, if you choose the left ear PBMAX and find its critical difference range, the results will be the same. Here's an example of determining whether the PBMAX has changed over time. The patient scored 76% in the right ear today and 88% correct last year. To determine if there's a statistically significant difference between the scores, locate 76% on the chart and view the range. The critical range is 58 to 90%. Given that both scores are within the range, there is no statistically significant difference between the scores, so the word recognition scores have not changed. I wanna point out that the 95% critical ranges on the Thornton and Raffin chart are smaller for the 50 word lists than the 25 word lists. As previously mentioned, word recognition test reliability is better for 50 word lists than 25 word lists. So the probability of making an interpretation error is less with a longer list. Another point is that the primary application of the information obtained by using the critical differences chart is related to the decision-making process that determines whether a patient should be referred for a medical evaluation based on their word recognition scores. That is an asymmetry or a change over time. If the word recognition scores are within the range of critical differences, then the word recognition scores are not a case for medical referral. The next slide shows SPRINT, which is an acronym for Speech Recognition Interpretation. The SPRINT chart addresses the three critical questions about word recognition in one tool. Are the scores symmetrical right and left? Have they changed over time? We just saw how the Thornton and Raffin chart answers these two questions. Now let's see how the SPRINT chart addresses those two questions and also answers the question, is the measured word recognition score within the range of expected variability for a particular hearing loss? The SPRINT chart is organized as follows. The upper left area of the grid is shaded gray and has a diagonal border with the unshaded lower right side. The upper left shaded area represents the word recognition scores that are determined by research to be disproportionately low for that degree of hearing loss as defined by the pure tone average. PBMAX analyses that fall into this shaded area may indicate a medical referral. The lower right unshaded area represents word recognition scores that are determined by research to be within the realm of variability for that degree of hearing loss as defined by the pure tone average. PBMAX analyses that fall into this unshaded area indicate that a medical referral is not necessary based on this issue. Notice that you'll enter the patient's pure tone average from the left Y-axis for the analysis of whether the word recognition score is consistent with the hearing level and similarly to check whether two word recognition scores are symmetrical or have changed over time, enter your first PBMAX scores from the Y-axis and enter the second from the right hand Y-axis. The diagonal oval that represents the confidence limits or range of variability for each PBMAX score as shown by the vertical two-tailed arrows that make up the pattern within the oval. These arrows represent the entire Thornton and Raffens chart for the 95% confidence limits for each PBMAX score. So here's an example of determining whether a PBMAX score is consistent with the hearing level. The right ear word recognition score is 82% and the pure tone average is 40 dBHL. So draw a horizontal line or a horizontal arrow from the 40 dBHL on the left Y-axis, draw a vertical arrow from the 82% spot on the X-axis until these two arrows intersect. Since the arrows met in the unshaded area of the sprint chart, the interpretation is that a word recognition score of 82% is consistent with the degree of hearing loss as defined by the pure tone average. If the arrows met in the upper left-hand shaded area, the conclusion would have been that the word recognition score was not consistent with the hearing loss. Here's an example of a right ear PBMAX score of 50% and a left PBMAX score of 42%. Since the sprint chart also includes all of the Thornton and Raffin data in the diagonal oval, you can use the one chart to answer all three critical questions about word recognition scores. When evaluating whether two word recognition scores are symmetrical or have changed over time, ignore the shading on the graph and only consider whether the PBMAX arrows meet within the oval or outside the oval. Here's an example. Draw a vertical arrow from the 56% point on the X-axis labeled first percent correct score. Then draw a horizontal arrow from the 42% spot on the right-hand Y-axis until it intersects with 56%. These two arrows meet at a point within the diagonal oval, or to put it another way, the tip of the arrows meet within the defined limits of variability and are considered equivalent. Here's the takeaway from the sprint chart for determining if two word recognition scores are equivalent. If the intersection of the two word recognition scores meets within the diagonal oval, then the two scores are considered statistically equivalent because their intersection falls within the defined range of variability. If the intersection of the two word recognition scores meets outside the diagonal oval, then the two scores are considered statistically different because their intersection falls outside the defined range of variability. If this is the outcome, a medical referral should be considered. In summary, the sprint chart is an evidence-based tool that enables the hearing aid specialist to determine if a PBMAX score is consistent with the degree of hearing loss as defined by the pure tone average, and if two PBMAX scores are statistically equivalent. The results of any sprint analysis impact recommendations that will be made, such as a medical referral or some other aspect of amplification management. Once proficiency with the chart is achieved, it should take less than a minute to come to a determination about word recognition scores. Keep in mind that the use of the sprint chart assumes that a recorded 50-word list was used. There is also a sprint chart that displays the Thornton and Raffin data for the recorded 25-word lists, but it displays greater data with greater variability. And at this point, I'm going to turn over the slides and the presentation again to Michelle. Thank you, Pat, for that great information about the clinical updates in the course. As you can tell, there have been some changes, so I'm sure everyone wants to know, how does the changes affect the ILE? The ILE uses the distance learning course as one of its recommended reference materials. Since there are content updates, the recommended edition to use when studying for the exam will change, but not this year. So let's take a closer look. If a trainee is taking the ILE in 2022, it is recommended that they use the 2016 edition of the course because it is fully compatible with the ILE. Those taking the ILE in 2023 can use either edition, 2016 or 2022, when studying because the exam will be compatible with both editions. Starting in 2024, the ILE will be compatible with the new 2022 edition of the course. And that concludes our presentation. We now have plenty of time for questions. So I'll head it back over to Sierra. Thank you so much, Pat and Michelle, for that great presentation. The questions have been flowing in, so let's get right to them. As a reminder to our attendees, you can enter your questions in the Q&A box at the bottom of your screen, and we will get to as many as we can in the time remaining. The first question we have here is from Charles. And, Michelle, this is a question for you. Charles wants to know, how do we purchase the course? Is there a member discount on the course? How do we become an IHS member to take advantage of that discount? Absolutely. So, yes, the course can be easily purchased from the IHS website, ihsinfo.org slash dlcourse. It'll lay out all of the information about the different options, pricing, and everything there. You can also give us a call, and we'll be happy to help you out purchasing that way. You can join as a member also on our website or by contacting our membership department. Professional membership is $325 annually, and we also have a student membership for only $40. Both of them, once you get your membership process, lead to a member discount on the course. So for the student course only, for example, the members would pay $739, whereas non-members would pay $769. Perfect. Thank you so much. We have a question here from Anon. Are physical books also available for those who want something tangible in addition to e-books, Michelle? Not only are physical books available, they're required. You can only get e-books if you also get the physical books. As I mentioned before, the e-books don't include access to the online learning system, which is where the tests are. So you'll have to purchase the physical books, and then you can optionally add e-books as well if you want to have another way to access the material. Perfect. Thank you. And Michelle, speaking of tests, Violet wants to know, how many times can we take the final exam on the IHS site? Of course. So the chapter tests can be taken only twice, but the final exam can be taken as many times as needed to pass, and the passing score is 75%. Perfect. Thank you. And we'll give Michelle a quick break. Pat, the next question is for you. This is, I believe, about the 2K threshold, the use of that for determining the presentation level for word recognition testing. From an anonymous asker, they ask if you could cite your source. They think this might be a recommendation from Gus Mueller. Is that correct? Do you have the reference for that offhand? I do, and that is, let me see. It's Guthrie and Mackersey. Guthrie and Mackersey. I know that Hornsby and Mueller did have audiology online presentation to bring people up to speed on word recognition, and they did mention the Guthrie and Mackersey research for the 2,000 hertz recommendation. Yes. Wonderful. Thank you for clarifying that, Pat. I want to add a quick thing on that as well. So, it didn't get mentioned earlier, but one of the other things that we've added with this edition of the course is a robust reference list. So, at the back of the textbook now, there is a very long list of all of the sources that we cited in developing the new content. So, you can find all of that in the back of the book as well. Perfect. Thanks for adding that, Michelle. Michelle, we're going to go back to you, and I'm going to ask, I'm going to kind of combine two attendee questions into one because I know that you can handle it. One person asks, and this is from an anonymous asker, they ask how the passing score on the final exam of 75% compares to the ILE, and are there theoretical questions on the final exam only, or are there any other demonstrations they have to show? And then Pankaj asks how the course prepares people for the ILE. Is the course alone sufficient to pass the ILE? Great. I'll do my best to answer all three of those questions. So, the first one is about the passing score on the final exam versus the passing score on the ILE. Officially, they're unrelated. What the final exam is determining is whether or not the student has learned the information in the course. So, that's where the 75% passing score comes from. The ILE, however, is set through a different process, and they're determining whether or not that person is prepared for independent professional practice and a license or registration. So, that's a separate issue. Officially, those two numbers aren't related. The second question was about, I have no idea, I lost it. Can you repeat it, please? Yeah, the second question is about how does the course prepare folks for the ILE? Is the course alone sufficient? And about the final exam in the course, is it theoretical only, or does it require demonstration of other types of knowledge? Sure. So, the final exam is a multiple-choice, computer-based exam. So, it is going to be practice-based. It's going to ask students to be able to, like that second question that we looked at earlier, look at an audiogram or read a scenario and apply their knowledge to that scenario to come to the correct answer. And the course prepares trainees for the exam. Well, let me clarify. The course doesn't, isn't intended specifically to prepare trainees for the exam. The course is prepared, is designed to prepare trainees for independent professional practice. And the ILE, the licensing exam, tests whether or not they're prepared for that. So, it kind of helps prepare you for the exam as a consequence of preparing you for the job. And no, the course alone is not usually going to be sufficient to help trainees be prepared for that job or pass the licensing exam, because it's meant to be completed at the same time as hands-on training from a professional. So, in a perfect world, a trainee is going to be going through the course materials while they're also going to the office and working with patients and clients every day and then getting that feedback from their trainer who's equipped with the trainer manual. Perfect. Thank you. And speaking of trainers and trainees, if I'm a trainer and I buy the course, can I use it for multiple people or is it one course per one trainee? And that's from Chelsea. It is one course per one trainee. So, when you buy the course materials, there is an access code included in the workbook for the online learning system. That access code is one-time use only. So, one trainee will redeem that access code, get logged on to Achieve, go through the chapter tests, the flashcards, the videos, the webinars, the articles, take and pass the final exam, and earn their Certificate of Completion. Then that code's been used. It can't be used for anyone else. Excellent. Thank you. We have another question, a lot of questions here from Michelle. This next one is from Kristen. How will the current students who are on the 2016 edition of the course and are working in the Hayden McNeil website, how might that be updated for current trainees and or will their work be transferred to the new Achieve platform? Sure. So, if you are enrolled in the 2016 edition of the course, you should have already been receiving communication from IHS by email about getting your progress transferred over. So, the current online learning system is being discontinued at the end of this year. So, everyone will be moved over to Achieve and those who are not yet finished will be able to pick up where they left off and continue the course and earn their Certificate of Completion. They will have to do this by May 31st, 2023. After May 31st, the 2016 edition will be sunset and no longer supported. So, we are in the process of getting that moved over. And then for people who've already completed the course or for trainers who want continued access to the Trainer Toolbox, they can also create Achieve accounts and have continued access there. Perfect. Thank you. I'm just reading this question so I make sure I'm representing it accurately. This is a question for Pat. And this is from an anonymous asker and they're asking or they're stating that they are board certified. They've been training folks for 20 years. So, lots and lots of experience in the field, which is fantastic. What would your advice be or how do you see trainers passing the newer testing procedures specifically around word recognition testing and PBMAX? Explaining these and passing them on to their trainees if they themselves have been performing these tests differently for many years? The best teacher is practice. Practice and perfect practice. It doesn't take long to make the evidence-based recommendations. First of all, use recorded materials and especially a 50-word list takes time for the trainer to get experience in using the ordered by difficulty list, the expedited word recognition testing, and then, of course, being very familiar with the sprint chart. And it sounds like a lot, but it really isn't because it is the process. It's the standard of care, the standard of practice, and the trainers really need to know how to do these processes themselves in order to pass that information on to the trainee. And, you know, I have a lot of experience as a doctoral level audiologist, and yet my involvement with the new distance learning materials taught me a lot. It changed the way I practiced. And it makes answering the questions, especially regarding word recognition scores, evidence-based. It is defensible, and the result is better patient recommendations, improved clinical efficiency, and improved validity and reliability of testing. Thanks, Pat. I know when you first showed me the sprint chart, it looked like Greek to me, but then once I heard the explanation and was able to read the explanation for myself, using it became a really quick and easy way to compare those word recognition scores. So thank you for that additional explanation. You're welcome. Michelle, we are back to you. Lots of logistical questions today from our attendees, which is great. So I'm going to kind of combine two questions from Tyler and from Kirsten. So they want to know, first of all, how ILE test prep might be updated or compare or contrast along with these new distance learning course updates. And additionally, can you remind us when the ILE will be aligned with the new materials? And also, I just want to give a shout out from Tyler to Michelle and Pat, who says that the new materials are an order of magnitude better than the 2016 edition, which is great feedback. Oh, that's great. Thanks for that. Thank you. Yeah, so ILE test prep is updated on a rolling basis, somewhat annually. So the ILE isn't really changing, right? So the way the questions are written isn't changing, the style of questions isn't changing. So they want to remind us that, as Pat covered in this webinar, there are some content and clinical differences between the 2016 and 2022 editions of the course with different recommendations. So starting in 2023, trainees can use either the 2016 or the 2022 editions to study for the ILE. And starting in 2024, they'll want to focus more solely on the 2022 edition, because the ILE will be more reflecting those clinical changes. As far as what's on ILE test prep now, ILE test prep is great for providing familiarity with the style of questions as they're written on the exam, the ILE, and for how to think about questions to arrive at the correct answer. But actually memorizing the answers to the questions in ILE test prep is not really going to help anybody. It's more about getting practice with that exam type situation than it is about the content covered there. So even though it'll take a few years for the new questions to kind of, for lack of a better phrase, trickle down to ILE test prep, it's still going to be providing a lot of benefit. Plus, all of the new test questions that were created or updated for this new edition of the distance learning course are really going to help prepare trainees for the licensing exam as well. Great, thank you. And this is a question that perhaps Michelle and Pat, you can both answer and maybe we can start with Pat. So an anonymous asker wants to know if you've connected with, if we have connected with various state and provincial associations or licensing agencies to adjust their recommendations for referral, for example, regarding word recognition scores. And I think maybe the extension of the question there is, what should I do if my state or provincial laws and rules about my scope of practice and my license maybe conflict or have a little bit of different information than these new recommendations in the distance learning course. So maybe Michelle, you want to speak to have we broached updating the referral criteria with licensing agencies and Pat, maybe you could speak to what do I do if my license says something different than these books. Sure. I, off the top of my head, I don't know that we have explicitly reached out about changing those guidelines. As you know, working with legislatures is a long process. Absolutely. We're going to take one last question here. And before we do, I have two questions that I'm just going to answer quickly. One of them is, can we get a copy of today's slides? Yes. And I'll cover that in my wrap-up. And the other person asked if a recording would be available. And the answer is also yes. And you'll receive an email in the next couple of weeks when that recording has been rendered, edited, and is available for you. So the last question I'm going to shoot to you, Michelle, today is from Violet. Violet wants to know where I can get a trainer manual. I received a workbook and a textbook. And my sponsor and I were talking about how it'd be easier to get a trainer manual. Yes, we have that. It's called the trainer manual. If you go to our website, ihsinfo.org.dlcourse, or give us a call, we can help you order that material. You can get the trainer package by itself, which is the trainer manual, and it's online learning support. So if you go to our website, ihsinfo.org.dlcourse, or give us a call, we can help you order that material. Thank you so much for joining us today. If you have any questions for our presenters, or if you asked a question that we weren't able to get to, please shoot us an email at education at ihsinfo.org. We would be more than happy to have additional conversations or answer any questions we were unable to get to today. Thank you again so much for joining us. We'll see you at the next IHS webinar.

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