TRAINEE MATTERS Communication Disorders: a combined discipline of audiology and speech and language pathology – the Israeli perspective

Liat Kishon-Rabin provides an excellent summary of audiology training in , encapsulating the development of audiology services in the country. Readers will be intrigued by the systematic approach taken to its development, and its pairing with speech and language pathology.

n Israel, academic and professional 2009). Tel-Aviv University and Haifa and language pathology services in organisations have adopted a dual University are the only ones to offer the country indicated the need for the specialty model for the disciplines of graduate programmes in all areas of establishment of a formal university- Ihearing (audiology) and speech and CD (MA with a thesis and PhD), while based and degree-awarding programme language pathology, suggesting that they Hadassah Academic College offers an MA in audiology and speech and language are interrelated and should be studied degree without thesis. pathology. together. Therefore, in Israel audiology In 1967, the first Department of and speech and language pathology are Milestones in the development of the Communication Disorders – Speech, not referred to or studied as separate communication disorders programme Language and Hearing, was founded by disciplines but rather as one. For this in Israel Prof Moshe Rubenstein as the School reason, the profession in Israel is called After the foundation of the State of Israel of Communication Disorders within the communication disorders, and the in 1948, rehabilitation and counselling Faculty of Medicine, Tel-Aviv University communication disorders (CD) clinician services in the fields of hearing and (TAU). Until then, no programme had is a professional who specialises in speech and language disorders were existed (academic or otherwise) for speech, hearing and language sciences provided by physicians and informally training professionals in Israel in the and disabilities. In 2008, a state law was trained nurses, technicians and teachers. fields of audiology and speech and passed defining that a “communication The establishment of the scientific and language pathology. Establishing the first disorders clinician” is an individual professional field of audiology in Israel programme in a leading university, in who has been awarded a certificate was a result of the first International addition to creating an academic degree, of the profession from the Ministry Course in Audiology, held in 1950 in allowed for the development of high of Health (http://www.health.gov.il/ Stockholm. One of the participants on quality candidates and a high quality LegislationLibrary/Mikzoha_01.pdf). the course was the late Professor Moshe curriculum, because being part of the In order to obtain this certificate, one Rubenstein, an otolaryngologist from Sackler Faculty of Medicine gave the must hold a bachelors (BA) degree in Tel Hashomer Hospital in Israel (Figure programme strong support in the basic Communication Disorders from one of 1). He approached the late Professor sciences. It also allowed for the later the CD programmes in Israel recognised Moe Bergman, a participant from the establishment of graduate programmes by the council of higher United States and one of the leading (MA and PhD) for developing leadership (CHE) and pass a state exam from the instructors at the Stockholm course, in the field, specialising in specific areas Ministry of Health1. Thus, it is illegal for and invited him to lecture and plan and conducting research. Currently, an individual to refer to him / herself as audiological services in Israel (Figure 2). all CD programmes in Israel are within a communication disorders clinician if Prof Bergman’s visit to Israel in 1953 led schools of health sciences, public health he / she does not hold a certificate from to the design and opening of several well- or health professions, thus maintaining the Ministry of Health. Currently there equipped audiology clinics in hospitals a curriculum with a strong scientific- are five academic institutes recognised including Tel Hashomer Hospital (now medical basis. by the CHE that offer a BA degree in Sheba Medical Center) and Hadassah Three basic principles guided the CD: Tel-Aviv University (since 1967), Hospital in , both affiliated development of the programme, which Haifa University (since 2002), Hadassah today to a CD programme (Tel-Aviv were also the basis of the 2008 state law Academic College, Jerusalem (since University and Hadassah Academic mentioned above. The first principle was 2002), Ono Academic College (private, College, respectively). By the mid-1960s, that the programme needed to offer an since 2007), and Ariel University (since the proliferation of audiology and speech academic degree (i.e. BA) to its graduates,

Note 1It should be noted that for new immigrants who studied abroad, the Ministry of Health awards a certificate of the profession based on different criteria.

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Figure 1. Professor Moshe Rubenstein, MD (1915- undergraduate programmes in Israel. 1989) was an otolaryngologist from Tel Hashomer hospital (known today as the Sheba Medical This is a structured programme of 220 Center), who foresaw the importance of building semester hours (3,080 clock hours), well-equipped audiology clinics with academically- approximately two thirds of which trained personnel, in the newly founded country where speech and hearing services had been is devoted to theoretical and clinical provided until then by informally trained staff. Prof teaching in the first two years, and one Rubenstein founded the first formal university- based, degree-awarding programme in the third of which is devoted to clinical combined discipline of Audiology and Speech and training in the final year of the study. Language Pathology (termed “Communication As a result of the intense nature of the Disorders”) in Israel. He was the head of that programme at Tel-Aviv University between 1967 programme, in 2003, the CHE approved and 1985. an increase of one semester to the undergraduate programme, extending it to three-and-a-half years with the condition that there would be no increase in the teaching units in the undergraduate thus lasting at least three years, which supervision. programme. The CD classes are limited included a curriculum that would The initial curriculum of the first to about 45-50 students in each of the meet entry to practice requirements undergraduate programme was drawn programmes. The major reason for as specified in North America (i.e. up in the USA by Prof Moe Bergman this limitation is the difficulty that all equivalent to the MA degree). The [who headed the academic programme programmes encounter in providing second principle was that speech, at Hunter College, City University of sufficient places in which students have language and hearing sciences and New York (CUNY), USA, and was the first hands-on clinical experience. In most pathologies should be studied together executive officer of the PhD programme CD programmes, these places need to as one discipline. Many language and in Speech and Hearing Sciences at the be in public institutes or run by non- speech disorders are associated with graduate school, CUNY], and reviewed profit organisations and have the clinical impaired auditory speech perception and amended by several American heads staff that meet the academic criteria for (especially in degraded conditions) of clinical and training programmes in student supervision (preference of MA and pathologies of the auditory audiology and speech and language degree, at least five years of experience system (peripheral and / or central) pathology. They were asked to propose in the area of supervision, and to have are usually associated with deficits an “ideal” speech, language and hearing passed a clinical instructors course). in speech and language capabilities. programme which would provide While the entry level to practice is a Thus, it was important to confer upon sufficient theoretical and clinical training bachelor’s degree from a CD programme the Israeli communication clinician a for transforming a BA candidate into a in Israel, clinicians are encouraged to comprehensive field of expertise related clinician who would be an independent obtain an MA degree (two years of further to both speech and hearing. This is in critical thinker able to make informative academic studies) for positions in the keeping with the current philosophy clinical decisions. This was a challenge national health care system, hospitals in healthcare, in which a patient with a considering the fact that in the USA the and in the education system. Graduate communication disorder is not treated entry level to practice is an MA degree. studies at Tel-Aviv and Haifa universities for the specific disorder in a purely An ad hoc curriculum committee in Israel allow the clinicians to select courses of technical manner but, rather, is viewed then modified the proposed programme their interest for specialising in different from the broader perspective of the in order to accommodate it within the areas within the discipline and to conduct speech / communication chain. The third academic structure of higher educational research in basic sciences or clinically principle that guided the development of institutions in Israel. The structure and oriented topics. Research is conducted the CD programme was that the clinical curriculum of the programme that was in well-equipped, state-of-the-art practicum should be part of the academic proposed, revised and accepted in 1967, laboratories within the departments. programme and under academic established the basis for all current Obtaining a PhD degree is necessary for

Figure 2. Professor Moe Bergman, EdD (1917- 2014) from the USA, was one of the leading instructors at the First International Conference in Audiology held in 1950 in Stockholm, where he met a group of otolaryngologists from Israel. His visit to Israel in 1953 led to the introduction of audiology clinics in the country. In 1967, he helped draft the curriculum for the first academic programme of Communication Disorders in Israel (at Tel-Aviv University) which was based on the interdisciplinary approach that speech, language and hearing should be studied together. He was the head of the Speech and Hearing department at Hunter College in New York and served as the first executive director of the PhD programme in Speech and Hearing Sciences at the Graduate School, City University of New York.

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those interested in holding an academic ENT Trainees, turn to page 100 for Charlie Huins and Matt Clark’s Cambodian position at one of the CD programmes, otology fellowship report. and is a significant advantage for those who want to hold a leading position at national level. It should be noted that each of the CD programmes also provide continuing education courses and clinically-oriented non-academic courses are offered by the Israeli Speech, Language and Hearing Association. For 49 years, the concept that audiology and speech and language pathology is a combined discipline that should be studied together has proved to be beneficial for the Israeli population, as well as for clinicians and researchers. Although the academic training is considered demanding and rigorous, and entry level to the undergraduate programmes in CD is high, the graduating clinicians are known to be well-rounded, are clinically proficient quality training of CD clinicians in Israel and have the ability to integrate are its population. Local clinicians have Acknowledgements information from several areas. Many always attempted to keep CD services I would like to thank Professors have moved on to obtain a PhD degree abreast of progress and developments Minka Hildesheimer, PhD and Chava in CD and now hold key positions in the worldwide. These include mandatory Muchnik, PhD, former heads of the field in Israel, including at institutes newborn hearing screening, cochlear CD department at Tel-Aviv University, for higher education, CD clinics at implants, early fitting of digital hearing Dr Ofer Amir, PhD, present head hospitals, rehabilitation centres, health aids, use of telemedicine for of the CD department and Dr Orly maintenance organisations and as chief (re)habilitation, development of diagnosis Herzberg, PhD, Chief Communication clinicians at the Ministry of Health and and intervention tools following Disorders Clinician at the Ministry of Ministry of Education. Graduates of head trauma, early identification and Health, for their valuable comments the programmes in Israel lead research intervention of learning and reading on this article. at prominent academic institutes disabilities, use of advanced imaging abroad and many are internationally techniques for diagnosis and treatment known researchers in various areas of of swallowing and voice disorders, and more. the discipline. Most importantly, the SECTION EDITORS immediate beneficiaries of the high Amanda Casey Director of Audiology Programmes, Aston University Birmingham, Liat Kishon-Rabin, ABOUT THE AUTHOR PhD, UK. Professor Liat Kishon-Rabin, PhD is a senior tenured E: a.e.a.casey@ Communication staff member at the Communication Disorders aston.ac.uk Disorders Department, department at Tel-Aviv University (TAU), which she has Sackler Faculty of headed for nine years. She earned her BA degree in Medicine, Communication Disorders from TAU and is a licensed Tel-Aviv University; communication disorders clinician for the Ministry of Emma Stapleton Communication Health. In 1990 she was awarded with a PhD degree Disorders Department, Sheba Medical from CUNY in New York, USA. Prof Kishon-Rabin has Cochlear Implant Fellow, Center, Tel-Hashomer, published over 70 peer-reviewed articles in the areas Crosshouse Hospital, 52621, Israel. of speech science, psychoacoustics, learning and Kilmarnock, UK T: +972544722868 plasticity, and on the effects of hearing loss on the E: emmastapleton@ F: +97235352868 development of speech perception and production in doctors.org.uk E: [email protected] infants, children and adults. She serves on numerous @otolaryngolofox committees at her university as well as at the higher council of education.

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