Xu Fei Shares Insights on Audiology Practice in China

By Timothy Cooke

With the development of new professional standards and educational programs at leading medical universities, audiology is gradually becoming recognized as an independent medical field in China, according to Ida Fellow Xu Fei, a Lecturer in Audiology at Zhejiang Chinese Medical University.

Audiology, in comparison to the study of otolaryngology, does not have a long history in China, according to Xu Fei. The first program for training audiologists in China was established at Capital Medical Sciences University in 1996. Zhejiang CHinese Medical University introduced the study of audiology as an independent educational track in 2004.

Before the recent introduction of audiology programs, the study of otolaryngology predominated across Chinese medical universities. To receive supplemental training in audiology practice, ENT specialists in China would attend six-month audiology training courses in the United States or Australia. 

The introduction of audiology as a separate educational track is a step in the right direction for audiology practice in China. There are approximately 20,000 ENT specialists in China according to Goulios and Patuzzi (2008). With a population of approximately 1.3 billion people, that would mean there is one ENT specialist for every 65,000 people. The number of audiologists in China is much lower. According to some estimates, there are less than 2,000 trained audiologists in China, despite the fact that there are many professionals working at private hearing aid dispenser chains across China.

"As a new field, qualifications for hearing care professionals and audiologists are not standardized across China. Hearing care professionals working in private dispensers and hearing clinics often have very different levels of qualifications and skills," states Xu Fei, Lecturer in Audiology at Zhejiang Chinese Medical University. "Since 2004, more than 400 students have graduated from the audiology program at Zhejiang Chinese Medical University. I believe that this is an important first step to increase the level of knowledge among all health care professionals in China."

Those that do graduate from an audiology program at medical university often face the daunting challenge of managing their time in an environment where scheduled appointments are not the norm.

"It is very difficult for audiologists in China to manage their time. Patients do not make appointments. They just come when they want to and will wait outside the front door until the audiologist has time to see them. This is similar to what occurs at Chinese hospitals. People show up and wait many hours until they are seen by a doctor," states Xu Fei. "Sometimes an audiologist may have one patient, and sometimes they may have up to four or five patients waiting at the same time. It is often the case that your time with the patient is severely limited due to lack of appointments and scheduling. This can often prevent audiologists from engaging with patients in a discussion about their life or communication challenges."

In addition to time management issues, new audiology graduates working in private clinics face the challenge of finding the right balance between commercial interests and the interests of individual patients.

"Most audiologists in China are employed by hearing aid manufacturers, dispensers, or hospitals. Those that work in the private sector, which is the majority, focus a great deal of their efforts on meeting financial goals and improving the efficiency of the clinic. The more clients one sees in a day, the more sales that can be made. Those working in hospitals are more likely to prioritize patient interests," states Xu Fei. "Audiologists in China are taught medical ethics, so they are exposed to the importance of patient-centered care and recognizing the autonomy of the patient. After introducing the Ida tools to colleagues, however, many find that the barriers to change are too much to overcome, and are unwilling to adopt these new methods. In this way, there is a long way to go in order to improve practice in China and implement the Ida tools into audiological practice."

Xu Fei is a trained ENT specialist and a Lecturer in Audiology at the Zhejiang Chinese Medical University, one of three schools specializing in hearing and speech science in China. In 2009, Xu Fei attended the Ida Institute's first seminar series on the Process of Defining Hearing.