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Supervision from the Inside Out

Supervision from the Inside Out
D'Anne Rudden, AuD
July 8, 2019

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Editor’s note: This text-based course is a transcript of the webinarSupervision from the Inside Outpresented by D'Anne Rudden, AuD.

Learning Outcomes

After this course, learners will be able to:

  • Define supervisor, preceptor, mentor, and colleague roles and understand their value and differences.
  • Describe the contrast between management duties and leadership training in the supervision of students and employees.
  • Initiate the process of developing an integrative leadership lens statement with optional tips/exercises to help empower supervising success.


This course is a way for you to change your lens or perspective on how we train, elevate, and launch the students and employees that you are responsible for. I hope that you get the basics to discover a more effective leadership path and highlight your awareness. Before we dive in, since this course is Supervision from the Inside Out, I want you to find a comfortable seat in your chair and place your feet flat on the floor. If you give yourself a moment to close your eyes. Feel yourself centered, rooted, and grounded in your chair and on the earth. Now just by means of breathing, see if you can lengthen your spine, taking nice deep breaths in and out through your nose, noticing any thoughts that move in through the mind. Let these thoughts move out, almost as if a breeze would move through a room. Let's take just a couple more deep breaths. Really arrive. Take a deep breath in through your nose and open your mouth, exhale. Let it go. On your next inhale, go ahead and blink your eyes open.

Course Objectives

Now that I have your attention let's talk a little bit about the objectives for the course. Even though supervision often starts from the inside out, we want to be able to define supervisor, preceptor, mentor, colleague, and to understand the differences in these roles. They can be different, but they're often misunderstood. I hope that you will understand the differences between what it means to manage people and what it means to have effective leadership as an audiologist in your professional role. Last but not least, I want you to take home today the basics of developing a personal and professional lens statement.

Statistics & Important Numbers

Let's talk about numbers because we are audiologists and we like to have data to back up the things that we might be discussing today. Audiology's future on paper looks bright. We have great statistics to back this up.

Growth in our profession. Audiology is expected to grow as a profession by at least 21% for the next ten years, and I've seen some of the statistics be even as high as 28%. At this point, we are going to need about 3,100 additional doctors of audiology to fill professional demand in that timeframe. That doesn't sound like a lot in some respects, but when we think about the fact that there are about 15,000 practicing audiologists currently in the profession, that's a pretty high number. How do we draw those people into our field?

Profession ranked. If you read the U.S. News & World Report, we are the 26th best job ranked by them in 2016. Forbes also referred to us as one of the fastest-growing professions for women. Which is not unexpected considering that if you look up data, there is an extremely high percentage of women in our field. 88.9% of us are female, and that's not surprising. I mean, it's a helping profession. Often, people report coming to the profession from other typical women or female-dominated professions like teaching or speech pathology. If we look at healthcare, U.S. News & World Report thinks we are pretty special too, ranking us 18th as best healthcare jobs.

Doctoral programs. We have quite a high percentage of doctoral programs across the U.S. In Fact, 73 doctoral programs for a professional doctoral degree is much higher than a lot of other professions like dentistry or optometry. We have a high number of people that enroll in their first year. Of the 73 programs, enrollment can be as high as 96%, almost 97%, that's pretty darn good. We are hoping with those statistics to collect 2,400 additional colleagues in the coming years, and there is still is a deficit. We are still going to fall short in some way. How do we gather more people into our profession?

The Mindset of Our Profession

From the sounds of those numbers, you would think audiology as a profession would be doing well. All of us should be able to command any number of rewarding or high-paying, secure job opportunities, right? If you scroll through the feeds of many of our online social media pages, you might think that a pervasive attitude dominates audiology and that we are under attack from all sides. I have heard from several colleagues that they would never recommend audiology as a career option. I want to get an idea of how you feel about audiology and its potential future. Do you have that same pervasive fear that we are going to be the Blockbuster of healthcare? Or do you feel like this is a new opportunity for us to change things up and find people that can take us into the next phase of our development? My hope is that although there are things to be aware of and we never want to put our heads in the sand, that, for the most part, audiology is safe and sound as a professional career choice. I hope the majority of you feel like audiology is not at its end. Would you recommend audiology as a career option? I actually, I love what I do. I think most of us when we get an opportunity to talk about why we got into the profession, we do enjoy what we do and love it. 

Underlying Issues in Audiology

Issue #1. We have some underlying issues. I feel some of our underlying problems are that history suggests that we are in a paradigm shift. The same way medicine has shifted, where the "physician tells me what to do" kind of model to a patient participation model. Medicine has had to learn to integrate patient self-knowledge and easy online research into a personalized, professionally-driven treatment plan with a positive customer service experience and customer-oriented experience. We are not the only ones feeling this bit of transformational vibration in our profession.

Issue #2. One of the things that we have to consider in how we look at the next generation of colleagues as well as the people that work with us in our practices is that we have to begin to develop an entrepreneurial mindset. You might think to yourself, I'm in a university or hospital setting, and I don't need to be an entrepreneur. What I would tell you is that an entrepreneurial mindset is about being willing to look at new opportunities and challenges, to be a risk-taker, to embrace change and take action persistently, to pursue initiatives and focus on what matters, and see the big picture. What successful individuals have in common is hard work, and that drives their success. Regardless of your setting, becoming forward-thinking creates the condition for some of those successes to happen whether you're a seasoned professional or a brand new student in their first externship. We are making success a habit. The entrepreneurial mindset is mental because you can't just flip a switch and get this mindset. You have to follow in the footsteps of those before you and understand how and why they earned that mindset, and I'm still working on it myself. The process is to retrain your brain. It takes practice to learn to remove distractions and develop positive habits, to learn to fail fast. To work towards improving yourself every day and to understand your "why". That becomes very critical.

Issue #3. Soft skills, in my opinion, are not given enough credit in professional training and professional work. We'll talk more about soft skills in a little bit, but professional development has to be more than just creating competency with technical skills (i.e., listening, collaborating, presenting ideas, communication with team members). This may ensure a more productive, collaborative, healthy work environment. Perhaps even though automation and artificial intelligence may or may not eventually permeate our profession, it will result in a higher proportion of jobs relying on soft skills. Tasks that require hard skills are continuing to decline and making soft skills a critical differentiator in the workplace is becoming more and more recognized. Deloitte Access Economics predicts that two-thirds of all jobs by the year 2030 will rely on soft skills.

Issue #4. The underlying condition that lead, adapt, or die truly begins with self-awareness. Because if you're in a highly competitive culture, you might think that this sounds pretty counter-intuitive. That you should be looking around at the people around you and observe what are they doing, not that you don't want to be aware, but if you're honest with yourself, it's essential to not only be mindful of your weaknesses and your strengths. To be self-aware and know when your limitations are popping up and have skills and tools to move through them.

Audiology: Performing a Process or Creating an Outcome?

What kind of profession is audiology? I recently listened to a podcast called the Good Life Project. If you've not listened to that, I would highly recommend it. The episode that I was listening to, Jonathan Fields, the host was interviewing entrepreneur and best-selling author Seth Godin. They were discussing changes in the landscape for today's professional leaders and workers. Stating that in so many areas, our society itself is changing from occupations where you're performing a process to those where you're creating an outcome.

For example, in audiology, we are shifting from an occupation of people who assess hearing loss, performing a wide variety of test protocols for the sole purpose of diagnosing a condition to one where we are using the tools and our test protocols. Also, our profession offers a variety of technology options to create the desired outcome for better living. This is done through the vehicle of hearing solutions, enhanced communication skills, auditory processing, and balance improvement for those populations that we serve. Thus, our supervision of students and employees have to reflect this change in mindset. I believe that part of our job is empowering those that we work with to be confident in their ability to guide the process of creating the patient experience of our services from start to finish.

History of Supervision

How did we get here? These shifts didn't happen overnight. When you look at the history of supervision, in 1935, our supervision of others was allocated to performing a series of assembly line tasks. For example, place widget A into widget B and then do it again over and over with absolutely zero expectation that you either did the job or not. As things began to evolve from that assembly line mindset, we moved into the 1960s where you were dictating to those you might be overseeing. If you wanted to talk to the person in the next office to you, you might call in your secretary and dictate a memo. She would walk over and give the note to somebody else. The human interaction wasn't nearly as human as it is now, and this shift happened in our lifetime. Now, with the use of screens, we are seeing that pendulum move even further away, becoming more disconnected than ever.

Shift Towards Knowledge Tasks

We want to continue to move closer to high-yielding knowledge work. There's a need to transcend basic tasks, meaning if someone writes down what you do for a living, they are going to find someone cheaper than you that will do it. If the task is performed in steps, basically you're doomed because the steps can be performed by a computer. People are racing to jobs where they cannot be easily replaced, and in those jobs, we are discovering that fear drives so much of what is possible or not possible. We have to pay attention to the intangibles. The art of whatever it is that you bring to the job is truthfully 96% of what holds people back, or what holds anyone back.

If you don't believe me, then let's talk a little bit about making an electric car. Before Tesla, other car companies like Ford, GM, Mercedes, all of those companies already knew how to make an electric car. There was absolutely nothing that Tesla brought to the table that was completely unknown. Those other companies were filled with people who said something akin to, "I didn't sign up to work at this 100-year-old car company so that I could risk anything, risk my entire career on some crazy scheme". Tesla succeeded not because no one could figure out the voltage parameters of a battery, but every member of their team integrated this growth-mindset of leadership and was taught to seek non-traditional answers. Their collective strategy was to allow everyone to focus on the possibilities rather than the limitations.

Teaching and Mentoring with "VUCA"

I believe that when we are supervising professionals, especially young professionals, and our support staff, we have to teach, encourage, and mentor them to get comfortable with VUCA. If you're unfamiliar with VUCA, it stands for volatility, uncertainty, complexity, and ambiguity. VUCA is a concept that originated with students at the U.S. Army War College to describe the volatility, uncertainty, complexity, and ambiguity of the world after the Cold War. Now this concept started to gain relevance, and in its current environment, leadership started to take this on to help navigate the unpredictable events for things that were happening outside of their organization. Things that were maybe positive. Sometimes they were negative, but basically, the higher the VUCA, the more difficult it is for leaders to make decisions. How do we navigate that, and how do we teach that to the people that we are working with?

According to the Harvard Business Review, there is a way to develop a crisis management strategy for this changing professional landscape. Some of the things that you can look at are to identify elements within each of these categories that may or may not be happening at any given time.

Volatility. For instance, with volatility, the characteristics of that type of situation are whatever your challenges may be. It may be unexpected, unstable, and it might last for an unknown duration of time. Knowledge about it is often available. One example of volatility might be prices fluctuating after a natural disaster. A supplier in a particular part of the marketplace might be taken out because of that fluctuation in prices. An example in audiology might be creating a competitive strategy to deal with the volatility of third-party administrators entering into our marketplace.

Uncertainty. If we are looking at uncertainty, one of the characteristics of dealing with uncertainty would be lack of other information. The event's underlying causes and effects are unknown, but change may still be possible although it's not a given. An example might be a competitor's pending product launch muddles the future of business in the marketplace. An example from audiology might be over-the-counter hearing aids. There's a little bit of uncertainty going on there. Now if we invest in information around uncertainty, collecting it, interpreting it, sharing it, then we may have a better way to reduce any oncoming, ongoing uncertainty.

Complexity. This deals with situations that may have inter-connected parts and variables. For example, maybe you're doing business in lots of countries with different regulatory environments. I think of this for audiology as the advent of TeleHealth. There's a lot of complexity that's going to go into that, and becoming comfortable with the complexity of that changing landscape is essential for all of us to be working towards. Maybe you embrace things like audiology assistance or hiring dispensers to work with you.

Ambiguity. The last category in the VUCA litany is ambiguity. These are where relationships might be unclear, there aren't any precedents and that you face unknown unknowns. Maybe you're moving into an emerging market, or you're launching products or services outside of your core competencies. Perhaps you add things like vestibular or cochlear implant services to your typical clinical offerings or exploring partnerships with other local businesses.

What makes for our future survival, if you will, is for us to create a profession of people that, through our integrative supervision, are willing to think critically and act compassionately. If not, audiology becomes nothing more than just a process. This is not the history or the future of audiology that I am interested in. What we have to do if we are going to transcend that is to change how we look at things and change how we do things. Changing from a command and control type of management strategy where you're not giving anybody any flexibility. It's the old school style of managing people. It's top down. It's hierarchical. Organizations tend to be functioning in independent functional groups. They're sort of separate from one another, and they go through chains of command.

Integrative and Collaborative Leadership

I would challenge us as a profession to look more towards integrative and collaborative leadership. We should be focusing on diversity, where there's not a hierarchy, and instead they are cooperative. There's complementary expertise that you might even refer to in your community. Where it becomes more where leaders seek input from employees and students at all the critical points of the decision-making process, where it's a team approach. You may have incentives for goals met, or expectations exceeded, but you're in partnership with both your students and your employees.

Defining Roles

How do you describe our potential roles of leadership?

Supervisor. According to AAA, a supervisor is someone who educates by providing feedback on the student's diagnostic, treatment, and interpersonal skills. A supervisor also maintains open communication with the student and the university. That doesn't seem like there's a lot of limitations on it. Seems pretty open, and then changing that towards what is a preceptor, and what is the difference between a supervisor and a preceptor?

Preceptor. A preceptor is tasked to help develop clinical skills. Now, this can certainly be hard skills like you might think about, or it could be things like professionalism and best practices and ethical and legal ways of navigating the professional world. A preceptor can also be a supervisor, so it can be a little bit gray in thinking about how this is translating for you in the everyday world.

Mentor. In comparison, a mentor is someone that is an experienced, trusted advisor, a counselor, if you will, that is detached from the outcome. A mentor is somebody that can hold up a mirror for you. Also, somebody that could provide you guidance over a period of time. You might think about this like professional coaching in any particular area of interest in your career, and then finally, a colleague.

Colleague. Your colleague is someone of similar rank or state, a fellow worker either in your practice or out of your practice. At any given time, your professional role could involve wearing any one of these hats or many of these hats simultaneously depending on the nature of the circumstance and the interaction.

Hard vs. Soft Skills

Does this matter? I would say yes, but I want to make sure that you understand the differences between hard skills and soft skills. What are the hard skills that we ask students or employees to learn? Audiometry, real ear measurements, fitting hearing aids, etc. Hard skills are our cookbook. Things that are tangible. Do step A, do step B, how to formulate skills that you can write down, so to speak. On the flip side, what are some soft skills that we often look for in our employees? I'm going to tell you that soft skills are not my favorite interpretation. I would call soft skills being nimble, flexible, and agile in an inflexible environment. The things you can't write down. The things that can often be challenging to help our students and our employees come to grips with when they're working with a particular area of the profession. Multi-tasking is a soft skill I continue to work on all the time.

Soft skills. We are looking for people that have a strong work ethic, a positive attitude, excellent communication skills, time management abilities, problem-solving skills, self-confidence, and the ability to accept and learn from criticism. These are difficult things to bring to your supervision situation because often times, we look at it as personality issues. Can those soft skills be taught? If you didn't come to the table with all of them, especially as a young professional, besides the school of hard knocks and time, can you develop those skills to become a more effective professional or leader?

We have to elevate our training and education. We have to get the education of our future doctors of audiology and staff away from the cookbook and investing in soft skills. The universal truth is that there must be a commitment on the part of the student or the employee. We can't legislate this kind of thing.

Truth #1. Professional training can often be terrible. The reason being is that it's usually this command and control type of model, and that's how compulsory education was designed and set up. You show up; there's attendance, a lecture, and maybe a test at the end. The same is happening for this particular course because the alternative doesn't match the paradigm of most of today's typical education and employee supervision models. We are worried if we treat students and employees like adults, that we'll be taken advantage of, and that can be true. If you grow up hearing that the only thing of importance is what's on the test, then why pay attention?

Truth #2. We have to change away from command and control and help to create some of these brave, generous professionals. I think we are going to have to have an awakening and integration of soft skills and things like confidence training and professional growth development for each of our students and employees. They're going to have to carry even more weight than the simple act of measuring hearing and of being responsible for pure numbers-oriented data.

Truth #3. Everyone will have to work outside of their comfort zones- students, employees, managers, and owners alike.

Leadership 101

Managers are taught to manage things like budgeting and forecasting. They're not prepared to be leaders. Essentially, they're working to evaluate performance and counsel on issues around that performance. Some managers may have been taught to hire or fire staff people. I personally never received that kind of training. It was something that I've had to learn over the years.

Mission. Leadership, on the other hand, is taking the opposite view. The traditional view of management may assume that the manager's job is to run an apparatus like an audiology department or a team of audiologists in a setting, and there are clear inputs and outputs expected from their job. The manager keeps the machine running smoothly, and in that worldview, the people on the manager's team are essential machine parts. They're interchangeable. They're hired into a role. They perform the job. They meet the goals or standards, or they don't. Leadership is the opposite. Leadership believes that the energy on your team powers everything that you'll accomplish. Also, that machine can change when it makes sense to change it. Maybe your machine should change, or perhaps it's just junk, and you have to trash it and invent something completely new because people are creative. Machines, in general, are not. We have to look at that as being part of our mission. We also have to create more self-awareness. Again, that old fashioned command and control view of management didn't require that a manager look in the mirror, but leadership requires that activity every day.

Self-awareness. A leader is someone who gets outside of his or her busy brain and is not controlled by emotions or changes like fear. Fear is the emotion that makes managers freak out and bring the hammer down. Fear makes them do things like yell at their subordinates or fear of termination so that people are uncomfortable with making mistakes. That type of management is prevalent, and it's, in my opinion, the opposite of leadership. Leaders have the confidence to lead through trust. You chose to work with me, so obviously we trust one another. They will learn from you, and you will learn from them, and leaders aren't always right. They have enough self-esteem to say, "did I say that last week?" "I must have missed my morning coffee because that's not what I meant to say. No, don't do what I said. You're right". 

Risk and trust. Leaders are willing to risk and trust in a situation giving people space to potentially make mistakes and helping them to recognize how to correct them.

Two-way learning. A leader invites two-way learning. It's a way where you're trusting that the people on your team understand that things are palpable and malleable and they may want to collaborate on that. All the time it takes for people to come alive at work involves trust. Simon Sinek dedicated an entire book to this concept that's called Leaders Eat Last, and if you haven't read that book, I would highly recommend it. When people are scared to share ideas, it's because they don't trust that their ideas will be handled with care. This isn't a failing on the part of the employee as much as it would be a failing of the leader. Trust your team. People have to trust that you have their back.

Find your voice. A good leader has to find their voice as well, that learning how to have a hard conversation and not stay silent on topics that matter. No one ever told me when I became a practice owner, at times it's going to be scary, and you're going to have your employees or your students tell you something that you don't want to hear. They didn't tell us we were going to have to have some of those hard conversations, but that's where the magic can be as a supervisor and a leader. Part of being a leader is to find the courage not just to bite your lip, but start a conversation that is less about hiding personality or playing the part of someone who's dominating,

Speak your truth. Last but not least, you have to be willing to speak up. Speak up for the profession, your practice, or as a part of your department and empower people.

Empowering Successful Leadership

Scripting answers to common questions. Some ways that I've found success in my practice is to help students and employees develop the confidence to stand in the truth of the information that they're relaying to people. Scripting answers to common questions will help a person put language in place that feels comfortable for them. They can learn to massage it over time or hear themselves say things and answer questions that they hear typically.

Record and review. I have all of my students that I work with record themselves giving counseling information, going over test results or even taking case histories so that they can hear their quality of voice and be able to almost self-critique. When I was learning to teach yoga, my yoga mentor used to have me tape my yoga classes and then take them. That was one of the most painful experiences of my life, but it was the fast track for working out some of my confidence in how I was able to relay information.

Action board. The last thing that can help to facilitate these leadership positions for your students and your employees is to have them create action boards at least on an annual basis. Have them create at least three goals, identify three stumbling blocks, and three key actions that they are going to take to achieve any of those goals.

Your Lens Statement

To wrap up today's course, let's discuss a lens statement. Full disclosure, over the last year, I have been working with a life coach who has helped me dig a little deeper and be able to upgrade how I saw the world and how I was seeing the people around me. One of the things that we worked on was a lens statement. You can do this on your own. You can even take a few notes right now if you want to,

Part #1. Select a list of virtues that resonate with you. Which qualities best summarize a view of the world you are trying to create? Which of these attributes do other people point out that they see in you? One of the activities, when I was developing my lens statement, was I interviewed acquaintances and what attributes would they describe me as? That helped me also to see how other people see me. The words you choose should be both inspirational (to you today) and aspirational (present a growth opportunity). 

Part #2. Take a few minutes and write an over-arching statement or personal philosophy around these selected virtues. Ideally, it should summarize how you intend to live these virtues every day. Write down some intentional language around your attributes. For example, using some of the words that I selected, "I am devoted to serving others with a limitless zeal and an authentic wonder."

Part #3. Draft and re-draft your lens statement until it feels air-tight. Sit with it a couple of days and reread it. You could memorize it and say it in a way that feels succinct, so it's easily accessible in your mindset, and then you're going to create a final version. Recite it to yourself both mentally, and aloud if you are feeling brave.

Part #4. Once you've created this final version of your lens statement, I challenge you to record it in your voice for your ears only and to listen to it. Listen to it when you're doing activities like being out in nature or after meditation, so it can begin to uplift you so that you see things differently. When you come across items that move you into volatility or uncertainty and ambiguity, you have this foundation. Return to your statement and how you're going to see your world through your lens to elevate yourself and others. I encourage you to have your team do this too and to record and even share their experiences of the process and the outcomes that they experience themselves.

It is always interesting to me that when we give people the space to share some of those vulnerable parts of themselves, it can bring the team together. This allows others to recognize that you as a seasoned professional, although coming to the table with more experience, actually have some of the similar struggles just because you're a human being on this earth at this time. Your lens statement can evolve. It isn't something that you set in stone, record, and then you never look at it again. I listen to my lens statement frequently, and it's changed and evolved.


This was not the cookbook approach to supervision that maybe you thought you were signing on for when you checked the box to register for this course, but I hope that it's been thought-provoking. I hope that it has given you some food for thought for how you not only deal with yourself within the container of your professional space but how you look at the people on your team and where you can find ways to create even more abundance within your practice and also the profession. We are in this together. When we lift each other up and create the condition to see each other from a different point of view and mindset, not as competitors but as colleagues, leaders, preceptors, mentors our future really is brighter.


Rudden, D. (2019). Supervision from the inside out. AudiologyOnline, Article 25258. Retrieved from

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d anne rudden

D'Anne Rudden, AuD

D’Anne Rudden, Au.D. has been the owner of Longmont Hearing & Tinnitus Center in Longmont, Colorado for 15 years. She is considered an industry expert on social media and Marketing with published articles in Audiology Today, Seminars in Hearing, Audiology Practices, and The Hearing Journal. Dr. Rudden is an Adjunct Professor at the University of Colorado-Boulder. She presents nationally on a variety of topics from business management to social media marketing to developing confidence and professional empowerment. Connect with her on social media channels (@AudioDocRudden) and on her websites – and

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