CLINICAL INTERNSHIP SUPERVISION DIARY

EXPLANATION & INSTRUCTIONS

1. Insert your name into the header.

2. Maintaining your Diary:
It is required that the intern makes regular entries in their diary. As a guide, there should
be five entries per week while their competency in Priority 1 clinical elements is still
Novice, Developing or Consolidating, reducing in length and frequency of entries over
time, with no fewer than one entry every week.
The diary must have up to date notations to the date of the supervisors sign off and the
date it is received by the Audiology Australia office.
The diary is to be completed electronically and emailed from your Supervisors
email address at the end of Q1, Q2, Q3 and Q4. If you must submit a hard copy
please ONLY print and send the pages for that quarter.
Any delay submitting your paperwork may delay your Internship completion date.
Week No. & Date: Must be recorded as Week 1, Week 2, etc. and the dates within the week as
a single date, e.g. 6/1/14,, 7/1/14, 8/1/14, etc (refer example at the beginning of Quarter 1 of the
diary and examples provided on the Audiology Australia website).
Hours Duration: Duration of the actual supervision time e.g. 1 hour.
Supervision Processes: Refer to Table 1 on the next page for examples of Supervision
Processes.
Clinical Development Activity: e.g. Infant Assessment, Hearing Aid Fitting, Adult Assessment,
VROA, etc.
Interns Comments: Description of Supervised clinical activity contributing to the development
of professional skills. Interns, however, are encouraged to make regular notations of any clinical
activity that has contributed to their professional development.
Supervisors Comments: Supervisors need to make regular, brief notations against the
interns comments encouraging their Intern and indicating that they have read the Interns
comments.
Supervisors Summary: Supervisors should briefly comment on their Interns overall progress
during the quarter in the section allocated at the end of each quarter. If the Intern has more
than one supervisor, the primary Supervisor could complete this section or all supervisors listed
could make a comment if they wish.
3. Quarter 4 optional submission: Interns have the option of submitting either the diary with
entries as per previous quarters or writing up two case studies which demonstrate their
application of their clinical knowledge and understanding of clinical concepts and practices.
Supervisors comments should include their observations and reflections on the Interns ability
to apply their knowledge and work with their clients. The Case Study Guidelines are available on
our website.
Documentation to be submitted at the end of each quarter:

At the conclusion of Quarter 1, 2 and 3, submit documents electronically to

internship@audiology.asn.au as attachments from your supervisors email address:
A signed off Supervision Diary for that quarter, including a short summary of the Interns
progress by their Supervisor. Electronic submission from the Supervisors email address will be
taken as the Supervisor having signed the diary. If submitting in hard copy, the Supervisor
must sign the diary at the end of each quarter and their name must also be clearly stated.
Updated Knowledge & Skills Matrix. This document will show progress over time so all
previous information must still be included with the upcoming quarters information added.
At the conclusion of Quarter 4 (a minimum of 48 weeks) when assessed as Independent in all
Priority 1 & 2 elements, the supervisor is to submit from their email address to
internship@audiology.asn.au:
Your signed off Quarter 4 diary (Option A) OR 2 Case Studies (Option B), including
comments from the Supervisor and your Supervisors Final Evaluation *
An updated Knowledge & Skills Matrix. This should indicate you have achieved
Independent competency in all Priority 1 & 2 clinical elements. Priority 3 elements are seen as
potential enrichment activities and are not mandatory. Reporting on these is optional.
Supervision
Diary v4. April 2014
 Interns name:

Your Reflective Statement **

A completed and signed Certificate of Clinical Practice (CCP) Application Form (scanned
and emailed)
If all is in order your application for the award of the Certificate of Clinical Practice will be presented
to Council at their next meeting.
# Remember to keep a copy for your records

*Supervisors Evaluation a report evaluating the outcomes against the original assessment, the
skills and competencies acquired relevant to the workplace and the Interns overall competency as a
clinician.
** Reflective Statement This will be a reflection on how you feel you have developed as a clinician
over the period of the Internship and how you think the profession of audiology can be advanced in
Australia in the future.
NOTE:
Remember to save your diary regularly.
Take your diary with you if you change locations/employers.
See the Audiology Australia website for examples of Supervision Diaries for ideas re number and
quality of entries.
Should there be a change in supervisor at any time during the internship, the finishing
supervisor needs to document and attest to your progress in sufficient detail on the Change of
Supervisor Notification Form for the new supervisor to be able to pick up where the
supervision left off.

WHAT IS REQUIRED FOR SUPERVISION?

Supervision is based on active interaction and development discussions between the supervisor and the
intern. Discussion/feedback with the intern about their clinical decisions for their cases is part of the
supervision process hours.
Table 1: Types of activities undertaken by the Intern and Supervisor that count as
supervision:

Possible Supervision methods and content

At elbow supervision File discussion

Case conceptualisation/formulation
Case Presentations presenting case overview and
interacting in problem solving with others about
case options
Case Review - a selected case where some or all
aspects are reviewed and discussed with the
supervisor
Discussion about clinical strategies
Discussion of Clinical relationship and engagement
issues
Direct observation of practice
Experiential exercises
Homework
Identification of Interns thoughts, attitudes,
beliefs with exploration of the impact of these on
professional behaviour
Rehearsal of Clinical techniques e.g. simulation,
role-play
Review of audio and videotapes (where used)
Review of clinical guidelines/manuals
Review of education material where appropriate

Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131

(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4
Interns name:

In House means that the supervisor is in the clinic and is available to be called upon as needed, so
must not be used as a descriptor for Type of Supervision
Mentoring is a development partnership through which the Supervisor shares knowledge, skills,
information and perspective to foster the professional and independent capabilities of the Intern.

The Supervisor

o A Supervisor must be a current Full Member or Fellow and hold a current Certificate of Clinical
Practice.

o Audiology Australia recommends that an Intern has a single supervisor throughout their entire
Internship program. However, Audiology Australia recognises that for some workplaces this
arrangement is impractical.

o If it is not possible for a single Supervisor to work with the Intern then they can apply to the
Audiology Australia office for approval of multiple Supervisors under the following circumstances:
1. A principal Supervisor is nominated and assumes responsibility for the design,
implementation and oversight of the supervision requirements of the Intern;
2. The principal Supervisor needs to specify how they will monitor the Interns development needs
and communicate with other supervisors (this should include a minimum of quarterly meetings
of the Intern and all supervisors);
3. The names of other supervisors who are significantly involved in the Interns supervision and
development (eg. who provide a month or more of supervision) are noted each quarter; and
4. Supervision must be continuous and documented in the Clinical Internship Supervision Diary.

QUARTER 1 (0 to 3 months)
Week No. Hours Type of Clinical Interns Comments
& Date Duration Supervision Development
Activity
Example
Week 1 2 Hours At Elbow Infant As well as familiarising myself with the equipment & performing my fir
5/1/13 Assessment OAE assessment on an infant, we outlined what needed to be discus
Adult with the Mother during the case history & how important it is to be car
Assessment & sensitive to new Mothers. Supervisor explained the need to insert t
probe deeply into the canal.

7/1/13 1 Hour Case Review Reviewed the difference between when to refit and when to replace a
aid with the supervisor explaining the requirement to show a real clini
need to refit.

Week 1
Week 2
Week 3
Week 4
Week 5

Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131

(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4
 Interns name:

Week 6
Week 7
Week 8
Week 9
Week 10
Week 11
Week 12

(Principal) Supervisors Name: Commencement Date:

Name(s) of additional Supervisor(s) this quarter who provided a month or more of supervision during this quarter (if a
Supervisors Name: From: T

(Primary) Supervisors summary of their Interns progress for Quarter 1:

The Supervisor should briefly describe how the intern is progressing, any difficulties that may have a
successes achieved. This summary should include any extra relevant information not contained in th

Supervisor must submit this diary electronically to Internship@audiology.asn.au within 10 working days
from the end of Quarter 1 along with an updated Knowledge & Skills Matrix (with previous entries still
included, end of Q1 assessments and further Strategies to meet the learning goals added).

If diary is submitted to Audiology Australia in hard copy, please complete this section:
Supervisors Signature: Supervisors Name:

Date: //

Workplace:

Name of Workplace (clinic):

Workplace address:
Supervisors email:
Supervisors phone number:

Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131

(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4
 Interns name:

QUARTER 2 (4 to 6 months)
Week Hours Type of Clinical Interns Comments
No. & Duratio Supervision Development
Date n Activity
Week 13
Week 14
Week 15
Week 16
Week 17
Week 18
Week 19
Week 20
Week 21
Week 22
Week 23
Week 24

(Principal) Supervisors Name:

Name(s) of additional Supervisor(s) this quarter who provided a month or more of supervision during this quarter (if a
Supervisors Name: From: T

Supervisors summary of their Interns progress this Quarter:

The Supervisor should briefly describe how the intern is progressing, any difficulties that may have a
successes achieved. This summary should include any extra relevant information not contained in th

Supervisor must submit this diary electronically to Internship@audiology.asn.au within 10 working days
from the end of Quarter 2 along with an updated Knowledge & Skills Matrix (with previous entries still
included, end of Q2 assessments and further Strategies to meet the learning goals added).

If diary is submitted to Audiology Australia in hard copy, please complete this section:
Supervisors Signature: Supervisors Name:

Date: //
Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131
(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4
Interns name:

Workplace:

Name of Workplace (clinic):

Workplace address:
Supervisors email:
Supervisors phone number:

Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131

(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4
 Interns name:

QUARTER 3 (7 to 9 months)
Week Hours Type of Clinical Interns Comments
No. & Duratio Supervision Development
Date n Activity
Week 25
Week 26
Week 27
Week 28
Week 29
Week 30
Week 31
Week 32
Week 33
Week 34
Week 35
Week 36

(Principal) Supervisors Name:

Name(s) of additional Supervisor(s) this quarter who provided a month or more of supervision during this quarter (if a
Supervisors Name: From: T

Supervisors summary of their Interns progress this Quarter:

The Supervisor should briefly describe how the intern is progressing, any difficulties that may have a
successes achieved. This summary should include any extra relevant information not contained in th

Supervisor must submit this diary electronically to Internship@audiology.asn.au within 10 working days
from the end of Quarter 3 along with an updated Knowledge & Skills Matrix (with previous entries still
included, end of Q3 assessments and further Strategies to meet the learning goals added).

If diary is submitted to Audiology Australia in hard copy, please complete this section:
Supervisors Signature: Supervisors Name:

Date: //
Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131
(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4
Interns name:

Workplace:

Name of Workplace (clinic):

Workplace address:
Supervisors email:
Supervisors phone number:

Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131

(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4
Interns name:

QUARTER 4
From 10 months until you are assessed as Independent (minimum of 48 weeks from internship
commencement date).

Complete EITHER the diary for the last period of your Internship (OPTION A), OR write up two (2)
case studies which will demonstrate your understanding and application of your clinical and client
contact skills (OPTION B),

OPTION A

Week Hours Type of Clinical Interns Comments

No. & Duratio Supervision Development
Date n Activity
Week 37
Week 38
Week 39
Week 40
Week 41
Week 42
Week 43
Week 44
Week 45
Week 46
Week 47
Week 48

OPTION B

Case study #1

Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131

(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4
Interns name:

Case study #1
Supervisors comments:

Case study #2

Supervisors comments:

Supervisors Final Evaluation

This should describe the outcomes against the original assessment, the skills and competencies acqu
workplace and the Interns overall competency as a clinician.

(Principal) Supervisors Name:

Name(s) of additional Supervisor(s) this quarter who provided a month or more of supervision during this quarter (if a
Supervisors Name: From: T

Once the Internship has been completed the following documents are to be submitted to the Audiology
Australia office from your Supervisors email:
Q4 supervision diary (Option A) OR two case studies (Option B), each with Supervisors comments, and
Supervisors final evaluation.
An updated Knowledge & Skills Matrix (with previous entries still included & end of Q4 assessments
added)
A signed and dated Reflective Statement from the Intern. This will be a reflection on how you feel you have
developed as a clinician over the period of the internship and how you think the profession of audiology can
be advanced in Australia in the future.
A completed and signed Certificate of Clinical Practice (CCP) Application Form

TO BE COMPLETED BY SUPERVISOR

Supervision completed on this date:

Signature of Supervisor:

Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131

(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4
Interns name:

Supervisors Name:
Name of Workplace (clinic):
Workplace address:
Supervisors email:
Supervisors phone number:

Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131

(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4