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 supervisor’s sign off and the date it is received by
the Audiology Australia office.

The diary is to be completed electronically and emailed from your Supervisor’s 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.
Intern’s 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.
Supervisor’s Comments: Supervisors need to make regular, brief notations against the interns comments encouraging
their Intern and indicating that they have read the Intern’s comments.
Supervisor’s Summary: Supervisors should briefly comment on their Intern’s 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. Supervisor’s comments should include their observations and
reflections on the Intern’s 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 [email protected] as attachments
from your supervisor’s email address:

A signed off Supervision Diary for that quarter, including a short summary of the Intern’s progress by their Supervisor.
Electronic submission from the Supervisor’s 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 quarter’s 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 [email protected]:

Your signed off Quarter 4 diary (Option A) OR 2 Case Studies (Option B), including comments from the Supervisor and
your Supervisor’s 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.

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
*Supervisor’s Evaluation – a report evaluating the outcomes against the original assessment, the skills and competencies
acquired relevant to the workplace and the Intern’s 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
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








File discussion
Experiential exercises
Homework
Identification of Intern’s 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

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 Intern’s 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 Intern’s 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.
Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131
(Suite 7, 476 Canterbury Road, Forest Hill, Vic 3131)
Supervision Diary – v4. April 2014
Intern’s name:
QUARTER 1 (0 to 3 months)
Week No.
& Date
Hours
Duration
Type of
Supervision
Clinical
Development
Activity
Intern’s Comments
Supervisor’s Comments (to
continue through each level)
Example
Week 1
5/1/13
2 Hours
At Elbow
7/1/13
1 Hour
Case Review
Infant
Assessment
Adult
Assessment
As well as familiarising myself with the equipment & performing my first
OAE assessment on an infant, we outlined what needed to be discussed
with the Mother during the case history & how important it is to be caring
& sensitive to new Mothers. Supervisor explained the need to insert the
probe deeply into the canal.
Reviewed the difference between when to refit and when to replace an
aid with the supervisor explaining the requirement to show a real clinical
need to refit.
Case history needs to be more in
depth
As this is an important part of any
work done for OHS, we will need to
provide a number of opportunities
for you to gain more confidence
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
Week 10
Week 11
Week 12
(Principal) Supervisor’s Name:
Commencement Date:
Name(s) of additional Supervisor(s) this quarter who provided a month or more of supervision during this quarter (if applicable):
Supervisor’s Name:
From:
To:
Supervision Diary – v4. April 2014
Intern’s name:
(Primary) Supervisor’s summary of their Intern’s progress for Quarter 1:
The Supervisor should briefly describe how the intern is progressing, any difficulties that may have arisen and/or any particular successes achieved. This summary
should include any extra relevant information not contained in the other documents.
Supervisor must submit this diary electronically to [email protected] 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:
Supervisor’s Signature: ……………………………………………………………… Supervisor’s Name: ……………………………………………………………………
Date: ………/………/…………
Workplace:
Name of Workplace (clinic):
Workplace address:
Supervisor’s email:
Supervisor’s phone number:
Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131
(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4 April 2014
Intern’s name:
QUARTER 2 (4 to 6 months)
Week
No. &
Date
Week 13
Week 14
Week 15
Week 16
Week 17
Week 18
Week 19
Week 20
Week 21
Week 22
Week 23
Week 24
Hours
Duration
Type of
Supervision
Clinical
Development
Activity
Intern’s Comments
Supervisor’s Comments (to
continue through each level)
(Principal) Supervisor’s Name:
Name(s) of additional Supervisor(s) this quarter who provided a month or more of supervision during this quarter (if applicable):
Supervisor’s Name:
From:
To:
Supervisor’s summary of their Intern’s progress this Quarter:
The Supervisor should briefly describe how the intern is progressing, any difficulties that may have arisen and/or any particular successes achieved. This summary
should include any extra relevant information not contained in the other documents.
Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131
(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4 April 2014
Intern’s name:
Supervisor must submit this diary electronically to [email protected] 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:
Supervisor’s Signature: ……………………………………………………………… Supervisor’s Name: ……………………………………………………………………
Date: ………/………/…………
Workplace:
Name of Workplace (clinic):
Workplace address:
Supervisor’s email:
Supervisor’s phone number:
Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131
(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4 April 2014
Intern’s name:
QUARTER 3 (7 to 9 months)
Week
No. &
Date
Week 25
Week 26
Week 27
Week 28
Week 29
Week 30
Week 31
Week 32
Week 33
Week 34
Week 35
Week 36
Hours
Duration
Type of
Supervision
Clinical
Development
Activity
Intern’s Comments
Supervisor’s Comments (to
continue through each level)
(Principal) Supervisor’s Name:
Name(s) of additional Supervisor(s) this quarter who provided a month or more of supervision during this quarter (if applicable):
Supervisor’s Name:
From:
To:
Supervisor’s summary of their Intern’s progress this Quarter:
The Supervisor should briefly describe how the intern is progressing, any difficulties that may have arisen and/or any particular successes achieved. This summary
should include any extra relevant information not contained in the other documents.
Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131
(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4 April 2014
Intern’s name:
Supervisor must submit this diary electronically to [email protected] 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:
Supervisor’s Signature: ……………………………………………………………… Supervisor’s Name: ……………………………………………………………………
Date: ………/………/…………
Workplace:
Name of Workplace (clinic):
Workplace address:
Supervisor’s email:
Supervisor’s phone number:
Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131
(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4 April 2014
Intern’s 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
No. &
Date
Week 37
Week 38
Week 39
Week 40
Week 41
Week 42
Week 43
Week 44
Week 45
Week 46
Week 47
Week 48
Hours
Duration
Type of
Supervision
Clinical
Development
Activity
Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131
(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Intern’s Comments
Supervisor’s Comments
Supervision Diary - v.4 April 2014
Intern’s name:
OPTION B
Case study #1
Supervisor’s comments:
Case study #2
Supervisor’s comments:
Supervisor’s Final Evaluation
This should describe the outcomes against the original assessment, the skills and competencies acquired relevant to the workplace and the Intern’s overall
competency as a clinician.
(Principal) Supervisor’s Name:
Name(s) of additional Supervisor(s) this quarter who provided a month or more of supervision during this quarter (if applicable):
Supervisor’s Name:
From:
To:
Once the Internship has been completed the following documents are to be submitted to the Audiology Australia office from your Supervisors email:
Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131
(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4 April 2014
Intern’s name:
 Q4 supervision diary (Option A) OR two case studies (Option B), each with Supervisor’s comments, and Supervisor’s 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:
Supervisor’s Name:
Name of Workplace (clinic):
Workplace address:
Supervisor’s email:
Supervisor’s phone number:
Audiology Australia, PO Box 504, BRENTFORD SQUARE VIC 3131
(Suite 7, 476 Canterbury Road, Forest Hill Vic. 3131)
Supervision Diary - v.4 April 2014