Traditional models of clinical placements for students in speech and language therapy (SLT) are often based on a one-to-one model where the structure of the learning process is: theory, observation and practice. Literature relating to adult learning and professional education suggests alternative approaches to clinical training which may be relevant to SLT. Work in progress is discussed where alternative approaches to placements and student learning in a range of placement settings are being developed.

Background: Hearing loss can add to the linguistic deficits present in aphasia to make comprehension of speech difficult. Although some studies document a relatively high prevalence of hearing loss in adults with aphasia, many people with aphasia do not have their hearing tested. Self-reported disability measures offer a possible alternative to pure-tone audiometry when this service is not readily available. Aims: This study aims to investigate the prevalence of hearing loss in a group of people with aphasia and to determine the usefulness of self-reported measures to screen for hearing impairment. Methods & Procedures: Hearing ability was measured using pure tone audiometry and five measures of auditory processing, which looked at speech perception in quiet and noise, for 21 individuals with aphasia recruited from a community clinic and 21 age-matched individuals without aphasia. The Speech, Spatial and Qualities of Hearing Scale (SSQ) and a brief questionnaire exploring whether they had experienced hearing difficulties, were used to measure self-perception of hearing acuity. Differences in scores between the groups were analyzed. Correlations and regressions were used to establish the relationship between selfperception of hearing and measures of hearing ability. Outcomes & Results: Despite minimal impairment and a non-significant difference between performance on pure tone audiometry for participants with and without aphasia, participants with aphasia performed significantly worse on measures of speech perception in noise than participants without aphasia. They also had a significantly greater degree of perceived hearing disability. Although SSQ scores were correlated with some behavioural measures for the participants with aphasia, the SSQ only predicted the hearing status and speech in noise performance of control participants. Conclusions: The results suggest that the prevalence of hearing loss for people with aphasia (at least for this group) is no greater than the general population. However, they are significantly more affected in their recognition of speech in noise and experience greater disability in listening situations than people without aphasia. The latter problems were not predicted by pure tone audiograms or sound-in-noise performance. The brief questionnaire was not effective in identifying hearing impairment, indicating the need for a regular hearing screen to ensure provision of the most effective rehabilitation. Ideally, the screen should include disability and behavioural measures, as our results suggest they cannot replace each other. These findings should assist clinicians in setting realistic goals and delivering interventions in the most effective way for people with aphasia.

The disparities identified in the participants' accounts suggest that both parties need to be more aware of the roles and responsibilities if individuals with disability are to have equal opportunities in further education.

How can the crisis in training be understood? How can it be resolved? A context for this paper is provided in terms of relevant professional and educational policy. A critical review of nationally available data is presented. It will be argued that commonly cited reasons for not offering student placements might have obfuscated underlying dynamics, which are related to the model of education adopted in the United Kingdom. It will be argued that a shift in emphasis in initial and continuing professional education is relevant.

For the consumer to function effectively in the new roles of adviser and policy-maker in the health field, skills and knowledge are required. This paper deals with the training of consumers serving on policymaking boards of neighborhood health centers and with issues raised in the training. The general issues are raised in the context of a specific demonstration project.