Combined on-site and tele-education to develop a locally led audiometry service in Cambodia and Bangladesh

There is a scarcity of audiological training programs in low-and middle-income settings. We aimed to co-develop an audiology training program combining on-site and tele-education at two locations: a charity hospital in Cambodia and a government hospital in Bangladesh. A novel program was designed to train local staff in pure tone audiometry which forms the basis of hearing assessment in adults. Prior to training, there were no in-house audiology services for patients. A combined short bespoke in-country training program, followed by ongoing support through remote live education enabled an audiometry set up. The model also consisted of continuing quality assurance during audiological assessments via an internet platform. The programs have allowed for successful training of seven local health care workers in Cambodia and two in Bangladesh, providing accurate hearing testing of adult patients, with associated streamlining of patient referral pathways. Trainee performance in both contexts has been positive. In Cambodia, trainees exhibit highly proficient audiological skills and assess over 1000 patients annually. In Bangladesh, trainees have gained competency in hearing screening. On-site training followed by remote support allowed for a low-cost model for audiological training. Critical to success was the motivation, trust and engagement of local staff, availability of equipment, and flexibility in teaching style. The program has proven a model of training health care workers in hearing assessments. An additional outcome of this cross-cultural collaboration has been the internationalisation of higher education at home.