Training activity information
Details
Safely perform and interpret core bedside tests of oculomotor function, vestibular function, functional balance and informal assessment of gait for adults with suspected vestibular deficit and document the results
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Patient centred care and support
- Explanation of tests and gaining consent
- Contraindications to testing
- Local and national guidelines
- Infection control
- Safety of the environment
- Adaption to different patient needs
- Scope of practice
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
- What does success look like when performing and interpreting these bedside vestibular tests safely and accurately? e.g., What are the specific procedures for each bedside test (oculomotor, vestibular, balance, gait? How do you ensure patient safety during these tests? How do you interpret the findings in the context of vestibular function? What are the documentation standards?
- What is your prior experience with performing or interpreting bedside vestibular tests? e.g., Which of these tests are you most familiar with? What technical or interpretation challenges have you faced, and how did you handle them? What is your scope of practice for performing and interpreting these tests independently? How do you feel about performing these tests?
- What do you anticipate you will learn from this experience? e.g., What skills related to test execution, observation of patient responses, or interpretation of bedside findings do you want to develop? What insights do you hope to gain about assessing vestibular function at the bedside?
- What additional considerations you need to make? e.g., Have you reviewed the specific bedside testing protocols? Are there any patient-specific factors, e.g., mobility, history of falls, that require particular attention during the assessment?
In action
- Are you noticing anything surprising or different from what you anticipate during the process of performing and interpreting core bedside tests for adults with suspected vestibular deficit? Are you encountering situations such as:
- The patient’s symptoms (e.g., dizziness, nausea) being exacerbated unexpectedly by the tests, requiring immediate adaptation or cessation?
- Difficulty eliciting clear nystagmus or other oculomotor signs during specific manoeuvres (e.g., Head Impulse Test, gaze holding)?
- The patient demonstrating unexpected balance instability or gait abnormalities that concern you for their safety?
- Ambiguous or inconsistent results across different bedside tests (e.g., Dix-Hallpike and functional balance tests), making initial interpretation challenging?
- The patient’s physical limitations (e.g., neck pain, reduced range of motion) unexpectedly hindering test performance or validity?
- How does this experience compare with previous experiences of similar activities?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to the procedure? Is it affecting your ability to undertake the activity independently Consider the steps you are taking in the moment, such as:
- Are you immediately stopping a test if the patient becomes unwell, or adapting the test parameters for their comfort?
- Are you consulting guidelines on vestibular bedside testing interpretation, contraindications, or safety protocols?
- Are you seeking advice from a more experienced colleague or your training officer regarding an unexpected finding, patient reaction, or the need for immediate medical consultation?
- Are you changing your approach to documenting qualitative observations of balance and gait based on the patient’s real-time presentation?
- How is any unexpected development being resolved as you progress during the activity? How are you working within your scope of practice? Are you successfully managing the situation yourself, or do you need support because it is beyond your current scope (for example, if the patient’s balance is severely compromised, or a neurological red flag is identified)?
- What are you learning in this moment as a result of any unexpected development? For example, are you learning to modify tests for improved patient comfort and safety, or to integrate observations from various tests more effectively to form a clearer clinical picture?
On action
- Begin by summarising the key points of how you performed and interpreted these bedside tests for an adult with suspected vestibular deficit and documented the results.
- Consider specific events, actions, or interactions that felt important (e.g., observing nystagmus, patient instability during balance tests, unusual gait patterns, patient dizziness). How did you feel during the assessment?
- Include any ‘reflect-in-action’ moments, where you adapted your technique or interpretation based on the patient’s responses, comfort level, or safety considerations.
- Identify what learning you can take from this experience regarding safely performing and interpreting core bedside vestibular tests.
- What strengths did you demonstrate (e.g., careful observation, precise technique, understanding of vestibular pathways)?
- What skills and/or knowledge gaps were evident (e.g., differentiating types of nystagmus, nuances of balance assessment, documentation clarity for vestibular findings)?
- Compare this experience against previous engagements with similar activities. Were any previously identified actions for development achieved? Has your practice in bedside vestibular assessment improved?
- Identify any challenges you experienced (e.g., patient dizziness or nausea, difficulty eliciting a specific sign, interpreting subtle findings) and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges?
- Identify anything significant about this activity, such as needing to seek advice or clarification on performing or interpreting any of these tests, or on the patient’s condition, or escalating due to significant findings or patient distress.
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learned, including from any feedback you received.
- What will you do differently next time you perform bedside vestibular tests?
- Has anything changed in terms of what you would do if you were faced with a similar situation again?
- Do you need to practise any specific aspect of these tests (e.g., specific manoeuvres, interpreting abnormal signs, ensuring patient safety) further?
Beyond action
- Have you revisited your previous reflections (reflect-before-action, reflect-in-action, and reflect-on-action) for this specific activity (performing and interpreting bedside vestibular and balance tests)?
- When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to precise execution of bedside tests, accurately observing subtle nystagmus or balance deficits, differentiating between central/peripheral signs, or concisely documenting clinical findings?
- Have you completed these previously identified actions? If not, what are the barriers? If so, how did completing them impact your subsequent performance of this activity? Are you ready to demonstrate this new learning confidently and consistently when performing this task?
- Have you engaged in professional storytelling or discussed your experiences of bedside vestibular/balance testing with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of patient safety during manoeuvres, the interpretation of equivocal findings, or the clinical utility of specific bedside tests?
- Considering your cumulative experiences and reflections on this activity, how will the learning you have gained support you in preparing for relevant observed ‘in-person’ assessments for the module?
- How has your practice related to performing and interpreting core bedside vestibular and balance tests developed and evolved over time across multiple instances of undertaking this training activity?
- Can you identify specific examples of improvement or increased confidence in eliciting clear clinical signs, assessing risk of falls, or forming an initial hypothesis about the underlying vestibular disorder?
- Based on your experiences, how has your ability to recognise when something related to bedside vestibular/balance assessment is beyond your scope of practice improved?
- Do you have a clearer understanding of when and from whom (e.g., supervisor, neurologist, ENT specialist, physiotherapist) you need to seek advice or clarification regarding unusual oculomotor findings, complex balance disorders, or suspected central nervous system involvement?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 7 |
Outcome
Practice in partnership with the multidisciplinary team to perform balance function assessments in adults, using a range of core diagnostic tests. |