Training activity information
Details
Take a clinical history and formulate an appropriate hearing assessment strategy for routine adult patients
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
- Principles of rehabilitation
- National, local and international guidelines and how they inform clinical practice
- Consent
- Collaborative decision making and patient centered care
- Use of interpreters
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 taking a history and planning assessment for routine adult patients? e.g., What key information do you need to gather during a history? What are the standard assessment tests for routine adult patients, and how do you decide which ones to use?
- What is your prior experience with taking histories or planning assessments for adults? e.g., What history-taking techniques are you familiar with? What do you already know about common adult hearing conditions and relevant tests? What challenges might you face (e.g., communication barriers, complex history), and how will you prepare for them? What is your scope of practice in formulating assessment strategies? How do you feel about conducting this part of the appointment?
- What do you anticipate you will learn from this experience? e.g., What skills related to effective history-taking or tailoring assessment plans do you want to develop? What insights do you hope to gain about the patient’s journey or specific conditions?
- What additional considerations do you need to make? e.g., Have you reviewed example case histories or assessment protocols? Are there any specific patient details in the referral you need to consider beforehand?
In action
- Are you noticing anything surprising or different from what you anticipate during the process of taking a clinical history and formulating an assessment strategy for a routine adult patient? Are you encountering situations such as:
- The patient presenting with unexpected symptoms, complex medical history, or comorbidities not initially indicated in the referral?
- Difficulty obtaining clear and relevant historical information due to communication barriers (e.g., strong accent, soft speech) or patient confusion?
- An initial assessment strategy needing significant modification due to new, unexpected information gathered during the history-taking?
- The patient expressing concerns or priorities that significantly deviate from a standard routine assessment pathway?
- 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 rephrasing questions, using visual aids, or employing different communication techniques to clarify information?
- Are you consulting internal guidelines or protocols for managing complex patient histories or specific symptom profiles?
- Are you seeking advice from a more experienced colleague or your training officer to discuss the patient’s presentation and refine the assessment strategy?
- Are you changing your initial assessment plan (e.g., adding or removing specific tests) based on newly acquired history details?
- 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 complexity requires a different specialist referral or a more in-depth medical evaluation)?
- What are you learning in this moment as a result of any unexpected development? For example, are you learning a more effective way to probe for information regarding specific symptoms, or a more flexible approach to adapting assessment plans on the fly?
On action
- Begin by summarising the key points of how you took the clinical history and formulated the hearing assessment strategy for a routine adult patient.
- Consider specific events, actions, or interactions that felt important, such as eliciting particular patient symptoms, managing patient communication, or adjusting your initial strategy based on the history. How did you feel during this process?
- Include any ‘reflect-in-action’ moments, where you had to adapt your questioning or your initial assessment strategy as the patient’s history unfolded.
- Identify what learning you can take from this experience regarding clinical history taking and strategy formulation for adult patients. What strengths did you demonstrate (e.g., active listening, effective questioning, critical thinking)? What skills and/or knowledge gaps were evident (e.g., deeper understanding of specific conditions, efficiency in formulating strategies, rapport building)?
- Compare this experience against previous engagements with similar activities. Were any previously identified actions for development achieved (e.g., more structured history taking, better tailoring of assessment plans)? Has your practice in taking clinical histories and formulating strategies improved?
- Identify any challenges you experienced (e.g., a patient providing vague information, difficulty prioritising tests within the timeframe) 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 regarding the history or the assessment strategy, or if you needed to escalate because the patient presented complexities beyond a routine case.
- Acknowledge any changes in your own feelings now that you are looking back on the experience.
- 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 on your history taking or strategy formulation.
- What will you do differently next time you take a history or formulate a strategy for a routine adult patient?
- 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 aspect of history taking (e.g., probing questions) or strategy formulation (e.g., test selection rationale) further?
Beyond action
- Have you revisited your previous reflections (reflect-before-action, reflect-in-action, and reflect-on-action) for this specific activity (taking clinical history and formulating assessment strategies for routine adult patients)?
- When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to active listening, asking open-ended questions, identifying key symptoms, structuring the history effectively, or selecting appropriate diagnostic tests based on the history?
- 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 clinical history taking and strategy formulation with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of patient communication nuances, the diagnostic value of specific history components, or best practices for tailoring assessment batteries?
- 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 taking clinical histories and formulating assessment strategies 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 comprehensive patient information, identifying red flags, or designing efficient and targeted assessment plans?
- Based on your experiences, how has your ability to recognise when something related to patient history or assessment strategy is beyond your scope of practice improved?
- Do you have a clearer understanding of when and from whom (e.g., supervisor, ENT consultant, specialist audiologist) you need to seek advice or clarification regarding complex patient presentations, unusual symptoms, or situations requiring highly specialised diagnostic approaches?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 4 |
Outcome
Assess and manage hearing function in adults, without co-morbidities. |