Training activity information
Details
Safely perform and interpret the following standard diagnostic tests on routine adult patients and document the results:
- Otoscopy
- Pure tone audiometry
- Tympanometry
- Acoustic reflex thresholds
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
- Infection control
- Effective communication
- Consent
- Adapting to different patient needs
- Local and national guidelines and international best 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 tests safely and accurately for adults? e.g., What are the correct procedures for performing each test (Otoscopy, PTA, Tympanometry, ART)? How do you interpret the results and ensure patient safety throughout? What are the standards for documentation?
- What is your prior experience with performing or interpreting these specific tests on adults? e.g., Which tests are you most familiar with? What technical or interpretation challenges have you encountered before, and how did you handle them? What is your scope of practice for independent testing and interpretation? How do you feel about performing this battery of tests?
- What do you anticipate you will learn from this experience? e.g., What skills related to test technique, interpretation, or documentation do you want to refine? What insights do you hope to gain about how these tests contribute to the diagnostic picture?
- What additional considerations do you need to make? e.g., Have you reviewed the procedural guidelines for each test recently? Are there any specific patient factors (e.g., mobility, cognition) that might affect test performance?
In action
- Are you noticing anything surprising or different from what you anticipate during the process of performing and interpreting standard diagnostic tests on a routine adult patient? Are you encountering situations such as:
- Unexpected findings during otoscopy (e.g., significant ear canal obstruction, active discharge, signs of infection) impacting subsequent tests?
- Difficulty obtaining reliable and consistent responses during pure tone audiometry despite clear instructions and patient engagement?
- Abnormal tympanometry results (e.g., flat trace, large ear canal volume) that contradict the patient’s reported symptoms or other initial test findings?
- Inability to elicit acoustic reflexes, or an unexpected pattern of reflexes, when expected?
- Equipment malfunction or inconsistent readings during the performance of any of the tests?
- 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 re-instructing the patient, re-positioning equipment, or re-testing specific frequencies/pressures?
- Are you consulting test protocols or clinical guidelines for unexpected results or challenging patient presentations?
- Are you seeking advice from a more experienced colleague or your training officer regarding an unusual finding or an interpretation challenge?
- Are you changing your sequence of tests or the specific parameters based on initial unexpected results (e.g., performing masking when not initially planned due to asymmetry)?
- 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 a significant medical finding requires immediate referral or intervention)?
- What are you learning in this moment as a result of any unexpected development? For example, are you learning new strategies for patient instruction to improve response reliability, or a more systematic approach to test interpretation when results conflict?
On action
- Begin by summarising the key points of how you performed and interpreted each of these diagnostic tests on a routine adult patient and documented the results.
- Consider specific events, actions, or interactions that felt important for each test (e.g., challenges during otoscopy, patient responses during pure tone audiometry, obtaining tympanometry traces, interpreting acoustic reflex patterns). How did you feel during the testing?
- Include any ‘reflect-in-action’ moments, where you adapted your technique or interpretation strategy as the tests unfolded or based on patient feedback.
- Identify what learning you can take from this experience regarding performing and interpreting these adult diagnostic tests.
- What strengths did you demonstrate (e.g., technical proficiency, accurate interpretation, patient management)?
- What skills and/or knowledge gaps were evident (e.g., specific ear canal anatomy in otoscopy, nuances of masking, recognising unusual patterns)?
- Compare this experience against previous engagements with similar activities. Were any previously identified actions for development achieved (e.g., smoother test execution, more confident interpretation)? Has your practice in these specific tests improved?
- Identify any challenges you experienced (e.g., patient discomfort, equipment malfunction, ambiguity in results) 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 escalating a case due to unexpected findings.
- 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 technique or interpretation.
- What will you do differently next time you perform these tests on an 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 specific aspect of these tests (e.g., positioning for otoscopy, masking procedures, interpreting complex tympanograms) 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 adult diagnostic 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 otoscopy technique, accurate audiometry (including masking), correct tympanometry probe placement, reliable acoustic reflex measurement, interpreting results in combination, or concise documentation?
- 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 adult diagnostic testing with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of common artefacts in testing, the clinical significance of specific test findings, or challenges in patient cooperation?
- 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 standard adult diagnostic 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 obtaining reliable test results, identifying patterns across the test battery, or formulating an initial diagnosis based on combined findings?
- Based on your experiences, how has your ability to recognise when something related to these diagnostic tests is beyond your scope of practice improved?
- Do you have a clearer understanding of when and from whom (e.g., supervisor, ENT consultant, experienced audiologist) you need to seek advice or clarification regarding unusual audiometric configurations, conflicting test results, or unexpected otoscopic findings?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 4 |
Outcome
Assess and manage hearing function in adults, without co-morbidities. |