Audiovestibular Assessment & Rehabilitation —
Training activity: 8

Details

Safely perform and interpret the following diagnostic tests on school-age children without complex needs and document the results:

• Otoscopy
• Play audiometry
• Pure tone audiometry
• Tympanometry

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 school-age children?  e.g., What are the age-appropriate procedures for each test (Otoscopy, Play audiometry, PTA, Tympanometry)? How do you ensure the child’s comfort and cooperation? How do you interpret the results in the context of paediatric hearing? What are the documentation requirements?

• What is your prior experience with performing or interpreting these tests on children? e.g., Which paediatric tests have you practised before? What challenges have you faced with engaging children or adapting test techniques, and how did you address them? What is your scope of practice for independent paediatric testing? How do you feel about testing children?

• What do you anticipate you will learn from this experience? e.g., What skills related to paediatric test administration, behavioural responses, or interpretation do you want to develop? What insights do you hope to gain about assessing hearing in this age group?

• What additional considerations do you need to make? e.g., Have you reviewed the paediatric testing protocols? Are there any specific notes about the child’s behaviour, developmental level, or previous test history?

In action

• Are you noticing anything surprising or different from what you anticipate during the process of performing and interpreting diagnostic tests on a school-age child without complex needs? Are you encountering situations such as:
  • The child being uncooperative, anxious, or easily distracted, significantly affecting test performance or completion?
  • Difficulty engaging the child in play audiometry, or obtaining inconsistent or unreliable responses during the play task?
  • Unexpected findings during otoscopy (e.g., cerumen impaction, signs of otitis media) in a child with no prior history of ear issues?
  • Tympanometry showing an unexpected pattern despite apparent clear ear canals and a cooperative child?
  • The child’s attention span limiting the number or type of tests you can perform, or the depth of assessment?
• 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 adjusting your interaction style, using more playful language, or incorporating short breaks for the child?
  • Are you consulting paediatric audiology protocols for managing challenging behaviours or adapting tests for varying developmental levels?
  • Are you seeking advice from a more experienced colleague or your training officer regarding specific paediatric test interpretation or patient management?
  • Are you changing your approach to explaining tests or presenting stimuli based on the child’s immediate reaction or engagement level?
• 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 child’s behaviour becomes too challenging for you to manage independently)?
• What are you learning in this moment as a result of any unexpected development? For example, are you learning new distraction techniques, or a more flexible approach to test sequencing and pacing for children?

On action

• Begin by summarising the key points of how you performed and interpreted each of these diagnostic tests on a school-age child without complex needs and documented the results.
  • Consider specific events, actions, or interactions that felt important for each test (e.g., engaging the child in play audiometry, maintaining attention for PTA, obtaining a clear tympanogram with a paediatric probe). How did you feel during the testing?
  • Include any ‘reflect-in-action’ moments, where you adapted your technique or approach based on the child’s cooperation or response during testing.
• Identify what learning you can take from this experience regarding performing and interpreting these paediatric diagnostic tests.
  • What strengths did you demonstrate (e.g., ability to adapt to child’s needs, patience, creative engagement)?
  • What skills and/or knowledge gaps were evident (e.g., specific age-appropriate norms, managing challenging behaviours, efficient transitions between tests)?
  • Compare this experience against previous engagements with similar activities. Were any previously identified actions for development achieved? Has your practice in paediatric testing improved?
  • Identify any challenges you experienced (e.g., child’s attention span, difficulty getting a consistent response, equipment issues with smaller ear canals) 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 for a child, or if you needed to escalate due to lack of cooperation or unusual 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.
  • What will you do differently next time you perform these tests on a school-age child?
  • 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 paediatric testing (e.g., behaviour management, stimulus presentation, interpretation for specific age groups) 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 diagnostic tests on school-age children)?
  • When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to engaging children for otoscopy, maintaining child attention during play audiometry, adapting pure tone audiometry for children, obtaining reliable tympanometry, interpreting paediatric results in context, or documenting clearly for this age group?
  • 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 paediatric diagnostic testing with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of behavioural management strategies during testing, the impact of child development on test results, or common challenges in paediatric clinics?
• 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 diagnostic tests on school-age children developed and evolved over time across multiple instances of undertaking this ETA?
  • Can you identify specific examples of improvement or increased confidence in adapting testing methods to individual children, achieving maximum information from cooperative children, or effectively communicating results to parents/carers?
  • Based on your experiences, how has your ability to recognise when something related to these paediatric diagnostic tests is beyond your scope of practice improved?
  • Do you have a clearer understanding of when and from whom (e.g., supervisor, paediatric audiologist, child development specialist) you need to seek advice or clarification regarding difficult-to-test children, highly unusual paediatric results, or concerns about non-organic hearing loss?

Relevant learning outcomes

#	Outcome
# 5	Outcome Assess hearing function in school age children and assist in the hearing assessment of infants and pre-school children using a range of standard diagnostic tests.