Adult Audiology —
Training activity: 1

Details

Manage the concerns of the patient, significant other(s) and/or carer(s) during routine adult appointments using an Audiology-led counselling approach

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

• The basis of clinical history, e.g. Calgary-Cambridge method and Four Habits model
• Principles of patient-centred care
• Shared decision-making
• The evidence base for patient preference, satisfaction and outcomes
• Cultural and social attitudes to hearing care
• Use of interpreters
• Scope of practice
• Onward referrals
• Validated questionnaire measures
• National and international rehabilitation guidance

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 for managing the concerns in this situation?
  • What are the specific expectations for managing patient/carer concerns using an Audiology-led counselling approach in a routine appointment?
  • What would a positive outcome be for the patient, significant other(s), and/or carer(s) in terms of their concerns being addressed effectively?
• What is your prior experience of managing the concerns of patients during routine adult appointments?
  • What do you already know about managing patient or carer concerns, or using counselling techniques in an audiology setting?
  • Based on previous experiences, what possible challenges might you face when managing concerns or counselling in a routine adult appointment?
  • How might you plan to handle these potential challenges?
  • What is the scope of your own practice regarding counselling and managing concerns in this specific context?
  • Do you know when you might need to seek advice or help, and from whom?
• What do you anticipate you will learn from the experience?
  • What specific counselling skills or techniques related to managing concerns do you want to develop or improve upon during this appointment?
  • What specific insights do you hope to gain about patient/carer perspectives on their concerns or the effectiveness of different counselling approaches?
• What additional considerations do you need to make?
  • Have you consulted any actions or points for development identified following previous experiences of managing concerns or counselling?
  • Are there any important details about the specific patient, their significant other(s), or carer(s) that you need to consider before the appointment (e.g., potential comorbidities, additional needs, or specific concerns they have previously raised)?

In action

• During the activity is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate during the counselling process? Are you encountering situations such as:
    • A patient or carer expressing high levels of emotion or distress that shifts the focus or tone of the counselling session beyond the anticipated level of concern?
    • A significant other or carer presenting conflicting goals or communication needs compared to the patient, complicating the shared decision-making process?
    • The patient revealing a significant, unanticipated non-audiological co-morbidity (e.g., severe mental health issue, complex relationship dynamic) that drastically changes the scope of audiology-led counselling?
    • The specific audiology-led counselling technique or approach you are using proving ineffective or counterproductive based on the patient’s real-time reaction or communication style?
  • How does this experience compare with previous experiences of similar counselling activities

• How are you reacting to the unexpected development?
  • How is the unexpected development being resolved as you progress during the activity? Are you successfully managing the situation yourself, or do you need support because the complexity is beyond your current scope (for example, if significant psychosocial intervention is required)?
  • What are you learning in this moment as a result of the unexpected development? For example, are you learning a more effective way to validate complex emotional responses, or a better method for ensuring equal participation from the patient and their significant others?
  • How is this impacting your actions?
    • Are you responding to the situation appropriately? Are you adapting or changing your approach to the counselling procedure (e.g., switching communication styles, adjusting the pace)?
    • Is this unexpected event affecting your ability to undertake the activity independently?
    • Specifically, are you immediately rephrasing your questions, ensuring empathy is communicated effectively, or carefully redirecting the conversation to stay within your professional scope?
  • How are you feeling in this moment? For example, are you finding it difficult to adapt? Is it affecting your confidence in using the counselling approach? Are you feeling positive you can reach a successful conclusion?
• What is the conclusion or outcome?
  • How do you work within your scope of practice? E.g. did you successfully conclude the counselling session, ensuring that the discussion remains within your professional scope and focused on audiological management? Did you practice within your scope by using active listening and validation techniques to address high levels of emotion or distress while carefully redirecting the conversation when significant non-audiological co-morbidities are revealed, ensuring appropriate onward referral is considered?
  • What do you learn as a result of the unexpected development? E.g. Did you learn a more effective way to validate complex emotional responses, enhancing your application of different counselling approaches? Did you gain increased proficiency in facilitating shared decision-making and ensuring equal participation when the patient and their significant others present conflicting goals?

On action

• Begin by summarising the key steps you take to manage the concerns of the patient and/or carers using the audiology-led counselling approach.
  • Consider specific events, actions, or interactions that feel important, such as eliciting emotional responses, navigating conflicting perspectives between the patient and carer, or establishing shared goals. How do you feel during this experience?
  • Include any ‘reflect-in-action’ moments, where you adapt your technique or approach based on the patient’s immediate reactions or unexpected emotional developments.
• Identify what learning you take from this experience regarding audiology-led counselling.
  • What strengths do you demonstrate (e.g., validation skills, rapport building, maintaining professional boundaries)?
  • What skills and/or knowledge gaps are evident (e.g., using specific counselling models, managing complex emotional distress, or understanding your scope of practice in psychosocial support)?
  • Compare this experience against previous similar engagements. Have any previously identified actions for development been achieved? Has your practice in audiology-led counselling improved?
  • Identify any challenges you experience (e.g., patient resistance, complex family dynamics, time constraints) and how you react to these. Does this affect your ability to deal with the situation? Are you able to overcome the challenges?
  • Identify anything significant about this activity, such as needing to seek advice or clarification on how to handle a sensitive psychosocial issue.
• Identify the actions or ‘next steps’ you now take to support the assimilation of what you learn, including from any feedback you receive.
  • What will you do differently next time you engage in audiology-led counselling?
  • Has anything changed in terms of what you would do if you are faced with a similar situation again?
  • Do you need to practise any aspect of this counselling approach further?

Beyond action

• Have you revisited your previous reflections (reflect-before-action, reflect-in-action, and reflect-on-action) for this specific activity – managing concerns using audiology-led counselling?
  • When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to shared decision-making, validating complex emotions, incorporating patient preferences into management, or establishing your scope in psychosocial support?
  • 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 audiology-led counselling with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of patient communication nuances, managing family dynamics, or the role of counselling in holistic care?
• 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 audiology-led counselling developed and evolved over time across multiple instances of undertaking this training activity?
  • Can you identify specific examples of improvement or increased confidence in maintaining patient-centred principles, setting realistic goals, or adapting your counselling approach for patients with additional needs?
• Based on your experiences, how has your ability to recognise when something related to managing patient concerns is beyond your scope of practice improved?
  • Do you have a clearer understanding of when and from whom (e.g., supervisor, mental health professional, social worker) you need to seek advice or clarification regarding significant psychosocial barriers, complex family conflict, or high levels of expressed distress?

Relevant learning outcomes

#	Outcome
# 2	Outcome Apply shared decision-making to develop an individualised management plan and counselling for adults with hearing loss and other auditory difficulties, taking into account differing cultural and social attitudes to hearing care.
# 3	Outcome Evaluate individual patient outcomes and safely manage a range of routine and complex hearing losses.
# 4	Outcome Practice within their own personal and professional scope, identifying where onward referral is appropriate.