Paediatric Audiology —
Training activity: 1

Details

Take detailed patient histories for each of the following patient groups (including those with more complex needs):

• Newborn hearing screening programme
• Infants
• Pre-school children

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 patient-centred care and support
• Referral information
• Known medical history
• Previous audiology information
• Development of the child
• Safeguarding procedures
• Communication with parents/ guardian

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?
  • What constitutes a detailed history for these specific paediatric age groups and those with complex needs?
  • What essential information (e.g., medical, developmental, family aspects) do you need to gather?
  • Have you discussed expectations with your training officer?
• What is your prior experience of this activity?
  • Have you taken histories from parents/guardians of children in these age groups or with complex needs before?
  • What do you already know about obtaining relevant paediatric history?
  • What specific challenges related to working with these groups or covering potentially sensitive topics might you face? How might you plan to handle them?
  • What is the scope of your own practice for history taking in these situations; when will you need to seek advice or help, and from whom?
  • How do you feel about embarking on taking histories for these specific patient groups?
• What do you anticipate you will learn from the experience?
  • What specific history-taking skills do you want to develop or refine, drawing upon previous experiences?
  • What specific insights into the impact of paediatric audiology conditions on patients and families, or the unique needs of different age groups or those with complex needs, do you hope to gain?
• What additional considerations do you need to make?
  • Have you reviewed any actions identified from your previous reflections on taking patient histories (paediatric or adult)?
  • Is there any important information you need to consider before starting, such as reviewing the clinic’s history template or specific questions for different age groups or conditions?

In action

• During the activity is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate during the paediatric history-taking process? Are you encountering situations such as:
    • A significant, unanticipated non-audiological co-morbidity or complex needs (e.g., dual sensory impairment, specific syndrome) that drastically changes the necessary test approach?
    • Parents/guardians presenting conflicting medical, developmental, or family aspectsof the history, complicating the development of an individualised test strategy?
    • The revelation of a serious child protection or safeguardingconcern that requires immediate action according to local protocols?
  • 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 (e.g., adapting questioning techniques), or do you need support because the complexity, such as immediate medical or safeguarding escalation, is beyond your current scope?
  • What are you learning in this moment as a result of the unexpected development? For example, are you learning a more effective way to explore sensitive developmental details, or a better method for validating complex emotional responses from the family?
  • How is this impacting your actions?
    • Are you responding to the situation appropriately, such as immediately following guidelines regarding child protection and safeguarding? Are you adapting or changing your approach to history taking (e.g., switching communication styles or adjusting the focus based on the child’s age or neuro-maturation)?
    • Is this unexpected event affecting your ability to undertake the activity independently?
    • Specifically, are you immediately rephrasing your questions to address conflicting information sensitively, or carefully redirecting the conversation to stay within your professional scope while maintaining the family-centred care principle?
  • How are you feeling in this moment?
• What is the conclusion or outcome?
  • How are you working within your scope of practice? E.g. Do you successfully conclude the history taking, ensuring that any immediate concerns related to child protection or safeguarding is escalated according to local protocols, demonstrating practice within your scope. Are you determining if the complexity of the medical, developmental, or family history requires a specific onward referral (e.g., to Paediatrics) before proceeding with the assessment, ensuring an individualised test strategy is informed by all relevant data?
  • What are you learning as a result of the unexpected development? E.g. Are you learning a more effective way to explore sensitive or conflicting developmental details, enhancing your ability to collect detailed patient history to inform assessment? Are you gaining increased proficiency in maintaining the family-centred care principle while ensuring the conversation is remaining within your professional scope?

On action

• What happened?
  • Begin by summarising the key points covered in the history for the specified patient group (e.g., Infant or pre-school child).
  • Consider specific events, actions, or interactions that felt important, such as successfully eliciting a specific piece of developmental history, managing emotional parent concerns, or navigating a communication challenge with a child. How did you feel during this process, especially during any challenging parts?
  • Include any moments where the conversation took an unexpected turn (reflect-in-action), such as discovering a previously unmentioned medical complexity or developmental delay, and how you adapted your line of questioning.
• How has this experience contributed to your developing practice?
  • Identify what learning you can take from this experience regarding paediatric history-taking. What strengths did you demonstrate (e.g., engaging with children, structured questioning for specific age groups)? What skills and/or knowledge gaps were evident (e.g., unfamiliarity with specific paediatric terminology, deeper understanding of aetiological factors, efficient integration of family/developmental history)?
  • Compare this experience against previous history-taking experiences. Were any previously identified actions for development achieved?
  • Identify any challenges you experienced (e.g., difficulty obtaining information from a shy pre-school child, managing parent expectations) and how you reacted to these.
  • Identify anything significant, such as needing to seek advice or clarification regarding history taking for a child enrolled in the Newborn Hearing Screening Programme follow-up.
• What will you take from the experience moving forward?
  • Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learned, including from any feedback.
    • What will you do differently next time you take a detailed paediatric history?
    • Do you need to practise specific questioning techniques (e.g., probing questions for developmental milestones) or approaches for specific patient groups?
    • Will you need to research unfamiliar paediatric terminology and complex medical histories that you encountered during the session to strengthen your knowledge base of aetiological factors?
    • Do you need to review the required specific history domains related to children enrolled in the Newborn Hearing Screening Programme follow-up before conducting the next assessment?

Beyond action

• Have you revisited the experiences?
  • Have you revisited your previous reflections (reflect-before-action, reflect-in-action, and reflect-on-action) for this specific activity (taking detailed patient histories for paediatric groups)?
  • When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to adapting your history-taking approach based on the child’s age and complexity needs, structuring the history effectively, or engaging with parents/carers of infants?
  • 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 detailed history taking for paediatric groups with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of the importance of detailed family history or specific safeguarding considerations?
• How have these experiences impacted upon current practice?
  • 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? For example, how does your improved understanding and skill in history taking contribute to your ability to succeed in general Case-Based Discussions (CBDs) involving paediatric patients, where the rationale for assessment is based on history?
  • How has your practice related to taking detailed patient histories 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 information about developmental milestones or identifying complex needs?
  • Based on your experiences, how has your ability to recognise when something related to history taking is beyond your scope of practice improved? Do you have a clearer understanding of when and from whom (e.g., supervisor, paediatrician, safeguarding officer) you need to seek advice or clarification regarding unusual developmental histories, suspected non-organic hearing loss, or complex multidisciplinary input?

Relevant learning outcomes

#	Outcome
# 1	Outcome Collect detailed patient history to inform an individualised test strategy.