Paediatric Audiology —
Training activity: 2

Details

Safely perform and interpret the following diagnostic tests on  infants and document the results:

• High-frequency probe tone tympanometry
• Diagnostic otoacoustic emissions
• Auditory brainstem response testing

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
• Newborn hearing screening programme pathways and testing
• Diagnostic and screening otoacoustic emissions
• Further electrophysiological testing, for example cochlear microphonic and auditory steady state responses
• Safeguarding procedures
• Local, national and international guidelines and 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?
  • What does it mean to safely perform and correctly interpret high-frequency tympanometry, OAEs, and ABR testing specifically on infants?
  • What are the criteria for valid results for these tests in this age group?
  • Have you discussed expectations with your training officer?
• What is your prior experience of this activity?
  • Have you performed these specific tests on infants before?
  • What do you already know about infant physiology relevant to these tests or the challenges of testing infants (e.g., movement, sleep state)?
  • What specific challenges related to test performance, interpretation, or documentation might you face, and how might you plan to handle them?
  • What is the scope of your own practice for performing and interpreting these tests on infants? When will you need to seek advice or help, and from whom?
  • How do you feel about performing these diagnostic tests on infants?
• What do you anticipate you will learn from the experience?
  • What specific skills in performing these tests or interpreting the results for infants do you want to develop, drawing upon previous experiences?
  • What specific insights into the performance and clinical utility of these objective test techniques in infants do you hope to gain?
• What additional considerations do you need to make?
  • Have you reviewed any actions identified from your previous reflections on performing or interpreting these tests?
  • Do you need to check the equipment is calibrated and ready for use with infants?
  • Do you need to review standard protocols for safe testing and interpretation in this age group?

In action

• During the activity is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate during the objective assessment of infants? Are you encountering situations such as:
    • Significant technical issues or patient discomfort that prevent you from successfully performing required objective tests, such as tympanometry or ABR?
    • Objective test results (e.g., ABR tracings or OAE findings) that are highly atypical or conflict significantly with the reported history or other test results?
    • Difficulty managing the infant’s state (e.g., movement, crying) which impacts the performance and clinical utility of the objective test techniques?
  • How is this experience comparing with previous experiences of similar 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., troubleshooting equipment), or do you need support because the necessary adaptation to testing procedures or interpretation of complex findings 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 efficient method for setting up ABR electrodes while maintaining infant comfort, or a clearer way to sequence objective tests when time is limited?
  • How is this impacting on your actions?
    • Are you responding to the situation appropriately, such as immediately prioritising safety? Are you adapting or changing your assessment approach immediately to suit the needs of the child?
    • Is this unexpected event affecting your ability to undertake the activity independently? Specifically, are you immediately consulting internal protocols regarding equipment troubleshooting, or are you changing the sequencing of your tests to ensure the synthesis of the test battery results remains robust?
  • How are you feeling in this moment?
• What is the conclusion or outcome?
  • How are you working within your scope of practice? E.g. Are you confirming the necessity of immediately consulting internal protocols regarding equipment troubleshooting or seeking support if the complexity of findings (e.g., atypical ABR results) is beyond your current scope? Are you successfully prioritising safety and adapting the test approach to suit the infant’s needs, recognising when further objective testing is not clinically viable due to state or discomfort?
  • What are you learning as a result of the unexpected development? E.g. Are you learning more efficient methods for setting up objective tests (like ABR electrodes) while minimising infant discomfort, thereby improving the performance and clinical utility of the techniques? Are you improving your ability to sequence tests effectively to ensure the synthesis of the test battery results is remaining robust despite time constraints or technical challenges?

On action

• What happened?
  • Begin by summarising the key points of the testing session, specifically noting your approach to High-frequency probe tone tympanometry and ABR testing.
  • Consider specific events, actions, or interactions that felt important, such as managing the infant’s state (e.g., during ABR) or achieving appropriate probe placement for high-frequency tympanometry. How did you feel during these moments?
  • Include any ‘reflect-in-action’ moments, where you adapted your actions, for instance, troubleshooting poor electrode impedance during ABR or switching from diagnostic OAEs to ABR based on the infant’s state.
• How has this experience contributed to your developing practice?
  • Identify what learning you can take from this experience. What strengths did you demonstrate (e.g., patience, technical proficiency with specific equipment like ABR or OAE)? What skills and/or knowledge gaps were evident (e.g., efficient interpretation of high-frequency tympanograms, adapting ABR protocol for specific risk factors)?
  • Compare this experience against previous engagements with similar activities. Has your practice in infant testing improved, perhaps in reducing testing time or improving data quality?
  • Identify any challenges you experienced (e.g., difficulty maintaining the infant’s quiet state, unexpected test result patterns) and how you reacted.
  • Identify anything significant, such as needing to seek advice or clarification on interpreting uncertain ABR findings.
• What will you take from the experience moving forward?
  • What specific adjustments will you make to your preparation or approach for future infant testing sessions, particularly when anticipating or reacting to challenging behaviours or unexpected results?
  • Are there particular techniques you need to practise further? E.g.
    • Troubleshooting poor electrode impedance during Auditory Brainstem Response (ABR) testing more efficiently to help reduce overall testing time and improve data quality.
    • Implementing specific strategies for managing infant behaviour immediately upon starting the session to help maintain a quiet state required for ABR or High-frequency probe tone tympanometry.
    • Seeking advice on adapting ABR protocols for infants presenting with specific risk factors identified during history taking to ensure appropriate diagnostic yield.

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 (performing and interpreting diagnostic tests on infants)?
  • When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to safely performing high-frequency probe tone tympanometry, achieving reliable OAEs on infants, or efficiently setting up/interpreting Auditory Brainstem Response testing?
  • 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 infant diagnostic testing with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of managing infant cooperation, the clinical significance of specific test findings, or how to react and adapt to unexpected occurrences during testing?
• 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? Your improved understanding and skill in these assessments contribute to your overall ability to perform hearing tests on children of all ages and will be central to general Case-Based Discussions (CBDs) involving infant cases.
  • How has your practice related to safely performing and interpreting diagnostic tests on infants 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 objective test results, adapting the test environment, or synthesising results accurately?
  • Based on your experiences, how has your ability to recognise when something related to infant testing is beyond your scope of practice improved? Do you have a clearer understanding of when and from whom (e.g., supervisor, experienced paediatric audiologist, equipment manufacturer support) you need to seek advice or clarification regarding unusual ABR findings, technical setup challenges, or conflicting objective test data?

Relevant learning outcomes

#	Outcome
# 2	Outcome Perform paediatric assessments adapting the test approach to suit the needs of the child.
# 3	Outcome Perform a hearing tests on children of all ages.