Paediatric Audiology —
Training activity: 3

Details

Select, perform and interpret the following diagnostic tests on pre-school age children, including those with complex needs, and document the results:

• Behavioural observation assessment
• Distraction testing
• Visual reinforcement audiometry
• Performance/play audiometry
• Otoscopy
• Tympanometry
• Speech testing
• Diagnostic otoacoustic emissions

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

• Complex needs, including, but not limited to, Down’s syndrome and autism spectrum disorder
• Principles of patient-centred care and support
• Testing dependent on clinical question
• Previous results
• Test selection and modification for the development of the child
• 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 are the indicators of successfully selecting, performing, and interpreting this range of behavioural and objective tests for pre-schoolers, including those with complex needs?
  • Have you discussed expectations with your training officer
• What is your prior experience of this activity?
  • Which of these specific tests have you performed on pre-schoolers or children with complex needs before?
  • What do you already know about child maturation and development relevant to choosing and adapting these tests?
  • What specific challenges related to engagement, behaviour management, test adaptation, or interpretation might you face, particularly with complex needs. How might you plan to handle them?
  • What is the scope of your own practice for testing pre-schoolers? When will you need to seek advice on test selection or adaptation, and from whom?
  • How do you feel about assessing hearing in pre-school children, especially those with complex needs?
• What do you anticipate you will learn from the experience?
  • What specific test techniques or adaptations for this age group and those with additional needs do you want to master?
  • What specific insights into the performance and clinical use of these behavioural and objective techniques, or tailoring assessment procedures, do you hope to gain?
• What additional considerations do you need to make?
  • Have you reviewed any actions identified from your previous reflections on testing pre-schoolers or children with complex needs?
  • Do you need to prepare specific testing materials, adapt the room setup, or review protocols for engaging children?
  • Do you need to review information about specific complex needs relevant to the child?

In action

• During the activity is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate during the assessment of pre-school children? Are you encountering situations such as:
    • The child displaying limited attention or cooperation, making Visual Reinforcement Audiometry (VRA) or Performance/Play Audiometry procedures ineffective?
    • Otoscopy findings that suggest an urgent or complex medical pathology (e.g., signs of active infection or cholesteatoma) not anticipated?
    • Unexpected difficulties arising in the adaptation of testing procedures required for a child with complex needs (e.g., physical disabilities or Autism Spectrum Disorder)?
  • 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., switching test modalities, adjusting reinforcement schedules), or do you need support because the complexity requires immediate medical escalation or complex adaptations?
  • What are you learning in this moment as a result of the unexpected development? For example, are you learning a more effective way to switch from VRA to Distraction testing, or a clearer way to adjust the assessment battery for children with different developmental stages?
  • How is this impacting your actions?
    • Are you responding to the situation appropriately (e.g., prioritising medical clearance over immediate continuation of behavioural testing)? Are you adapting or changing your assessment approach immediately (e.g., adjusting the level of complexity of speech testing, or modifying the test approach 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 for managing medical red flags, or are you ensuring empathy is communicated effectively when explaining the need for test adaptation to the family?
  • 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 practising within your scope by immediately consulting internal protocols for managing medical red flags identified during otoscopy, prioritising medical clearance over continued behavioural testing? Are you successfully performing paediatric assessments by adapting the test approach (e.g., switching from VRA to Distraction testing) to suit the attention and cooperation needs of the pre-school child?
• What are you learning as a result of the unexpected development? E.g. Are you learning a clearer method for adapting the assessment battery for children at different developmental stages or with complex needs? Are you enhancing your skills in ensuring empathy is communicated effectively when you explain the necessity of test adaptations to the family.

On action

• What happened?
  • Begin by summarising the key steps of selecting and performing tests like Visual Reinforcement Audiometry (VRA), Distraction testing, or Performance/play audiometry.
  • Consider specific events, actions, or interactions that felt important, such as successfully conditioning the child for VRA or efficiently transitioning between different behavioural tests. How did you feel during these adaptive moments?
  • Include any ‘reflect-in-action’ moments, where you adapted your approach, for instance, changing the VRA stimuli or modifying play audiometry reinforcement when the child lost attention.
• How has this experience contributed to your developing practice?
  • Identify what learning you can take from this experience regarding testing pre-school children. What strengths did you demonstrate (e.g., communication, engaging the child, test selection rationale)? What skills and/or knowledge gaps were evident (e.g., efficient transitioning between tests, interpreting speech test results for this age group)?
  • Compare this experience against previous activities. Has your practice in selecting and adapting tests for pre-schoolers improved?
  • Identify any challenges (e.g., a child refusing to cooperate with tympanometry, difficulty obtaining reliable thresholds) and how you reacted.
  • Identify anything significant, such as seeking clarification on interpreting behavioural results when cooperation was inconsistent.
• What will you take from the experience moving forward?
  • Identify the actions or ‘next steps’ you will take to support assimilation.
  • What will you do differently next time? Are there particular techniques you need to practise further? E.g.
  • Practising any aspect of communication with pre-school children or tailoring test strategies further.
    • • Developing a smoother, more efficient method for transitioning between different behavioural tests (e.g., Visual Reinforcement Audiometry (VRA) to Performance/play audiometry) to sustain the child’s cooperation and attention?
      • Practising interpretation of speech test results for pre-school age children and ensure you accurately reflect these findings in the documentation.
      • Tailoring the test strategy more effectively to reduce the likelihood of a child refusing cooperation, particularly with physical assessments like tympanometry.

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 (selecting, performing, and interpreting diagnostic tests on pre-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 managing child attention during Visual Reinforcement Audiometry (VRA), efficiently transitioning between different behavioural tests, or adapting test selection for children with complex needs?
  • 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 pre-school diagnostic testing with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of behavioural management strategies, the impact of developmental stage on test interpretation, or refining intuitive responses to unexpected events?
• 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, your improved understanding and skill in VRA and PPA supports your broader ability to perform hearing tests on children of all ages.
  • How has your practice related to selecting, performing, and interpreting diagnostic tests on pre-school children 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 behavioural thresholds quickly, combining objective and behavioural findings, or ensuring appropriate documentation for this age group?
  • Based on your experiences, how has your ability to recognise when something related to pre-school testing is beyond your scope of practice improved? Do you have a clearer understanding of when and from whom (e.g., supervisor, child psychology specialist, experienced paediatric audiologist) you need to seek advice or clarification regarding difficult-to-test children, assessment of children with profound complex needs, or managing ambiguous test results?

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.