Paediatric Audiology —
Training activity: 5

Details

Develop, discuss and amend with a family an individual management plan for hearing-impaired children in each of the following age groups:

• School age child, including those with complex needs
• Pre-school child, without complex needs
• Infant

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
• Sharing the news
• Informed choice and shared decision making
• Differing cultural and social attitudes to hearing care
• Impact of intervention vs. no intervention
• Role of the National Deaf Children’s Society and other family centred organisations
• Importance of bimodal communication to some families
• Educational and social aspects.
• Appropriate 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 successful, individualised, holistic, and family-centred management plan for these different age groups?
  • How does a successful discussion and amendment process look, taking into account differing cultural and social attitudes?
  • Have you discussed expectations with your training officer?
• What is your prior experience of this activity?
  • Have you previously discussed management plans with families of hearing-impaired children?
  • What do you already know about developing management plans for children of different ages or needs?
  • What specific challenges related to communicating complex information, managing family expectations, or addressing sensitive topics might you face. How might I plan to handle them?
  • What is the scope of your own practice for developing and discussing management plans? When is it appropriate to seek senior advice on a management approach or escalation?
  • How do you feel about leading discussions on management plans with families?
• What do you anticipate you will learn from the experience?
  • What specific skills in discussing test results appropriately and sensitively, developing individualised plans, or applying the principles of family-centred and transdisciplinary care do you want to develop, drawing upon previous experiences?
  • What specific insights into the impact of childhood hearing loss and available support options do you hope to gain?
• What additional considerations do you need to make?
  • Have you reviewed any actions identified from your previous reflections on patient/family communication or management planning discussions?
  • Do you need to review specific management options relevant to the child’s age and needs?
  • Do you need to consider potential sources of support for the family or professionals you might need to liaise with before the discussion?

 

In action

• During the activity is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate during the development and discussion of the management plan? Are you encountering situations such as:
    • A significant other or carer presenting conflicting goals or communication needs compared to the patient, complicating the shared decision-making process?
    • The family strongly rejecting the proposed management strategy (e.g., amplification, surgical options) due to differing cultural and social attitudes to hearing care?
    • The child/adolescent (if school age) asserting independent needs or preferences that conflict with the parents’/guardians’ expectations for the management plan?
  • How does this experience compare 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., facilitating discussion, validating complex emotional responses), or do you need support because the conflict surrounding the holistic management approaches is significantly impacting the application of family-centred care?
  • What are you learning in this moment as a result of the unexpected development? For example, are you learning a more effective way to ensure equal participation from the patient and their significant others, or a better method for discussing complex management principles with differing age groups?
  • How is this impacting your actions?
    • Are you responding to the situation appropriately? Are you adapting or changing your approach to the management discussion (e.g., simplifying explanations, ensuring empathy is communicated effectively)?
    • Is this unexpected event affecting your ability to undertake the activity independently?
    • Specifically, are you immediately rephrasing your recommendations to incorporate the family’s cultural or social attitudes, or carefully redirecting the conversation to focus on the value of holistic and transdisciplinary care?
  • 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 successfully discussing test results and developing an individualised management plan, ensuring the discussion incorporates differing cultural and social attitudes to hearing care expressed by the family? Are you practising within your scope by focusing the discussion on the value of holistic and transdisciplinary care, recognising when conflicts require support from professionals outside of audiology?
  • What are you learning as a result of the unexpected development? E.g. Are you learning more effective methods to facilitate shared decision-making and to ensure equal participation from the patient and their significant others when goals are conflicting? Are you gaining proficiency in discussing complex long-term management principles (e.g., amplification or surgical options) with differing age groups sensitively?

On action

• What happened?
• • Begin by summarising the process of developing and discussing the management plan, focusing on how you incorporated the principles of family-centred care.
  • Consider specific events or interactions that felt important, such as successfully negotiating a shared decision regarding technology choice or detailing the support plan with the family. How did you feel during discussions that deviated from your initial plan?
  • Include any ‘reflect-in-action’ moments, where you had to adjust the plan immediately, for instance, switching focus from technology to educational support based on a parent’s immediate concern, or modifying timelines based on family capacity.
• How has this experience contributed to your developing practice?
• • Identify what learning you can take from this experience regarding plan development. What strengths did you demonstrate (e.g., tailoring discussion to age group, integrating multidisciplinary information)? What skills and/or knowledge gaps were evident (e.g., detailed knowledge of non-technological support options, addressing psychosocial aspects, documenting comprehensive long-term plans)?
  • Compare this experience against previous similar activities. Has your practice in collaborative planning improved?
  • Identify any challenges you experienced (e.g., patient resistance to recommended intervention, difficulty balancing the needs of the infant patient with parental anxiety) and how you reacted.
  • Identify anything significant, such as needing to seek advice or clarification on management options for a complex case (e.g., Auditory Neuropathy Spectrum Disorder).
• What will you take from the experience moving forward?
• • Identify the actions or ‘next steps’ you will take.
  • What will you do differently next time? Do you need to practise any specific aspect of shared decision-making or ensuring all components of a holistic plan are covered? E.g.
  • Practising techniques for shared decision-making when discussing technology options, ensuring the family’s capacity and preferences are fully integrated into the holistic plan.
  • Developing a tool or checklist to ensure all psychosocial aspects, educational support (e.g., Teachers of the Deaf), and non-technological support options are systematically covered and documented in the individual management plan.
  • Preparing for discussions by anticipating potential points of parental anxiety (especially for infants) and allocating sufficient time to address emotional concerns before detailing the intervention timeline.

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 (developing, discussing, and amending management plans with a family)?
  • 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 families in shared decision-making, adapting the plan content for different age groups (infant vs. school-age), discussing management options sensitively, or incorporating family feedback?
  • 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 management plan development with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of patient-centred decision-making, navigating cultural and social attitudes to hearing care, or handling sensitive emotional responses from families?
• 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?
  • How has your practice related to developing, discussing, and amending individual management plans developed and evolved over time across multiple instances of undertaking this training activity? Can you identify specific examples of improvement or increased confidence in setting achievable, collaborative goals, documenting plan amendments, or ensuring continuity of care across different services?
  • Based on your experiences, how has your ability to recognise when something related to management planning is beyond your scope of practice improved? Do you have a clearer understanding of when and from whom (e.g., multidisciplinary team members, social services, paediatric clinical lead) you need to seek advice or clarification regarding safeguarding issues impacting the plan, significant psychosocial barriers to implementation, or complex management decisions for children with multiple conditions?

Relevant learning outcomes

#	Outcome
# 4	Outcome Discuss test results with parents/guardian and patients in an appropriate and sensitive manner, taking into account differing cultural and social attitudes to hearing care.
# 5	Outcome Develop individualised management plans for children who have a hearing loss.