Paediatric Audiology —
Training activity: 8

Details

Evaluate/validate  hearing aid fitting in for school-age children and report the findings to the relevant professionals

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
• Selection and interpretation of speech perception/discrimination outcome measures
• Selection and scoring of a patient reported outcome measure
• Family centred care
• Local, national and international guidance 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 appropriate methods for evaluating/validating hearing aid fitting outcomes in school-age children?
  • What constitutes successful validation and reporting the findings to relevant professionals?
  • Have you discussed expectations with your training officer?
• What is your prior experience of this activity?
  • Have you used outcome measures or other validation techniques with school-age children before?
  • What do you already know about different validation tools and their suitability for children?
  • What specific challenges related to obtaining reliable feedback from the child/parent, selecting appropriate measures, interpreting results, or communicating findings to professionals might you face. How might you plan to handle them?
  • What is the scope of your own practice for evaluating/validating fittings and reporting findings. When may you need advice on interpreting validation results or formulating recommendations, and from whom?
  • How do you feel about evaluating the real-world benefit of hearing aids for school-age children?
• What do you anticipate you will learn from the experience?
  • What specific validation method or outcome measure do you want to practice using or interpreting more effectively, drawing upon previous experiences?
  • What specific insights into the real-world impact of hearing loss and hearing aid use in school-age children do you hope to gain?
• What additional considerations do you need to make?
  • Have you reviewed any actions identified from your previous reflections on evaluating hearing aid outcomes or reporting findings?
  • Do you need to review specific questionnaires, behavioural validation techniques, or methods for reporting results to professionals?
  • Do you need to consider which relevant professionals might need the report?

In action

• During the activity is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate during the validation and outcome measures assessment? Are you encountering situations such as:
    • Validation questionnaires or functional assessments (outcome measures) indicating significantly poorer performance than expected, despite successful objective verification?
    • Parents/guardians reporting major barriers to consistent hearing aid use (e.g., difficulties with maintenance, poor user confidence) that were not identified during the initial fitting?
    • The school-age child expressing a strong reluctance or negative self-image related to using the device, impacting the successful evaluation of the fitting?
  • How does this experience compare with previous experiences of similar activities?
• How do you react 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., immediate re-instruction on device use, performing further counselling), or do you need support because the validation failure suggests a significant social/educational barrier or the need for psychological intervention?
  • What are you learning in this moment as a result of the unexpected development? For example, are you learning a more effective way to integrate school and educational input into the validation process (e.g., Teachers of the Deaf), or a clearer way to assess the social impact of hearing loss on the child?
  • How is this impacting your actions?
    • Are you responding to the situation appropriately? Are you adapting or changing your approach immediately (e.g., switching from focusing on technical evaluation to discussing holistic management approaches)?
    • Is this unexpected event affecting your ability to undertake the activity independently?
    • Specifically, are you immediately rephrasing your questions to identify underlying educational or psychosocial challenges, or are you adjusting the management discussion to focus on support resources (e.g.., charities)?
  • 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 identifying where onward referral is appropriate, specifically when poor functional outcomes are linked to significant social or educational barriers rather than just technical issues? Are you successfully evaluating the fitting by ensuring the discussion is adapted to address parental barriers (e.g., maintenance) or the child’s psychosocial resistance (e.g., negative self-image), moving toward a holistic management approach?
  • What are you learning as a result of the unexpected development? E.g. Are you learning a more effective way to integrate educational input into the validation process to overcome school-related challenges? Are you enhancing your ability to assess the social impact of hearing loss on the child and adjusting the management discussion to focus on relevant support resources?

On action

• What happened?
• • Begin by summarising the key methods used to evaluate/validate the fitting (e.g., parent/child questionnaires, functional gain measures).
  • Consider specific events or interactions that felt important, such as receiving unexpected negative feedback on sound quality from the child or difficulty interpreting conflicting reports from the child and the parent. How did you feel trying to interpret this feedback?
  • Include any ‘reflect-in-action’ moments, where you adapted your questioning or approach, for instance, shifting from a standardised questionnaire to open-ended dialogue based on the child’s body language.
• How has this experience contributed to your developing practice?
• • Identify what learning you can take from this experience regarding validation. What strengths did you demonstrate (e.g., patient/family counselling, effective use of subjective outcome measures)? What skills and/or knowledge gaps were evident (e.g., interpreting objective versus subjective data discrepancies, advanced fine-tuning strategies)?
  • Compare this experience against previous activities. Has your practice in evaluating fitting benefit improved?
  • Identify any challenges you experienced (e.g., vague patient complaints, low return rate of questionnaires) and how you reacted.
  • Identify anything significant, such as needing to seek advice or clarification on documenting functional benefit in noisy environments.
• 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 integrating validation tools or fine-tuning based on complex feedback further? E.g.
    • Practising advanced fine-tuning strategies based on subjective feedback, particularly when dealing with vague complaints or negative reports on sound quality from the child.
    • Integrating open-ended dialogue and communication strategies alongside standardised questionnaires to better interpret conflicting objective and subjective data.
    • Seeking advice on documenting functional benefit in challenging listening environments to strengthen the evidence base for the fitting.

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 (evaluating/validating hearing aid fitting and reporting findings)?
  • When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to selecting appropriate outcome measures for school-age children, interpreting complex validation questionnaires, discussing results with families effectively, or reporting outcomes to relevant professionals?
  • 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 hearing aid evaluation/validation with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of managing patient/parent expectations, the limitations of specific validation tools, or strategies for addressing suboptimal outcome scores?
• 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 increased proficiency in evaluation is crucial for all general Case-Based Discussions (CBDs) where you discuss ongoing paediatric management, contributing to your ability to provide hearing habilitation.
  • How has your practice related to evaluating/validating hearing aid fitting and reporting findings developed and evolved over time across multiple instances of undertaking this training activity? Can you identify specific examples of improvement or increased confidence in diagnosing the source of dissatisfaction based on validation results, modifying the plan based on outcomes, or effectively communicating the value of validation to stakeholders?
  • Based on your experiences, how has your ability to recognise when something related to hearing aid validation is beyond your scope of practice improved? Do you have a clearer understanding of when and from whom (e.g., supervisor, educational audiologist, speech and language therapist) you need to seek advice or clarification regarding significant mismatch between objective and subjective outcomes, persistent functional difficulties impacting school life, or complex issues requiring interagency action?

Relevant learning outcomes

#	Outcome
# 6	Outcome Provide hearing habilitation for school-age children.