Paediatric Audiology —
Training activity: 9

Details

Identify candidacy and discuss referral with  children and their families for at least two of the following:

• Surgical interventions
• Investigations/support for speech and language concerns
• Onward investigation/support following a diagnosis of permanent hearing loss (e.g., Paediatrics, Teachers of the deaf, or speech and language therapy)
• Cochlear implants and other implantable devices

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
• Informed choice and shared decision making
• Effective communication and counselling
• Cultural and social attitudes to hearing care
• Multidisciplinary working
• Onward referral paperwork
• Local and national guidance, pathways and referral criteria

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 criteria for accurately identifying candidacy for at least two of these specific interventions/support pathways?
  • What constitutes a clear, sensitive, and informative discussion with children and their families about these options?
  • Have you discussed expectations with your training officer?
• What is your prior experience of this activity?
  • Have you previously identified candidacy or discussed referral options for any of these specific interventions/support pathways with children/families?
  • What do you already know about the criteria, processes, and implications for each of these options?
  • What specific challenges related to discussing complex or sensitive topics, managing expectations, or liaising with other professionals might you face. How might you plan to handle them?
  • What is the scope of your own practice for identifying candidacy and discussing referral? When must you recognise that something is beyond your scope and seek advice or escalate?
  • How do you feel about discussing these significant referral options with children and their families?
• What do you anticipate you will learn from the experience?
  • What specific knowledge about the candidacy criteria for different interventions (e.g., implants, surgical options) do you want to deepen?
  • What specific communication skills in explaining complex options and supporting shared decision-making do you want to develop, drawing upon previous experiences?
  • What specific insights into interagency support and multi-disciplinary working do you hope to gain?
• What additional considerations do you need to make?
  • Have you reviewed any actions identified from your previous reflections on complex case discussions, referral processes, or liaising with other professionals?
  • Do you need to review the specific criteria for the interventions you will be discussing?
  • Do you need to prepare information or consider who else might need to be involved in the discussion or referral process?

In action

• During the activity is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate during the referral discussion? Are you encountering situations such as:
    • The family/child expressing extreme fear or resistance to a necessary surgical intervention (e.g., cochlear implants) based on misinformation?
    • The child’s need for investigations/support for speech and language concerns being significantly more complex than anticipated, requiring immediate transdisciplinary working?
    • The family strongly resisting the need for onward referral (e.g., to Paediatrics or Teachers of the deaf) due to cultural or social attitudes toward intervention?
  • 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., using evidence-based discussion, providing relevant support material), or do you need support because the need for specialist input (e.g., regarding genomics or specific surgical criteria) is beyond your current personal and professional scope?
  • What are you learning in this moment as a result of the unexpected development? For example, are you learning a more sensitive way to discuss complex surgical candidacy (Cochlear implants), or a clearer method for ensuring the family understands the value of transdisciplinary care?
  • How is this impacting your actions?
    • Are you responding to the situation appropriately? Are you adapting or changing your approach to the referral discussion (e.g., simplifying complex management principles, carefully redirecting the conversation)?
    • Is this unexpected event affecting your ability to undertake the activity independently?
    • Specifically, are you immediately clarifying your role and identifying where onward referral is appropriate to ensure you are practicing within your scope, or are you using empathy and validation techniques to address patient/family distress regarding a diagnosis?
  • 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 personal and professional scope by identifying where onward referral is appropriate (e.g., for specific surgical criteria like cochlear implant candidacy or complex speech and language support).? Are you successfully identifying candidacy and discussing referral by using empathy and validation techniques to address family distress, clarifying your role in the overall transdisciplinary working structure?
  • What are you learning as a result of the unexpected development? E.g. Are you gaining increased knowledge regarding the discussion of specific surgical or medical criteria (e.g., related to genomics) that may be outside of your primary scope, enabling appropriate consultation? Are you learning a more effective way to ensure the family understands the value of transdisciplinary care and referral to support groups or other agencies?

On action

• What happened?
  • Begin by summarising the discussion regarding potential referrals (e.g., discussing candidacy for Cochlear Implants or onward referral to Speech and Language Therapy).
  • Consider specific events or interactions that felt important, such as clearly explaining the criteria for a surgical intervention or managing a family’s significant apprehension about a diagnosis. How did you feel managing the conversation when the family’s reaction was unexpected?
  • Include any ‘reflect-in-action’ moments, where you adapted your explanation or the pace of the conversation, perhaps by simplifying complex medical terminology or spending more time discussing prognosis than initially planned.
• How has this experience contributed to your developing practice?
  • Identify what learning you can take from this experience regarding referral discussions. What strengths did you demonstrate (e.g., sensitive communication, detailed knowledge of referral pathways)? What skills and/or knowledge gaps were evident (e.g., efficiently explaining complex options, managing difficult family dynamics, understanding the scope of other specialist services like Teachers of the Deaf)?
  • Compare this experience against previous similar activities. Has your practice in discussing sensitive or complex options improved?
  • Identify any challenges you experienced (e.g., a family dismissing the need for further investigation, difficulty prioritising referrals within the consultation time) and how you reacted.
  • Identify anything significant, such as needing to seek advice or clarification on specific referral criteria for implantable devices.
• 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 you discuss referrals? Do you need to practise any specific aspect of explaining complex options or supporting families in their decision-making process further? E.g.
    • Practising explaining the criteria for complex referral options (e.g., Cochlear Implants or surgical interventions) in a simple, sensitive, and clear manner, avoiding complex medical terminology.
    • Allocating more time at the start of the discussion to assess the family’s emotional reaction to a diagnosis or prognosis before proceeding to detailed referral pathways.
    • Expanding knowledge of the scope and role of associated specialist services (e.g., Speech and Language Therapy and Teachers of the Deaf) to provide comprehensive and accurate advice during onward referrals.

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 (identifying candidacy and discussing referrals)?
  • When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to clearly explaining complex referral options (e.g., Cochlear Implants), managing family expectations regarding specialist input, structuring multi-option discussions sensitively, or understanding the criteria for onward investigation/support?
  • 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 referral discussions with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of the roles of professionals you refer to (e.g., Teachers of the deaf, Paediatrics), navigating ethical decisions in candidacy, or refining communication techniques for difficult conversations?
• 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 skill in discussions and referrals contributes to your overall ability to practice within your own personal and professional scope.
  • How has your practice related to identifying candidacy and discussing referral developed and evolved over time across multiple instances of undertaking this training activity? Can you identify specific examples of improvement or increased confidence in determining appropriate timing for referral, communicating necessity of investigations, or liaising effectively with external agencies?
  • Based on your experiences, how has your ability to recognise when something related to candidacy or referral is beyond your scope of practice improved? Do you have a clearer understanding of when and from whom (e.g., supervisor, Cochlear Implant specialist, multidisciplinary surgical team) you need to seek advice or clarification regarding highly contentious candidacy decisions, complex surgical risks, or multi-agency failure to progress a required referral?

Relevant learning outcomes

#	Outcome
# 7	Outcome Practice within their own personal and professional scope, identifying where onward referral is appropriate.