Vestibular —
Training activity: 6

Details

Debrief patients and their significant other to explain the test results, and where appropriate the treatment, prognosis, and aetiology, of the following common test findings:

• Unilateral vestibular weakness
• Bilateral vestibular weakness
• Central findings
• BPPV
• Normal results with a positive vestibular history

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
• Patient-friendly language
• Communication skills and patient-centred care
• Cultural and social attitudes to healthcare
• The role of physical/psychological co-morbidities in overall symptom presentation
• Local, national and international classifications of vestibular conditions

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 debriefing, ensuring appropriate and sensitive discussion of test results, treatment, prognosis, and aetiology for these specific common findings?
  • Have you discussed expectations for communication and sensitive handling of diagnoses (especially central findings or bilateral weakness) with your training officer?
• What is your prior experience of this activity?
  • Have you previously debriefed patients and their significant others on complex vestibular diagnoses or prognosis?
  • What do you already know about sensitive communication, explaining complex medical concepts clearly, and dealing with potential patient distress?
  • What specific challenges related to explaining central findings or managing anxiety associated with bilateral vestibular weakness might you face? How might you plan to handle them?
  • What is the scope of your own practice for debriefing and prognosis discussion? When will you need to seek advice or help regarding complex communication or urgent referral, and from whom?
  • How do you feel about delivering potentially significant diagnostic information?
• What do you anticipate you will learn from the experience?
  • What specific communication skills in explaining aetiology and prognosis do you want to develop, drawing upon previous experiences?
  • What specific insights into managing patient expectations and referring patients to sources of support (e.g., charities) 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 debriefing or risk communication?
  • Do you need to prepare clear analogies or supporting information to explain specific conditions like BPPV or bilateral weakness?

In action

• During the activity is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate during the debriefing? Are you encountering situations such as:
    • The patient or family expressing denial or strong resistance to the diagnosis or prognosis (e.g., refusing to accept a diagnosis of BPPV or bilateral weakness)?
    • The patient asking complex questions about the aetiology (e.g., linking the condition to specific genetic factors or external events) that you were not immediately prepared to answer?
    • The significant other presenting a goal for treatment (e.g., cure of bilateral weakness) that is clinically unrealistic based on the evidence base?
  • How is this experience comparing with previous experiences of similar debriefing 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., providing emotional validation), or do you need support because the complexity requires input from a physician or counsellor?
  • What are you learning in this moment as a result of the unexpected development? For example, are you learning effective communication styles (e.g., validation techniques) to address patient anxiety, or gaining confidence in discussing management principles (like rehabilitation) even when objective results are normal but the history is positive?
  • How is this impacting your actions?
    • Are you responding to the situation appropriately (e.g., ensuring empathy is communicated effectively)? Are you adapting or changing your approach to the explanation (e.g., simplifying jargon, changing the focus from diagnosis to functional improvement)?
    • Is this unexpected event affecting your ability to undertake the activity independently?
    • Specifically, are you immediately clarifying the necessity for onward referral to a specialist when discussing complex findings (like Central findings)?
  • How are you feeling in this moment? For example, are you finding it difficult to adapt? Is it affecting your confidence in discussing complex prognoses? Are you feeling positive you can reach a successful conclusion?
• What is the conclusion or outcome?
  • How are you working within your scope of practice? E.g. Are you successfully concluding the debriefing, confirming that the patient understands the aetiology, treatment, and prognosis using clear, jargon-free language? Are you ensuring that complex findings (like Central findings) are explained while clearly outlining the necessity for onward referral to a specialist or physician?
  • What do you learn as a result of the unexpected development? E.g. Are you learning effective communication styles (e.g., active listening and validation techniques) to address patient anxiety or denial regarding the prognosis? Are you gaining improved confidence in discussing management principles (like rehabilitation) even when objective results are normal but the history is positive?

On action

• What happened?
  • Begin by summarising the key points of the debriefing session, focusing on how you explained the test results, treatment, prognosis, and aetiology for the common findings.
  • Consider specific events, actions, or interactions that felt important, such as managing a patient’s emotional response or explaining a complex central finding. How did you feel during the debriefing session?
  • Include any ‘reflect-in-action’ moments, where you had to adapt your communication approach or explanation in the moment based on the patient’s reaction or questions.
• How has this experience contributed to your developing practice?
  • What learning can you take from explaining these specific test results or findings?
  • What strengths did you demonstrate in communicating the information? What skills or knowledge gaps were evident (e.g., related to explaining complex concepts, managing patient/family expectations, responding to emotions)?
  • How did this experience compare against previous engagements with similar activities? Were any previous identified actions for development achieved? Has your practice improved?
  • Identify any challenges you experienced (e.g., communication barriers, dealing with distress, unexpected questions, time constraints) and how you reacted to these. Did these challenges affect your ability to deal with the situation? Were you able to overcome them?
  • Was there anything significant about this activity, such as needing to seek advice or clarification on the information to provide or how to handle a situation, or considering if you were working within your scope of practice?
• What will you take from this experience moving forward?
  • Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you received.
  • What will you do differently next time you debrief a patient with similar findings?
  • Has anything changed in terms of what you would do if you were faced with a similar communication situation again?
  • Do you need to practise any aspect of patient debriefing further? E.g.
    • Preparing simplified analogies or visual aids to use when explaining complex diagnoses, such as bilateral vestibular weakness or central findings, to enhance patient understanding.
    • Practising techniques for managing emotional responses and severe patient anxiety that arose during the debriefing session.
    • Covering expected prognosis and treatment timelines for common conditions like BPPV and unilateral weakness, ensuring all necessary information is conveyed.
    • Seeking feedback on your ability to tailor communication to the patient’s level of understanding and emotional state during the debriefing.

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 (debriefing patients on test results and 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 explaining complex findings (e.g., central signs) clearly, managing emotional responses from patients, adapting explanations for significant others, or discussing prognosis empathetically?
  • 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 challenging debriefing sessions with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of patient-centred decision-making, discussing aetiology sensitively, or handling communication barriers?
• 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 communication skills in debriefing are vital for general Case-Based Discussions (CBDs) where clinical explanations are required.
  • How has your practice related to debriefing patients and their significant other developed and evolved over time across multiple instances of undertaking this training activity? Can you identify specific examples of improvement or increased confidence in tailoring terminology to patient literacy, ensuring shared understanding of the diagnosis, or managing challenging questions effectively?
  • Based on your experiences, how has your ability to recognise when something related to patient debriefing is beyond your scope of practice improved? Do you have a clearer understanding of when and from whom (e.g., supervisor, psychologist, medical specialist) you need to seek advice or clarification regarding patients demonstrating severe psychological distress, highly sensitive prognosis discussions, or cultural/social factors significantly impacting understanding?

Relevant learning outcomes

#	Outcome
# 3	Outcome Perform and interpret a wide range of diagnostic vestibular tests.
# 4	Outcome Discuss test results in an appropriate and sensitive manner according to the needs of the patient, taking into account differing cultural and social attitudes to hearing care.