INDIVIDUAL RECORD OF CLINICAL PRACTICE ASSESSMENTSeclinics.aston.ac.uk/mycourse/3/22/54/9b. Guidance...

BSc (Honours) AUDIOLOGY, ASTON UNIVERSITY 1

GUIDANCE NOTES FOR UNIVERSITY PRACTICAL ASSESSMENTS 1. General Information i) Role of the University Appointed Assessor The University Appointed Assessor will represent Aston University during their designated visits and is responsible for undertaking the clinical assessments for the Individual Record of Clinical Practice. This shall entail liaising with the supervisor to arrange a mutually convenient assessment time, undertaking the assessment and completing/returning the assessment report form within two weeks of the visit. The assessor should also advise the Programme Support Assistant (Placements) of the agreed assessment date, as soon as this has been confirmed with the host department. The assessor will need to check the student's Individual Record of Clinical Practice before the assessment to check which areas have already been assessed by a University Assessor. During the assessment, the assessor is responsible for ensuring that safe practice is maintained and must, if required, intervene to ensure patient safety. However, such intervention should be carefully and sensitively handled with respect to the patient and the student. Such interventions would usually lead to a mandatory fail of the assessment. The assessor is not required to monitor the student’s academic progress nor discuss the training provided in the department unless there is any cause for concern, as evident from the practical assessment. Any such concerns may be discussed with the supervisor, if deemed appropriate, but must be brought to the attention of the Chief Assessor/Director of Practice Learning. ii) University Appointed Assessors qualifications and training All assessors used by Aston University will hold assessors qualifications or, in exceptional circumstances, be accepted due to substantial work-based or professional body experience. The application process and criteria for new assessors can be found on Blackboard. Assessor training will be reviewed on a regular basis and it is compulsory that all assessors undertake future training and assess on a regular basis in order to continue in this role. The Assessor’s Group shall meet at least twice a year to discuss assessment issues. Information regarding the Assessor’s Group remit may be found on Blackboard along with summaries of the meetings held. As part of the ongoing quality monitoring for the BSc (Hons) Audiology, the Chief Assessor will also attend a number of visits as an observer to ensure that the assessor is assessing to the appropriate national standards and in the appropriate manner. These observational visits may also be undertaken by designated senior assessors who have considerable experience, for example, acting as a senior assessor for the professional body. Assessors from other HEIs may also be used to observe assessor’s performance. All assessors will be observed a minimum of once every two years. iii) Allocation of students Assessors will usually be attached to two departments. The assessors will decide between them who shall undertake which assessments but it is compulsory that the assessments are split evenly between the assessors to ensure that a student is not assessed by only one assessor.

INDIVIDUAL RECORD OF CLINICAL PRACTICE ASSESSMENTS

BSc AUDIOLOGY, ASTON UNIVERSITY


Assessors may request to undertake assessments at the same time to encourage support mechanisms to be developed; although the assessor should assess the same student during visit one and a different student at visit two. This is necessary incase a student fails a section to ensure they have a different assessor on the following assessment. 2. Assessment details

i) Assessment schedule Five assessments are required to be carried out: Direct Referral Hearing Aid Fitting & Verification Hearing Aid Reassessment Hearing Aid Follow-up Hearing Aid Repairs These assessments should be spread over two visits, the content of which may be determined locally, in line with the given timescales: Visit one: January Visit two: April Prior to the visit taking place, it is recommended that wherever possible the student have a minimum of four ‘Fulfills Definition’ entries for the assessment area, signed off by the department’s supervisor or clinical educators. This will therefore mean that the student has consistently been signed off as competent and will then be expected to pass their external assessment. It is important that students are not assessed before they are deemed competent due to the limited resources of assessors. Whilst it is important that timescales are adhered to wherever possible in order to address any issues regarding student progress, if it is felt necessary to delay the assessment, the supervisor should discuss this with the University Assessor. Should it be felt necessary to delay the assessment any later than one month after the scheduled time, this must be brought to the attention of the Director of Practice Learning. Any failed sections will need to be arranged following discussions with the assessor and the Placement Tutor. ii) Role of the supervisor The supervisor must liaise with the assessor to agree a mutually convenient assessment date. They must also ensure that suitable patients have been booked for the assessment and at appropriate times to allow completion of each section (see appendix A for guidance on likely duration). In order to minimise the risk of patients not attending on the assessment session, patients should be asked to confirm their attendance or the supervisor should arrange for a back-up patient to be booked. If despite these efforts no patients are available, the assessor should use their discretion regarding alternative assessment subjects or should arrange an alternative visit if it is not possible to assess the student’s abilities. The supervisor must be available throughout the time that the assessor is undertaking the assessment visit. If this is not possible, another senior member of staff should be mad available. Assessors should not be left alone in departments whilst assessing. The supervisor must check that the patient due to be seen for the assessment is suitable (e.g. ears clear of wax) and gives their consent to being part of the assessment process. At the end, the supervisor must also check that the patient is happy with the management undertaken during the assessment before they leave the department. The assessor is responsible for advising the supervisor of any difficulties which need addressing immediately after the assessment, for example, further reinstruction, failure of TTSA criteria, urgent follow-up required.


The supervisor must also inform the assessor of any local variance from the recommended procedures, for example, if only able to fit monaural hearing aids. For the follow-up assessment, the supervisor must ensure that the patient has had a Glasgow Part I Profile undertaken so that the student will be able to complete Part II of the questionnaire. For the repair assessment, the supervisors must ensure that the student/assessor has access to data sheets for the main hearing aids issued locally. iii) Competency/Grading The assessment grading is pass or fail. In order to pass students must demonstrate competence, which includes having the knowledge, clinical abilities and interpersonal skills required for each individual situation. It should be noted and agreed by all assessors that when grading a student’s level of competence, this should be related to the level expected of a competent, newly qualified Audiology practitioner. This is vital to ensure reliability and repeatability between assessors. All students must be following the procedures recommended by the British Academy of Audiology (as stated on the BAA website) as well as the additional guidance given in appendix A. Assessments will also include an oral component to assess students critical thinking (see appendix B for suitable questioning techniques). The British Academy of Audiology has produced guidance for supervisors (see appendix 8.4 of the year three section), which states areas that students should be able to discuss. These areas have been incorporated on to the Aston University Assessment Report forms used by the assessors. The Individual Record of Clinical Practice (IRCP) requires students to have a FD (Fulfils Definition) level signed off by a University Assessor. FD requires the student to have performed to a satisfactory level for all of the given criteria. Assessors will sign students off for the relevant parts of section A, section B and the ‘edit competency sheet’ of the IRCP. Supervisors should ensure that sufficient space is available for this to be done. iv) Assessment Reports In addition to the above entries being made in the Student’s Individual Record of Clinical Practice, Assessors are required to complete the Assessment Report form (appendix C) for each assessment area and return it to the university (see section 3). Assessors should report on the student’s clinical competence, ensuring that appropriate, constructive feedback is recorded (appendix D). Details on any failed sections must be fully reported stating specific reasons for the failure, which can be reported back to the student by the Chief Assessor. Verbal feedback should be given to the student directly at the end of the day’s assessment session. It should not be given at the end of each patient appointment in case the student is unsuccessful as this is likely to affect the student for the remainder of the assessment process. v) Failed assessments Students failing an assessment will receive written notification of the outcome within four weeks of the assessment. Recommendations for improvements and advice regarding a repeat assessment timescale will be given. There is no set number of attempts that a student may have to successfully pass the assessments. Following a second fail of a section, cases will be considered on an individual basis by the Chief Assessor. vi) Appeals procedure Should a student be unhappy with the outcome of their assessment, they should contact the Chief Assessor, in writing or by e-mail, within two weeks of receiving notification of their outcome. Specific details of the reason for the appeal must be given. Any complaints will be investigated and the student advised of the outcome within two weeks of receiving the written appeal.


3. Administration i) Completion of Assessment Report The Assessment Report form should be sent to the Programme Support Assistant (Placements) within 2 weeks of the visit date, a copy of which should also be retained. The Chief Assessor will send the student a formal letter confirming the assessment outcome and give advice regarding future supervision requirements. ii) Payment of assessors fees University Appointed Assessors undertaking visits in NHS time will require their line manager/designated person to invoice the university, for the attention of the Programme Support Assistant (Placements). For visits undertaken in a person’s own time, a form 7 should be completed (available from the Programme Support Assistant (Placements). Payment is at an hourly rate, which includes travelling time. Travelling expenses will not be paid in addition to this. The current payment rate is available from the Programme Support Assistant (Placements). Any queries regarding the assessor’s role, when representing Aston University, should be directed to the Programme Support Assistant (Placements) as appropriate. Director of Practice Learning Emma Wilson Email: [email protected] Audiology, Aston University Tel: 0121 204 4192 Aston Triangle Birmingham B4 7ET


ADDITIONAL GUIDANCE FOR INDIVIDUAL RECORD OF CLINICAL PRACTICE ASSESSMENTS

Following discussions with West Midlands Audiologists (including head of services, supervisors, clinical educators, trainers, university appointed assessors and university staff) on October 26th 2005, the following points have been discussed and agreed with respect to expectations for assessments carried out by the university appointed assessors. It is expected that supervisors and clinical educators work within the scope of these guidelines when completing the logbook for local students. Guidance is given regarding the expected duration of each assessment, which includes preparation (e.g. calibration), patient management and oral questioning. This is given as a guide only. All sections Students must undertake all procedures in line with policies recommended by BSA/BAA

(copies of which have been made available to each department) Satisfactory patient care must be demonstrated at all times, including: professional attitude,

rapport and empathy with the patient/carer/significant other, effective communication, responding to individual patient needs and maintaining health and safety

Assessments include the writing up of patient records. A full account of all information, as covered in the appointment, must be given.

The assessor will intervene if patient safety is at risk. This will result in a mandatory stop of the assessment and a mandatory fail outcome being recorded

Any areas where competence is not demonstrated during the course of the patient session will be discussed with the assessor, and may involve the undertaking of tests on the assessor or a volunteer, in order to ensure appropriate knowledge and understanding in all areas. Knowledge of the patient’s pathway and given management, including clinical reasoning and judgment will also be assessed

B1 Direct Referral (120 minutes) Calibration

– Clinic preparation and calibration of audiometer/admittance equipment should be undertaken at the start of the session, unless previously assessed and signed off by the university assessor (found in section A1)

History taking – Must include detailed medical history (following TTSA guidelines) and social history (see example sheet as used at City Hospital)

Glasgow profile or alternative questionnaire – Should be done as a separate questionnaire style approach, rather than using information gained from history taking in order to complete the patients answers – Must be done unless the student is able to give a valid clinical reason for not doing so. If it is not undertaken, the student will be required to do it on the assessor/volunteer. Alternative profiles, e.g. the IHR Family questionnaire may be done if suitable but is not essential

Assessment strategy – Otoscopy (A2): if a patient has no abnormal findings, and the student correctly recognises this, this is sufficient to have fulfilled the definition and hence be signed off – PTA (A4): Where equipment is calibrated to effective masking, masking should be set at the level equal to the pure tone threshold of the non-test ear (i.e. it is not necessary to add 10dB) – Covering the ear at 4 kHz when testing BC is recommended by the BSA 2004 procedure but is not compulsory. However, all students must be fully aware of the BSA recommendation when questioned


– Students must also be fully aware of BSA recommended symbols and may be required to plot results by hand during the assessment. Knowledge/use of masking charts may also be assessed – ULLs (A5): must be undertaken on the patient, unless there are clear contra-indications (e.g. tinnitus), during the Direct Referral appointment in order for the student to be assessed on this procedure – Acoustic admittance (A6 & A7): testing must be done on a diagnostic machine in order to fully assess the students’ capabilities. If diagnostic equipment is not available the supervisor must advise the Director of Practice Learning before the assessment. Acoustic Reflex Thresholds (ARTs) should follow departmental protocol in the absence of a BSA procedure. It was suggested that a regional protocol is developed and agreed. Whilst this is developed and agreed, it is recommended that students use a local protocol or the enclosed draft protocol – The assessor is required to ensure that students are competent in all of the test procedures listed (otoscopy, PTA, ULLs, tympanometry and acoustic reflex thresholds). Any tests not performed as part of the assessment strategy must be performed on the assessor/volunteer afterwards unless previously signed off by a university assessor at a previous visit. Students must be able to explain to the assessor their clinical reasoning for the assessment strategy adopted. For ARTs, a minimum of one frequency (ipsilateral stimulation) must be assessed by the university assessor

Integration of test results and counselling – Students may wish to use the AMEQ questionnaire (attitudes, motivation and expectation questionnaire) as part of the process of identifying patient motivations and expectations. Alternative questioning techniques may be used instead.

Management strategy – Decisions regarding monaural/binaural aiding and hearing aid type (BTE/ITE/open fitting etc) should be in line with local policy. However, students must be able to discuss the BSA/BAA recommended procedures with the assessor and be able to identify the preferred patient management if this has not been applied

Impression taking (A10): a maximum of two attempts per ear in total to obtain an earmould fit for manufacture is allowed. The student is responsible for identifying whether or not the earmould is satisfactory. If binaural impressions are required, the student should ideally produce two satisfactory impressions. If, however, only one impression is not satisfactory but this is recognised by the student, the student may still be signed off as fulfilling the definition, at the discretion of the assessor. If impression taking is not demonstrated due to unsuitability of ears, patient declining an aid or decision made to fit an Open Fit, it must be done afterwards on a volunteer.

Patient debriefing – B: ALL relevant information must be included on the patient records in order to ensure full and accurate information is available to all professionals viewing patient records (see example)

Mandatory fails

– Failure to perform otoscopy prior to PTA, ULLs, acoustic admittance testing or impression taking – Failure to perform otoscopy after impression taking


GENERAL HISTORY SHEET Date: Audiologist: Main presenting problems:

Conversation: One to one: Groups: Background noise: Observed ability today:

Home: Phone (inc mobile), ring & conversation: Which ear for phone? Doorbell: Alarm clock: Television: Shopping: Socialising: ALD’s required?

Employment/ Education: ALD’s required?

Current aid and settings (if applicable): Rt: Lt: Frequency of use: Comfort: Ease of use:


Direct Referral Criteria:

Yes

No

Comments:

Sudden loss:

Fluctuating loss:

Family history:

Pain:

Infections/Discharge:

Operations:

Tinnitus:

Vertigo:

Abnormal otoscopy:

Other:

Audiometric findings:

Asymmetric loss:

Air-bone gap > 30dB:

Expectations/ Motivation:

Manual Dexterity/Visual Ability:

Other Comments:


TYMPANOMETRY & ACOUSTIC REFLEX THRESHOLD ESTIMATION USING A

DIAGNOSTIC MACHINE*

*(example machine used here is Grayson-Stadler GSI 33 or GSI Tympstar) DAILY CHECKS

1) Check machine is in diagnostic mode. 2) Use test cavities (0.5 & 2.0cm³). Acceptable deviation +/- 10% for 2.0cm³ but 0.5cm³ must

be exactly 0.5 cm³. 3) Calibrate tympanometer subjectively (on self) by sweeping from positive to negative. (A

sweep from negative to positive is optional.) Press left start button until peak is found, (then press the hold button, followed by the right

start button if also doing negative to positive sweep), then press stop. Press reflex button. Do not set middle ear pressure yet. Machine should default to ipsilateral

test mode. Check machine is set to automatically use a timed stimulus of 1.5s (‘auto stimulus’ on the screen rather than ‘manual stimulus’)

4) Listen to all acoustic test signals @ 70dB (comfortable listening level) to check all sounds are being emitted by the probe.

5) At 1KHz listen to intensity range between 70dB and 90dB to check that intensity increases linearly.

6) Find your own ipsilateral ART @ 1KHz using pure-tone (or alternative acoustic stimuli such as broadband noise if local policy).

Set middle ear pressure by pressing start button. Start @ 70dB, in 5’s until a reflex is observed by 5dB until no reflex is recorded and demonstrate this is repeatable (ensure you

have 2 ‘no reflex’ responses at this level). in 5’s until your reflex threshold is found (look for the first measurable change in

baseline compliance, usually 0.03 ml or above) Repeat @ suspected ART level by 5dB from ART to show it gets bigger – no need to repeat if reflex clearly grows Press stop to release pressure then remove probe

E.g: After going up in 5’s you suspect ART is approx 90dB.

Go down to 85dB to see if ART is present. If not, repeat to prove it’s not there. Retest at 90dB to check still there (not artefact) Increase by 5dB to prove change in compliance increases.

If however, a reflex is then obtained at 85dB, by 5dB to 80dB – continue by 5dB until no reflex is obtained. Repeat at this level (2 definite ‘no response’) and then increase in 5dB steps until reflex threshold is established. Repeat at this level (2 definite responses at minimal levels) and then check that reflex grows (as detailed above)

Should produce a row of traces showing; ART not present x 2, ART present x 2, ART increased.

TESTING PATIENTS

Check machine is in diagnostic mode. Tympanometry Use left start button and stop machine after peak is found or, if no peak, once trace reaches all the way to left/negative side of graph (unless patient uncomfortable with negative pressure).


Results Normal middle ear compliance (MEC) = 0.3 – 1.6ml equiv air vol. Normal middle ear pressure (MEP) = adults +50 to –50daPa, children +50 to –150daPa. Normal equivalent ear canal volume (ECV) = no normative values from BSA for this. The Grason-Stadler GSI Tympstar instruction manual states 0.2 – 2.0cm³ as normative ECV values for a 226Hz test tone. This range would cover children and most adults but the actual size will vary with age and bone structure. It is worth noting that if values are found in the lower end of this range in an adult it may also indicate that the probe is blocked, is facing the ear-canal wall or there may be an occlusion. Margolis and Heller (1987) and Shanks et al (1992) cited in Katz (2002) states normative values of 0.63 to 1.46cm³ adults, 0.3/4 – 0.9cm³ children

ART’s

Use same procedure as 7) unless 70dB starting level is known to be @ or above ULL. References Grason-Stadler (2008) The GSI Tympstar version 2 middle ear analyser reference instruction manual,Part 2000-0120, Grason-Stadler Katz J (2002) Handbook of Clinical Audiology, 5th edition, Lippincott, Williams and Wilkins


EXAMPLE JOURNAL ENTRY: Patient attended for Direct Referral appointment, referred by GP. Lives alone but son and daughter-in-law regularly visit, approximately twice a week. Came with son today. Medical history taken – see Adult Assessment Questionnaire for full details. No contra-indication to aiding, meets DR criteria. Socially, patient spends most of her time at home on her own. Hears conversation when 1:1, although son says that people speak loudly. Finds it difficult to hear the TV (family c/o volume on loud). Uses the right ear on the telephone but struggles to hear. Cannot hear the telephone or doorbell ring. Goes shopping once a week and also attends a coffee morning on a Wednesday – finds it difficult to hear due to the background noise. Goes to church on a Sunday – struggles to hear. Friend has a hearing aid and can hear well with it – uses loop system at church. Patient doesn’t know much about hearing aids but is keen to try one, as she knows that she struggles – she particularly finds it upsetting not hearing her grandson. Son’s friend has recently swapped to a digital aid and finds it much better. Discussed advantages and disadvantages of digital aids to ensure realistic expectations for both patient and family. Discussed monaural/binaural aiding and the patient decided she would like to try two aids. Impressions taken for earmoulds 2112 left/right – nothing abnormal detected before or after impression taking. GHABP part I undertaken and results discussed. No problems with dexterity. Wears glasses for reading. Briefly discussed possible ALD’s for telephone, television and doorbell. Written information given to consider. Please discuss further at the next appointment. Placed on fitting waiting list.


B2 Hearing Aid Fitting and Verification (90 minutes) Verification (Real Ear Measurements - REMs)

– Must be undertaken unless a clear justifiable contra-indication is found – A11: a minimum of one input target (65dB) to be recorded, multiple targets may be recorded

in line with local procedures Integration of test results

– A: Should read ‘follows Interpretation and Patient Management in REMs guidelines A11’ – A11 B: Live voice subjective checks must also be undertaken

Patient debriefing – B: Communication tactics must be explained to all patients (unless there is a clinical reason not to) in order to maximise patient’s benefit in identified situations

Additional procedures: – Test box measurements – may be undertaken if appropriate but not compulsory

Mandatory fails

– Failure to perform otoscopy prior to REMs/probe placement – Failure to perform otoscopy after REMs


B3 Hearing Aid Reassessment (without hearing aid fitting) (90 minutes) For this section, a full hearing assessment must be undertaken. Management will depend on the patient situation. For example: – If the current hearing aid is thought to be suitable (for example, still within the fitting range for the PTA), the aid should be reprogrammed, using REMs, to the new target, based on the new PTA results – If the current earmould is not suitable for any adjustments to be made to the hearing aid, impressions should be taken and a further appointment booked – no further student assessment would be required – If a different or second hearing aid is required, this should be identified, impressions taken as appropriate and a further patient appointment made – no further student assessment would be required Calibration

– Clinic preparation and calibration of audiometer/admittance equipment should be undertaken at the start of the session, unless previously assessed and signed off by the university assessor (found in section A1)

History taking – Must include detailed medical history (following TTSA guidelines) and social history (see example sheet as used at City Hospital). If previous details are present, this data should be used and acted upon as appropriate. If no data is present, a full history should be taken as with a new patient

Glasgow difference profile or alternative questionnaire – Should be done as a separate questionnaire style approach, rather than using information gained from history taking in order to complete the patients answers – Must be done unless the student is able to give a valid clinical reason for not doing so. If it is not undertaken, the student will be required to do it on the assessor/volunteer. Alternative profiles, e.g. the IHR Family questionnaire may be done if suitable but is not essential - If this is not undertaken during the assessment, the assessor should assess this at the end of the session on a volunteer

Assessment strategy – Otoscopy (A2): if a patient has no abnormal findings, and correctly recognises this, this is sufficient to have fulfilled the definition and hence be signed off – PTA (A4): Where equipment is calibrated to effective masking, masking should be set at the level equal to the pure tone threshold of the test ear (i.e. it is not necessary to add 10dB) – Covering the ear at 4 kHz when testing BC is recommended by the BSA 2004 procedure but is not compulsory. However, all students must be fully aware of the BSA recommendation when questioned – Students must also be fully aware of BSA recommended symbols and may be required to plot results by hand during the assessment. Knowledge/use of masking charts may also be assessed – ULLs (A5): should be undertaken dependant on clinical reasoning – Acoustic admittance (A6 & A7): testing must be done on a diagnostic machine in order to fully assess the students’ capabilities. If diagnostic equipment is not available the supervisor must advise the Director of Practice Learning before the assessment. ARTs should follow departmental protocol in the absence of a BSA procedure. It was suggested that a regional protocol is developed and agreed. Whilst this is developed and agreed, it is recommended that students use a local protocol or the enclosed draft protocol – The assessor is required to ensure that students are competent in all of the test procedures listed (otoscopy, PTA, ULLs, tympanometry and acoustic reflex thresholds). Any tests not performed as part of the assessment strategy must be performed on the assessor/volunteer afterwards unless previously signed off by a university assessor at a previous visit. Students must be able to explain to the assessor their clinical reasoning for the assessment strategy adopted. For ARTs, a minimum of one frequency (ipsilateral stimulation) must be assessed by the university assessor.


Management strategy/Patient debriefing/Reporting Results – A: REMs should be undertaken if it is felt that the patients current aid is still suitable but

may require reprogramming – C: students should be aware of whether a further referral may be required, for example

hearing therapy, social services, BAHA/cochlear implant. It is reasonable that students may wish to discuss more difficult cases with a senior colleague

Additional procedures:

– Test box measurements – may be undertaken if appropriate but not compulsory Mandatory fails

– Failure to perform otoscopy prior to PTA, ULLs, acoustic admittance testing, impression taking and REMs/probe placement – Failure to perform otoscopy after impression taking and REMs


B4 Hearing Aid Follow-up (60 minutes) For this section, the supervisor must ensure that the patient due to be seen for the assessment has had a Glasgow part I profile undertaken. Assessment strategy

– It is noted that departments may use different acceptable methods of assessing patient’s tolerance to loud sounds

Integration of Results/Management Strategy/Patient Debriefing/Reporting Results – D: the amount of information given to the patient will depend on the patient's progress as identified during the follow-up. In some cases, it may be appropriate to repeat all of the information given at the fitting with respect to acclimatization, for example, if the patient has not worn the aid. In other cases, certain points may just need to be reminded – The minimum standards for counselling and acclimatization would include: Checking previous programming information so as to be aware of settings of aid,

including any REM data Checking how much of the time the hearing aid is being worn Checking comfort of earmould/open fitting earpiece Clarifying with patient the situations aid is being worn and whether additional programs

need to be added Checking the patient's understanding of information provided at previous appointment Identifying and addressing any problems that the patient has had with using the hearing

aid Providing further information, as appropriate, with regard to further equipment or other

agencies Giving clear instructions for acclimatization, if appropriate, and checking that they can be

followed by the patient Identifying expectations of aid's performance with the patient and addressing any issues

that arise Discussing suitability of binaural aiding if not already provided Answering any questions that the patient may have or passing the patient onto a more

experienced person when appropriate Identifying whether further REMs/fine tuning would be required

Glasgow Profile or alternative questionnaire – Should be done as a separate questionnaire style approach, rather than using information gained from history taking in order to complete the patients answers – Must be done unless the student is able to give a valid clinical reason for not doing so. If it is not undertaken, the student will be required to do it on the assessor/volunteer. Alternative profiles, e.g. the IHR Family questionnaire may be done if suitable but is not essential

Additional procedures: – Test box measurements – may be undertaken if appropriate but not compulsory.

Mandatory fails

– Failure to perform otoscopy prior to impression taking and REMs/probe placement – Failure to perform otoscopy after impression taking and REMs


B5 Hearing Aid Repairs (90 minutes) For this section, the student must undertake a session of booked/walk-in hearing aid repairs for approximately 30-45 minutes, seeing a minimum of three patients. The assessor may request that the student undertakes certain tasks in order to demonstrate competency if not observed with patients. A viva will also be undertaken at the end of the session in order to assess problem solving skills and identification of appropriate management in a range of scenarios, which were not observed during the assessment. Supervisors must ensure that the student/assessor has access to data sheets for the main hearing aids issued locally. Students are expected to manage all routine adult patients that attend the repair clinic, including

the management of standard NHS analogue and digital aids. Exceptions would include reprogramming of any non-routine aids issued locally, although students should demonstrate competence by working within their scope of practice and undertaking other relevant tasks, for example, retubes, identifying the need for impression taking, etc

During the sessions, students must demonstrate competence in the following areas, either on a patient or afterwards with the assessor. – Retubing of earmoulds – Test box (analogue (A12) and digital hearing aids)/use of data sheets – Identifying the need for impression taking – Replacement/reprogramming of aids – Earmould modification (A13) – Identifying the need for referral, e.g. ENT, GP, hearing therapy, reassessment appointment


APPENDIX B: QUESTIONNING TECHNIQUES TO DEVELOP AND

ASSESS CRITICAL THINKING SKILLS IN STUDENTS


DEVELOPING CRITICAL THINKING SKILLS IN STUDENTS Critical thinking is not a method but a process and includes cognitive and emotional components. The skills can be understood as:

Interpretation: accurately interpreting problems as well as objective and subjective data from common information sources

Analysis: examining ideas/arguments in problems, objective and subjective data and possible courses of action

Inference: querying claims, assessing arguments (recognising faulty reasoning) and reaching appropriate conclusions

Explanation: clearly explaining and defending the reasoning by which an individual arrives at specific decisions in the context of health care of the patient

Evaluation: evaluating information as its trustworthiness and relevance Self-regulation: constantly monitoring one’s own thinking, using criteria such as clarity,

precision, accuracy, consistency, logicality, significance and correcting oneself as appropriate.

Attitudes of mind important for critical thinking:

Open-mindedness Inquisitiveness Truth-seeking Analytical Systematic Self-confidence

QUESTIONING TECHNIQUES TO DEVELOP CRITICAL THINKING SKILLS Good questioning techniques by supervisors are essential in helping students develop critical thinking skills. An assortment of questioning tactics exists to promote critical thinking. Depending on how a question is asked, the student may use various critical thinking skills such as interpretation, analysis, and recognition of assumptions to form a conclusion. The thoughtful use of questions may be the quintessential activity of an effective teacher. Questions are only as good as the thought put into them and should go beyond knowledge-level recall. Researchers have found that often clinical teachers asked significantly lower-level cognitive questions than higher-level questions. Questions should be designed to promote evaluation and synthesis of facts and concepts. Higher-level thinking questions should start or end with words or phrases such as, “explain,” “compare,” “why,” “which is a solution to the problem,” “what is the best and why,” and “do you agree or disagree with this statement?” As supervisors you may find it helpful to consider questions that get the best results from your students, and start to keep a list, which you can use whenever you think appropriate.


The Bloom Taxonomy is a hierarchy of thinking skills that ranges from simple skills, such as knowledge, to complex thinking, such as evaluation. Depending on the initial words used in the question, students can be challenged at different levels of cognition.

Bloom’s Taxonomy (1956) has stood the test of time. Recently Anderson & Krathwohl (2001) have proposed some minor changes to include the renaming and reordering of the Taxonomy, using verbs rather than nouns, to reflect the concept of thinking as an active process. This reference reflects those recommended changes.

ATHERTON J S (2005) Teaching and Learning: Available: http://www.learningandteaching.info/teaching/contents.htm. Last accessed: 23 October 2005


QUESTIONS TO ASSIST CRITICAL THINKING

CATEGORY VERBS SAMPLE QUESTION REMEMBER Choose

Describe Define Identify Label List Locate Match Memorize Name Omit Recite Recognize Select State

What happened after…? How many…? What is…? Can you name…? Name all the … Who? Where? Which One? What? How? What is the best one? Why? How much? When? What does it mean?

UNDERSTAND Classify Defend Demonstrate Distinguish Explain Express Extend Give Illustrate Indicate Interpret Infer Judge Match Paraphrase Represent Restate Rewrite Select Show Summarize

Can you describe in your own words…? How would you explain…? What do you think could have happened next…? Clarify why…? Illustrate the… Which are facts? What does this mean? Is this the same as…? Give an example of... What would happen if…? State in one word… Explain what is happening… What expectations are there? What are they saying? This represents… What seems to be . . .? Is it valid that . . .? What seems likely? Show in a graph, table… Which statements support…? What restrictions would you add?

APPLY Apply Choose Dramatize Explain Generalize Judge Organize Prepare Produce Select Show Solve Use

Can you describe in your own words…? How would you explain…? What do you think could have happened next…? What was the main idea…? Clarify why…? Illustrate the… Predict what would happen if… Choose the best statements that apply to… Judge the effects of… What would result from…? Tell how, when, where, why How much change there would be if… Identify the results of…

ANALYSE

Analyse Categorize Classify

What could not have happened…? How is…similar to…? What do you see as other possible outcomes?


Compare Differentiate Distinguish Identify Infer Point out Select Subdivide Survey

Why did…changes occur? Can you explain what must have happened when…? Can you distinguish between…? What are some of the problems of…? What were some of the motives behind…? What is the function of…? What's fact? Opinion? What are the assumptions? What statement is relevant? What motive is there? What conclusions? Make a distinction between... State the point of view of… What is the premise? What ideas apply? What ideas justify the conclusion? What's the relationship between…? The least essential statements are…? What's the main idea? Theme? What inconsistencies, fallacies? Implicit in the statement is . . .

EVALUATE Appraise Judge Compare Criticize Defend

Is there a better solution to…? Judge the value of… What do you think about…? Can you defend your position about…? How would you have handled…? What changes to…would you recommend? Do you believe…? How would you feel about…if…? How effective are…? Which is more important, moral, better, logical, valid, appropriate? Find the errors in...

CREATE Choose Combine Compose Construct Create Design Develop Do Formulate Hypothesize Invent Make Organize Plan Produce

Is there a better solution to…? Can you see a possible solution to…? If you had access to all the resources, how would you deal with…? What would happen if…? How many ways can you…? How would you test . . .? Propose an alternative to… Solve the following… How else would you . . .? State a rule for…

Another type of questioning technique is Socratic questioning. Socratic questioning is defined as a type of questioning that deeply probes or explores the meaning, justification, or logical strength of a claim, position, or line of reasoning. Questions are asked that investigate assumptions, viewpoints, consequences, and evidence. The Socratic method focuses on clarification. Asking a fellow student to summarize the previous answer can follow a student’s answer to a question. Summarizing the information allows the student to demonstrate whether he or she was listening, had digested the


information, and understood it enough to put it into his or her own words. Avoiding questions with one set answer allows for different viewpoints and encourages students to compare problems and approaches. There is no right or wrong answer because the answers depend upon the individual student's experiences. Regardless of the answer, the student must think critically about the topic to form a conclusion.


TAXONOMY OF SOCRATIC QUESTIONS CLARIFYING QUESTIONS

QUESTIONS THAT PROBE ASSUMPTION

S

QUESTIONS THAT PROBE

REASONS

QUESTIONS ABOUT

VIEWPOINTS

QUSTIONS THAT PROBE IMPLICATIO

NS What do you mean by…? What is your main point? How does … relate to…? Could you put that another way? Is your basic point X or Y? What do you think is the main issue here? Let me see if I understand you; do you mean X or Y? How does this relate to our problem/discussion/issue? What do you mean by this remark? What do you take X to mean by his remark? Can you summarize in your own words what was said? X, is this what you meant? Could you give me an example? Would this be an example, . . .? Could you explain this further? Could you say more about that?

What are you assuming? What is X assuming? What could we assume instead? You seem to be assuming Y. Do I understand you correctly? All of your reasoning depends on the idea that... Why have you based your reasoning on X instead of Y? You seem to be assuming X. How do you justify taking that for granted? Is that always the case? Why do you think the assumption holds here? Why would someone make that assumption?

What would be an example? How do you know that? Why do you think that is true? Do you have any evidence for that? What difference does that make? What are your reasons for saying that? What other information do you need? Could you explain your reasons to us? Are these reasons adequate? What led you to that belief? How does that apply to this case? What would change your mind? But, is that good evidence for that belief? Is there a reason to doubt that evidence? What would you say to someone who said X? Can someone else give evidence to support that view? By what reasoning did you come to that

What are you implying by that? When you say X, are you implying Y? But, if that happened, what else would happen as a result? Why? What effect would that have? Would that necessarily happen or only possibly/probably happen? What is an alternative? If X and Y are the case, then what might also be true? If we say that X is ethical, how about Y?

How can we find out? What does this question assume? Would X ask this question differently? How could someone settle this question? Can we break this question down at all? Is this question clear? Do we understand it? Is this question easy or hard to answer? Why? Does this question ask us to evaluate something? What? Do we all agree that this is the question? To answer this question, what other questions must we answer first? I'm not sure I understand how you are interpreting this question. Is this the same as X? How would X state the issue? Why is this issue important? Is this the most important question, or is there an underlying question that is


conclusion? How could we find out if that is true?

really the issue?

Adapted from: Paul, Richard (1993) Critical Thinking: How to Prepare Students for a Rapidly Changing World. Foundation for Critical Thinking


GUIDED CRITICAL THINKING – KING’S STEM QUESTIONS

GENERIC QUESTIONS SPECIFIC THINKING SKILLS INDUCED

What are the strengths and weaknesses of…?

Analysis /inference

What is the difference between…and…? Compare/contrast Explain why/how…? Analysis What would happen if…? Predict/hypothesize What is the nature of…? Analysis Why is…happening? Analysis /inference What is a new example of? Application How could…be used to…? Application What are the implications of…? Analysis /inference What is … analogous to? Identification and creation of analogies

and metaphors What do we already know about…? Activation of prior knowledge How does…affect…? Analysis of relationship (cause/effect) How does…tie in with…? Activation of prior knowledge What does…mean? Analysis Why is…important? Analysis of significance How are…and…similar? Compare/contrast How does…apply in everyday life? Application to the real world What is a counterargument for…? Rebuttal to argument What is the best…and why? Provision and evaluation of evidence What is a solution to the problem of…? Synthesis of ideas Compare…and…with regard to… Compare/contrast What do you think causes…and why? Analysis of relationship (cause/effect) Do you agree or disagree with this statement?

Evaluation of evidence

What evidence is there to support your answer?

Provision of evidence

What is another way to look at…? Taking other perspectives Adapted from King A (1995) Designing the instructional process to enhance critical thinking across the curriculum. Teaching of Psychology 22(1):13-17


APPENDIX C: ASSESSMENT REPORT FORMS


INDIVIDUAL RECORD OF CLINICAL PRACTICE: PRACTICAL ASSESSMENTS BSc AUDIOLOGY, ASTON UNIVERSITY

ASSESSMENT REPORT FORM: DIRECT REFERRAL

Student: …………………………… Department:…………………….. Date:…………………... 1. Pre-session preparation (A1) Outcome: Pass/Fail

Room – A) Prepares the clinic room(s) ensuring that all the required resources are available and that the room and test environment are safe Equipment preparation – A) Ensures that all equipment is working correctly and safely. B) Where appropriate performs stage A equipment checks or required calibration and records results. Patient – A) Checks the patient identification details, identifies self to patient. B) Outlines reason for appointment and aims of the session, checks consent.

2. History and Counselling Outcome: Pass/Fail

A) Uses effective communication strategies in order to take a full history including relevant information on hearing loss, tinnitus and balance disorders and resulting effect on quality of life, manipulation or visual difficulties. Includes significant others as appropriate. B) Maintains a rapport with the patient and is aware of their concerns. N.B. This must include a full medical and social history

3. Glasgow Hearing Aid Benefit Profile Part 1/or an equivalent questionnaire can be used

Outcome: Pass/Fail

A) Sets the scene for how the interview will take place, instructions are clear and concise B) Identifies whether each of the four specific listening situations occurs in their life, asks how much difficulty they have in each situation, and how much the difficulty worries, annoys or upsets them C) Effectively draws patients attention to appropriate answers and identifies where difficulty in pre-defined situations may differ for similar situations i.e. busy street as opposed to shop D) User defined situations are appropriately encouraged and accurately recorded E) Summary of results used to guide patient rehabilitation N.B. If not done, identifies suitable clinical reason to support action and demonstrates competence by completing the Glasgow Profile (or equivalent) on a volunteer

4. Assessment Strategy Outcome: Pass/Fail

Selects appropriate test strategy: A) Otoscopy (follows A2 guidelines) B) Pure tone audiometry (follows A4 guidelines) – guidelines were/not followed C) Uncomfortable Loudness Levels (follows A5 guidelines) D) Tympanometry (follows A6 guidelines) – N.B. using diagnostic equipment E) Acoustic Reflex Thresholds (follows A8 guidelines) – N.B. using diagnostic equipment N.B. Performance of ULLs is compulsory to demonstrate competence Any tests not performed must be assessed at the end of the session on a volunteer

5. Integration of test results and counselling Outcome: Pass/Fail

A) Identifies motivation and expectations towards hearing aids B) Integrates hearing disability and handicap questionnaire results with audiometric results and patient motivation and expectations. C) Motivates patient or adjusts expectations where necessary N.B. Various methods are acceptable, e.g. AMEQ questionnaire or questioning strategies

6. Management Strategy Outcome: Pass/Fail

A) After integration of results, reaches decision with patient in regards to appropriate management plan i.e. unilateral or bilateral personal amplification; environmental aids and referral to other services (e.g. social services, Access to Work agency, volunteer scheme) – N.B. This should be inline with local policy. An awareness of MHAS policy is also expected


B) Identify patients who do not meet TTSA direct referral criteria and applies local policy C) If appropriate discuss hearing aid options and agree type/model with patient D) Impression taken following A10/A11 guidelines, critiques impression for suitability for processing – N.B. A maximum of two attempts are allowed E) Identification of appropriate earmould type and acoustic specification (must be discussed afterwards if Open-Fit is decided to be most suitable option for the patient) F) Considers the patient's visual, manual dexterity and motor skills and uses this information to establish the most appropriate format of earmould fitting/instrumentation for the patient. N.B. If impression taking is not demonstrated due to unsuitability of ears, patient declining an aid or decision made to fit an Open Fit, it must be done afterwards on a volunteer.

7. Patient debriefing and recording of results Outcome: Pass/Fail

A) Discuss management time scales, hand out relevant patient information leaflets, book or arrange next appointment B) All relevant appointment information recorded on PMS i.e. GHABP data, audiometric results, counselling results, ear impression number etc C) Results and management strategy documented to referrer

8. Patient care techniques Outcome: Pass/Fail Demonstrates professional attitude Demonstrates and maintains rapport/empathy with the patient/carer/significant other Effectively communicates throughout the appointment Responds to individual patient needs Maintains health and safety

9. Oral Outcome: Pass/Fail

The student must demonstrate understanding and clinical reasoning in the following areas: patient pathway/management, including the role of other professionals BSA/BAA recommended procedures hearing function and how it is assessed clinical indications for onward referral, and mechanisms to do so awareness of both standard earmoulds and open fittings disability of hearing loss and associated psychological issues

Outcome statement (delete as appropriate): The student has demonstrated competency in all of the above areas The student has NOT demonstrated competency in all of the above areas

University assessors name: Assessor’s report/recommendations: (please state section number against relevant feedback if the student has failed or requires specific recommendations)

Positive Feedback


Chief Assessor/Director of Practice Learning comments:


INDIVIDUAL RECORD OF CLINICAL PRACTICE: PRACTICAL ASSESSMENTS BSc HEARING AID AUDIOLOGY, ASTON UNIVERSITY

ASSESSMENT REPORT FORM: HEARING AID FITTING AND VERIFICATION

Student: ……………………………………………… Department: …………………………………… Date: …………… 1. Preparation Outcome: Pass/Fail

A) Follows preparation REM guidelines in A11 A11 - Patient preparation: A) Connects hearing aids to PC and performs initial 'auto-fit' to appropriate prescription target e.g. NAL-NL1 B) Calibrates probe tubes C) Checks prescription target set-up box in REM software and modifies if necessary e.g. unilateral fitting, changes in channel, REAG D) Selects (or checks) appropriate stimulus type and level in REM software E) Reviews GHABP or equivalent data and any special circumstances

2. Patient Briefing Outcome: Pass/Fail

A) Uses effective communication strategies in order to continue to assess the patient's attitude and motivation towards the use of a hearing aid. B) Maintains a rapport with the patient and is aware of their concerns with regards to the use of a hearing instrument C) Gives advice where appropriate to enable patient to make informed choices in respect of hearing aid features and loop system

3. Verification (REMs) Outcome: Pass/Fail

A) Follows Performing the procedure in REM guidelines A11 & BAA/BSA Procedure (2007) A11 - Performing the procedure: A) Otoscopy to check for contra-indications B) Checks fit and comfort of earmould/s or open fitting, modify/file if necessary. C) Informs patient on test procedure and positions at 45º or 0º loudspeaker D) Inserts probe tube using BAA/BSA recommended procedures E) Uses appropriate input levels (50, 65, and 80 dB) of modulated speech noise (if possible) and accurately measures REIG or REAG if non average ear canal resonance. Additional input levels may be used if desired/useful. F) Measures REOG or RESR (optional) G) Troubleshoots any problems e.g. feedback, blocked tube H) Patient centred rapport maintained throughout the procedure N.B. Otoscopy must be performed after removing the REM probe N.B. In line with BAA/BSA procedure, REUR & REOR should also be measured prior to REIG (REOR may be omitted if Open Fit) N.B. In line with BAA/BSA procedure, output must be checked to ensure it does not exceed ULLs. Aston procedure recommends running a REIG trace at 80dB to monitor for discomfort, or an alternative method can be used

4. Integration of test results Outcome: Pass/Fail

A) Follows Interpretation and patient management in REM guidelines A11 A11 - Interpretation and patient management: A) Uses the results of REM measures to fine tune the hearing aid response to match targets within MHAS/HAC recommended tolerances B) Evaluates subjective sound quality including own voice and tolerance to loud sounds, adjusts frequency gain control, compression characteristics, MPO, feedback management as appropriate. Runs additional REM curve documenting changes if appropriate C) Able to explain test results and management options

5. Management Strategy Outcome: Pass/Fail

A) Identifies patients who are currently unilaterally fitted and who would benefit from bilateral amplification. Identifies patients who would benefit from environmental aids and referral to other services (e.g. social services, Access to Work, volunteer scheme) B) Advises follow-up appointment(s) within an appropriate time scale


6. Patient debriefing and reporting results Outcome: Pass/Fail A) Demonstrates and instructs the patient on handling, technical operation and maintenance of the hearing aid/s including use of the telephone. Issue written information on aids, local services etc B) Advises client on hearing aid adaptation process and encourages use in GHABP or equivalent listening situations. Sets realistic goals and expectations in a motivating and positive manner. – N.B. The patient must also be advised of relevant communication tactics C) Deals sensitively with any questions and anxieties and are able to explain future care provision to the patient, including how to access services in case of difficulties with the instrumentation. D) Concise, accurate and objective reporting of results and management strategy in patient journal ensuring REMs and hearing aid settings have been saved into NOAH. E) Serial numbers of hearing aid(s) recorded and stock records updated on PMS F) Hearing aid record book is issued with complete record of hearing aid and earmould details



The student must demonstrate understanding and clinical reasoning in the following areas: patient pathway/management, including the role of other professionals BSA/BAA recommended procedures hearing aid technology and application of prescription formulae appropriate knowledge of the fitting software (as opposed to a ‘click and fit’ approach) awareness of earmoulds and open fittings rehabilitation of patients with hearing loss


University assessors name: Were test box measurements undertaken? Yes/No N.B. As the logbook refers to analogue aids only for test box, please do NOT sign the front competency sheet for this section Assessor’s report/recommendations: (please state section number against relevant feedback if the student has failed or requires specific recommendations)

Positive Feedback





ASSESSMENT REPORT FORM: HEARING AID REASSESSMENT

Student: ……………………………………………… Department: …………………………………… Date: …………… 1. Pre-session preparation (A1) Outcome: Pass/Fail/Previously assessed

Room – A) Prepares the clinic room(s) ensuring that all the required resources are available and that the room and test environment are safe Equipment preparation – A) Ensures that all equipment is working correctly and safely. B) Where appropriate performs stage A equipment checks or required calibration and records results. Patient – A) Checks the patient identification details, identifies self to patient. B) Outlines reason for appointment and aims of the session, checks consent.

2. History Outcome: Pass/Fail

A) Uses effective communication strategies in order to confirm medical history including relevant information on any changes in hearing, tinnitus and balance and resulting effect on quality of life. Checks for any manipulation or visual difficulties. B) Assesses current hearing aid/s and earmould/s suitability, patient satisfaction, patient handling, care and maintenance skills. C) Maintains a rapport with the patient and is aware of their concerns. N.B. This must include a full medical and social history but may include rechecking of data already recorded in the patient’s records

3. Glasgow Hearing Aid Difference Profile Part 1 (or GHABP part 1) or an equivalent questionnaire

Outcome: Pass/Fail

A) Sets the scene for how the interview will take place, instructions are clear and concise B) Identifies how much the patient is using their hearing aids and how much residual disability still exists C) User defined situations are appropriately encouraged and accurately recorded D) Information is recorded accurately in PMS and results are discussed with patient N.B. If not done, identifies suitable clinical reason to support action and demonstrates competence by completing the Glasgow Profile (or equivalent) on a volunteer

4. Assessment Strategy/Procedural Skills/Integration of test results

Outcome: Pass/Fail

Selects appropriate test strategy: A) Otoscopy (follows A2 guidelines) B) Pure tone audiometry (follows A4 guidelines) C) Uncomfortable Loudness Levels (follows A5 guidelines) D) Integrates all test results including GHABPdiff (or equivalent) with available information on the communication needs of the patient in order to inform appropriate management strategy N.B. Any tests not performed must be assessed at the end of the session on a volunteer, unless previously signed off

5. Management Strategy/Patient debriefing/Reporting Results

Outcome: Pass/Fail

A) If appropriate verifies amplification characteristics of current aid using REMs, fine tunes if necessary based on match to targets and subjective evaluation of sound quality B) Identifies patients who require referral to ENT or GP for medical management. C) Identifies patients who would benefit from a change in unilateral or bilateral personal amplification, environmental aids and/or referral to other services (e.g. hearing therapy, social services, Access to Work agency, volunteer scheme) D) Identifies the need for changes in earmould provision and takes new ear impressions following guideline A10/A11 if necessary


E) All results are explained to patient and a decision regarding the most appropriate management plan is made with the patient F) Goal setting, counselling and setting of realistic expectations (with current aid or new aid) G) Concise, accurate and objective reporting of results and management strategy in PMS H) Amplification changes documented in hearing aid record book N.B. Students are only expected to demonstrate the above competencies IF appropriate to the patient management



The student must demonstrate understanding and clinical reasoning in the following areas: patient pathway/management, including the role of other professionals BSA/BAA recommended procedures hearing function and how it is assessed rehabilitation programme set for the patient broader rehabilitation issues, e.g. ALDs, lip-reading, self-help groups, etc


University assessors name: Were test box measurements undertaken? Yes/No N.B. As the logbook refers to analogue aids only for test box, please do NOT sign the front competency sheet for this section if digital aids were tested. Assessor’s report/recommendations: (please state section number against relevant feedback if the student has failed or requires specific recommendations)

Positive Feedback




INDIVIDUAL RECORD OF CLINICAL PRACTICE: PRACTICAL ASSESSMENTS BSc AUDIOLOGY, ASTON UNIVERSITY

ASSESSMENT REPORT FORM: HEARING AID FOLLOW-UP

Student: ……………………………………………… Department: …………………………………… Date: …………… 1. History and Debriefing Outcome: Pass/Fail

A) Establishes any relevant change in history since last appointment B) Evaluates subjective sound quality, comfort and expectations C) Maintains a rapport with the patient and is aware of their concerns D) Checks if patient has been experiencing problems with the hearing aid(s) E) Checks how often patient the patient has been wearing the hearing aid(s)

2. Assessment Strategy Outcome: Pass/Fail

A) Evaluates subjective sound quality including tolerance to loud sounds B) Performs otoscopy and checks fit and comfort of earmoulds/open-fit earpiece C) Checks use of programmes

3. Glasgow Hearing Aid Benefit Profile Part 2 (or GHABPDiff) or an equivalent questionnaire can be used

Outcome: Pass/Fail

A) For each pre-specified situation and user defined situation asks patient the extent to which the hearing aid is used, the extent to which problems have been reduced, extent to which problems remain and the extent to which the client has been satisfied by the intervention N.B. If not done, identifies suitable clinical reason to support action and demonstrates competence by completing the Glasgow Profile Part II (or equivalent) on a volunteer

4. Integration of Results/Management Strategy/Patient debriefing/Reporting Results

Outcome: Pass/Fail

A) Uses results of GHABP to guide patient rehabilitation, i.e. demonstrate benefit, highlight where problems remain B) Fine tunes hearing aid response based on subjective sound quality evaluation and/or GHABP results, repeat REMs if necessary C) Modifies earmould(s)/open fitting if comfort/fit problems D) Provides information and counselling to the patient in appropriate use of the hearing aid to promote auditory acclimatisation E) Identifies patients who would benefit from changes to current personal amplification and/or environmental aids F) Evaluates the need for referral to other services or the need for further follow-up G) Able to explain results and management options to patient including time scales H) Accurate reporting of GHABP (or equivalent) in PMS I) Concise, accurate and objective reporting of results and management strategy in PMS and/or record book if appropriate



The student must demonstrate understanding and clinical reasoning in the following areas: patient pathway/management, including the role of other professionals BSA/BAA recommended procedures appropriate knowledge of the fitting software to make adjustments to the aid awareness of both standard earmoulds and open fittings Glasgow profiles/alternative outcome measure profiles, including subsequent rehabilitative advice and use of percentile date



University assessors name: Were test box measurements undertaken? Yes/No N.B. As the logbook refers to analogue aids only for test box, please do NOT sign the front competency sheet for this section Assessor’s report/recommendations: (please state section number against relevant feedback if the student has failed or requires specific recommendations)

Positive Feedback




ASSESSMENT REPORT FORM: HEARING AID REPAIR

Student: ……………………………………………… Department: …………………………………… Date: …………… For this section, the student must undertake a session of booked/walk-in hearing aid repairs for

approximately 30-45 minutes, seeing a minimum of three patients in order to observe a range of basic skills, as listed in part 2 on the assessment report form. Any of these skills not undertaken during the patient session must be demonstrated afterwards with the assessor to show competency.

A viva will also be undertaken in order to assess problem solving skills and identification of appropriate management in a range of scenarios.

PART 1: OBSERVATION OF PATIENT MANAGEMENT 1. History Outcome: Pass/Fail

Discusses the nature of the problem with the patients. 2. Assessment Strategy / Procedural Skills / Integration of test results

Outcome: Pass/Fail

A) Identifies the procedures required based on the information obtained/ from history. B) Depending on test strategy one or more of the following: Otoscopy, basic hearing aid listening checks, hearing aid test box measurements, real ear measurements, hearing aid adjustment or replacement, earmould modification, impressions. Note range of procedures in comments box C) Reinstructs the patient as necessary regarding the use and maintenance of aid/s. D) Integrates all available information on the communication needs of the patient.

3. Management Strategy /Patient Debriefing Outcome: Pass/Fail

A) Identifies patients who would benefit from reassessment, new earmould/s, further counselling and communication training, lip-reading classes, environmental aids. B) Evaluates the need for referral to other services (e.g. social services, Access to Work agency, volunteer scheme, GP, ENT). C) Where appropriate explain and instruct the patient regarding the nature of the fault. D) Explain additional management options to the patient, including time scale.

4. Reporting Results Outcome: Pass/Fail

Concise, accurate and objective reporting of findings and management strategy for patient records and hearing aid record book as appropriate. (database patient management system)



PART 2: ASSESSMENT OF BASIC SKILLS Basic skills – all skills listed must be demonstrated

Outcome: Pass/Fail

Skill: Demonstrated on patient

Demonstrated with assessor

Retubing of earmoulds Yes/No Yes/No Test box (analogue (A12*) and digital hearing aids)/use of data sheets

Yes/No Yes/No

Identifying the need for impression taking Yes/No Yes/No Replacement/reprogramming of aids (for both analogue and digital hearing aids)

Yes/No Yes/No

Earmould modification (A13) – grinding activity

Yes/No Yes/No

Identifying the need for referral, e.g. ENT, GP, reassessment appointment

Yes/No Yes/No

* A12 section of logbook to be signed off in competency section

PART 3: VIVA The student has successfully answered questions covering a range of scenarios and has demonstrated clinical reasoning and critical thinking skills Yes/No Outcome statement (delete as appropriate): The student has demonstrated competency in all of the above areas The student has NOT demonstrated competency in all of the above areas

University assessors name: Assessor’s report/recommendations: (please state section number against relevant feedback if the student has failed or requires specific recommendations)

Positive Feedback



APPENDIX D: GIVING CONSTRUCTIVE FEEDBACK

This is essential if a student is to grow in their skills. It requires the supervisor/educator to be observant and to think critically. However, it is important that feedback is constructive and not destructive so it should follow these guidelines:

1. Constructive criticism has to be genuine. A person giving this criticism has to genuinely feel it is important to give it

2. The person receiving the criticism must have some level of understanding of your role, and understand that you truly want them to improve

3. Do not use statements like, “I want you to…”, “You must understand…”, “You must see the difference…”, “I need you to…” You are immediately setting the stage for the other person to become defensive, especially if there is already a bad history of communication

4. Take a team approach. In other words, sentences like, “Let us look at the following…”, “Let us look at how you are dribbling or passing the ball, and how we can improve your passing ability or your shooting technique so you can improve and be a better basketball player.” At the job setting, “Let’s brainstorm together.” This creates a collaborative approach. All participants are on the same level and it sets the stage for critique, not criticism, and the foundation for improvement.

When constructively criticising it’s important that you: Be specific: state exactly what you are commenting on Be measurable: describe how often something happens or when it happens Be realistic: should be something that is achievable Be timely: don’t stew on things – discuss them as they happen Be future focused: if things change how will they look when they are different?

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