EUROPEAN UNION OF MEDICAL SPECIALISTS UEMS Hearing and Balance in adults Training Programme and Logbook October 2012 revised October 2013 Subspecialty working group ID: 776652
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Slide1
D R A F T
UNION EUROPEENNE DES MEDECINS SPECIALISTES (UEMS)EUROPEAN UNION OF MEDICAL SPECIALISTS (UEMS)Hearing and Balance in adults Training Programme and Logbook
October 2012 / revised October 2013
Subspecialty working group:
Chair
Kajsa
-Mia
Holgers
Ligija
Kise
Ulf
Schönsted
-Madsen
Rene
Dauman
Heikko
Löppönen
Eva Raglan
Slide2Consensus curriculum
This document presents the content of the
hearing and balance module
based on the curriculum for
audiovestibular
medicine,
speciality
concerned with investigation, diagnosis and management of disorders of balance, hearing ,tinnitus and auditory communication.
The
aim of the curriculum is to define the core competencies including knowledge , skills and attitudes for a specialist practicing that subject as applied to adults.
Paediatric
audiology
although an
intergral
part of
audiovestibular
medicine in some countries ,is practiced separately in the others or in
conjuction
with
phoniatrics
in some other countries. ( the curriculum for
peadiatric
audiology is within the Phoniatrics training program and logbook document).
Slide3curriculum
General internal medicine and neurosciences
form the basic foundations for Hearing and Balance module. Modern care for hearing and balance disorders requires the
whole system approach
in which the “ ear “ problem is not considered in isolation but as part of the patient’s overall health.
Multidisciplinary team
Slide4curriculum
This curriculum adapted from the
Audiovestibular
Medicine Curriculum of the Royal College of Physicians of England 2010/2013, comprises two main fields of clinical practice, that of
Adult Hearing and Adult Balance/Vestibular.
In
addition and common to all the fields are the
backround
knowledge, generic skills and experience in
related medical disciplines
. Training in those specific areas can occur either before or during specialist training.
This training program is a guide for trainers and trainees, and is endorsed by the International Association of
Audiovestibular
Physicians. .
Slide5CONTENT -logbook of training sections
2.1
Background Knowledge
a/Basic Sciences
b/Preventive Medicine
c/ Instrumentation
Generic skills
a/ clinical skills
b/ communication skills
c/ attitudes
Core Fields
a/ Adult
Hearing Section
a/1/ knowledge base, skills and attitudes
b/ Adult Balance Section
b/1/ knowledge base, skills , attitudes
2.4
. Practical procedures
a/ for specialist in adult hearing disorders
b/
for specialist in adult balance
disorders
Slide6CONTENT
2.5 Related medical disciplines
a
/
otolaryngology
b
/
neurology
c/ophthalmology
d/psychology
/
psychiatry
e/genetics
f/care of the elderly
g
/ immunology and allergy
h
/ radiology
3. Learning
and teaching , training programs
a
/ Diploma in
Audiovestibular
medicine ( relevant modules)
b
/ Requirements of training posts
4
. Assessments
Slide7KnowledgePerformance CategoryDateSignature TrainerDetailed anatomy, physiology, neurochemistry and pharmacology of the auditory and vestibular systems, their central pathways and connections and related systems or organs. Embryological development of the above. Psychology of hearing and balance including psychoacoustics. Basic acoustics including room acoustics. Requirements for sound proofing. Standards relating to acoustics, calibration and audiological medicine. Physics of sound, waves and motion. Basic electroacoustic properties of hearing aids. Recent advances in molecular biology: repair and regeneration in relation to the cochlea and vestibular system, stem cell research in relation to the ear, genetic manipulation etc.
2. BACKGROUND KNOWLEDGE
a) BASIC SCIENCES
A sound and comprehensive knowledge of the basic sciences
subserving
the audiological and vestibular systems is essential to practice.
Slide8KnowledgePerformance CategoryDateSignature TrainerGeneral principles of primary, secondary and tertiary prevention Screening principles, methods and practice; including setting up a screening programme in a district, dealing with screen failures, monitoring and audit Screening for hearing loss — newborn, school, industrial, elderly etc. Noise and its effect on the audio-vestibular system, damaging noise levels, sources of such noise and prevention of exposure including noise surveys, hearing conservation, ear protection and international standards Ototoxicity; substances and drugs that affect the audio-vestibular system and their effects, including industrial toxins Genetics affecting predisposition to ototoxic agents Epidemiology and prevention of hearing loss Role of immunisation and therapy in the prevention of hearing and balance disorders
b) PREVENTIVE MEDICINE
Slide9KnowledgePerformance CategoryDateSignature TrainerPrinciples, technology and limitations of auditory and vestibular test equipment Analogue and digital hearing aids, including body worn, post aural, in the ear, in-the-canal, totally-in-the-canal aids, vibrotactile aids, bone-anchored hearing aids (BAHA), frequency transposition aids, CR05 (contralateral routing of signal) and BiCR0S aids and implantable hearing aids including cochlear implants Hearing aid fitting formulae and real ear measurements in adult practice The “plumbing system” (hooks, moulds, tubing etc) and its effect on sound amplification Assistive devices available including the radio aid and FM soundfield systems, alarm systems, loop systems Methods of assessing benefit of amplification in adults
c) INSTRUMENTATION
Practice of hearing and balance specialist requires a comprehensive knowledge of auditory and vestibular test equipment, and of amplification, including assistive listening devices for adults .
Slide10Skills: To be able to:Performance CategoryDateSignature TrainerCritically review audiometric and vestibular test results Determine the appropriateness and type of amplification (including cochlear implant) through discussion with audiological colleagues, patients Discuss the current best technology with both patients, their families, and other professionals Refer appropriately for amplification
To have practical experience of: Performance CategoryDateSignature TrainerSelecting, testing and fitting of hearing aids including BAHA and cochlear implants in adults Measuring benefit of amplification Use of hearing aid test box for testing hearing aids and measuring insertion gain and RECD
c) INSTRUMENTATION Continued
Slide11Clinical Skills: To be able to: Performance CategoryDateSignature TrainerTake an accurate, relevant and detailed history of auditory and vestibular disorders and associated problems from the patient or their carer including a developmental or psychosocial history. Perform a relevant and detailed clinical examination, including ENT, neuro-otological, oculomotor, neurological, and full general examination. Select and interpret audiological, vestibular and aetiological tests appropriate to the patient’s presentation, age and additional difficulties Select and interpret appropriate multidisciplinary assessments including speech and language assessment, psychometric assessment Integrate the history, examination and investigative findings and formulate a diagnosis and management plan Select appropriate management strategies through multidisciplinary team discussion and discussion with the patient and carers; e.g. hearing aids, tinnitus instruments, cognitive therapy, relaxation, pharmacological options, physiotherapy, occupational therapy, educational strategies, surgical options - depending on the cause and impact of the problem and the age and additional disabilities of the patient Assess the impact of a management strategy using appropriate outcome measures Assess disability accurately and judge occupational fitness e.g. use of machinery and fitness to drive Identify additional medical problems which may be causative or may adversely affect rehabilitation e.g. visual defects, neurological disease, endocrine disease, joint pathology, cardiac disease, developmental delay Identify psychological problems needing psychology/psychiatric referral Identify syndromic and genetic causes of hearing and balance disorders
3. GENERIC SKILLS
Aside from the generic skills required of all practicing doctors there are specific required generic skills These are an integral part of training in all aspects of the work.
a. SKILLS
Slide12Communication Skills: to be able to: Performance CategoryDateSignature TrainerCommunicate effectively with patients of all ages, including the elderly with disorders of hearing with poor speech production due to deafness or other disorders of speech and language with visual disorders including the deaf-blind with intellectual disability needing sign language or spoken language interpretation in order to explain clearly to all patients and their carers the results of investigations, the management options and the prognosis of audiovestibular problems so that they understand and can make informed decisions, where able to do so. Communicate effectively with colleagues within the multidisciplinary team and with specialists in other disciplines Determine the communication abilities and needs of the congenitally deaf and the deaf/blind patient and where needed use finger spelling and some basic signs Counsel the patient appropriately
3. GENERIC SKILLS - Continued
Slide13The need for an empathetic, tactful and positive approach Performance CategoryDateSignature TrainerThe impact of disorders of hearing and balance on the individual and their family with regard to everyday function including employment, psychology and social interaction The impact of disorders of hearing on the development and maintenance of speech and language and education The combined effect of deafness with other difficulties, such as visual defects, learning disability etc. The importance of holistic care The importance of the history including family history & developmental history in making a diagnosis. The importance of a social, educational and psychological history in managing individuals with audiovestibular impairment The importance of education of significant others to aid rehabilitation The value of multidisciplinary team working both within and outside the clinic The attitudes of those within the Deaf Community The use and value of complementary medical approaches to holistic management of tinnitus and of otitis media with effusion The importance of patient confidentiality and informed consent. The importance of effective multidisciplinary team work and communication with colleagues both verbally and in writing The importance of sharing information with patients and their carers The value of voluntary agencies in supporting the patient with hearing and balance disorders and their family/carers
b. ATTITUDES
The specialist must
recognise
and understand:
Slide144.. CORE FIELDS a. Adult “ Hearing” module Clinical Topics - Knowledge Base
Tinnitus Performance CategoryDateSignature TrainerAetiological and triggering factors Current pathophysiological theories about tinnitus generation Prevalence of tinnitus and its natural history of habituation. Audiometric and aetiological investigations Psychological effects on the patient and how these can be managed Management of patients with tinnitus including instrumentation
Sudden hearing loss
Performance Category
Date
Signature Trainer
Presentation and causes.
Audiological and aetiological investigations
The psychological impact of sudden hearing loss, particularly if permanent and bilateral.
Current evidence based management of acute presentation
Management including indications for surgery, communication strategies and hearing tactics
Slide15Unilateral hearing loss, progressive or fluctuating unilateral or bilateral hearing loss Performance CategoryDateSignature TrainerPresentation and causes Audiometric and aetiological investigations Identification of site of lesion Impact on the patient Current evidence based pharmacological management Indications for surgical referral.
Clinical Topics - Knowledge Base - Continued
Hearing problems in younger adults
Performance Category
Date
Signature Trainer
Conditions leading to hearing problems in younger adults
Audiometric and aetiological investigations
Current evidence-based management of hearing problems including pharmacological, surgical, audiological and rehabilitative
The possible impact of the hearing problems on the individual’s life and the effect on immediate family members, including psychosocial and speech & language issues
Management including:
appropriate instrumentation and the benefits and limitations e.g. Hearing aids, BAHA, CI, tactile and environmental aids
non instrumental rehabilitation e.g. Hearing tactics, speechreading
External support agencies, voluntary bodies and policies including employment support
Slide16Congenitally deaf adult Performance CategoryDateSignature TrainerCauses of congenital deafness/hearing impairment Effects on speech & language and communication Impact on individuals and significant others, including psychosocial effects Associated symptoms such as tinnitus or balance difficulties Alternative communication systems Deaf culture and the local support facilities for deaf people Hearing aids and environmental aids Rapid advances in the research of genetic deafness and its impact on patient management
Hearing problems in the elderly Performance CategoryDateSignature TrainerCauses of hearing impairment in the elderly. Effects of the general ageing process on the auditory system General medical problems or other impairments which might affect rehabilitation e.g. Loss of tactile sensitivity, joint mobility, blindness, poor memory Associated problems such as balance disturbance and falls Psychosocial issues including feelings of isolation and avoidance Rehabilitative approaches in the elderly External support agencies, voluntary bodies and policies e.g. Social workers
Clinical Topics - Knowledge Base - Continued
Slide17Dysacuses, auditory processing disorders (APD) and auditory neuropathy/dysynchrony (AN/AD)Performance CategoryDateSignature TrainerPresentation and causes of dysacuses, APD and AN/AD Investigation and management of dysacuses and their causes Methods of testing the function of the different parts of the central auditory pathway The rehabilitative approaches available for APD and AN/AD The psychosocial effects of these hearing difficulties
Intellectually disabled adult Performance CategoryDateSignature TrainerAudiological or neuro-otological problems that may be associated with intellectual handicap and the specific effects that such problems may have Presentation, diagnosis, investigation and management of hearing problems in adults with learning difficulties Rehabilitative approaches available for such patients Issues concerning ‘consent’ in these patients
Clinical Topics - Knowledge Base - Continued
Slide18Background Knowledge Specific to the FieldPerformance CategoryDateSignature TrainerAn understanding of vestibular test equipment, investigative techniques, and interpretation of results The anatomy and physiology of the vestibular system, its central connections and interactions with the visual and oculomotor systems. When and to whom to refer adults with balance problems e.g. psychology, social services, neurology, cardiology, ophthalmology, physiotherapy, occupational therapy etc. An understanding of multidisciplinary working and its value The existence of national guidelines and their value and limitations.
b. Adult “ Balance “ Module
The specialist should be able to
Performance Category
Date
Signature Trainer
Determine the cause of acute and chronic vertigo, chronic imbalance, drop attacks and falls in the elderly
Assess the impact of the balance disorder on the individual
Select and interpret an appropriate set of investigations
Identify factors likely to affect rehabilitation
Define a management plan
Explain to the patient the likely cause and outcome of the problem
Identify those patients for whom the condition affects their fitness to drive
Slide19Acute vertigo Performance CategoryDateSignature TrainerCauses, presentation and natural history of acute vertigo Associated eye movement abnormalities Audiovestibular and aetiological investigation Management options, including rehabilitation, dietary manipulation, pharmacological and surgical
Recurrent disequilibrium Performance CategoryDateSignature TrainerThe sensorimotor physiology involved in balance maintenance Causes of peripheral and central vestibular disorders with remitting and relapsing courses Factors hindering vestibular compensation including pathology in other stabilising sensory and motor effector systems The psychological impact of recurrent disequilibrium Vestibular tests and aetiological investigation Management options including pharmacological, physical rehabilitation and psychological /psychiatric interventions
Adult
Balance -
Clinical Topics - Knowledge Base
Slide20Chronic imbalance Performance CategoryDateSignature TrainerThe range of central vestibular disorders causing chronic imbalance Pathology in the stabilising sensory systems which give rise to multisensory imbalance Pharmacotherapeutic agents causing chronic imbalance Aetiological and vestibular investigations Management options
Adult Balance - Clinical Topics - Knowledge Base
Blackouts/drop attacks Performance CategoryDateSignature TrainerThe mechanisms of epilepsy, pseudo-epilepsy, syncope, vasovagal attacks, and blackouts, and to know the aetiological factors involved The investigation protocol and type of abnormalities found for each of the above The pharmacotherapeutic options available to treat each cause The law regarding black-outs and syncope and fitness to drive
Slide21Falls in the elderly Performance CategoryDateSignature TrainerThe effects of ageing and neurological disorder on the postural and righting reflexes The causes of black-outs and drop attacks including cardio- and cerebrovascular pathology The musculo-skeletal disorders impairing maintenance of the upright posture and locomotion Audiovestibular and aetiological investigations The pharmacological and physiotherapeutic management options
To be able to: Performance CategoryDateSignature TrainerDistinguish peripheral from central vestibular causes of vertigo and define site of lesion in the CNS Carry out particle repositioning manoeuvres e.g. Epley, Semont etc Instruct the patient in appropriate exercises e.g. Cawthorne-Cooksey, Brandt-Darroff, customised, exercises and protocols for visual vertigo
Adult
Balance -
Clinical Topics - Knowledge Base
Skills
With regard to the above stated clinical topics a specialist in addition to the generic skills outlined in Section 2.2 needs:
Attitude
With regard to the above stated clinical topics a specialist in this filed, needs to develop the attitudes outlined in Section 2.2.c.
Slide22Knowledge: Performance CategoryDateSignature TrainerTheoretical basis of audiological testing See Basic Sciences section 2.1a Indications for the various audiological tests Values, limitations and practical difficulties of audiological testing
5. PRACTICAL PROCEDURES
a. PRACTICAL PROCEDURES – specialist in adult hearing disorders
Slide23Skills Performance CategoryDateSignature TrainerSelect appropriately and interpret correctly all the following audiological tests. Practical experience of all the following tests. Competency in performing particular tests will depend on the specific clinical practice of the country. Subjective tests of hearing and auditory function: Pure tone audiometry (air conduction, bone conduction with or without masking) Behavioural and conditioning techniques for soundfield and ear specific audiometry in learning disabled adults Speech perception tests including speech in noise Tests of auditory processing Objective tests of auditory function Acoustic immitance measures and middle ear reflex measures Otoacoustic emissions (transient, distortion product, spontaneous, contra-lateral suppression) Evoked responses (electro-cochleography, auditory brainstem responses, middle latencies, cortical responses, auditory steady state responses etc)
a. PRACTICAL PROCEDURES – specialist in adult hearing disorders - Continued
Slide24Knowledge: Performance CategoryDateSignature TrainerTheoretical basis of vestibular testing see Basic Sciences section 3a Indications for vestibular testing Values, limitations and practical difficulties of vestibular testing in adults. Age-related changes in postural control and responses to visuo-vestibular stimulation
Skills: Performance CategoryDateSignature TrainerTo be able to select appropriately and interpret correctly all the following vestibular tests in adults. To have practical experience of all the following tests. Competency in performing particular tests will depend on the specific clinical practice of the country Dix-Hallpike testing Video-nystagmoscopy Caloric irrigations Posturography , HTT, VDA ENG/EOCJ recordings during visuo-vestibular stimulation Vestibular evoked myogenic potentials (VEMPs) To be able to integrate the results of audiological, vestibular and aetiological tests to formulate a diagnosis and a management plan
b. PRACTICAL PROCEDURES- Specialist in adult balance / vestibular disorders
Slide25Objectives: Performance CategoryDateSignature TrainerTo gain a detailed knowledge of pathology and management of otological conditions To observe audiology related ENT surgery such as grommet insertion, mastoidectomy, tympanoplasty, surgery for cochlear implantation, bone anchored hearing aids and vestibular schwannoma. To be experienced and competent in use of ENT referral criteria To gain knowledge of rhinological, oropharyngeal, upper airway and other head & neck conditions that may affect the audiovestibular system and speech.
Knowledge: Performance CategoryDateSignature TrainerEmbryology, anatomy, physiology of the ear and head & neck Pathology, appropriate investigations (including imaging) and management of congenital, acquired and other conditions of the ear including indications, risks, outcomes and complications of surgery Head and neck conditions that may produce aural symptoms including conductive hearing loss, and their appropriate management
6. RELATED MEDICAL DISCIPLINES
a, OTORHINOLARYNGOLOCY
Slide26Skills: To be able to: Performance CategoryDateSignature TrainerTake a full otological/ENT history relevant to the audiovestibular system and speech. Perform an accurate and comprehensive examination of the ear, nose, oral cavity, pharynx and head & neck including use of otoscope, operating microscope, head mirror Examine the ear competently using a microscope and describe and identify abnormalities accurately. Identify and treat causes of otalgia, external and middle ear dysfunction Perform intratympanic injections of medications
To be competent at: Performance CategoryDateSignature TrainerRemoval of wax and debris from the external auditory canal using appropriate instruments, syringing or suction either under direct vision or using the operating microscope as appropriate
a, OTORHINOLARYNGOLOCY - Continued
Slide27Objectives Performance CategoryDateSignature TrainerTo make an accurate neurological assessment of a patient To know when to refer a patient to a neurologist or a neurosurgeon
Knowledge Performance CategoryDateSignature TrainerCauses of central audiological and vestibular disorders Neurological disorders with neuro-otological manifestations Investigation protocols for the above disorders Pharmacological treatments and side-effects of common neurological disorders with neuro-otological manifestations
Skills: To be able to: Performance CategoryDateSignature TrainerTake a complete neurological history and perform competently a full neurological examination Recognise neuro-otological manifestations of neurological disorders and select appropriate investigations
b. NEUROLOGY
Slide28Objectives: Performance CategoryDateSignature TrainerTo know how to screen a patient for ophthalmological and oculomotor disorders To know when to refer a patient with such symptoms
Knowledge: Performance CategoryDateSignature TrainerOphthalmological disorders with associated audiological and neuro-otological manifestations Eye movement disorders Impact of visual disorders on balance and the confounding effect upon vestibular test procedures Impact of visual problems on communication for the hearing impaired Management of common visual problems Causes, impact and management (including the role of voluntary bodies) of dual sensory impairment
Skills: To be able to: Performance CategoryDateSignature TrainerTake a history of ophthalmological symptoms from a patient Make an accurate assessment of a strabismus, latent nystagmus, saccades, smooth pursuit, spontaneous and optokinetic nystagmus Perform a full ophthalmological examination and correctly recognise optic field defects, papilloedema, conjunctivitis, choroiditis, iritis, retinitis and disordered eye movements Recognise relevant and common visual disorders i.e. Altered visual acuity. strabismus, benign intracranial hypertension, glaucoma, presby- and hyper-metropia
c. OPHTHALMOLOGY
Slide29Objectives: Performance CategoryDateSignature TrainerTo understand the psychological difficulties and psychiatric disorders associated with deafness and hearing impairment and the presentation of these disorders in the deaf patient To understand the psychological difficulties and psychiatric disorders associated with tinnitus, dysacuses, vertigo and imbalance To obtain an adequate psychological profile, to recognise manageable conditions and refer appropriately To acquire appropriate counseling skills
Knowledge: Performance CategoryDateSignature TrainerPsychiatric disorders with audiological and vestibular manifestations How psychotropic medication may influence audiovestibular disorders Psychological/psychiatric morbidity of neuro-otological disorders, tinnitus, dysacusis and sudden hearing loss Pathogenesis and presentation of non-organic hearing loss. Psychological morbidity of hearing impairment including dual sensory impairment Presentation of psychological problems and psychiatric disorder in the congenitally deaf patient
Skills: To be able to: Performance CategoryDateSignature TrainerIdentify behavioural disturbances and psychiatric disorder from the clinical presentation Discuss psychological/psychiatric disorder appropriately with patient
d. PSYCHOLOGY/PSYCHIATRY
Slide30Objectives: Performance CategoryDateSignature TrainerTo obtain an understanding of genetics in audiovestibular disorders and the role of the clinical geneticist
Knowledge: Performance CategoryDateSignature TrainerInheritance patterns of hearing loss. Genetics of and available tests for conditions associated with audiovestibular disorders. The psychological impact of genetic disorders.
Skills: To be able to: Performance CategoryDateSignature TrainerElicit and record correctly a detailed family tree. Interpret correctly a diagnostic DNA report together with its implications
e. GENETICS
Slide31Objectives: Performance CategoryDateSignature TrainerTo obtain an overview and understanding of the medical conditions affecting the elderly including falls, multi-system disease, cognitive and visual impairment
Knowledge: Performance CategoryDateSignature TrainerCommon causes of falls and imbalance in the elderly. The effect of ageing on cognition and memory The impact of multi-system disease and its pharmacological management Roles of other members of the multi-disciplinary teams caring for the elderly.
f. CARE OF THE ELDERLY
Slide32Objectives Performance CategoryDateSignature TrainerTo understand the effect of disordered immunity and allergy on the audiovestibular system
Knowledge: Performance CategoryDateSignature TrainerThe pathophysiology, presentation, diagnosis, management and prognosis of auto-immune diseases that affect the audiovestibular system The pathophysiology, presentation, diagnosis and management of allergy affecting audiovestibular function, in particular allergic rhinitis Immune deficiency disorders affecting the audiovestibular system - their pathophysiology, diagnosis and management
g. IMMUNOLOGY & ALLERGY
Slide33Objectives Performance CategoryDateSignature TrainerTo appreciate the value of imaging in the diagnosis and management of audiovestibular disorders Ability to select and request optimal imaging technique and views for specific disorders Knowledge The congenital and acquired abnormalities of the petrous temporal bone and central nervous system that can be identified by radiological imaging techniques, such as CT scan, MRI scan, fMRl scan and PET scans.
h. RADIOLOGY
Slide34Training programsDiploma / MSc in Audiovestibular Medicine ( UCL)
SYLLABUS( Diploma)
Module 1 –
Audiovestibular
Physics
Module 1.1 – Physics and Acoustics
Module 1.2 – Statistics and Research Methodology
Module 2 – Anatomy and Physiology
Module 3 –
Audiovestibular
Diagnosis
Module 4 – Clinical Disciplines Allied to Audio vestibular Medicine
Module 4.1 – Pathology, Speech and Language, Genetics & Radiology
Module 4.2 – Evidence based Medicine, Immunology, Ophthalmology,
Psychology/Psychiatry.
Module 5 - Vestibular Medicine
Module 6 - Clinical Auditory Medicine – Children and Adults
Slide35Training programsRequirements of the training posts
In institutions with appropriate standard of clinical governance
Training posts must provide the necessary clinical exposure
Training posts must provide the evidence that required supervision and assessments can be achieved.
The sequence of training should ensure appropriate progression in experience and
responsability
The trainees have access to all facilities required to gain practical competencies
Training should take place in a range of district general hospitals ,teaching hospitals ,community clinics.
Trainee has an educational and clinical supervisors
Learning through observation, clinical practice, attendance at regional training days, presentations, national audit meetings, attendance at lectures, tutorials, journal reviews, additional courses, research projects,
Slide36ASSESSMENT METHODS Principles
It is expected that trainees will undergo regular assessment of competencies in the various areas of the curriculum covered according to the training requirement of the individual country.
The
intergrated
assessment system should comprise both work based assessments and knowledge based assessments ( Diploma or similar course)
Workplace assessments should take place throughout the training program to allow trainee to continually gather evidence of learning and to provide trainee with formative feedback.
Slide37Assessments methods
Workplace based assessments
MSF
– multisource feedback
Mini-
Cex
-
miniclinical
evaluation exercise
CBD
- case based discussion
DOPS
– direct observation of practical skills
PS
- patient survey
TO
- teaching observation
Slide38Assessments methods
MSF-
communication,
leadership,team
working, reliability
Mini-CEX
competencce
in practical
skills,essential
good clinical care
CbD
competence in clinical reasoning, decision making,
application of medical knowledge to patient care.
PS
behaviour of the
doctor,effectiveness
of the consultation,
assessment of interpersonal skills, communication skills,
professionalism,
Slide39Reference:
Specialty Training Curriculum for
Audiovestibular
Medicine May 2010/2013. Joint Royal College of Physicians Training Board
http://
www.jrcptb.org.uk/trainingandcert/ST3-SpR/Pages/Audiological-Medicine.aspx
Diploma/ MSc in
Audiovestibular
Medicine , UCL, London