How to complete the Knowledge and Skills Matrix (This document is to be completed by the supervisor in conjunction with the Intern, not by the Intern alone) This document lists 25 clinical elements that relate to skill development. Each is considered to be an important element in the development of the Intern. When completing the K&SM for the first time, follow these five steps. This should be completed within their first 1 2 weeks of clinical work. Step 1: For each listed Clinical Element determine if it is available in your clinic and if exposure to that element will be offered to the Intern during their internship. Step 2: Step 3: Step 4: Step 5: Fill in the Skill Priority column of the matrix: For elements not available in your clinic mark For elements that are available in your clinic but won t be offered to the Intern mark NO. For all other elements label the priority column with 1, 2 or 3, depending on the importance of each element as it relates to your clinic and your Intern (see the Item Priority Descriptor box below). This priority level will vary across clinics: e.g. a hearing aid dispenser will consider Item 5: Prescription and Fitting of Hearing Aids a Priority 1 item, whereas a diagnostic clinic may not. Then for each element offered in your clinic, assess the Intern s current skills against the Competency Level Descriptors of Novice, Developing, Consolidating, Competent and Independent as detailed on the next page. The Intern skill level should be marked using the date of the assessment in the competency column (NOT a tick in the box). At the end of this document is a table Assessment Processes. Note how the competency level of the Intern was determined (see suggestions). Complete a learning plan for the first quarter in the table below Assessment Processes, labeled Learning Strategies. The information provided must include the methods that will be used to increase the Intern s skills in each Priority 1 area and the resources that will be required. NOTES: This is a progressive document that is intended to show the Intern s progress over time. These initial assessment dates will remain on the matrix and subsequent assessment dates will be added at the end of each quarter (in different colours each time). At the end of each quarter, every element in the matrix that is on offer to the Intern must be reassessed. The Intern skill level should again be marked using the date of the assessment in the competency column but in a different colour to the previous assessment date and how the Intern was assessment documented in the Assessment Processes table. Any Priority 1 elements that have NOT reached independence must have updated learning strategies entered in the Learning Strategies table, along with any Priority 2 (and/or 3) elements that may possibly be introduced in the upcoming quarter. This process continues for each quarter, using a new colour for each quarter s assessment entries. There is no set time frame for introduction of Priority 2 and 3 elements although since the Intern is expected to reach independence in priority 2 elements they are likely to be introduced by the third quarter. At the end of the Internship, the matrix should be quite informative (and colourful) as it will contain five sets of assessment data (initial, end of Q1, end of Q2, end of Q3 and final assessment dates) and associated assessment and learning strategies related to each quarter. See the worked example provided on the Audiology Australia website. If a priority changes during the internship (for example, a Priority 2 element becomes a Priority 3 or is no longer available at the clinic), this can be amended when the KSM is reassessed each quarter. A useful discussion can arise from the Intern assessing their competency levels independently, and then comparing them with the Supervisor s assessment. If your clinic offers a clinical element not listed (eg. Indigenous Audiology), you may add additional elements with a description of learning goals. An Intern must have achieved Independence in all Priority 1 and Priority 2 clinical elements before they can complete their Clinical Internship and be awarded their CCP.
COMPETENCY LEVEL DESCRIPTORS: Novice: The Intern is not familiar with this activity in a clinical setting The activity is performed by the Supervisor. The Intern is learning through observation and discussion. At elbow supervision is required at all times. Developing: The Intern performs the activity with significant supervision and guidance. The Intern performs basic routines and predictable tasks. The Intern has little or no responsibility or autonomy. At elbow supervision is required at all times. Consolidating: At elbow supervision is only required in more complex circumstances. The Intern has some individual responsibility or autonomy. The supervisor is required to be in house at all times. Competent: The Intern performs the activity in some complex and non routine contexts. The Intern has significant responsibility and autonomy. The Intern can oversee the work of others. The supervisor is required to be in house at all times. ITEM PRIORITY DESCRIPTORS Priority One Items - P1: Required skills essential for everyday clinical practice in that location. Skills that will be focussed on initially and included in the Intern s learning plan from the outset of the Internship. Skills that the clinic requires the Intern to reach independence in most quickly. Priority Two Items - P2: Skills that are considered enriching but required for clinical practice in that location. Skills that will be focussed on, and included in the learning plan, later than P1 items. Skills that the clinic requires the Intern to reach independence in but over a longer period of time or later in the Internship process than P1 items. Priority Three Items - P3: Skills that are considered enriching and are additional to those required for clinical practice in that location. The Intern may or may not reach independence in these areas. Independent: The Intern can develop others in the activity The Intern performs activities across a wide range of complex and non routine contexts The Intern can take a strategic view The Intern applies a significant range of fundamental principles and complex techniques across a wide and often unpredictable variety of contexts. The Intern has a wide scope of personal autonomy. The supervisor has primarily a mentoring role and is required to be easily accessible to the Intern. THIS IS A MINIMUM 48 WEEK SUPERVISION PROGRAM AND SUPERVISION IS UNDERTAKEN DURING THE ENTIRE INTERNSHIP. THE HEADINGS AT ELBOW, IN HOUSE AND MENTORING INDICATE THE REQUIRED PROXIMITY OF THE SUPERVISOR TO THE INTERN.
KNOWLEDGE & SKILLS MATRIX 1. Diagnostic audiology and otoscopy Interns should be able to recognise the presence of conditions of the external ear preventing accurate threshold audiometry and refer appropriately for management. Interns should be able to obtain accurate pure tone air and bone conduction thresholds, using appropriate masking techniques, for most hearing loss configurations. They should be able to take account of subject variables, such as age, motivation, tinnitus, and intellectual ability, and modify or simplify procedures in an appropriate way. They should also be aware of tester variables, which could affect results, such as rate of presentation and additional cues, and be able to modify their technique when necessary. They should be aware of the effects of calibration errors and be able to take account of such errors with unfamiliar equipment. They should be able to practise identification audiometry according to the principles of screening. 1 5/04/12 2. Impedance (immittance) audiometry Interns should be able to recognise conditions of the external ear and canal preventing tympanometry and refer appropriately for management. Interns should be able to obtain accurate tympanometry and acoustic reflex results under most clinical conditions with all age groups. They should be able to assess impedance results against audiometric findings and evaluate their consistency. 1 5/04/12 3. Speech audiometry Interns should be able to select appropriate speech audiometry measures for clients and carry out such testing in a manner likely to give reliable results. They should be able to assess speech results against audiometric findings and evaluate their consistency. 1 5/04/12 4. Integration of audiological results Interns should be able to form reasonable conclusions about the likely type and site of pathology in patients with auditory symptoms based on case history and interview, behavioural audiometric information and electrophysiological measures. In particular, Interns should be able to analyse the results for consistency and recommend further action that is likely to resolve inconsistencies. They should also be able to evaluate results to recommend medical and/or other follow up. Interns should be able to produce clear and concise reports on 1
audiological findings and their interpretation for clients, parents, and other health and education professionals, and to write clear and concise referrals to other professionals. 5. Prescription and Fitting of Hearing Aids Interns should be able to recommend, fit and evaluate appropriate amplification and monitor and document outcomes. It is expected that they should be able to take into account factors including the type and degree of hearing loss, use appropriate prescriptive techniques and modify their approach according to client variables such as age and communication needs. It would be expected that they perform a communication needs analysis to establish realistic rehabilitation goals and develop appropriate strategies. They should have the ability to select appropriate earmould features and take quality ear impressions 1 09/10/12 6. Assistive listening devices Interns should be able to describe the principles of assistive listening device technology (e.g. alarms, telephone devices, FM devices) and their applications to assist people with hearing loss. They should be able to interpret audiological and communication assessment results and recommend appropriate devices for adults and children, which are compatible with their personal device use. 2 09/10/12 7. Informational counselling Interns should demonstrate the basic communication skills required to impart useful information about audiological results and management to clients. 1 8. Communication assessment and intervention Interns should be able to assess a client's communication needs and formulate an appropriate management plan. Interns should be able to provide basic advice on hearing re/habilitation options and services to the client and relevant others. 1 9. Earplugs (Custom noise/swim/musicians plugs) Interns should be able to take quality impressions of the ear. Interns should be familiar with the different styles and types of earplugs available and be able to recommend the appropriate type to meet the client needs.
10. Standards and procedures Interns should be able to perform simple electro acoustic measures of audiometer output and of sound field acoustics. Interns should be able to describe and apply local standards of workplace safety, including infection control. 1 11. Paediatric Diagnostic audiometry Interns should be able to select and/or modify procedures for the assessment of hearing thresholds in children of all ages; carry out these procedures in children over three years, developmentally, in a manner likely to obtain accurate results; interpret results appropriately, and recommend follow up assessment that is likely to provide accurate diagnosis of hearing loss as early as possible. Please indicate below the age range the clinic offers assessments for: Neonates 3 years 6 years 2 09/10/12 14/12/12 9 mths 3 yrs 6 years + 12. Educational audiology Interns should be aware of the range of educational options available to hearing impaired children and be able to provide descriptions and information about these to parents and to other professionals. 3 09/10/12 14/12/12 13. Community Education Interns should be able to describe a range of formal and informal methods to educate individuals and groups of all ages about audiology and hearing health care. 3 09/10/12 14/12/12 14. Aural Rehabilitation and Communication programs for complex clients Interns should be able to devise an aural rehabilitation program to meet the individual needs of a client. The program should address the specific goals the client has outlined. Interns should be able to identify additional tests complex clients may require to assess their communication needs and assist with formulating a specific rehabilitation program including device(s) fitting/strategies/communication training. Interns should be able to provide basic advice on hearing re/habilitation options and services to the client and relevant others. 3 09/10/12 14/12/12
15. Tinnitus assessment and intervention Interns should be able to recommend assessment and management strategies for clients with tinnitus and to advise of their effectiveness. They should be able to make appropriate referrals to specialist tinnitus services and interpret the information thus acquired. 16. Evoked potential testing Interns should be able to recommend the use of suitable evoked potential testing in the diagnosis of hearing loss (e.g. ABR, ERA, ECochG). In particular, the applications of ABR in identifying retrocochlear pathology and to the assessment of hearing in infants and difficult to test clients should be thoroughly understood. Interns should be able to carry out ABR assessment, interpret results and integrate these with other audiological findings. 17. Otoacoustic emissions Interns should be able to explain the principles of otoacoustic emissions and their application to the description of auditory function. They should be able to recommend OAE testing and interpret the results appropriately and integrate them with other audiological findings. 3 09/10/12 14/12/12 18. Vestibular assessments Interns should be able to explain the principles of electronystagmography and caloric testing and be able to recommend vestibular tests appropriately for clients with balance disorders. They should be able to interpret results from these assessments appropriately and integrate them with other audiological findings 19. Central auditory function assessments Interns should be able to explain the principles of central auditory function and assessment and be able to recommend tests of central auditory function for clients with auditory disorders. They should be able to interpret results from these assessments appropriately and integrate them with other audiological findings. Adults: School Aged Children:
20. Sensory devices Interns should be able to describe the principles of cochlear implant and other sensory device technology (e.g. vibrotactile aids, implantable hearing aids) and their application to assist people with severe and profound hearing loss. They should be able to interpret audiological results and histories in relation to candidacy for sensory devices for adults and children and advise clients on their suitability. 3 09/10/12 14/12/12 21. Hyperacusis Assessment Interns should be able to describe the causes and possible mechanism of hyperacusis. They should be able to outline an appropriate test battery and appropriate management strategies. They should be able to make appropriate referrals to specialist services and support networks. 22. Occupational hearing loss Interns should be able to explain the principles of hearing conservation and describe the legislation, which applies in their state. They should have the skills to advise employers and employees of their rights and obligations under the relevant sections of their state Occupational Health and Safety Act. 2 09/10/12 23. Deafness studies Interns should understand the needs and aspirations of the Deaf community. They should have an understanding of the variety of non verbal communication systems used by members of Deaf communities and be able to recognise and describe these. 3 09/10/12 14/12/12 24. Intra operative monitoring Interns should demonstrate an understanding of common situations in which audiologists may use electro physiological tests to monitor cranial nerve function during surgery.
25. Practice management Interns should demonstrate an understanding of a range of issues relevant to the conduct of an independent audiological practice; e.g. business, legislative, management, ethical, promotional and NO marketing issues.
ASSESSMENT PROCESSES employed to assess Intern s competence Examples are observation, questioning, file review, clinical role playing, training modules, case discussion, case presentation, at elbow supervision, use of a formal assessment tool (eg. SLAT). Initial assessment Observation; at elbow supervision; training modules; questioning; reviewing academic transcripts End quarter 1 Observation; file review; clinical role playing; training modules; at elbow supervision; participation in workshops End quarter 2 Observation; questioning; case discussion; file review End quarter 3 Observation; questioning; case presentation; file review End quarter 4 Observation; questioning; file review LEARNING STRATEGIES to be employed to develop Intern s competence Information provided must include the methods that will be used to increase the Intern s skills in each Priority 1 area and the resources that will be required. Strategies should relate to the priority clinical elements to be focussed on for the next quarter. Examples of learning strategies are self paced training modules, workshops, tutorials, demonstration, observation of other clinicians, case discussions, case presentations, case studies, guided reading, review of other audiologists files, at elbow supervision, practice with feedback, role playing. For quarter 1 Methods: guided reading; in house tutorials; observation of other clinicians; review of other audiologists files; at elbow supervision; training by product manufacturers; case study discussion; demonstration; practice with feedback Resources: in house training materials; clinical and technical experts; library materials (articles, journals, etc); company documents; clinical equipment For quarter 2 Completion of in house training modules; at elbow supervision; case discussion; role playing For quarter 3 Skill practice with feedback; at elbow supervision for more complex clients; case presentations For quarter 4 Workshop attendance; case discussion re management of more complex clients