D R A F T UNION EUROPEENNE DES MEDECINS SPECIALISTES (UEMS)

1. 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: ChairKajsa-Mia Holgers LigijaKise Ulf Schönsted-Madsen Rene Dauman HeikkoLöppönen Eva Raglan

2. Consensus 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. • Paediatricaudiology 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).

3. curriculum • 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

4. curriculum • 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. .

5. CONTENT -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

6. CONTENT • 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

7. 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.

8. b) PREVENTIVE MEDICINE

9. 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 .

10. c) INSTRUMENTATION Continued

11. 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

12. 3. GENERIC SKILLS - Continued

13. b. ATTITUDES The specialist must recognise and understand:

14. 4.. CORE FIELDS a. Adult “ Hearing” module Clinical Topics - Knowledge Base

15. Clinical Topics - Knowledge Base - Continued

16. Clinical Topics - Knowledge Base - Continued

17. Clinical Topics - Knowledge Base - Continued

18. b. Adult “ Balance “ Module

19. Adult Balance - Clinical Topics - Knowledge Base

20. Adult Balance - Clinical Topics - Knowledge Base

21. 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.

22. 5. PRACTICAL PROCEDURES a. PRACTICAL PROCEDURES – specialist in adult hearing disorders

23. a. PRACTICAL PROCEDURES – specialist in adult hearing disorders - Continued

24. b. PRACTICAL PROCEDURES- Specialist in adult balance / vestibular disorders

25. 6. RELATED MEDICAL DISCIPLINES a, OTORHINOLARYNGOLOCY

26. a, OTORHINOLARYNGOLOCY - Continued

27. b. NEUROLOGY

28. c. OPHTHALMOLOGY

29. d. PSYCHOLOGY/PSYCHIATRY

30. e. GENETICS

31. f. CARE OF THE ELDERLY

32. g. IMMUNOLOGY & ALLERGY

33. h. RADIOLOGY

34. Training 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

35. Training 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,

36. ASSESSMENT 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.

37. Assessments 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

38. Assessments methods • MSF- communication, leadership,team working, reliability • Mini-CEX competencce in practical skills,essential good clinical care • CbDcompetence 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,

39. Reference: • 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