Clinician: ______UNIVERSITY OF CONNECTICUT
Date(s):______DEPARTMENT OF COMMUNICATION SCIENCES
Supervisor:______
AUDIOLOGY CHECKLIST OF CLINICAL SKILLS
Key: X = Not applicable
Õr
1 = Skill not evident; requires constant supervisory modeling/intervention Õ = End-of-Term Rating of Achievement
2 = Skill is emerging; requires frequent supervisor instruction/modeling r = End-of-Term Expected Achievement
3 = Demonstrated skill that needs refinement/consistency; requires supervisory monitoring
4 = Well developed, consistent skill; requires supervisory guidance/collaboration
5 = Predominantly independent; requires supervisory consultation I. Evaluation
I / II / III / IV / V / VI / VII / A. Basic Skills / Comments1. Prepares for evaluation
3 / 4 / 4 / 4 / 4 / 4 / 4 / a. Reviews all existing data/information
2 / 3 / 4 / 4 / 4 / 4 / 4 / b. Devises test battery
3 / 4 / 4 / 4 / 4 / 4 / 4 / 2. Obtains culturally sensitive and pertinent case history effectively, efficiently, and accurately
2 / 2 / 3 / 3 / 4 / 4 / 4 / 3. Performs otoscopy
2 / 2 / 3 / 4 / 4 / 4 / 4 / 4. Administers clinically appropriate and culturally sensitive assessment measures
5. Reports, General
4 / 4 / 4 / 4 / 4 / 4 / 4 / a. Submits records and reports on time
3 / 3 / 4 / 4 / 4 / 4 / 4 / b. Follows established formats for records and reports
2 / 2 / 3 / 3 / 4 / 4 / 4 / c. Includes relevant information
2 / 2 / 3 / 3 / 4 / 4 / 4 / d. Organizes information appropriately
2 / 2 / 2 / 3 / 4 / 4 / 4 / e. Summaries background information accurately and succinctly, and in topically appropriate chronological order
3 / 4 / 4 / 4 / 4 / 4 / 4 / f. Expresses information succinctly and uses correct grammar, spelling, punctuation
2 / 2 / 3 / 4 / 4 / 4 / 4 / g. Summarizes results of all formal and/or informal testing accurately.
I / II / III / IV / V / VI / VII / A. Basic Skills / Comments
2 / 2 / 3 / 3 / 4 / 4 / 4 / h. Analyzes and interprets qualitative and quantitative data precisely
2 / 2 / 3 / 3 / 4 / 4 / 4 / i. States impressions and recommendations concisely
4 / 4 / 4 / 4 / 4 / 4 / 4 / j. Submits written materials on time
3 / 4 / 4 / 4 / 4 / 4 / 4 / k. Revises reports accurately following feedback
2 / 3 / 3 / 4 / 4 / 4 / 4 / 6. Interprets results of the evaluation with attention to normative data to establish type and severity of disorder
2 / 2 / 3 / 3 / 4 / 4 / 4 / 7. Provides counseling to facilitate understanding outcomes of the evaluation
2 / 3 / 3 / 4 / 4 / 4 / 4 / 8. Uses instrumentation according to manufacturer’s specifications and recommendations
4 / 4 / 4 / 4 / 4 / 4 / 4 / 9. Performs biologic listening check of equipment and demonstrates ability to troubleshoot equipment
2 / 2 / 3 / 3 / 4 / 4 / 4 / 10. Recognizes need for conducting special tests
B. Basic Audiology Procedures
1. Demonstrates competence with obtaining thresholds
3 / 4 / 4 / 4 / 4 / 4 / 4 / a. Air conduction
3 / 4 / 4 / 4 / 4 / 4 / 4 / b. Bone conduction
3 / 4 / 4 / 4 / 4 / 4 / 4 / c. Sound field
2. Basic competence with implementing speech audiometry procedures
2 / 3 / 4 / 4 / 4 / 4 / 4 / a. Monitored live voice
3 / 4 / 4 / 4 / 4 / 4 / 4 / b. Recorded voice
2 / 3 / 3 / 3 / 4 / 4 / 4 / 3. Demonstrates competence with using masking procedures
I / II / III / IV / V / VI / VII / A. Basic Skills / Comments
2 / 2 / 3 / 3 / 4 / 4 / 4 / 4. Modifies procedures according to client’s level of functioning (developmental, cognitive, physical, etc.)
C. Basic Audiology Procedures
2 / 2 / 3 / 4 / 4 / 4 / 4 / 1. Performs hearing aid assessment (visual, listening, electroacoustic check)
2 / 2 / 3 / 4 / 4 / 4 / 4 / 2. Performs needs assessment for assistive listening devices
2 / 2 / 2 / 3 / 3 / 3 / 4 / 3. Performs sensory aid assessment
2 / 2 / 3 / 4 / 4 / 4 / 4 / 4. Performs hearing aid evaluation
2 / 2 / 3 / 3 / 4 / 4 / 4 / 5. Performs programming of amplification devices
2 / 2 / 3 / 3 / 4 / 4 / 4 / 6. Services (troubleshoots and/or repairs) amplification devices
2 / 3 / 3 / 4 / 4 / 4 / 4 / 7. Provides orientation for hearing aids
2 / 2 / 3 / 4 / 4 / 4 / 4 / 8. Provides orientation for assistive listening devices
2 / 2 / 2 / 3 / 3 / 3 / 4 / 9. Provides orientation for sensory devices
D. Specialty Areas
1. Auditory Processing Disorders
2 / 2 / 2 / 3 / 3 / 3 / 4 / a. Determines when and which tests/protocols/strategies are necessary
2 / 3 / 3 / 4 / 4 / 4 / 4 / b. Sets up tests/protocols/strategies accurately
2 / 3 / 3 / 4 / 4 / 4 / 4 / c. Administers test battery accurately, effectively and efficiently
2 / 2 / 3 / 3 / 4 / 4 / 4 / d. Modifies protocols and/or procedures when necessary
2 / 2 / 3 / 3 / 3 / 3 / 4 / e. Interprets results accurately
2 / 2 / 2 / 3 / 3 / 3 / 4 / f. Develops and implements treatment plan(s)
I / II / III / IV / V / VI / VII / A. Basic Skills / Comments
2. Electrophysiology
2 / 2 / 3 / 3 / 4 / 4 / 4 / a. Determines when and which tests/protocols/strategies are necessary
2 / 2 / 3 / 3 / 4 / 4 / 4 / b. Sets up tests/protocols/strategies accurately
2 / 2 / 2 / 3 / 4 / 4 / 4 / c. Administers tests accurately, effectively, and efficiently
2 / 2 / 2 / 3 / 3 / 4 / 4 / d. Modifies protocols and/or procedures when necessary
2 / 2 / 2 / 3 / 3 / 4 / 4 / e. Interprets results accurately
3. Immittance (includes tympanometry, reflex threshold testing, reflex decay, Eustachian Tube function testing)
3 / 3 / 4 / 4 / 4 / 4 / 4 / a. Determines when and which tests/protocols/strategies are necessary
3 / 4 / 4 / 4 / 4 / 4 / 4 / b. Sets up tests/protocols/strategies accurately
3 / 3 / 4 / 4 / 4 / 4 / 4 / c. Administers tests accurately, effectively, and efficiently
3 / 3 / 3 / 4 / 4 / 4 / 4 / d. Modifies protocols and/or procedures when necessary
2 / 3 / 3 / 4 / 4 / 4 / 4 / e. Interprets results accurately
4. Otoacoustic Emissions
2 / 2 / 3 / 3 / 4 / 4 / 4 / a. Determines when and which tests/protocols/strategies are necessary
2 / 2 / 3 / 4 / 4 / 4 / 4 / b. Sets up tests/protocols/strategies accurately
2 / 2 / 3 / 4 / 4 / 4 / 4 / c. Administers tests accurately, effectively and efficiently
2 / 2 / 3 / 3 / 4 / 4 / 4 / d. Modifies protocols and/or procedures when necessary
2 / 2 / 3 / 4 / 4 / 4 / 4 / e. Interprets results accurately
I / II / III / IV / V / VI / VII / A. Basic Skills / Comments
5. Vestibular Function
2 / 2 / 2 / 3 / 3 / 4 / 4 / a. Determines when and which tests/protocols/strategies are necessary
2 / 2 / 3 / 3 / 3 / 4 / 4 / b. Sets up tests/protocols/strategies accurately
2 / 2 / 3 / 3 / 3 / 4 / 4 / c. Administers test battery accurately, effectively and efficiently
2 / 2 / 3 / 3 / 3 / 4 / 4 / d. Modifies protocols and/or procedures when necessary
2 / 2 / 3 / 3 / 3 / 4 / 4 / e. Interprets results accurately
2 / 2 / 3 / 3 / 3 / 3 / 4 / f. Develops and implements treatment plan(s)
6. Screening (Audiology and Speech-Language)
3 / 4 / 4 / 4 / 4 / 4 / 4 / a. Determines when and which tests/protocols/strategies are necessary
3 / 4 / 4 / 4 / 4 / 4 / 4 / b. Sets up tests/protocols/strategies accurately
3 / 4 / 4 / 4 / 4 / 4 / 4 / c. Administers test battery accurately, effectively and efficiently
3 / 4 / 4 / 4 / 4 / 4 / 4 / d. Modifies protocols and/or procedures when necessary
3 / 4 / 4 / 4 / 4 / 4 / 4 / e. Interprets results accurately
7. Cochlear Implants
2 / 2 / 3 / 3 / 4 / 4 / 4 / a. Determines when and which tests/protocols/strategies are necessary
2 / 2 / 3 / 3 / 4 / 4 / 4 / b. Sets up tests/protocols/strategies accurately
2 / 2 / 3 / 3 / 4 / 4 / 4 / c. Administers tests accurately, effectively and efficiently
2 / 2 / 3 / 3 / 4 / 4 / 4 / d. Modifies protocols and/or procedures when necessary
I / II / III / IV / V / VI / VII / A. Basic Skills / Comments
2 / 2 / 3 / 3 / 4 / 4 / 4 / e. Interprets results accurately
2 / 2 / 2 / 2 / 3 / 3 / 4 / f. Develops and implements treatment plan(s)
8. Assistive Listening Devices
2 / 3 / 3 / 4 / 4 / 4 / 4 / a. Determines when and which tests/protocols/strategies are necessary
2 / 3 / 3 / 4 / 4 / 4 / 4 / b. Modifies protocols and/or procedures when necessary
2 / 3 / 3 / 4 / 4 / 4 / 4 / c. Interprets results accurately
2 / 3 / 3 / 4 / 4 / 4 / 4 / d. Develops and implements treatment plan(s)
9. Tinnitus
2 / 2 / 2 / 3 / 4 / 4 / 4 / a. Determines when and which tests/protocols/strategies are necessary
2 / 2 / 2 / 3 / 4 / 4 / 4 / b. Sets up tests/protocols/strategies accurately
2 / 2 / 2 / 3 / 4 / 4 / 4 / c. Administers test battery accurately, effectively and efficiently
2 / 2 / 2 / 3 / 4 / 4 / 4 / d. Modifies protocols and/or procedures when necessary
2 / 2 / 2 / 3 / 4 / 4 / 4 / e. Interprets results accurately
2 / 2 / 2 / 3 / 4 / 4 / 4 / f. Develops and implements treatment plan(s)
10. Hearing Conservation
2 / 2 / 2 / 2 / 2 / 2 / 4 / a. Oversees noise assessment measures successfully
2 / 2 / 2 / 2 / 2 / 2 / 4 / b. Works with management and/or other stakeholders to determine appropriate engineering noise controls and administrative control of noise exposure
2 / 2 / 2 / 2 / 2 / 2 / 4 / c. Performs selection, fitting, training, and supervision of use of personal hearing protection
I / II / III / IV / V / VI / VII / A. Basic Skills / Comments
2 / 2 / 3 / 4 / 4 / 4 / 4 / d. Performs audiometric testing and review in accordance with OSHA standards
2 / 2 / 3 / 4 / 4 / 4 / 4 / e. Educates and motivates employees and employers in hearing conservation
2 / 2 / 3 / 4 / 4 / 4 / 4 / f. Determines effectiveness of hearing conservation program
11. Cerumen Management
2 / 3 / 4 / 4 / 4 / 4 / 4 / a. Determines need for cerumen removal
2 / 2 / 3 / 4 / 4 / 4 / 4 / b. Demonstrates knowledge and skills in determining when cerumen can be removed
2 / 2 / 2 / 2 / 2 / 2 / 4 / c. Removes cerumen successfully when appropriate
D. Prevention
2 / 3 / 3 / 3 / 4 / 4 / 4 / 1. Identifies individuals at risk for hearing impairment
SI 24 7
Revised 10/05; 3/09