Feedback III

Session Introduction

• The feedback session is being conducted by Patrick and another facilitator.

• Patrick is back feeling better and emphasizes that feedback is a learning process.

• Students are encouraged to practice feedback as they move into clinic placements, developing skills over time.

Session Overview

• The previous feedback sessions focused on straightforward feedback.

• Today's session introduces more complex topics and difficult situations.

Learning Outcomes for Today

• Use the feedback roadmap to deliver feedback to patients (both adults and pediatric).

• Apply domains of feedback, including techniques for challenging cases.

• Discuss how to deliver bad news and manage emotions in patients.

• Handle uncertainty surrounding diagnoses.

Complex Feedback and Challenging Cases

• Situations may include multiple suspected pathologies, emotional responses such as distress or denial, and breaking bad news.

• Feedback approaches include:

  • Validating emotional responses without confirming denial.

  • Subtly incorporating patient concerns in feedback; for instance, not alarming patients unnecessarily about potential serious conditions.

• Class discussion on tailoring feedback depending on different scenarios, particularly for pediatric cases with limited information.

  • Teachers and students shared thoughts on modifying feedback based on patient emotions, abilities, and situations such as crying or distress.

• Discuss the importance of honesty and transparency when dealing with uncertainty and unknowns in diagnoses.

Patient and Clinician Uncertainty

• Within the diagnostic process, patient uncertainty includes:

  • Their desire to know the diagnosis and the extent of what they want to know.

  • Confusion regarding their current health status or scepticism about the clinician's conclusions.

• Clinician uncertainty may stem from a lack of training in discussing uncertain diagnoses or inadequately documenting uncertainty in patient records.

  • Emphasis on documenting the reasons behind any uncertainty in clinical notes.

  • Recognition that patient reactions to uncertainty vary; some appreciate honesty while others respond negatively to perceived doubt.

Key Communication Skills

• Active Listening:

  • Importance of both verbal and non-verbal cues to demonstrate attentiveness.

• Building Rapport:

  • Engage patients with small talk to ease tension.

• Clarification:

  • Use phrases like "I’m curious" to encourage dialogue on potentially sensitive topics.

• Patient-Centered Goal Setting:

  • Ascertain what's important to the patient to prioritize discussions around management options.

• Providing Information:

  • Offering comprehensive education on diagnoses and management options empowers patients and informs better decision-making.

Handling Patient Emotions

• Recognizing and addressing emotional responses is crucial for effective communication, particularly during feedback.

  • Acknowledge emotions without shifting focus to the clinician’s experiences.

• Situations where patients cry or show signs of distress require sensitivity and space for emotional processing.

• Importance of maintaining focus on the patient, avoiding redirecting conversations to personal anecdotes.

Breaking Bad News Framework

• Preparing to deliver bad news involves:

  • Clear understanding of the information being presented.

  • Honest and direct communication about the diagnosis.

  • Strategic pauses after delivering bad news to allow emotional processing.

  • Validating the patient's feelings and encouraging questions about next steps and ongoing support.

Specific Framework Steps

1. Prepare: Clearly understand the diagnosis and gather necessary resources (e.g., referrals, support materials).

2. Set the Scene: Recap the purpose of the visit and any relevant testing previously conducted.

3. Deliver News: Communicate findings compassionately and directly, allowing room for emotional reactions.

4. Validation: Acknowledge the emotional impact of the news and offer assurance.

5. Questions and Next Steps: Allow for questions and discuss future actions, setting a supportive plan going forward.

Role Play Exercise Explanation

• Class will conduct role play with challenging case studies to practice feedback delivery.

• Case study roles include clinician, patient, and observer.

• Key focus is on applying learned techniques in a practical setting to improve feedback skills.

Case Studies Overview

1. Leah - Sudden Hearing Loss Case: Key concerns related to a patient experiencing auditory decline after a recent deterioration in hearing, with an emphasis on urgent ENT referral.

2. John - Symmetric Hearing Loss: Feedback focusing on high-frequency hearing loss and implications on communication, management options, and involving family in discussions.

3. Tani - Community Health in Indigenous Populations: Addressing moderate hearing loss without full diagnostic capabilities and emphasizing urgency of repeated assessments to prevent further developmental delays.

Conclusion of the Session

• Reminders of the importance of practicing feedback in clinical settings.

• Notice of an upcoming guest lecture on planetary health and its relation to audiology.

• Students are asked to reflect on sustainability in audiology during practical experiences at their placements.

• The session wraps up with an invitation for questions and final thoughts from students about the topics covered today.

1. Focus & Learning Outcomes

• Deliver feedback for complex or emotionally charged cases.

• Apply communication skills in uncertainty and emotional situations.

• Manage breaking bad news compassionately.

• Practise reflective, transparent communication.

2. When Feedback Becomes Challenging

Situations include:

• Multiple or unclear pathologies.

• Incomplete or inconclusive results.

• Strong emotional reactions (distress, denial, anger).

• Breaking bad news (e.g., infant hearing loss).

• Cultural or linguistic differences.

• Family involvement or conflicting expectations.

3. Strategies for Common Challenges

4. Communicating Uncertainty

Clinician Perspective

• Acknowledge limitations without eroding trust.

• Explain clearly what is known vs. unknown.

• Document the reason for uncertainty (e.g., limited cooperation, equipment issue).

Patient Perspective

• May vary in tolerance for uncertainty—some appreciate honesty, others feel anxious.

• Tailor the tone to the patient’s emotional state.

Phrase examples

5. Communication Skills Refresher

• Active Listening: verbal and non-verbal (nodding, paraphrasing).

• Rapport Building: brief friendly small talk reduces anxiety.

• Clarifying Prompt: “I’m curious—can you tell me more about …?”

• Patient-centred Goal Setting: ask what’s most important to them.

• Empathic Presence: hold space during emotional moments; silence is OK.

• Keep Focus on Patient: avoid turning the conversation to yourself (“I know how you feel – my …”).

6. Framework for Breaking Bad News

(Commonly applied in paediatric ABR diagnosis)

Note: Cultural sensitivity matters—some Deaf families may welcome a deaf child; respect diverse perspectives.

7. Key Takeaways

• Feedback is a conversation, not a monologue.

• Empathy + clarity = trust.

• Use the Feedback Roadmap consistently.

• Adjust delivery for emotional, cultural, or informational needs.

• Silence, transparency, and compassion are strengths, not weaknesses.

1. Validating emotion / empathy

“I understand that this is upsetting news and you know, that's affecting you right now”

2. Being open when results are incomplete

“As you've been seeing today, like actually they didn't really wanna participate in the type of game that we need to play to figure out what their hearing is doing, but I was able to figure out this because of this”

“We did get this, we didn’t get that”

3. Clarifying uncertain or incomplete results

“As you can see, you know, there’s sort of maybe a bit too distracted by that or whatever was going on… and then talk about what we do know”

4. “I am curious” — communication tool

“I am curious, can you tell me more about blah blah blah.”

Example applied to developmental concerns:

“I’m curious to know like are there other health professionals that you’ve consulted already…”

“I’m curious to know like has the… doctor mentioned any other professionals to you like a pediatrician?”

5. Breaking bad news — the exact wording

“These results have found that Jacob is deaf.”

“This news can be upsetting to learn.”

(Instruction for delivery)

6. Example of explaining ABR in real time (during testing)

“I’m actually needing to turn up the sound, which means that they aren’t hearing these softer sounds, which means that they do have some form of hearing loss today, and I’m still figuring out the exact type…”

7. Sudden SNHL – how to handle prognosis questions (student example)

“We can’t say for sure, but you’ve done the right thing by coming in as soon as possible and that will give you the best chance.”

8. ENT uncertainty & scope boundary explanations

“There might be some further medical management that the ear, nose and throat specialist might be able to provide…”

“…we’re not sure exactly what they’ll recommend for your specific case…”

9. Hearing loss: one-sentence main concern

“Today’s results did find there was a hearing loss in both ears.”

10. Signposting in management

“OK, so now I’m gonna talk about the next steps. There’s 4 different things I wanna talk about. The first thing is that…”

11. Explaining high-frequency hearing loss (do NOT do this)

(Verbatim caution — not an example to use, but mentioned explicitly as something students did)

“…please don’t do that because the person probably won’t hear it… you could say something like, ‘higher pitched speech sounds like the letter S or the letter TH’…”

12. Handling partner dynamics / disagreement

“I’m curious, why do you feel like that isn’t needed?”

13. Explaining HND purpose

“…this is not an appointment for you to come and buy hearing aids on the day… but more like an opportunity to learn more about your needs and then talk through all the different options…”

14. In VRA / paediatrics, avoid confusing test-setup explanations

“…today we actually used a speaker so we don’t know the difference between the two ears, but we can do that when we put headphones on them, so come back when they’re 3…”

15. Emphasising urgency while not alarming parents

(Not a scripted phrase but the only verbal guidance given toward feedback wording for Tani)

“…really trying to impress that we do need to test this again and get more information… not downplaying their results…”