PP409 - Development of Competency Criteria for Real-Ear Measurement: Findings from a Modified e-Delphi Study

Abstract:
Best practice guidelines recommend using Real-ear Aided Response (REAR) for hearing aid verification. Skill development in REAR progresses through stages from novice to expert, with competency demonstrated at the "competent" stage, allowing for independent practice.

Summary:
Objective
The primary aim of this study was to develop a consensus-based competency framework for audiologists to perform real-ear measurement (REM) using both on-ear and simulated techniques for hearing aid verification. Through a modified Delphi process, expert opinions were gathered and analyzed to define the essential skills required in clinical practice, contributing to the standardization of REM training and enhancing audiologists' competence in this crucial area.

Rationale
Real-ear measurement is a cornerstone of evidence-based hearing aid fitting, yet there is a significant lack of standardized competency criteria outlining the knowledge and skills necessary for effectively performing REM. Variability in training and practice across different regions and clinics can lead to inconsistent patient outcomes. Literature suggests that many audiologists experience gaps in REM proficiency, which can affect the precision of hearing aid fittings and, ultimately, the quality of patient care. The purpose of this study was to address these gaps by developing a competency framework that defines the required proficiencies for performing REM, aiming to improve clinical practice and training standards worldwide.

Design & Methods
The study employed a modified e-Delphi method, involving two rounds of structured feedback from expert audiologists (29 experts in round 1, 14 experts in round 2) selected based on their clinical and teaching experience in REM. Participants rated each proposed competency on a Likert scale (1-5) for importance, and consensus was defined as an agreement level of 70 percent or higher. The competencies were refined across rounds, with final agreement on key skills essential for REM.

Results
A total of 54 competencies were initially identified across critical domains such as calibration, patient preparation, REM procedures, hearing aid prescription, real-ear to coupler difference (RECD), and on-ear verification. By the conclusion of the Delphi process, consensus had been reached on 46 of these competencies.

Conclusions
The competency framework developed provides a comprehensive set of criteria for training and assessing audiologists in REM. It offers a foundation for standardizing the teaching and clinical application of REM, which may reduce variability in practice and enhance patient outcomes. This framework can be integrated into audiology education programs and professional development initiatives, ensuring audiologists acquire the necessary skills for effective hearing aid verification.

Brief Summary of Clinical Takeaways:
This work addresses a critical need in audiology by offering a structured approach to training and assessing competencies in REM. It has the potential to significantly improve clinical outcomes and the quality of hearing care worldwide. Furthermore, the use of a modified Delphi approach provides a novel contribution to advancing audiology training and clinical practice.