Guidance

2. Education and training

Updated 10 October 2024

Applies to England

This guidance describes the education and training requirements for the NHS newborn hearing screening programme (NHSP).

The term ‘screening staff’ applies to anyone working in NHSP who carries out screening, and includes local managers, deputies, and screeners. Their initial training should be based on the screener competency assessment checklists.

New local managers

New local managers should contact the NHS NHSP team via their screening quality assurance team (SQAS) for information, support and details of new local manager workshops and training.

New local managers are required to successfully complete the NHSP new screener training detailed in this guidance, including the:

• introduction to population screening e-Learning module

• NHSP e-Learning module

• NHSP external competency assessment (ECA)

• level 3 health screener diploma (HSD) (newborn hearing)

New local managers do not have to complete the HSD if they hold a current professional registration in a healthcare role such as midwifery, health visiting or audiology.

If an individual was previously a newborn hearing screener and trained before April 2017 their learning requirements are described in more detail, below. They are the same as for:

• established screeners

• screening staff returning to practice after 1 to 3 years/those moving between local services

The NHSP operational guidance, national IT system resources and NHSP mentorship guidance can support new and existing local managers in their role.

New screener or screeners returning to practice

Newborn hearing screening should only be carried out by trained and competent individuals working within agreed national NHSP protocols.

The HSD is the recommended national training programme for new screeners and assures providers of their competence to undertake screening safely, independently and in line with programme requirements.

All personnel carrying out newborn hearing screening in England must:

• complete local induction and mandatory training

• be issued a national IT system login and password – the NHSP local service manager can request this from the national IT system helpdesk, using the S4H user authorisation form,  (remember to include the appropriate role and permissions)

• complete training to enable them to use the NHSP national IT system

• complete the introduction to population screening and NHSP eLearning modules on eLearning for Healthcare  

• complete practical training in automated otoacoustic emission (AOAE) and automated auditory brainstem response (AABR) – including completion of routine and QA equipment checks

• have been locally assessed using the performance observation checklists as competent to carry out the screen

• be supervised at all times while screening until the local manager is satisfied that they are competent

• successfully complete an NHSP ECA  ideally within 3 months of starting employment as a screener

• only screen with on-site support from a local manager or experienced screener until an ECA has been successfully completed

• register for the HSD (newborn hearing) within 6 months of starting employment as a screener if not previously completed

• be supported to successfully complete the HSD within expected timescales

The e-LfH guidance includes information on registering new users and reporting.

Prior learning and experience should be recognised for evidence of the HSD for screeners returning to practice who do not already hold a HSD (newborn hearing), but local policies will be applicable for any other training requirements.

Registered healthcare professional screener  

Registered healthcare professionals such as health visitors (HV), registered nurses and audiologists must successfully complete:

• the Introduction to population screening e-Learning module

• the NHSP e-Learning module

• practical training in automated otoacoustic emission (AOAE) and automated auditory brainstem response (AABR) (if required) – including completion of routine and QA equipment checks

• local assessment of their competency to carry out the screen using observation checklists

• an NHSP ECA if performing AABR’s

Healthcare professionals do not have to complete the HSD if they hold a current registration. However, they must complete an ECA (ideally within three months) if they are performing AABR’s.

  

Registered healthcare professionals returning to practice after a break of 3 years or more should complete the above requirements. Learning requirements for those returning without a current registration are set out below.

Screening staff returning to practice (after 1 to 3 years) or those moving between local services

When screening staff return to practice after 1 to 3 years or move between NHSP local services their new local manager should establish they are qualified and competent by:

• assessing competencies using the performance observation checklists  before they screen unsupervised

• making sure they repeat the NHSP e-Learning in line with established screener guidance

• are familiar with the screening equipment in use

Established screeners

Every year, all staff undertaking screening should:

• have their competencies assessed by the local manager or experienced screener using the performance observation checklists

• repeat unit 7 plus at least 1 or 2 additional modules of the NHSP e-Learning recommended by a local manager to suit individual or team training needs

    

Registered healthcare professionals must do the above every 2 years.

Monitoring of screener activity through quality reports should be used to identify and inform any specific training needs. Guidance can be found in the national IT system Resource tile.

ECA

The aim of the ECA is to make sure candidates have the communication skills and knowledge of the screening pathway to meet the requirements of the NHSP.

The ECA is a formalised assessment of competency and acts as an external verification of internal training standards. These guidelines are to help candidates and their local manager prepare for the ECA.

General guidelines

The ECA is a professional discussion between the candidate and 2 assessors who will assess the candidates’ understanding and knowledge of the screening pathway in the same way a candidate is trained for the role.

Clinical skill competencies will be assessed by the local manager, before attendance, and will not form part of the ECA.

The ECA has 2 sections, and all candidates will need to complete both:

• Section 1: informing parent – NICU and Well Baby and AOAE screening

• Section 2: equipment checks, AABR screening, referral to audiology and information governance

The candidate will be assessed by 2 assessors, to provide a balanced assessment of competency. The professional discussion technique will be used to engage the candidate throughout the process. They will listen to and encourage the candidate’s communication skills while evaluating knowledge and understanding of the NHSP and its protocols. Candidates must achieve 80% of the ‘essential’ criteria to meet the requirements for competency.

Assessors will be from a group specifically trained to provide the ECA. They should be confident and experienced in competency assessment of screeners and currently working within the NHSP. They may possess a CAVA or equivalent certification, or they can act as an expert witness for the health screener diploma (HSD). To maintain an independent opinion of competency, assessors will not be able to assess their own screeners.

An ECA registration and evidence checklist must be completed and validated by the local manager, before screener attends the ECA. This will make sure the candidate is fully prepared and will provide evidence that they:

• have successfully completed introduction to population screening and NHSP e-Learning modules

• are competent in completion of 5 x AOAE practical skills

• are competent in completion of 5 x AABR practical skills

• are competent in completion of routine and QA equipment checks

Registering for an ECA

For candidates who require an ECA the local manager should:

• contact the NHSP training email: [email protected] for dates of the upcoming ECAs

• choose a suitable ECA date for the candidate

• download, complete and return the ECA registration and evidence checklist

Candidates will only receive further details and a confirmation when their completed and validated ECA registration and evidence checklist has been provided.

What to expect

The ECA assessors:

• are there to support and encourage the candidate

• will be positive, objective and neutral

• are experienced, trained NHSP local managers or senior screeners

• will make notes during the discussion

Candidates will only be expected to demonstrate what has been learnt from the e-Learning resources and practised within their local NHSP service at the ECA. There will be no trick questions and candidates will have the opportunity to correct themselves if they make an error or omit to say something in their responses. There will be no assessment of practical clinical skills.

The ECA has 2 sections and candidates must complete both. Each section should take no longer than 40 to 45 minutes to complete. There will be a 5-minute comfort break between each section.

Questions will be asked on the following themes:

Section 1: Informing parent – NICU and Well Baby and AOAE screening

Expect questions on:

• the aims of the NHSP

• identifying the eligible population

• initial discussions or offering the screen

• gaining informed choice or consent

• the AOAE screening test

• AOAE – test complete including targeted follow-up

SECTION 2: equipment checks, AABR screening, referral to audiology and information governance

Expect questions on:

• equipment checks

• the AABR screening test

• the AABR screening test including referral

• information governance (IG)

There are additional questions within each theme to further check the candidate’s knowledge and understanding. Two scenario-based questions will be selected in each section to provide additional evidence of a candidate’s understanding of the screening pathway.

After the ECA

Candidates will be asked to leave the assessment after the ECA has finished while the assessors complete the NHSP ECA outcome – HSD criteria checklist. Assessors to record if the essential and HSD criteria for each theme was met or not, to score the candidate and agree the outcome.

Candidates must achieve 80% of the ‘essential’ criteria to meet the requirements for competency. Candidate will be given their results on the day.

NHSP ECA outcomes

The 2 possible outcomes are:

• competent – yes

• competent – no

If competent a certificate will be emailed to successful candidates and their local manager within 10 working days together with a completed NHSP ECA outcome – HSD criteria checklist. This will form part of the candidate’s portfolio of achievement for the HSD. The local manager will be informed of the outcome.

If not competent, the assessors will indicate on the NHSP ECA outcome – HSD criteria checklist, the themes on which the candidate requires further improvement and development and email that to them and their local manager.

Candidates assessed as not competent must book a place to repeat both sections of the ECA assessment within 3 months when they have revisited their training by:

• spending as much time as possible completing more supervised practical screening

• reviewing the themes identified where the essential criteria was not fully met and making a plan to address these

• repeating the NHSP e-Learning module and the Introduction to population screening e-Learning module to consolidate their knowledge

• having their competency assessed for AOAE, AABR and QA checks (5 more times), using the performance observation checklists

Candidate outcomes will be added to a national log maintained by the NHSP.