What medical students can learn about paediatric communication from children
In a new study, published in the journal Medical Teacher, the researchers aimed to demonstrate how children can give honest and valuable feedback on candidates’ communication skills, rather than using paediatricians to give assessments in place of children.
The research programme, carried out in partnership with Leeds Teaching Hospitals Trust and a local primary school, involved a group of healthy children aged between eight and 10 years. The children were invited to help with a particular type of student assessment, called an Objective Structured Clinical Examination (OSCE), which uses patient volunteers or simulated patients to test candidates on a range of core skills and competencies, such as communication and clinical examination. It is currently common practice to use paediatricians to give scores on behalf of child patients in these assessments.
Following the assessment, the children were asked how happy they would be to see a particular doctor again and, a few days after that, the researchers visited the school and spent some time with the children exploring, using games, what attributes they felt denoted a ‘good doctor’. The children were then asked to reflect again on the OSCE and consider why they had given candidates high or low scores. The researchers used these to build an overall picture of what types of characteristics the children valued.
Attributes rated highly included knowledgeability and confidence as well as friendliness and humour, while traits the children related to bad doctors included not paying attention, making mistakes, forgetting things and being too serious.
“The work we did showed that children do discriminate between what they perceive as ‘good’ and ‘bad’ doctors, and this is contrary to what many of our paediatrician examiners expected,” says Dr Liz Webster, of Leeds Beckett University, who was co-author on the study.
“The key question is how much weight to put on a child’s views and whether these are robust enough to form an integral part of the OSCE process,” added Dr Webster. “It’s evident, from the work we’ve done, that the children had very clear views of what they want from a doctor and these views can’t be simulated by paediatricians speaking on the children’s behalf.”
Further research by the team will explore whether the responses given by the group of healthy schoolchildren would differ from those given by young patients who are frequent hospital visitors. The researchers believe their research could be used to develop new assessment tools that would properly place greater value on the views of children in whether or not a medical student was competent in communicating and engaging with children. Such tools could also be used in other areas of medical training to help put children’s experience at the centre of paediatric care.
“Children with long term or life-limiting conditions have to go to hospitals regularly and they need a sense of ownership over what’s happening to them during a consultation,” says Dr Webster. “The work we’re doing will help students – and even experienced medical practitioners to understand how to engage with children better in this setting and give them a sense of empowerment over what is happening to them.”