The stability of maternal ratings of medical student interviews

INTRODUCTION: Little information is available on the intrarater reliability of parent ratings of medical student interview skills. The aim of this study was to compare maternal ratings of a videotaped medical student interview, with ratings by the same mother of the same interview seen a month later. METHOD: Thirty mothers rated 1 of 2 'medical student' interview videotapes (random allocation). An actor played the role of the student and demonstrated different student skill levels in each interview. Mothers rated the same interview again a month later (mean +/- SD 34 +/- 13 days). Maternal satisfaction was measured using the Medical Interview Satisfaction Scale (MISS, maximum score 203) and the Interpersonal Skills Rating Scale (IPS, maximum score 91) with higher scores indicating higher satisfaction. RESULTS: No significant differences in mean maternal ratings were observed following the first and second viewings of each interview. The average percentage difference in first and second viewing scores was MISS 4%, IPS 8% with correlation coefficients MISS 0.96, IPS 0.87 (P < 0.05). CONCLUSIONS: The high levels of stability in maternal evaluations of simulated medical student interviews supports the use of maternal evaluations for longitudinal monitoring of medical student performance.     

Medical student interviewing: a randomized trial of patient-centredness and clinical competence

BACKGROUND: It is widely accepted that the quality of doctor interviewing skills is an important determinant of health care outcomes. Two interviewing skills contributing significantly to optimal health outcomes are the clinical competence of the interviewer and the use of patient-centred techniques. However, the relative importance of these to health outcomes is unknown. OBJECTIVE: The purpose of this study was to examine the relative effect on maternal recall and satisfaction of medical student clinical competence and use of patient-centred interview techniques. METHODS: Sixty-nine mothers of children attending the Paediatric Medical Out-patient Clinic, Women's and Children's Hospital, South Australia agreed to participate in the study, with 60 successfully completing the study. They viewed two of four standardized 'medical student' interview videotapes in which the level of clinical competence and patient-centredness were varied independently. All other interview variables were controlled. Each mother rated the interviews by questionnaire (balanced incomplete block design, each interview rated by 30 mothers). Maternal satisfaction with the 'student' interview was measured using the Medical Interview Satisfaction Scale (MISS) and the Interpersonal Skills Rating Scale (IPS). Maternal recall of interview information was assessed by questionnaire, with maternal answers coded independently before analysis. RESULTS: Significant, independent effects of clinical competence and patient-centredness were observed with both MISS (F = 42.1, P < 0.0001) and IPS (F = 49.3, P < 0.0001) scores. The effect of clinical competence was stronger than that of patient-centredness. Maternal recall for specific information was greater for some items following the more clinically competent interviews, but was lower for others. There was no association between maternal recall and the level of patient-centredness demonstrated by the 'student'. CONCLUSION: Clinical competence was a more significant determinant of maternal evaluations of medical student interviews and maternal recall of information than was patient-centredness. High levels of both patient-centredness and clinical competence were associated with the highest maternal satisfaction.     

Medical student interviewing skills and mother-reported satisfaction and recall

BACKGROUND: Providing feedback to medical students about their interviewing skills is an important component of teaching programmes. There is very little information about mothers' views of medical student consultations in paediatrics, and in particular about what mothers consider to be the key elements of a successful consultation. Patient-centred interviewing is a model which emphasizes the active seeking of patient views. In association with appropriate clinical skills, it is reported to promote improved health outcomes. OBJECTIVES: To examine whether greater medical student clinical competence and more frequent use of patient-centred techniques is associated with higher maternal satisfaction, higher maternal rating of the medical student's interpersonal skills, and greater maternal recall of relevant diagnosis and treatment recommendations. METHOD: Two standardized 'medical student' videotaped interviews were created based on actual senior medical student consultations. Interview A demonstrated both higher student clinical competence and higher patient-centredness compared with interview B. Both videotaped interviews were viewed and then rated, using a questionnaire, by 11 mothers attending a teaching general practice. RESULTS: Significantly higher mean scores, indicating greater maternal satisfaction, were associated with interview A (P < 0.01 for all measures). Accurate recall for diagnosis and management was also significantly greater after interview A (mean diagnosis recall, interview A 35%, interview B 14%, P < 0.01; mean management recall, interview A 95%, interview B 57%, P < 0.01). CONCLUSIONS: Maternal satisfaction and recall were higher following a more clinically competent and patient-centred medical student interview. Maternal ratings of student interviews could be used as an additional method of assessment as well as providing feedback to medical students on their interview skills development.     

Early identification of 'at-risk' students by the parents of paediatric patients

INTRODUCTION: Assessment of medical student clinical skills is best carried out using multiple assessment methods. A programme was developed to obtain parent evaluations of medical student paediatric interview skills for feedback and to identify students at risk of poor performance in summative assessments. METHOD: A total of 130 parent evaluations were obtained for 67 students (parent participation 72%, student participation 58%). Parents completed a 13-item questionnaire [Interpersonal Skills Rating Scale (IPS) maximum score 91, higher scores = higher student skill level]. Students received their individual parent scores and de-identified class mean scores as feedback, and participants were surveyed regarding the programme. Parent evaluation scores were compared with student performance in formative and summative faculty assessments of clinical interview skills. RESULTS: Parents supported the programme and participating students valued parent feedback. Students with a parent score that was less than 1 standard deviation (SD) below the class mean (low IPS score students) obtained lower faculty summative assessment scores than did other students (mean +/- SD, 59% +/- 5 versus 64% +/- 7; P < 0.05). Obtaining 1 low IPS score was associated with a subsequent faculty summative assessment score below the class mean (sensitivity 0.38, specificity 0.88). Parent evaluations combined with faculty formative assessments identified 50% of students who subsequently performed below the class mean in summative assessments. CONCLUSIONS: Parent evaluations provided useful feedback to students and identified 1 group of students at increased risk of weaker performance in summative assessments. They could be combined with other methods of formative assessment to enhance screening procedures for clinically weak students.     

Psychological adjustment in children with end stage renal disease: the impact of maternal stress and coping

OBJECTIVE: To explore maternal and child perspectives on children's adjustment in the context of paediatric renal disease, and maternal psychological variables that may account for variance in child and maternal ratings. METHODS: Forty-three children with end stage renal disease and their maternal caregivers completed the Strengths and Difficulties Questionnaire (SDQ). Mothers also reported on their own mental health, and the strategies they used to cope with their child's illness.The severity of the child's condition was rated independently by a renal clinician. RESULTS: Compared with normative data for the SDQ mothers reported their children to be at increased risk of psychological problems. However, the children themselves reported no more problems than a normative sample. Mothers' coping and mental health explained some of the variance in their ratings of the child's adjustment but were not predictive of the children's self-ratings. CONCLUSIONS: The results suggest that maternal factors may not explain the variability in children's adjustment to chronic illness, perhaps especially within the age range studied here. Practical implications of the data are also discussed. In particular, a systemic approach to paediatric liaison by psychologists is emphasized.     

Maternal styles of talking about child feeding across sociodemographic groups

This study sought to identify maternal styles of talking about child feeding from a semistructured interview and to evaluate associated maternal and child characteristics. Mothers of preschool-aged children (n=133) of diverse race/ethnicity and socioeconomic status (SES) (45 lower SES black, 29 lower SES white, 32 lower SES Hispanic, 15 middle to upper SES white, and 12 middle to upper SES Asian) participated in a semistructured interview about feeding. Interviews were audiotaped and transcribed. Themes were identified, and individual interviews were coded within these themes: authority (high/low), confidence (confident/conflicted/unopinionated), and investment (deep/mild/removed). Demographic characteristics were collected and a subset of children had measured weights and heights. Cluster analysis was used to identify narrative styles. Participant characteristics were compared across clusters using Fisher's exact test and analysis of variance. Six narrative styles were identified: Easy-Going, Practical No-Nonsense, Disengaged, Effortful No-Nonsense, Indulgent Worry, and Conflicted Control. Cluster membership differed significantly based on maternal demographic group (P<0.001) and child weight status (P<0.05). More than half (60%) of children of mothers in the Conflicted Control cluster were obese. Maternal styles of talking about feeding are associated with maternal and child characteristics.     

Maternal self-efficacy and maternal perception of child language competence in pre-school children with a communication disability

BACKGROUND: The aim of this study was to describe maternal self-efficacy beliefs within the parenting domain and maternal ratings of pre-school children's language abilities, where the child has a communication disability. The association between these two constructs was also investigated. METHOD: Twenty-five mothers completed a questionnaire consisting of two subsections: parental self-efficacy and maternal rating of child language ability. Convenience sampling was used, and mothers with children attending four special-education schools in the Pretoria area consented to participate in the study. RESULTS: The results revealed that mothers generally had high self-efficacy beliefs within certain parenting roles, in spite of the fact that their child has a communication disability. The lowest competence was reported in discipline and teaching roles. In addition, mothers' reports of patterns of child ability correlated with what has been written in the literature. Correlation statistics generally revealed weak association between the constructs, with the strongest association between the parental domain of discipline and maternal reports of their child's receptive language abilities. CONCLUSIONS: Possible reasons for the weak correlation values are proposed. These include factors that may alter the way parents of children with disabilities construct and maintain self-efficacy beliefs; as well as the fact that the two sections of the questionnaire measure maternal appraisals at two very different levels (objective observations and evaluative self-regulatory processes).     

The determinants of negative maternal parenting behaviours: maternal,child, and paternal characteristics and their interaction

This study tested Belsky's determinants of parenting, namely maternal characteristics, child characteristics, and contextual issues, namely the mother's perception of the husband as a father, husband, and person. Three hundred and seventy-nine mothers first investigated by Sears, Maccoby, and Levin completed a standardised interview to assess their parenting attitudes and behaviours, as well as their five-year-old child's (202 boys, 177 girls) behaviours. Rejecting mothers had lower maternal self-esteem and higher academic expectations of their children, who showed less conscience and less similarity to the mother, and perceived their husbands as being colder towards the child. Furthermore, mothers with low self-esteem were more rejecting of girls with a difficult temperament, but less rejecting of boys with a difficult temperament. Controlling mothers were more educated and had higher academic expectations for their children, while their children were less likely to dominate their relationship, but only in mothers with low maternal self-esteem. Results partially support Belsky's model of the determinants of parenting.     

Communication Skills Training and Patients' Satisfaction

Effective physician-patient encounters require the doctor to have consulting skills that facilitate communication flow. When adequate communication does not occur, patients express dissatisfaction with their medical interactions. Many medical students show interview behaviors that may not contribute to patients' satisfaction. Poor communication skills reduce the reliability of elicited medical information and lead to reduced satisfaction for both patients and students. In the present study, a communication skills training course was evaluated using ratings of students' videotaped history-taking interviews with patients and patients' satisfaction ratings. Trained students showed significantly improved consultation skills and techniques compared with a group of control students who displayed few changes in behavior over the course of the study. Satisfaction ratings given by patients of students improved significantly after training, whereas ratings given by patients of control group students decreased over the same period.     

Disordered eating among preadolescent boys and girls: the relationship with child and maternal variables

Objective: (i) To analyze the eating behaviors and body satisfaction of boys and girls and to examine their mothers’ perceptions of these two domains; and (ii) to evaluate eating problem predictors using child body mass index (BMI), self-esteem, and body satisfaction as well as maternal BMI, eating problems, and satisfaction with their child’s body. The participants included 111 children (54.1% girls aged between 9 and 12 years old) and their mothers. Assessment measures included the Child Eating Attitude Test, the Self-Perception Profile for Children, the Eating Disorders Questionnaire, and the Child Eating Behavior Questionnaire. Child and maternal measures also included BMI and Collins Figure Drawings. Results: (i) No association between child and maternal BMI for either sex was found; (ii) no difference was found between boys and girls with regard to eating behavior; (iii) most children revealed a preference for an ideal body image over their actual body image; (iv) most mothers preferred thinner bodies for their children; (v) greater BMI was related to higher body dissatisfaction; and (vi) child BMI and dissatisfaction with body image predicted eating disturbances in boys, whereas self-esteem, maternal BMI, and eating behavior predicted them in girls. Discussion: Maternal eating problems and BMI were related to female eating problems only.     

Predictors of maternal child-feeding style: maternal and child characteristics

We investigated relationships among maternal and child characteristics, and two aspects of maternal child-feeding styles that may place daughters at risk for developing problems with energy balance. Participants included 104 overweight (BMI> or =25) and 92 non-overweight (BMI<25) mothers and their 5-year-old, non-Hispanic, White daughters. Child-feeding styles included (a) restriction of daughters' intake of energy-dense snack food, and (b) pressure to eat more food. Predictors of child-feeding styles included measures of (1) maternal investment in weight and eating issues, including dietary restraint and weight concern, (2) child adiposity, (3) maternal perceptions of the child as underweight or overweight, and (4) maternal concern for child weight. Mothers reported using more restrictive feeding practices when they were invested in weight and eating issues, when they perceived daughters as overweight, when they were concerned about daughters' weight, and when daughters were heavier. Mothers reported using more pressure in child feeding when daughters were thinner, and when mothers perceived daughters as underweight. Further analyses examined whether relationships among child-feeding styles were different for overweight and non-overweight mothers. Overweight mothers' child-feeding styles appeared to be influenced by observable child weight characteristics, concerns for the child's weight status, and mothers' own history of overweight. Non-overweight mothers' child-feeding styles appeared to be influenced by distorted perceptions of and concerns for children, as well as distorted self-perceptions.     

Child involvement in the paediatric consultation: a qualitative study of children and carers' views

Background This study aimed to investigate child and carers' attitudes towards child involvement in paediatric consultations. Methods Semi‐structured qualitative interviews explored child and carers' attitudes towards child involvement at different stages of the paediatric consultation process. Twenty families (21 children, 17 mothers and 5 fathers) were interviewed following a paediatric (index) consultation in two UK paediatric inpatient and outpatient departments. Results All but one family felt the child should be involved at some stage of the consultation process but the desired extent and nature of involvement depended on child, family and illness characteristics, as well as on the stages of the consultation. During history gathering, some parents and children felt it was the decision and responsibility of the parent to facilitate communication between the child and the doctor. Others expected the doctor to decide when and how to facilitate this process. At diagnosis the desired amount of information given to the child increased with increasing maturity in the child. Some felt making a diagnosis should be a collaborative process; others felt it was solely the domain of the doctor. In discussing and making a treatment plan, some children wanted to be given the choice of being involved and some wanted their parents to be responsible for implementing the plan. Some families with a seriously ill child, however, wanted the burden of involvement in the management plan taken away from them. Conclusions Families vary in their views about involvement of children in paediatric consultations in a way that may be unique to each child, family and illness. Moreover, different views were expressed about involvement in each stage of the consultative process and in management of the child's health. The challenge for doctors is to determine the level of involvement and information exchange favoured by a particular parent and child. Good practice recommendations emerging from the analysis are described.     

Association of maternal prenatal depressive symptoms with child cognition at age 3 years

Tse AC, Rich‐Edwards JW, Rifas‐Shiman SL, Gillman MW, Oken E. Association of maternal prenatal depressive symptoms with child cognition at age 3 years. Paediatric and Perinatal Epidemiology 2010; 24 : 232–240. We examined the association of prenatal depressive symptoms at mid‐pregnancy with child cognition at age 3 years in Project Viva, a pre‐birth cohort study of 1030 mother–child pairs in eastern Massachusetts. We measured maternal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS), a self‐report measure validated for use during pregnancy. Measures of child cognition included the Peabody Picture Vocabulary Test (PPVT) and the Wide Range Achievement of Visual Motor Abilities (WRAVMA). At mid‐pregnancy, 81 mothers (7.9%) scored 13 or above on the EPDS, indicating probable depression. In the unadjusted model, children born to mothers with prenatal depressive symptoms had PPVT scores that were 3.8 points lower [95% confidence interval (CI) ?7.1, ?0.5]. With adjustment for sociodemographic variables, the association substantially attenuated [adjusted regression coefficient b for PPVT score = ?0.7 (95% CI ?3.6, 2.3)]. In both unadjusted and multivariable models, prenatal depressive symptoms were not associated with WRAVMA scores [adjusted b for total WRAVMA score = ?0.5 (95% CI ?3.0, 2.1)]. We found no evidence to suggest that maternal prenatal depression is independently associated with early child cognition.     

Paediatricians' attitudes about discussing maternal depression during a paediatric primary care visit

OBJECTIVES: To assess paediatricians' beliefs about discussing maternal depressive symptoms during a paediatric visit, and methods paediatricians use to identify mothers with depressive symptoms. METHODS: In-depth telephone interviews were conducted with 23 primary care paediatricians from a practice-based research network. We asked a series of previously developed questions about discussing maternal depressive symptoms during a paediatric visit; methods used to identify mothers at risk; barriers encountered, and potential strategies to improve recognition and treatment of maternal depression. Interviews were audiotaped and transcribed. Data were codified and analysed using standard qualitative data techniques. RESULTS: All paediatricians agreed that it is appropriate to ask mothers about their own health during a well-child visit, because a mother's well-being affects her children. Paediatricians relied on observational cues to identify a mother with depressive symptoms, especially mother-child interactions. Few used direct questions or a checklist. Almost all paediatricians felt that lack of time was the barrier most often faced in addressing maternal depression. Lack of training, inadequate knowledge of resources and distractions encountered in the primary care setting were additional barriers cited. One-third of paediatricians acknowledged the fear of judgement and stigma that a mother may face when discussing maternal stresses. Paediatricians desired better ability to refer mothers to social workers for help. CONCLUSIONS: Observational cues are used more often than direct questions or screening tools to identify mothers at risk of depression. This may under-identify mothers at risk. Paediatricians prefer to rely on other professionals, particularly social services, to address maternal depression, yet mothers may be hesitant or ambivalent about such assistance because of fear of judgement. Paediatricians, in fact, may be the professional mothers most want to communicate with. Thus, appreciation of mothers' perspectives, empathetic communication skills and knowledge of community resources can enhance paediatricians' abilities to assist mothers at risk for depression.     

Linkages between maternal education and childhood immunization in India

While correlations between maternal education and child health have been observed in diverse parts of the world, the causal pathways explaining how maternal education improves child health remain far from clear. Using data from the nationally representative India Human Development Survey of 2004-5, this analysis examines four possible pathways that may mediate the influence of maternal education on childhood immunization: greater human, social, and cultural capitals and more autonomy within the household. Data from 5287 households in India show the familiar positive relationship between maternal education and childhood immunization even after extensive controls for socio-demographic characteristics and village- and neighborhood-fixed effects. Two pathways are important: human capital (health knowledge) is an especially important advantage for mothers with primary education, and cultural capital (communication skills) is important for mothers with some secondary education and beyond.     

应用母婴床旁护理模式的效果

目的:探讨母婴床旁护理模式对产妇及家属的影响,以指导产科护理工作。方法:将120对产妇分为实验组及对照组各60对,对照组按传统护理模式护理,而实验组实施母婴床旁护理模式(各项护理操作及健康教育由专科护士在床旁完成)。出院前统计两组产妇健康教育知识、护理技能掌握情况,调查产妇及家属对护理工作的满意度。结果:实验组产妇健康教育知识达标率及新生儿护理技能掌握情况均明显优于对照组,差异有统计学意义(p<0.05);实验组产妇及家属对护理工作满意度也明显高于对照组(P<0.05)。结论:采用母婴床旁护理模式可以提高护理工作满意度及护理工作质量,同时让产妇、家属掌握母婴保健知识与保健技能,提高了母婴生活质量。     

Determinants of controllable in-home child safety hazards

Interviews with 230 mothers of young children (less than 5 yearsof age) were used to observe hazards in the home that parentscould control. Factors indicative of informational, stress andcoping, and parenting deficits on the part of mothers are majorexplanatory groups of variables in the prediction of controllablehazards in the home. Additional self-report measures includedchild's previous injury experience, and sociodemographic andsocioeconomic indicators. The most important predictors of controllablehome hazards were socioeconomic status, housing repair, perceivedrisks (informational deficits), maternal social support (deficitsin handling stress) and maternal supervision (parenting deficits).Findings suggest that educational programs on child injury controldirected at parents need to incorporate parenting skills educationas well as child development components.     

妇幼卫生专业毕业生反馈信息分析

目的：通过对毕业生追踪调查的反馈信息分析当前我校妇幼卫生专业教育现状,以期进一步优化专业教育,提高本专业毕业生的综合素质。方法：对安徽医科大学妇幼卫生专业2003年-2007年毕业生进行信函问卷调查,内窬包括基本情况、自我评价、对教学情况和课程设置的评价等。结果：该校妇幼卫生专业毕业生自评心理素质、自学能力、观察分析能力、独立工作能力、现场工作能力、保健动手能力、实际解决问题能力、语言表达能力、社会交往能力、工作适应能力、人际关系等方面评价较好（所有的评价均在一般以上水平）;而在临床动手能力、开拓创新能力、科研能力、组织管理能力、论文写作能力等方面有4．8％～23．8％的毕业生评价较弱;对教学过程中教学环境评价较好,对师资力量评价有待提高,对技能培训及实习情况不满意率较高。结论：应针对本专业的培养目标及存在的不足之处,加强教学改革,提高妇幼卫生毕业生的适应能力,满足社会的需求。     

Family day care and day care centres: Carer, family and child differences and their implications

The present study investigated child, maternal and caregiver characteristics in two day care settings, the independent contributions of these characteristics to children's adjustment to day care, and the utility of a goodness-of-fit framework as a means of assessing the impact of parent-caregiver differences on children's adjustment. Eight measures were used to assess child behavioural problems, maternal satisfaction with care, child temperament, maternal and caregiver child rearing practices, developmental timetables, day care goals, and demographic background. The study found strong support for the existence of differences between mothers choosing different types of care, between caregivers in these two settings, and between mothers and caregivers; and for the linkage between child, maternal and caregiver characteristics and child adjustment. However, the impact of goodness-of-fit between mothers and caregivers on children's adjustment to day care was not supported.