Residents' asthma communication skills in announced versus unannounced standardized patient exercises.

OBJECTIVE: The aim of this study was to test the hypothesis that pediatric residents would display similar levels of asthma interpersonal and communication skills in announced versus unannounced adolescent standardized patient (SP) encounters. METHODS: We conducted a prospective repeat measures experimental study at a pediatric residency program at an inner-city children's hospital. A cohort of residents (N = 18) was subjected at random to 3 SP exercises: announced and being directly observed by faculty, announced and not observed by faculty, and unannounced and unobserved. Six adolescent SPs were trained to complete checklists that included items like asthma daytime and nighttime symptoms, exercise-induced symptoms, triggers, and asthma education. For the unannounced exercises, SPs were inserted into residents' regularly scheduled clinics. Standardized patients rated residents immediately following each exercise. Residents were rated by faculty following the observed encounter. Faculty rating validated SP ratings on the observed encounter. Differences in proportions of categorical variables were tested by chi-square analyses. RESULTS: Fifty-four resident-SP encounters were analyzed. Residents consistently displayed significantly lower levels of desired behaviors in interpersonal and communication skills in the unannounced SP encounters on 10 of 14 checklist items. For example, residents asked about exercise-induced symptoms 90% of the time in announced/observed encounters versus 95% in announced/unobserved encounters versus 72% in unannounced/unobserved encounters (P = .001). There were no significant differences in residents' behaviors in the announced SP exercises (whether observed or unobserved). CONCLUSION: In this study, residents demonstrated lower levels of asthma communication skills during unannounced SP exercises. By using unannounced SPs, we were able to assess residents' interpersonal and communication skills in real clinical settings.     

The feasibility of implementing a communication skills training course in pediatric hematology/oncology fellowship

Communication skills are a competency highlighted by the Accreditation Council on Graduate Medical Education; yet, little is known about the frequency with which trainees receive formal training or what programs are willing to invest. We sought to answer this question and designed a program to address identified barriers. We surveyed pediatric fellowship program directors from all disciplines and, separately, pediatric hematology/oncology fellowship program directors to determine current use of formal communication skills training. At our institution, we piloted a standardized patient (SP)-based communication skills training program for pediatric hematology/oncology fellows. Twenty-seven pediatric hematology/oncology program directors and 44 pediatric program directors participated in the survey, of which 56% and 48%, respectively, reported having an established, formal communication skills training course. Multiple barriers to implementation of a communication skills course were identified, most notably time and cost. In the pilot program, 13 pediatric hematology/oncology fellows have participated, and 9 have completed all 3 years of training. Precourse assessment demonstrated fellows had limited comfort in various areas of communication. Following course completion, there was a significant increase in self-reported comfort and/or skill level in such areas of communication, including discussing a new diagnosis (p =.0004), telling a patient they are going to die (p =.005), discussing recurrent disease (p <.001), communicating a poor prognosis (p =.002), or responding to anger (p ≤.001). We have designed a concise communication skills training program, which addresses identified barriers and can feasibly be implemented in pediatric hematology/oncology fellowship.     

Adolescent medicine: attitudes and skills of pediatric and medical residents

Adolescents receive care from different specialists whose training may affect the quality of care. To measure possible effects, all 80 level 1 and 3 pediatric and medical residents at one institution completed a questionnaire that asked if they planned to care for adolescents and determined their attitudes and skills for 30 relevant tasks. The mean age chosen for transfer of care from a pediatrician to an internist was 18.7 years by the pediatric residents and 16.6 years by the medical residents (P = .00001). Skill in obtaining histories; staging puberty; screening for scoliosis; performing pelvic examinations; diagnosing delayed puberty, psychiatric disorders, or learning disabilities; immunizing; and treating knee and hip pain more often were thought to be important by pediatric residents (88% to 100%) than by medical residents (40% to 75%) (P less than .02). More than 70% of PL-3 but fewer than 50% of ML-3 residents rated themselves skilled for these tasks (P less than .05). Fewer than 60% of each resident group rated themselves skilled in contraception. Both groups rated themselves underskilled in adolescent history-taking; counseling; evaluation of psychopathology; and treatment of dysmenorrhea and hypertension. In both groups, the decision to care for an adolescent was negatively influenced by the presence of a psychosocial disorder. In conclusion, both pediatric and medical residents plan to care for adolescents, and both recognize deficiencies in their training. Pediatric residents, however, are more confident of their skills in adolescent care than are medical residents.     

Teaching Death Disclosure: A Mixed-Method Comparison of Resident Self-Assessment and Standardized Patient Assessment

ObjectiveTo characterize how pediatric resident self-evaluation compares to standardized patient evaluations in simulated child death disclosure scenarios.MethodsThis was a prospective, observational, mixed-methods study in which 18 second-year pediatric residents delivered the news of a death of a child to a trained standardized patient (SP) couple. The SPs evaluated residents via a quantitative global rating (1–3 scale) and via qualitative comments. Following the training, the residents completed self-assessments consisting of a global rating, qualitative comments, and their confidence related to 5 death disclosure skills.ResultsAgreement between SPs and resident ratings was poor; resident scores were compared to each of their 2 SP evaluators yielding Kappa coefficients of −0.23 (95% confidence interval = −0.60 to −0.07) and −0.30 (95% confidence interval = −0.70 to −0.04). Residents uniformly rated themselves as less capable in their communication skills than SPs did. Residents reported significant increases in their confidence in discussing autopsy and organ donation. Major themes determined from the qualitative comments from SPs included nonverbal communication, verbal communication, attunement to parents, and management of next steps. Residents’ comments mirrored these themes with the exception of the absence of nonverbal communication.ConclusionsPediatric residents underestimated their abilities in a self-assessment of their performance in a SP death disclosure scenario, demonstrating the importance of external feedback, particularly from SPs themselves. Based on SP feedback, future death disclosure trainings should emphasize nonverbal communication skills and specific behaviors that convey effective attunement to families.     

Simulated parents: Developing paediatric trainees' skills in giving bad news

Aim:   In curriculum documents for medicine in undergraduate, post-graduate and continuing professional development, there is now a focus on communication skills. The challenges are to place communication skills in the crowded curriculum and then to construct and sustain a programme that uses an evidence-based approach to the teaching and learning of communication skills. For 6 years, we have conducted a programme that involves simulated parents supporting junior medical staff to refine their skills in communication, particularly in giving parents bad news. The aim of our study was to obtain a better understanding of the trainees' experiences of the programme.
Methods:   Nine junior residents individually worked through two scenarios and received feedback from the simulated parent. They gave bad news to a simulated parent/actor who then gave feedback. A recording of the simulation was provided for discussion with a designated colleague at an arranged time. The tapes were then separately appraised by two independent raters – another actor and a paediatrician. Brief written reports and conducted semi-structured interviews provided more insights into the trainees' experience of the simulation. Other participating medical/medical education staff were interviewed about the simulation programme.
Results:   Five themes emerged from the qualitative data: timeliness, emotional safety, the complexity of communication, practical usefulness and the challenge of effecting change. In addition, the ratings of the videos helped to clarify those 'parent-centred' communication skills that trainees may neglect in difficult conversations: 'ask about support', 'encourage the parent to ask questions' and 'repeat key messages'.
Conclusion:   The evaluation highlighted the value of an early-career experiential programme to highlight the importance of communication skills in post-graduate paediatrics practice.     

A pediatric clinical skills assessment using children as standardized patients.

OBJECTIVES: To develop and implement a pediatric clinical skills assessment (PCSA) for residents, using children as standardized patients (SPs); to assess the psychometric adequacy of the PCSA and use it to evaluate the performance of residents; and to evaluate the feasibility of using child SPs and the response of the residents and the child SPs to participation in the PCSA. METHODS: Ten 22-minute complete patient encounters were developed, 7 with child SPs. Fifty-six residents (10 second-year pediatric residents, 29 first-year pediatric residents, and 17 first-year family practice residents) were evaluated on the following clinical skills: history taking, physical examination, interpersonal skills, and documentation and interpretation of clinical data/patient note. MAIN OUTCOME MEASURES: Patient encounter checklists, focus groups, and questionnaires. RESULTS: Average skill scores for the 56 residents were 68% (SD, 12%) for history taking, 56% (SD, 26%) for physical examination, 46% (SD, 12%) for patient note, and 68% (SD, 16%) for interpersonal skills. Second-year pediatric residents scored significantly higher on history taking than first-year pediatric and first-year family practice residents; first-year pediatric residents scored significantly higher on interpersonal skills than second-year pediatric and first-year family practice residents; and first- and second-year pediatric residents scored significantly higher on the patient note component than first-year family practice residents. All differences noted were significant at P<.05. There were no significant differences on physical examination between the groups. Reliabilities were 0.69 for history taking, 0.64 for physical examination, 0.76 for interpersonal skills, and 0.81 for the patient note component. On a Likert scale (5 indicates high; 1, low), residents rated the PCSA 3.9 for realism, 4.1 for challenge, 3.1 for enjoyment, and 2.9 for fairness. Child SPs found the experience positive. No negative effects on the children were identified by their real parents or their SP parents. CONCLUSIONS: Our development method gives content validity to our PCSA, and resident scores give indication of PCSA construct validity. Reliabilities are in the acceptable range. Residents found the PCSA challenging and realistic but less than enjoyable and fair. Use of child SPs is feasible. Resident performance scores were low relative to the performance criteria of the PCSA development group. The adequacy of clinical skills teaching and assessment in residency programs needs to be reviewed. Deficits in specific skills and overall performance of residents identified by a PCSA could be used to guide individual remediation and curricular change.     

RADPED: an approach to teaching communication skills to radiology residents

Background: The Accreditation Council for Graduate Medical Education mandates that radiology residency programs teach communication skills to residents. Objective: The purpose of this paper is to present a mnemonic, RADPED, that can be used to enhance communication in the radiology setting. It reminds the resident of the salient points to address during an imaging encounter with pediatric patients and their families for the purpose of enhancing communication. Materials and methods: Recent history and research in medical communication are reviewed. Various communication guides used by primary care physicians, such as SEGUE, and the Kalamazoo consensus statement are discussed. This methodology was adapted into a format that could be used to teach communication skills to radiology residents in the context of an imaging encounter. Results: RADPED reminds the resident to establish rapport with the patient, ask questions as to why the patient and family are presenting for the study, discuss the exam, perform the procedure, use exam distractions, and discuss the results with the referring physician and family when appropriate. This guide is available with movie clips as part of an on-line pediatric radiology curriculum, . Summary: This simple memory aid promotes the key points necessary to optimize the radiology residents encounter with pediatric patients and their families.This paper was presented at the Society for Pediatric Radiology 46th annual meeting in San Francisco, California, 7–10 May 2003.     

Effect of multisource feedback on resident communication skills and professionalism: a randomized controlled trial

OBJECTIVE: To determine whether augmenting standard feedback on resident performance with a multisource feedback intervention improved pediatric resident communication skills and professionalism. DESIGN: Randomized controlled trial. SETTING: Children's Hospital Medical Center, Cincinnati, Ohio, from June 21, 2004, to July 7, 2005. PARTICIPANTS: Thirty-six first-year pediatric residents. INTERVENTIONS: Residents assigned to the multisource feedback group (n = 18) completed a self-assessment, received a feedback report about baseline parent and nurse evaluations, and participated in a tailored coaching session in addition to receiving standard feedback. Residents in the control group (n = 18) received standard feedback only. The control group and their residency directors were blinded to parent and nurse evaluations until the end of the study. MAIN OUTCOME MEASURES: Residents' specific communication skills and professional behaviors were rated by parents and nurses of pediatric patients. Both groups were evaluated at baseline and after 5 months. Scores were calculated on each item as percentage in the highest response category. RESULTS: Both groups had comparable baseline characteristics and ratings. Parent ratings increased for both groups. While parent ratings increased more for the multisource feedback group, differences between groups were not statistically significant. In contrast, nurse ratings increased for the multisource feedback group and decreased for the control group. The difference in change between groups was statistically significant for communicating effectively with the patient and family (35%; 95% confidence interval, 11.0%-58.0%), timeliness of completing tasks (30%; 95% confidence interval, 7.9%-53.0%), and demonstrating responsibility and accountability (26%; 95% confidence interval, 2.9%-49.0%). CONCLUSION: A multisource feedback intervention positively affected communication skills and professional behavior among pediatric residents.     

Assessing pediatric senior residents' training in resuscitation: fund of knowledge, technical skills, and perception of confidence

OBJECTIVE: To describe pediatric housestaff knowledge, experience, confidence in pediatric resuscitations and their ability to perform important resuscitation procedures during the usual training experience. DESIGN AND PARTICIPANTS: Cohort study of PGY-3 level residents in a ACGME accredited pediatric residency training program at a large, tertiary care children's hospital. METHODS: Fund of knowledge was assessed by administering the standardized test from the Pediatric Advanced Life Support (PALS) Course in addition to a supplemental short answer test requiring clinical problem-solving skills. Procedural skills were evaluated through observation of the resident performing four procedures during a skills workshop using a weighted step-wise grading sheet. Resident experience and confidence was quantified using an anonymous survey. RESULTS: Ninety-seven percent of residents participated. Residents achieved high scores on the standardized PALS test (93.2%+/-5.5), but performed less well when answering more complicated questions (60.0%+/-9.9) on the short answer test. No resident was able to successfully perform both basic and advanced airway skills, and only 11% successfully completed both vascular skills. Although residents were overall confident in their resuscitation skills, performance in the skill workshop revealed significant deficits. For example, only 18% performed ancillary airway maneuvers properly. None of the residents performed all four skills correctly. Experience in both real and mock resuscitations was infrequent. Residents reported receiving feedback on their performance less than half of the time. Over 89% of them felt that resuscitation knowledge and skill were important for their future chosen career. CONCLUSION: Pediatric residents infrequently lead or participate in real or mock resuscitations. Although confident in performing many of the necessary resuscitation skills, few residents performed critical components of these skills correctly. Current pediatric residency training may not provide sufficient experience to develop adequate skills, fund of knowledge, or confidence needed for resuscitation.     

A comparison of the radiographic interpretation skills of pediatric transport nurses and pediatric residents

OBJECTIVE: To compare the radiograph interpretation skills of pediatric/neonatal transport nurses to those of 3rd-year pediatric residents. DESIGN: A validation study of radiograph interpretation. METHODS: Twelve pediatric transport nurses and nine senior pediatric residents were asked to interpret 20 radiographs or sets of radiographs. These films had been previously selected and interpreted by a panel of pediatric radiologists. The subjects' interpretations were compared with those of the radiologists, and a score was assigned for each film or set of films. Five points were awarded for an interpretation in complete agreement with the radiologists' interpretation; 2.5 points were awarded for partial agreement. No points were awarded for complete disagreement. Subjects also answered questions about prior training and experience in radiograph interpretation. RESULTS: The 3rd-year residents' mean score was 66.34 (range 57.5-82.5), while the nurses had a mean score of 33.75 (range 17.5-47.5). This difference was significant (P < 0.001). The residents had a mean of 133.33 of formal radiology instruction, while the nurses had less than 10 hours of instruction. The nurses had received focused training in the identification of pneumothoraces. The nurses had higher mean scores than the residents on the two sets of films demonstrating pneumothoraces, but this difference was not significant. CONCLUSIONS: The 3rd-year residents had significantly higher mean scores on a test of radiograph interpretation. The major difference between the groups appears to be the amount of formal training afforded the residents. The nurses' performance on the films demonstrating pneumothoraces suggests that focused training may be an effective means by which to gain skills important to transport.     

Primary Palliative Care for Pediatric Residents: A Curricular Framework and Pilot

ProblemPalliative care (PC) is high-value, holistic care for a child and their family across the entire arc of an illness. All physicians should be competent in symptom management and providing goal-concordant care that acknowledges the quality of life; however, there is insufficient education in pediatric residency to develop competence in basic or ..úPrimary..Ñ PC.ApproachWe completed a needs assessment and developed a longitudinal, comprehensive, and integrated primary PC curriculum for pediatric residents with the goal of developing foundational primary PC skills regardless of eventual career trajectory. After 1 year of implementation, we assessed resident comfort with primary PC skills via a retrospective pre-post survey.OutcomesWe found a statistically significant (P.ß<.ß.05) increase in residents... comfort with pain management, delivering serious news, and discussing goals of care. An increase in comfort with the management of other symptoms was not statistically significant.Next StepsAfter 1 year of implementation, residents describe an increase in comfort with primary PC skills. The next steps include more rigorous evaluation and expansion to include more education in medical ethics. While the educational need is universal, resident needs are constantly evolving and each institution should tailor this curriculum to fit their specific trainee needs and institutional expertise.     

How to break bad news

Breaking bad news is never easy. There is no right way to do it. However, it is a vitally important communication skill which we should be helping our juniors to learn. In the past, we have all tended to learn by experience and there has been little or no formal training in this important area. While there is no substitute for experience, we highlight features of good practice in the way we communicate with our patients. We also identify common faults in the breaking of bad news.     

Improvement of cardiac auscultation skills in pediatric residents with training

Cardiac murmurs, most of which are harmless, are present in more than 50% of children. Good auscultation skills are required to prevent unnecessary referrals. The auscultation skills of a group of 21 pediatric residents were assessed. Based on their identification of key features such as S1, S2, timing, grade, location, quality of the murmur, and any extra sounds, residents were asked to make a clinical diagnosis. The overall diagnostic accuracy for all residents was 30% and improved with years of training. The average score for correctly identified key features was 46% with no significant improvement with year of training. Residents who had completed a cardiology rotation scored better than the others (41% vs 18% for correct diagnosis). Clinical auscultation skills of pediatric residents in our institution showed significant improvement with training, especially in the ability to recognize a harmless heart murmur.     

Pediatric resident education about medical errors.

BACKGROUND: National organizations have called for patient safety curricula to help reduce the incidence of errors. Little is known about what trainees are taught about medical errors. OBJECTIVE: 1) To determine the amount and type of training that pediatric residents have about medical errors and 2) to assess pediatric chief resident knowledge about medical errors. METHODS: We surveyed chief residents from a national sample of 51 pediatric training programs by selecting every fourth program from the American Council on Graduate Medical Education list of accredited programs. The 21-item telephone survey was developed with patient safety specialists and piloted on several chief residents. It asked about patient-safety training sessions and awareness and knowledge about medical errors. RESULTS: The 51 chief residents helped teach 2176 residents, approximately one third of all pediatric residents. One third of programs had no lectures about medical errors and 23% did not have morbidity and mortality rounds. Sixty-one percent of respondents stated that outpatient medical errors were rarely discussed. Informal teaching was most often reported as the primary method for educating residents about medical errors. Although 58% of respondents did not know that a systemic change should be made in response to a medical error, 83% felt that residents are adequately trained to deal with a medical error. DISCUSSION: Pediatric resident education about medical errors varies widely. Attention by pediatric residency training programs to this important issue seems limited.     

Pediatric resident confidence in resuscitation skills relates to mock code experience

To assess confidence in resuscitation skills among pediatric residents and its relationship to training and experience, all pediatric residents at one institution were surveyed regarding their confidence in technical and leadership resuscitation skills and their prior experience with real and mock codes. Respondents (61/82, 74%) reported participation in 4.9 +/- 3.6 mock and 3.9 +/- 5.0 real codes. Confidence score for all skills was 2.7 +/- 0.6 (scale 1-5). Senior residents were more confident than interns (2.8 +/- 0.5 vs 2.3 +/- 0.5). Residents were more confident in basic (3.9 +/- 0.6) than in advanced (2.6 +/- 0.6) or expert resuscitation skills (1.6 +/- 0.7). Confidence correlated with mock codes (r = 0.52) and to a lesser degree with real codes attended (r = 0.36). Performance of active roles and debriefing occurred more commonly with mock than with real codes. The data indicate that pediatric residents have limited confidence in resuscitation skills and that mock code training with active participation and debriefing may be an effective educational tool.     

Observation of resident clinical skills: outcomes of a program of direct observation in the continuity clinic setting

ObjectiveTo assess the feasibility of a new multi-institutional program of direct observation and report what faculty observed and the feedback they provided.MethodsA program of direct observation of real patient encounters was implemented in 3 pediatric residency programs using a structured clinical observation (SCO) form to document what was observed and the feedback given. Outcome variables included the number of observations made, the nature of the feedback provided, resident attitudes about direct observation before and after implementation, and the response of the faculty.ResultsSeventy-nine preceptors and 145 residents participated; 320 SCO forms were completed. Faculty provided feedback in 4 areas: content, process of the encounter, patient-centered attitudes and behaviors, and interpersonal skills. Feedback was 85% specific and 41% corrective. Corrective feedback was most frequent for physical examination skills. After program implementation, residents reported an increase in feedback and a decrease in discomfort with direct observation; in addition, they agreed that direct observation was a valuable component of their education. Participation rates among faculty were high.ConclusionsDirect observation using SCOs results in timely and specific feedback to residents about behaviors rarely observed in traditional precepting models. Resident competency in these clinical skill domains is critical for assessing, diagnosing, and managing patients. The SCO methodology is a feasible way to provide formative feedback to residents about their clinical skills.     

Teaching physicians how to break bad news: a 1-day workshop using standardized parents

OBJECTIVE: To evaluate the effectiveness of a training program using standardized parents (SPs) to improve the performance of pediatric intensive care fellows in communicating bad news to parents. DESIGN: Self-controlled crossover design. SETTING: Tertiary pediatric intensive care unit in a university-affiliated children's hospital. PARTICIPANTS: Seven pediatric intensive care fellows and 4 trained volunteers (2 sets of SPs) participated in the study. METHODS: Two case scenarios of children admitted to the intensive care unit with a near-fatal diagnosis were used for the fellow's interactions with the SPs. The SPs had received 15 hours of training in role playing, performance evaluation, and giving feedback to the physicians. At the end of the first session, SPs provided feedback to the physicians under each of the 5 following categories: communication skills, content issues, support systems, interventions, and parent perceptions. During the second session, the parent meeting was repeated with a new but similar case scenario and a different set of SPs. Both sessions were videotaped, and a rater blinded to the order of the sessions used a weighted scale based on a checklist to score changes in physician performance. RESULTS: The performance by the fellows showed a significant mean (+/-SEM) improvement in scores of 18.1 (+/-5.2) points (P = .007) between the first and the second sessions. Ranking of session scores revealed that physician performance improved significantly during the second session (Wilcoxon signed rank test, P = .002). CONCLUSIONS: To our knowledge this is the first study that demonstrates short-term improvement in physician performance in conveying bad news in a pediatric intensive care setting using SPs in a 1-day workshop.     

Parents' perspectives on physician-parent communication near the time of a child's death in the pediatric intensive care unit.

OBJECTIVE: Communicating bad news about a child's illness is a difficult task commonly faced by intensive care physicians. Greater understanding of parents' scope of experiences with bad news during their child's hospitalization will help physicians communicate more effectively. Our objective is to describe parents' perceptions of their conversations with physicians regarding their child's terminal illness and death in the pediatric intensive care unit (PICU). DESIGN: A secondary analysis of a qualitative interview study. SETTING: Six children's hospitals in the National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. PARTICIPANTS: Fifty-six parents of 48 children who died in the PICU 3-12 months before the study. INTERVENTIONS: Parents participated in audio recorded semistructured telephone interviews. Interviews were analyzed using established qualitative methods. MEASUREMENTS AND MAIN RESULTS: Of the 56 parents interviewed, 40 (71%) wanted to provide feedback on the way information about their child's terminal illness and death was communicated by PICU physicians. The most common communication issue identified by parents was the physicians' availability and attentiveness to their informational needs. Other communication issues included honesty and comprehensiveness of information, affect with which information was provided, withholding of information, provision of false hope, complexity of vocabulary, pace of providing information, contradictory information, and physicians' body language. CONCLUSIONS: The way bad news is discussed by physicians is extremely important to most parents. Parents want physicians to be accessible and to provide honest and complete information with a caring affect, using lay language, and at a pace in accordance with their ability to comprehend. Withholding prognostic information from parents often leads to false hopes and feelings of anger, betrayal, and distrust. Future research is needed to investigate whether the way bad news is discussed influences psychological adjustment and family functioning among bereaved parents.     

Clinical decision-making training using the Script Concordance Test and simulation: A pilot study for pediatric residents

BackgroundEach year, new pediatric residents begin their shifts in the pediatric emergency room. While technical skills are often acquired during workshops, non-technical skills such as communication, professionalism, situational awareness, or decision-making are rarely tested. Simulation enables non-technical skills to be developed in situations frequently encountered in pediatric emergencies. Adopting an innovative approach, we combined two pedagogical methods: the Script Concordance Test (SCT) and simulation to improve clinical reasoning and non-technical skills of first-year pediatric residents in dealing with clinical situations involving febrile seizures. The aim of this work is to report the feasibility of such a combined training.MethodsThe first-year pediatric residents participated in a training session on how to manage a child attending the emergency department with a febrile seizure. At the beginning of the session, the trainees had to complete the SCT (seven clinical situations) and then participated in three simulation scenarios. Student satisfaction was assessed by means of a questionnaire at the end of the session.ResultsIn this pilot study, 20 residents participated in the training. The SCT scores for the first-year pediatric residents were lower and more widely distributed than those of the experts with better concordance for diagnostic items compared to investigation or treatment items. All were satisfied with the teaching methods employed. Further sessions on additional topics relating to the management of pediatric emergency cases were requested.ConclusionAlthough limited by the small size of our study, this combination of teaching methods was possible and seemed promising for the development of non-technical skills of pediatric residents. These methods are in line with the changes being made to the third cycle of medical studies in France and can be adapted to other situations and other specialties.     

Teaching and learning consultation skills for paediatric practice

Effective consultations with patients and their families are important for patient satisfaction, adherence to treatment, and recovery from illness. Communication problems among health professionals are common. Fortunately, the skills of effective communication can be taught and learned. This paper highlights evidence based approaches to teaching these skills with minimal resources.