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Measuring the Functional Abilities of Children Aged 3-6 Years Old with Observational Methods and Computer Tools
Published on: June 20, 2020
Republished paper: assessment of doctors' consultation skills in the paediatric setting: the Paediatric Consultation
R J Howells1, H A Davies, J D Silverman
1Derriford Hospital, Plymouth, Devon, UK. rachel.howells@phnt.swest.nhs.uk
Insights
The Paediatric Consultation Assessment Tool (PCAT) reliably measures clinicians' communication skills with children and parents. This tool is valid and feasible for assessing paediatric consultation effectiveness.
Area of Science:
- Medical Education
- Clinical Communication Skills Assessment
- Paediatric Healthcare Quality
Background:
- Effective communication between clinicians and children/parents is crucial in paediatric care.
- Existing tools may not adequately capture the nuances of paediatric consultations.
- Assessing clinician communication behaviour requires reliable and valid measurement instruments.
Purpose of the Study:
- To evaluate the utility and psychometric properties of a novel Paediatric Consultation Assessment Tool (PCAT).
- To determine the reliability and validity of PCAT for assessing clinician communication in paediatric settings.
Main Methods:
- The Paediatric Consultation Assessment Tool (PCAT) was developed based on consensus guidelines.
- Video recordings of 188 paediatric consultations from eight UK centres were analysed.
- Trained assessors used PCAT to score clinicians' communication behaviours with children and parents.
Main Results:
- Three video assessments using PCAT reliably evaluate overall triadic consultation skills (r > 0.8).
- PCAT identified two key factors: "clinical skills" and "communication behaviour," with higher scores for clinical skills.
- Significant differences were observed in communication scores directed at parents versus children, particularly for ages 2-10 years.
Conclusions:
- The Paediatric Consultation Assessment Tool (PCAT) demonstrates reliability, validity, and feasibility for assessing paediatric consultation skills.
- PCAT can be used for direct observation and evaluation of clinician communication in paediatric practice.
- Findings support the use of PCAT to improve the quality of paediatric patient-clinician interactions.
Objective:
To determine the utility of a novel Paediatric Consultation Assessment Tool (PCAT).
Design:
Developed to measure clinicians' communication behaviour with children and their parents/guardian, PCAT was designed according to consensus guidelines and refined at a number of stages. Volunteer clinicians provided videotaped real consultations. Assessors were trained to score communication skills using PCAT, a novel rating scale.
Setting:
Eight UK paediatric units.
Participants:
19 paediatricians collected video-recorded material; a second cohort of 17 clinicians rated the videos.
Main Outcome Measures:
Itemised and aggregated scores were analysed (means and 95% confidence intervals) to determine measurement characteristics and relationship to patient, consultation, clinician and assessor attributes; generalisability coefficient of aggregate score; factor analysis of items; comparison of scores between groups of patients, consultations, clinicians and assessors.
Results:
188 complete consultations were analysed (median per doctor = 10). 3 videos marked by any trained assessor are needed to reliably (r > 0.8) assess a doctor's triadic consultation skills using PCAT, 4 to assess communication with just children or parents. Performance maps to two factors - "clinical skills" and "communication behaviour"; clinicians score more highly on the former (mean (SD) 95% CI 0.52 (0.075)). There were significant differences in scores for the same skills applied to parent and child, especially between the ages of 2 and 10 years, and for information-sharing rather than relationship building skills (2-tailed significance < 0.001). Conclusions The PCAT appears to be reliable, valid and feasible for the assessment of triadic consultation skills by direct observation.
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