Clinical data used by pediatric residents to assess parenting

To determine how pediatricians assess parenting at well-child visits, pediatric residents were interviewed following the well-child visit of a child less than 24 months of age. Using a structured format, the residents were interviewed about their judgments concerning the characteristics of the mother just seen and the data used to make these judgments. In addition, ratings were made of the quality of the descriptions of the parents. Fifty interviews, 2 each with 25 residents, were completed. Residents described the parenting abilities of 82% of the mothers in predominantly positive terms and 18% in negative terms. To make these judgments, residents relied on one or more of five categories of data: how mothers used the medical system (98%); observations during the office visit of the mother-child interactions (96%), of the child (74%), and of the mother (68%); and information obtained by interview about the mother's caregiving skills and her feelings toward the child (50%). In 30% of cases the residents' descriptions of the mother contained only minimal information. We conclude that residents rely more on observational data than data acquired during the interview. These findings suggest that residency training programs should sharpen the residents' ability to make behavioral observations and teach more effectively the process of interviewing so that residents will be able to make appropriate assessments of parenting skills.