A Pediatric Clinical Skills Assessment Using Children as Standardized Patients

Abstract

THE AMERICAN Board of Pediatrics¹ has defined the clinical skills in which each graduate of a pediatric residency should have competence. They are (1) attitudes, (2) factual knowledge, (3) interpersonal skills (IPS), (4) technical skills (which includes physical examination [PE]), and (5) clinical judgment. It is easy to reliably and validly assess factual knowledge but difficult to do the same for attitudes, IPS, data gathering (history taking [HX] and PE) skills, and clinical judgment. Attitudes and IPS are known to have a critical effect on medical outcomes and patient satisfaction,² and because of this, they clearly should be evaluated. Data gathering and clinical judgment, which have a direct, easily recognizable effect on medical outcomes, should also be evaluated during residency training. In response to the need to assess clinical skills and performance, different assessment formats using standardized patients (SPs) have been developed and refined for the past 20 years.^3-5 One format that is generally referred to as an objective structured clinical examination (OSCE) requires the performance of a single task (eg, examine the heart, obtain a social history, interpret a radiograph) at multiple short "stations." Another format, which is generally referred to as a clinical skills assessment, requires the performance of several complete patient encounters and requires the sequential use of HX skills, PE skills, information-giving skills, and patient management skills, as well as the continuous use of interpersonal and communication skills during each encounter. The SPs used for these encounters may be actual patients with a medical problem or individuals who have been trained to portray a particular medical problem, symptom, or physical finding; they are educated to always respond to the same question or PE maneuver in the same way.