Teaching and assessing the clinical examination skills of children

Dear Sir

I agree with the authors (Darling & Bardgett 2013) that being able to examine a child is a core skill for practitioners in many settings. Teaching and assessing this core skill in children is always a challenge.

One of the most important skills for students to acquire is how to assess the acutely unwell infant and toddler. This can only truly be achieved by learning and being assessed in the acute setting either in the emergency department or on the children’s wards. Manifestations of illness vary according to age and the younger the child, the greater is the challenge to identify and assess these. Examining an 8 to 11-year-old child even when unwell is similar in many ways to examining an adult.

At the University of Auckland in New Zealand, students attend a workshop on the first afternoon of their paediatric rotation where using manikins, they learn how to approach the examination of the different systems in infants and toddlers. This simulation makes them more confident to start seeing children in their placements in acute and ambulatory settings the next day (Pinnock et al., 2007).

Many students are hesitant to approach mothers and their acutely unwell child. They appreciate that both are stressed by the illness and by their unfamiliarity with the hospital setting. They are most reluctant to add to this distress. Fortunately both parents and children of different ages are prepared to be involved in medical student teaching provided students are mindful of the potential distress they may cause. Some even feel under an obligation to assist in the training of the next generation of doctors (Pinnock et al. 2011).

Several miniCEXs in the acute setting throughout the rotation provide the opportunity for students to be assessed in real life. We found them to be less time-consuming than a whole class OSCE. After the miniCEX the examiner always has to return to the caregiver and child to ensure that any concerns raised in the assessment are addressed. This is also an opportunity to seek the opinion of the caregiver and if old enough of the child, on the student’s performance. I am always reassured when the child says they would be happy to see the student again.

Assessment drives learning. If we want our students to be able to learn to examine acutely unwell infants and toddlers they need to be assessed on that skill.

It is always helpful to hear how others rise to the challenge of teaching and assessing the clinical skills of medical students in the examination of children. Darling’s (Darling & Bardgett 2013) study is an important addition to the literature.

Declaration of interest: The author reports no conflicts of interest.