Assessment of doctors‘ consultation skills in the paediatric setting: the Paediatric Consultation Assessment Tool

Rachel J Howells ^1*, Helena A Davies ², Jonathan D Silverman ³, Julian C Archer ⁴ and Andrew F Mellon ⁵

¹ Plymouth Hospitals NHS Trust, United Kingdom
² University of Sheffield, United Kingdom
³ University of Cambridge, United Kingdom
⁴ Peninsula College of Medicine and Dentistry, United Kingdom
⁵ City Hospitals Sunderland NHS Foundation Trust, United Kingdom

^* To whom correspondence should be addressed. E-mail: rachel.howells{at}phnt.swest.nhs.uk.

Accepted 3 November 2008

Abstract

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 ± 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 Paediatric Consultation Assessment Tool appears to be reliable, valid and feasible for the assessment of triadic consultation skills by direct observation.