Send letter to journal:
Re: Teaching students Paediatric history taking and examination.

Dear Editor,

I read with interest the paper from Oxford by Craze et al(1) and agree with the general gist of the subject. As a paediatrician with interest in medical student education, I facilitate the teaching of paediatrics to the students posted to my DGH for the 6-8weeks scheduled for paediatrics and have examined on the subject. The observations in the paper from Oxford clearly reflects my experience. Over the years I have exposed students to this subject by using the following approach

~ Introductory notes and videos on how to examine children

~ Practical bedside teaching on systems examination

~ Practical sessions while attached to SHOs

~ Daily attendance at Consultant ward rounds (Hot week)

~ Teaching on consent issues and competence emphasized

~ evaluation usually carried out to encourage confidence.

At the beginning of the posting,most students find this task daunting but later could accommodate this. Paediatric patients are spread over clinical set ups be it community or hospital and so an 'encounter' is almost inevitable. This paper from Oxford will help to stress the importance of this subject and process in medical student training.I will be refering my students to this piece of information -very timely.

Reference:

Send letter to journal:
Re: Teaching Medical Students to Examine Children: Different Not Difficult

Dear Editor,

In 2003, the Royal College of Paediatrics recommended “training in adolescent health should be mandatory for undergraduates…”. Although the recent article “Teaching medical students to examine children” briefly acknowledged the challenges undergraduates face when examining adolescents, the authors sadly did not take the opportunity to emphasise the importance of such training. Rather, the authors suggested that “it may be sensible to consider whether what will be learnt from any particular examination could be learnt equally well from adult patients at a different period in training”. We would argue that there are significant differences in the clinical assessment of adolescents as compared to that of younger children and/or adults. As there are now more adolescents than under 10s in the UK and greater proportions in ethnic minorities(1), it is timely to consider how we can integrate adolescent health into the undergraduate core curriculum.

For example, issues such as growth and development during adolescence and the presentation of specific diseases during adolescence cannot be demonstrated during examination of adults. With any consultation the importance of establishing trust and empathy during the history taking to facilitate the physical examination should not be forgotten, and this is particularly true with young people who often perceive barriers in health care(2). Health professionals should acknowledge that the physical examination is a potential opportunity for young people to disclose health concerns when their parents are not present. Furthermore, the physical examination provides an opportunity to educate young people about their bodies.

Young people value healthcare professionals who are supportive and consistent; they also value communication which is honest, realistic and jargon-free(3). Privacy and confidentiality is also of prime importance to them and it is important not to assume a young person will always choose their parent as a chaperone. The presence of students has been reported to negatively impact communication between adolescents and doctors(3,4). Young people however are often more than willing to be a “case study” in a learning environment, separate from their consultation, when they are learning the skills to manage their own health.

We would therefore propose that the way to move adolescent medicine and health care forward in the UK is to adequately train the medical students of the present day. Rather than dismissing adolescents as too complex for undergraduates, adolescent health should be considered as an excellent teaching model to include in the core curriculum to explore issues such as growth and development, ethics, transitional care, professional attitudes, triadic consultation etc. Formal training in adolescent health has been shown to be effective in improving doctors' skills which are maintained after several years(5).

There are now many readily available resources to facilitate adolescent health training at undergraduate level to educate medical students before face-to-face contact with adolescent patients including the excellent video clips on the www.youthhealthtalk.org website, hosted by the DIPEX group at the University of Oxford, the use of adolescent actors and the involvement of the young people themselves in the assessment of trainees(6). The outcome of the current GMC consultation exercise involving children and young people regarding their views on how they think doctors should behave will hopefully inform us about what young people want from tomorrow’s doctors.

As we discussed previously simple messages can be conveyed by inclusive terminology when discussing service provision as well as in current medical literature i.e. children AND young people, paediatrics AND adolescent health(7). As the RCPCH and the Department of Health work together to develop training programmes in adolescent health and to ensure health services are young person friendly(8); let us also ensure medical education is too.

References:

(1)Coleman J, Schofield J. Key data on Adolescence 2005. Trust for the Study of Adolescence, Brighton, UK, 2005

(2)Oppong-Odiseng ACK, Heycock EG. Adolescent health services – through their eyes. Arch Dis Child 1997;77:115-119.

(3)Shaw KL, Southwood TR, McDonagh JE on behalf of the British Paediatric Rheumatology Group. User perspectives of transitional care for adolescents with juvenile idiopathic arthritis. Rheumatology (Oxford). 2004 Jun;43(6):770-778

(4)Beresford B, Sloper P. Chronically ill adolescents’ experiences of communicating with doctors: a qualitative study. J Ado Health 2003; 33:172-179.

(5)Sanci L et al, Sustainability of change with quality general practitioner education in adolescent health, Medical Education 2005; 39(6):557-560

(6)Blake K, Vincent N, Wakefield S et al. A structured communication adolescent guide (SCAG): assessment of reliability and validity. Medical Education 2005; 39: 482-491

(7)McDonagh JE, Walker V, Foullerton M et al. Young people – lost in transition. Arch Dis Child 2006; 91(2): 201