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Teaching medical students to examine children
  1. J Craze1,
  2. T Hope2
  1. 1Department of Paediatrics, John Radcliffe Hospital, Oxford, UK
  2. 2Department of Public Health and Primary Health Care, University of Oxford, The Ethox Centre, Oxford
  1. Correspondence to:
    J Craze
    Department of Paediatrics, Level 4, John Radcliffe Hospital, Oxford OX3 9DU, UK; janet.craze{at}orh.nhs.uk

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In most medical schools in the UK, 7 or 8 weeks of the clinical course are devoted to the study of paediatrics and child health. The syllabus to be covered during this relatively short time is vast. Students quickly realise that the (by now well-practised) skills of adult history taking and physical examination are not entirely applicable to children; so perhaps it is not surprising that many students look forward to paediatrics, but approach it with some trepidation.1 For students, the idea of examining children is daunting. Most recognise that they cannot necessarily follow the familiar sequence of examination and that adaptability is needed. Many lack confidence in their ability to win over a shy or unwilling child. Others fear causing pain or distress—as one student recently explained to me “I’m afraid I might break one”. Paediatricians acknowledge that children do not always wish to be examined, but sometimes clinical need prevails. Students, however, are usually acutely aware of their non-essential role. At worst, this combination of anxieties may lead them to shy away from situations in which opportunities for patient contact may arise—for example, in the emergency department2—and hence to miss out on vital learning experiences. At best, they may graduate without really developing a confident approach to children.

Whatever specialty a student may ultimately choose, there are few in which he or she will never come across child patients. The need for a broad base has been acknowledged by Modernising Medical Careers (http://www.mmc.nhs.uk), and many Foundation schemes include a paediatric placement. To get the most out of these posts, a new graduate must be competent at basic skills, including child examination, from the outset. Furthermore, if we do not grasp the opportunity to capture the enthusiasm of medical students and introduce them to the breadth …

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