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Assessment of doctors' consultation skills in the paediatric setting: the Paediatric Consultation Assessment Tool
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  1. R J Howells1,
  2. H A Davies2,
  3. J D Silverman3,
  4. J C Archer4,
  5. A F Mellon5,6
  1. 1Plymouth Hospitals NHS Trust, Plymouth, Devon, UK
  2. 2University of Sheffi eld, Sheffi eld, Yorkshire, UK
  3. 3University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
  4. 4Peninsula College of Medicine and Dentistry, Plymouth, Devon, UK
  5. 5City Hospitals Sunderland NHS Foundation Trust, Sunderland, Tyne & Wear, UK
  6. 6Sunderland Royal Hospital, Sunderland, Tyne & Wear, UK
  1. Correspondence to Rachel J Howells, Derriford Hospital, Plymouth, Devon PL6 8DH, UK; rachel.howells{at}phnt.swest.nhs.uk

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 (SD) 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 relationshipbuilding skills (2-tailed significance <0.001).

Conclusions The PCAT appears to be reliable, valid and feasible for the assessment of triadic consultation skills by direct observation.

https://doi.org/10.1136/adc.2008.146191

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    Footnotes

    • RH wrote the manuscript with assistance from the other authors.

    • Funding RH was supported by a grant donated to the Royal College of Paediatrics and Child Health by WellChild, and by the Department of Paediatrics, University of Cambridge. RH sought multicentre ethical approval, collected video material, trained assessors and undertook data analysis. HD, JS and JA supported development of the PCAT and study methodology. AM recruited clinicians/assessors.

    • Competing interests None.

    • Ethics approval Multicentre ethical approval was obtained for this study.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.