title: Assessment of doctors' consultation skills in the paediatric setting: the Paediatric Consultation Assessment Tool.
abstract: OBJECTIVE
  To determine the utility of a novel Paediatric Consultation Assessment Tool (PCAT).
  
  
  METHODS
  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.
  
  
  METHODS
  Eight UK paediatric units.
  
  
  METHODS
  19 paediatricians collected video-recorded material; a second cohort of 17 clinicians rated the videos.
  
  
  METHODS
  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 relationship-building 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.
authors.affiliation: Plymouth Hospitals NHS Trust, Plymouth, Devon, UK. rachel.howells@phnt.swest.nhs.uk
authors.forename: R J
authors.initials: RJ
authors.lastname: Howells
authors.forename: H A
authors.initials: HA
authors.lastname: Davies
authors.forename: J D
authors.initials: JD
authors.lastname: Silverman
authors.forename: J C
authors.initials: JC
authors.lastname: Archer
authors.forename: A F
authors.initials: AF
authors.lastname: Mellon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D004812:Epidemiologic Methods; D006801:Humans; D007223:Infant; D010372:Pediatrics / Q000592:standards*; D010380:Peer Review; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D011594:Psychometrics; D014741:Video Recording