Lifelong Learning Programme

This project has been funded with support from the European Commission.
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Training for Paediatricians and Paediatric Students

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This training package is addressed to students and medical practitioners in paediatrics on how to autonomously learn, develop and consolidate their soft skills for improving the quality of paediatric services.

Communicating with Peers

Table of Content

4.1 – Communicating an Oral Case Presentation between Students, Residents and Medical Practitioners in Paediatrics
Clinical competences are the most relevant aspects to perform patient care and satisfy his/her health care needs. Good clinical practice requires teamwork oriented to allow the common goal of patient’s care through a most cost-effective therapeutic strategy. The quality of communication process in the teamwork can be very important during the children care in order to cope with stressful circumstances and avoid medical errors (Frush & Krug, 2015). Medical errors and adverse events are common in paediatric population, a recent survey performed by Canadian researchers showed their incidence is >9% of children admitted to hospitals Medical errors are avoidable circumstances if teamwork communication is improved in the care unit, where the role of patient and parents are more complex than in adult care (Koller, et al.; 2016). Communication errors are frequently due to the misunderstanding and misinterpretation generated by care pressures, complexity of decision-making and plurality of professional competences required by health care professionals working with children. In order to lead with such a complex scenario of paediatrics oral presentations are relevant tools to communicate among medical practitioners and assess medical students competences. A good oral clinical presentation should represent a contribution to discuss and organize the most significant clinical aspects of the clinical interview between doctor and patient and enhance the diagnostic reasoning (Chan, 2015). Through the analysis of all the clinical information and the application of rhetorical and linguistics characters, such as the accurateness of the symptoms description, report sequence of the events previous the last hospitalization, offering to the listener the same conclusions deduced by the speaker from the element described in the presentation (Bushan et al.; 1998). Structure a clear message is a key element for an oral clinical presentation, organization of text and data, exhaustive report of all the relevant details to understand the clinical reasoning associated to the case, a case summary where clinical details are processed and interpreted, and the treatment plane discussed in every aspect and its internal coherence transferred to the listeners. An high-quality oral clinical presentation improve the coordination of patient care, efficiency and teaching and learning processes, reliability, organization, clinical reasoning and making decision processes (Dell et al.; 2011). Following the Dell’s description the requirement for an effective oral clinical presentation are: 1) present information in an expected order, set out a context to the describe the clinical circumstances - diagnosis, prognostic, treatment; 2) present the patient’s history to support the clinical reasoning integrating information available to assure the most precise diagnostic analysis process, the past medical history can be compared with the present illness in order to refine the clinical reasoning; 3) in order to perform a better assessment family history, socio-demographic charters are relevant information to build a good clinical history. Pertinent information help to understand the present illness; 4) a good oral clinical presentation should involve vital signs, outcomes of clinical examination, a general assessment of the patient. The relevant clinical aspects of the presentation are those relevant to understand the diagnosis. 5) Distinguish clearly between history and medical examination is an essential aspect to develop and adequate clinical reasoning organized in order to the most significant data collected during the patient examination; 6) summarize in one or two sentences the medical history, physical examination and clinical data collected including key features, epidemiology and an adequate qualification of the information available as assessment of the clinical case; 7) based on the summarization formulate a diagnosis elucidating the arguments supporting the diagnostic process; 8) the treatment plan should be organized by a problem list ad classified in diagnostic and therapeutic plans. Finalize the oral presentation applying the RIME scheme: report, interpret, manage and educate. Report the reliable data collected in a clear and efficacy way, exhibit the clinical reasoning interpreting available data, provide diagnostic and therapeutic plans and finally educate colleague and patients transferring clinical expertise.
Practical Applications
Scenario 1 – Oral clinical presentation in paediatric emergency unit Two weeks patient named Ashley brought in the clinic by her mother with 38.33 body temperature, mild nasal congestion, fuzziness, mild cough, and the patient is mildly tachycardic. Diagnostic assessment identified the risk of a serious bacterial infection, for that reason a 48h admission to the paediatric floor is recommended due to the patient’s age. Complementary are recommended with antibiotics treatment. The presentation is performed in an emergency unit by a resident to the medical team.
Soft-skills in the video: the oral clinical presentation improves the coordination of patient care, efficiency, teaching and learning processes, and shows reliability, organization, clinical reasoning and making decision processes
The video is in English and subtitle in English are available
Scenario 2 – Family-centred presentation in paediatric ward The scenario represents the same clinical case explored in the scenario 1 but in a different context, a family centred round in paediatric ward. Clinical circumstances are depicted to the medical staff involving family, the interesting aspect of this scenario is the consistent enrichment of communication process due to the interaction among medical team, patient’s family and resident. The presentation is at the same time a transfer of clinical knowledge among health care professional and a process of building the patient history through the involvement of the family knowledge.
Soft-skills in the video: communication with family is an enriching tool to improve the quality of medical history and family information. This oral presentation contributes to perform a patient-centred care approach and enrich the educational process to integrate history with medical examination.
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This project has been funded with support from the European Commission. This web site reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.