The Value of Paediatrics Placements: Confidence or Competence? [Response to Letter]

Dear editor

We appreciate the opportunity to respond to correspondence relating to our pilot survey regarding self-perceived confidence in medical students communicating with pediatric patients.

Janmohamed et al discussed potential variation in clinical supervision and experiences across different pediatric teaching hospital sites which may affect medical students’ perception of self-confidence at the end of the placement. In addition, Janmohamed et al highlighted that allocation of hospital sites was not included in the study which may contribute to selection bias. All students were invited to participate in the study at the beginning of each rotation during the centralised introductory lecture-based teaching. We did not specifically ask participants’ allocated hospital sites because the School of Medicine goes to great lengths to ensure equity of teaching and clinical exposure across all sites, and the study was underpowered to detect differences in students’ self-perceived confidence by the five different sites.

Furthermore, Janmohamed et al highlighted other potential factors that may affect students’ postplacement confidence such as attendance rate and exposure to paediatric conditions across different months of the year. We did not have measurements on the confounders they mentioned, prohibiting the modelling of effects for these factors in our study. We encourage other researchers to consider “time-of-year” variation moderators of pediatric placement-clinical exposure association in their analysis.

We agree with Janmohamed et al’s view that the aim and philosophy of the pediatric attachment is to prepare medical students to take on the role of a newly qualified foundation doctor in paediatrics by the end of the rotation. In this regard, we concur that pediatric clinical knowledge and skills are more appropriate indicators of the impact of the pediatric attachment in achieving satisfactory foundation level competence as within various domains of pediatric practice. The original aim of this study was to identify whether previous professional experiences with children have a role in preparing medical students to engage with paediatric patients more confidently to maximise their learning during the placement. We acknowledge that this aim might be captured better in a prospective longitudinal study. We encourage other researchers to investigate the relationship between medical students’ self-perceived confidence and attained competence in pediatric clinical practice.