Tackling obesity while preventing obesity stigma.

Obesity is a significant public health problem. Prevalence is rising in children and young people, with lifelong health impacts and implications for paediatric clinical practice. Obesity stigma is increasingly acknowledged as a problem within health services. Health professionals can inadvertently contribute to this stigma, which is harmful and in itself can promote weight gain. A complex web of factors contributes to obesity, and a simplistic approach exclusively focused on personal responsibility, diet and exercise is unhelpful. A more nuanced, sensitive and informed approach is needed, with careful use of language and non-judgemental partnership working.

The First Thousand Days: early, integrated and evidence-based approaches to improving child health: coming to a population near you?

The 'First Thousand Days' refers to the period from conception to the child's second birthday. It is increasingly gaining traction as a concept to guide public health policy. It is seen as a crucial window of opportunity for interventions that improve child and population health. This review outlines the origin and growth of the First Thousand Days concept, and the evidence behind it, particularly in the areas of brain development and cognition; mental and emotional health; nutrition and obesity; programming and economic benefits. The review then describes UK experience of use of the concept to inform policy, and a recent government inquiry that mandates more widespread implementation.

Including children and young people in assessments: a practical guide.

The ability to interact with children and young people (CYP), appropriately examine and competently interpret signs is an essential skill for many medical practitioners and allied healthcare professionals; yet, how do we ensure competence in our students and trainees? One method is to include CYP in both formative and summative assessments; this provides an invaluable opportunity for examiners not only to evaluate the clinical interaction but also to gain an understanding of the CYP experience and what characteristics they value in a 'good children's doctor'. This paper explores the benefits and challenges of involving CYP in assessments and provides practical advice for course organisers, assessors and students when encountering CYP in assessment.

Can children acting as simulated patients contribute to scoring of student performance in an OSCE?

BACKGROUND: The voice of the child is increasingly recognized as important, as summed up in the Department of Health report "No decision about me, without me". In medical education, however, the child's voice is little heard: often in a pediatric OSCE, the examiner assigns a mark for the child. AIM: To explore whether children can contribute meaningfully to summative scoring of student performance. METHODS: We studied this in two phases: first we compared child scores (CSs) to examiner predictions of the child scores (EPCS), and other simulated patient (SP) scores within a single exam. Then we looked at CS over a further 4 exams. RESULTS: The Pearson correlation between CS and EPCS was 0.40 (p < 0.001), therefore EPCS accounted for 16% of variation in CS. Across 4 exams, the mean CS was higher than the mean adult SP score: exploratory factor analysis indicated that both may be measuring the same characteristic. Cronbach's alpha (0.66 to 0.76) did not significantly increase when SP scores (including CS) were removed. CONCLUSIONS: Although there was some correlation between CS and EPCS, pediatricians could not accurately predict CS. We conclude that the child's voice can and should be heard within the OSCE marking process.

Setting standards in knowledge assessments: Comparing Ebel and Cohen via Rasch.

INTRODUCTION: It is known that test-centered methods for setting standards in knowledge tests (e.g. Angoff or Ebel) are problematic, with expert judges not able to consistently predict the difficulty of individual items. A different approach is the Cohen method, which benchmarks the difficulty of the test based on the performance of the top candidates. METHODS: This paper investigates the extent to which Ebel (and also Cohen) produces a consistent standard in a knowledge test when comparing between adjacent cohorts. The two tests are linked using common anchor items and Rasch analysis to put all items and all candidates on the same scale. RESULTS: The two tests are of a similar standard, but the two cohorts are different in their average abilities. The Ebel method is entirely consistent across the two years, but the Cohen method looks less so, whilst the Rasch equating itself has complications - for example, with evidence of overall misfit to the Rasch model and change in difficulty for some anchor items. CONCLUSION: Based on our findings, we advocate a pluralistic and pragmatic approach to standard setting in such contexts, and recommend the use of multiple sources of information to inform the decision about the correct standard.

What makes a good children's doctor? Exploring the child perspective in the OSCE setting.

BACKGROUND: Patient feedback is increasingly important in clinical practice, and this should include children's views. 28 children aged 8-10 years participating in a large-scale OSCE underwent cranial nerve examination by student candidates. They scored each out of 10 for the question: 'If you had to see a doctor again, how happy would you be to see this one?' An age-adapted qualitative focus group methodology was used to explore why they scored some students more highly than others. RESULTS: Children's scores for the 256 medical students ranged from 2 to 10 (median 9; mean 8.46). 76% of scores were above 8. 'Good' doctor attributes included: 'friendly', 'funny', 'knowledgeable', 'confident'; 'bad' doctor attributes were: 'making mistakes', 'not paying attention', 'forgot everything', 'serious'. Children's reasons for specific scores are further explored. DISCUSSION AND CONCLUSION: Scores were positively skewed, in line with most patient/simulated patient feedback, and children discriminated between candidates. It should not be assumed that clinician examiners can accurately represent the views of child patients who may value different qualities in doctors. Children participating in our study had clear views of what they want from a doctor: a consultative approach with clear and kind explanation of the process of examination.

A semi-quantitative and thematic analysis of medical student attitudes towards M-Learning.

RATIONALE, AIMS AND OBJECTIVES: Smartphone and mobile application technology have in recent years furthered the development of novel learning and assessment resources. 'MBChB Mobile' is a pioneering mobile learning (M-Learning) programme at University of Leeds, United Kingdom and provides all senior medical students with iPhone handsets complete with academic applications, assessment software and a virtual reflective environment. This study aimed to evaluate the impact of MBChB Mobile on student learning. METHODS: Ethical approval was granted to invite fourth and fifth year medical students to participate in a semi-quantitative questionnaire: data were collected anonymously with informed consent and analysed where appropriate using chi-squared test of association. Qualitative data generated through focus group participation were subjected to both content and thematic analysis. RESULTS: A total of 278 of 519 (53.6%) invited participants responded. Overall, 72.6% of students agreed that MBChB Mobile enhanced their learning experience; however, this was significantly related to overall usage (P < 0.001) and self-reported mobile technology proficiency (P < 0.001). Qualitative data revealed barriers to efficacy including technical software issues, non-transferability to different mobile devices, and perceived patient acceptability. CONCLUSIONS: As one of the largest evaluative and only quantitative study of smartphone-assisted M-Learning in undergraduate medical education, MBChB Mobile suggests that smartphone and application technology enhances students' learning experience. Barriers to implementation may be addressed through the provision of tailored learning resources, along with user-defined support systems, and appropriate means of ensuring acceptability to patients.

Primary school children in a large-scale OSCE: recipe for disaster or formula for success?

BACKGROUND: Many medical schools have moved to large end-of-year Objective Structured Clinical Examinations (OSCEs) in which it is difficult to involve children as patients. It is nevertheless important to assess student competencies in clinical examination of children. METHODS: We set up a partnership with a local primary school, where children aged 8-11 years have assisted with our OSCE annually from 2007 to 2012. Approximately 30 children attend each exam, and are distributed between 14 simultaneous stations, each part of a 20-station circuit. Approximately 280 candidates complete the same paediatric station (e.g. cardiovascular examination) in one morning. EVALUATION: A total of 160 children took part in the exams over this period, and of 129 (80.6%) who filled a questionnaire: 99.2% agreed that they 'had enjoyed taking part in the exam'; 100% 'thought it was a good experience'; and 96.1% 'thought that it was well organised'. Parent and teacher feedback has been overwhelmingly positive. CONCLUSION: We conclude that it is feasible to involve school children in a large-scale OSCE. A school - medical school partnership is mutually beneficial, improving assessment of important paediatric clinical skills, while providing a positive experience for children who participate.

Thirteen-year-old female with an unusual presentation of deep venous thrombosis.

We report a case of a 13-year-old female presenting with deep venous thrombosis in her left lower limb. Investigations led by her symptoms and history revealed persistently positive lupus anticoagulant and anticardiolipin antibodies, indicating the diagnosis of antiphospholipid syndrome. Double-stranded DNA antibodies were detected positive pointing to the coexistence of systemic lupus erythematosus (SLE). Antiphospholipid syndrome-related vascular occlusive events are causing high morbidity and mortality. Therefore, a high index of suspicion is mandatory for the recognition of children being at risk for primary or recurrent thrombotic complications.

UK health professionals' attitudes and knowledge regarding Human Papillomavirus (HPV) vaccination: a West Yorkshire Study.

AIM: To investigate the willingness of clinicians to recommend human papillomavirus (HPV) vaccination, the strength of support for a national HPV vaccine programme and to determine which factors, if any, affected these. METHODS: An online, invitation-only questionnaire was developed and distributed to three medical professional groups in the West Yorkshire Region, United Kingdom. RESULTS: Two hundred twenty-two responders were included in the final analysis, from the following specialties: general practice (62), paediatrics (103) and obstetrics and gynaecology (57). The majority of doctors were in favour of an National Health Service-funded national vaccination programme. Over 90% supported vaccination of girls as early as ages 11-13. Fewer doctors felt comfortable recommending vaccination to parents of girls under 16 than to young women. Latent class analysis demonstrated that doctors' self-rated knowledge of the HPV vaccine was an important determinant of willingness to recommend vaccination. Younger, more recently qualified doctors were less likely to be willing to recommend vaccination. CONCLUSIONS: There is widespread support for vaccination. Information provision to doctors will be important in maximising clinician confidence in recommending vaccination, and may be most beneficial when targeted at more junior doctors.