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. 2005 Feb;10(2):95-9.
doi: 10.1093/pch/10.2.95.

Paediatricians' validation of learning objectives in paediatric cardiology

Kenny K Wong  1 , Andrew P Barker, Andrew E Warren
Affiliations

Paediatricians' validation of learning objectives in paediatric cardiology

Kenny K Wong et al. Paediatr Child Health. 2005 Feb.

Abstract
in English, French

Background: The current objectives for teaching paediatric cardiology to paediatric residents have not been validated and may not be relevant to current paediatric practice.

Objectives: To validate the cardiology component of the Royal College of Physician and Surgeons of Canada's objectives for training paediatricians.

Methods: A questionnaire was sent to practising paediatricians in Atlantic Canada. The questions were based on the Royal College of Physician and Surgeons of Canada's training objectives. The frequency of problems seen, confidence in assessment and management of problems, and reasons for referral were identified. Clinical vignettes were followed by short questions. The outpatient referrals were reviewed to validate the questionnaire responses.

Results: One hundred fifty-one questionnaires were mailed and the response rate was 60%. Murmurs were the most common problem encountered (92%). Syncope (9%), Kawasaki disease (8%) and chest pain (6%) were less frequently encountered. Paediatricians were confident in assessing and managing problems despite the low frequency of encounters. Less confidence was expressed regarding physical examination skills and interpretation of electrocardiograms. Uncertainty of the diagnosis was the most common reason for patient referral, with parental anxiety and medicolegal concerns accounting for 24% and 7% of referrals, respectively. Syncope with exercise was relatively poorly recognized as a worrisome symptom.

Conclusions: Most cardiology objectives for general paediatric training remain relevant and appropriate to clinical practice. Physical examination skills, electrocardiogram interpretation and the assessment of syncope need to be emphasized.

HISTORIQUE: Les objectifs courants d’enseignement de la cardiologie pédiatrique aux résidents en pédiatrie n’ont pas été validés et ne sont peut-être pas adaptés à l’exercice actuel de la pédiatrie.

OBJECTIFS: Valider la partie des objectifs de formation des pédiatres du Collège royal des médecins et chirurgiens du Canada reliée à la cardiologie.

MÉTHODOLOGIE: Un questionnaire a été expédié aux pédiatres en exercice dans les Maritimes. Les questions étaient fondées sur les objectifs de formation du Collège royal des médecins et chirurgiens du Canada. La fréquence des problèmes observés, la confiance à évaluer et à prendre en charge les problèmes et la raison des aiguillages y étaient précisées. Des scénarios cliniques étaient suivis de courtes questions. Les aiguillages en consultation externe ont été examinés afin de valider les réponses au questionnaire.

RÉSULTATS: Cent cinquante et un questionnaires ont été postés, et le taux de réponse s’est élevé à 60 %. Les souffles cardiaques constituaient le problème le plus courant (92 %). La syncope (9 %), la maladie de Kawasaki (8 %) et les douleurs thoraciques (6 %) étaient plus rares. Les pédiatres se sentaient confiants pour évaluer et prendre en charge les problèmes, malgré le peu d’occurrences. Ils se sentaient moins à l’aise quant aux compétences nécessaires pour procéder à l’examen physique et interpréter les électrocardiogrammes. L’incertitude quant au diagnostic représentait la principale cause d’aiguillage, tandis que l’angoisse des parents et des inquiétudes médicolégales en expliquaient 24 % et 7 %, respectivement. La syncope à l’exercice était relativement peu perçue comme un symptôme inquiétant.

CONCLUSIONS: La plupart des objectifs de cardiologie pour la formation en pédiatrie générale demeurent pertinents et convenables en pratique clinique. Il faudrait accorder plus d’importance aux compétences reliées à l’examen physique, à l’interprétation des électrocardiogrammes et à l’évaluation des syncopes.

Keywords: Auscultation; Medical education; Paediatric; Paediatric cardiology; Referral; Residency.

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Figures

Figure 1
Figure 1
Percentage of paediatricians who ranked each cardiology problem as the one most commonly seen in their practice
Figure 2
Figure 2
Percentage of paediatricians who ranked each cardiology problem as the most common one referred to a paediatric cardiologist. CHF Congestive heart failure; CXR Chest x-ray; ECG Electrocardiogram
Figure 3
Figure 3
The final diagnosis following referral to the paediatric cardiologist. Innocent – Innocent murmurs and patients with a final diagnosis of ‘normal heart’; NYD – Not yet diagnosed; Other – Heart disease not classified under any other heading; Structural – All forms of structural heart disease; SVT – Supraventricular tachycardia
None
See this image and copyright information in PMC

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