Using children as standardised patients for assessing clinical competence in paediatrics.

BACKGROUND Standardised patients (SPs) have been widely used to assess physicians' clinical competence. However, in paediatrics, the use of children in such a way has long been questioned with regard to ethics and the examination quality (in terms of validity, reliability, and feasibility). AIMS To summarise the current state of the use of child SPs, and to highlight the difficulties inherent in the use of children for this purpose. METHODS Nineteen articles dealing with the use of child SPs for clinical assessment were reviewed. RESULTS Child SPs, ranging in age from infancy to adolescence, were present in varied proportions of paediatric objective structured clinical examination stations (12-27%). In most of these reports, there were several children with cases who could substitute for one another. Child SPs successfully portrayed various roles, although only older children had to learn a scenario. In general, clinical examinations using child SPs were found to be valid and generated reliable scores. Child SPs also provided effective feedback. The experience tended to be considered negative for younger children but was quite positive for a number of older children. The use of young SPs should be avoided for ethical reasons, and the use of child SPs should be limited to assessments that cannot be satisfactorily measured by other methods. CONCLUSION Through meticulous attention to detail and careful planning, a clinical examination using children as SPs can be practical, valid, and reliable.