Engaging the Pediatric Patient: Building Trusting Relationships with Children

This learning module teaches medical students how to form a trusting relationship with children and their families during medical encounters, through classroom, tutorial, role-play, and team-based learning. Introduction: The learning module is part of the six-week Pediatrics clerkship at Boston Children's Hospital for second-year Harvard medical students, and is divided into three sections: an introductory talk on the first day, individual clinical tutorials during the first three weeks, and a case-based learning session at the end of the clerkship.

Goals: The goal is to teach medical students a methodology for establishing trusting relationships with children. In the process, students learn how to effectively manage a child’s emotional state by perceiving, accurately interpreting, and appropriately responding to the child’s verbal and nonverbal cues.

Procedure: Part I – Introductory talk

During the introductory talk, students are first introduced to the principles and concepts of the methodology. They then watch videos of clinical interactions with children of different ages and developmental levels, which illustrate these principles and concepts and also showcase interactive techniques that they can use to rapidly engage and build rapport with children. Students are then asked to comment on what they observed in the interactions.

Procedure: Part II – Clinical Tutorials

Before the tutorial, students are asked to view a pair of educational videos on cognitive development and managing procedural anxiety in children, review a summary of the introductory talk, and complete an exercise on clinical observation.

In the one-on-one tutorials with the instructor, students interact with patients of four developmental stages: pre-verbal, toddler, school-age, and adolescent. Prior to entering a patient’s room, the instructor discusses a framework for how to approach a child of that developmental level. Each patient interaction lasts roughly five minutes and is followed by a debrief on the student's experience. Together, the instructor and student extract, examine, and discuss the central principles and concepts from the interaction, so that the student sees how they can be applied in practice. The student also receives feedback on how they conducted the interaction. This pattern of discussion-practice-feedback continues for each patient interaction in the tutorial.

After the tutorial, students receive a summary of the key principles and concepts utilized during the session. In turn, students provide an overview of their takeaways.

Procedure: Part III – Case-Study Session

For the case-based learning session, students are asked to prepare a summary of the patient interactions that went well and those that did not, along with an analysis of factors that influenced the success or failure of the interaction.

The learning session is divided into four parts. In the first part, students discuss specific cases that they had during the clerkship. Students present these cases to the group, and their colleagues provide them with feedback, coaching, and insights on ways that they can improve their interactions. In Part 2, the instructor elicits feedback on the students’ experience of the learning module and ways to improve it. In the third part, the instructor introduces several new advanced concepts for discussion. In the last part, students participate in a role-playing exercise that emulates a case seen during a tutorial: one student plays a frightened and withdrawn child and a second plays a physician who attempts to establish rapport with the child. The rest of the students coach the “physician” on how to best interact with the “child” and move them from fear to trust. This exercise is repeated several times with different students.

Procedure - After Class: At the completion of the learning module, students receive a pocket reference card that has photo illustrations summarizing the elements of the methodology. Students are also provided with an evaluation form that asks about what they had learned and the value they received from the learning module.