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Overview:This activity was designed for 3rd year medical students in their pediatric clerkship to provide them with an opportunity to practice developmental assessment of young children during the COVID19 pandemic. We capitalized on school closures and the “shelter-in-place”ordinance by engaging faculty and fellows in the Department of Pediatrics with children in the age range 1-5 years. We provided students with instructions and learning materials before the activity and arranged individual meetings between students and child/parent(s) using a web-based meeting platform. The feedback discussed is documented in our school’s electronic evaluation platform by either the student or the parent as per routine practice.Learning Objectives: By the end of this activity, the learner will be able to:Identify tasks that can be used to assess a child's development.Apply strategies to create rapport with a young child during a clinical assessment.Synthesize information about a child’s development into a verbal petencies Addressed:Patient Care: Assess child development. Practice-Based Learning & Improvement: Solicit and incorporate feedback, and actively reflect on one's experiences and continued learning. Interpersonal & Communication Skills: Demonstrate effective rapport and communication with children (using a developmentally based approach) and families to provide therapeutic, supportive, culturally sensitive, and language appropriate care. Professionalism: Demonstrate respectful treatment of all patients, families, staff, and colleagues, and effective collaboration and communication with others. MaterialsInstructions for StudentsInstructions for Parents Development Tasks Developmental Milestones ChartResourcesI. INSTRUCTIONS FOR STUDENTSGiven current restrictions on access to medical facilities and the general guidelines set forth by the AAMC, we are offering you an opportunity to interact with a child between the age of 1 and 5 years old and their parent(s) remotely in order to practice assessment of childhood development. You will have approximately 20 minutes to engage with the child and parent via a video encounter. DO NOT ASK THE CHILD THEIR AGE OR GRADE!You can take time immediately afterwards to gather your thoughts and work through your reasoning on your estimate of the child’s age based on your assessment. Depending on parent availability, you will re-connect with the parent directly thereafter or at a different time to verify the age of their child and to discuss feedback on your communication skills. This will be determined prior to the encounter. At the end of the document (Section III) are a list of tasks you can use to assess the child as well as a list of developmental milestones (Section IV).We have asked only parents to volunteer who have developmentally typical children. We have asked parents to have a few tools nearby that may aid in your assessment. The parent will serve as not only your clinical aid to coach the child through your instructions and answer questions but also as a teacher to discuss feedback on your communication skills during the interaction. The assessment will be based on the competencies listed below. The parents are faculty or fellows in the department of pediatrics but not necessarily experts in child development. If you have questions about the developmental assessment, please contact your clerkship director.Learning Objectives: By the end of this activity, you will be able to:Identify tasks that can be used to assess a child's development.Apply strategies to create rapport with a young child during a clinical assessment.Synthesize information about a child’s development into a verbal assessment.Tasks: Review developmental milestonesPerform interviewEstimate age of child based on your knowledge of developmental milestonesFollow-up with parent for review of assessment and feedback[include instructions about school-specific documentation of feedback]Competencies:Patient Care: Assess child development. (PC1)Practice-Based Learning & Improvement: Solicit and incorporate feedback, and actively reflect on one's experiences and continued learning. (PBLI3)Interpersonal & Communication Skills: Demonstrate effective rapport and communication with children (using a developmentally based approach) and families to provide therapeutic, supportive, culturally sensitive, and language appropriate care. (ICS1)Professionalism: Demonstrate respectful treatment of all patients, families, staff, and colleagues, and effective collaboration and communication with others. (P2)Remote Meeting Etiquette Tips:A few suggestions to make the remote learning aspect successful: sit close to your computer and speak clearly. Choose a brightly lit area. Consider headphones if you are a soft-speaker. II. INSTRUCTIONS FOR PARENTSThank you for volunteering yourself and your child for what we hope will be a fun activity with a medical student. Please note that expertise in child development is not required.In brief, the agenda of the activity will be:Student will interact with your child (and you) based on the list of tasks provided to them (see Section III) for about 20 minutes. Their goal is to perform a developmental assessment and gather enough information to provide a guessed estimate of your child’s age. Please DO NOT tell them your child’s age and try to make sure your child does not reveal their age.Student will discuss the age they estimated for your child and their reasoning. They may need time to gather their thoughts and if so will reconnect with you.You and the student will discuss feedback based around their communication skills.[include instructions about school-specific documentation of feedback]The learning objectives are as follows:By the end of this activity, the learner should be able to:Identify tasks that can be used to assess a child's development.Apply strategies to create rapport with a young child during a clinical assessment.Synthesize information about a child’s development into a verbal assessment.What to expect:The student will have approximately 20 minutes to interact with your child, 15-20 minutes on their own to create an assessment of the child (if needed), and 10-15 minutes for a feedback session with you to discuss their development assessment and to evaluate their communication skills. If better for you, you can schedule the feedback at a different time. The students are aware that you may not have expertise in child development and that the feedback discussion will focus on their communication skills. Be prepared for the student to ask your child questions based on the developmental information that they will also be provided (Section III and IV). We ask that you have something similar to the following tools available (if applicable based on your child’s age): BallDrawing utensil and paperBlocks/stacking objectsToyBookWe also ask that you be able to help coach your child through the tasks the student may ask your child to perform. A few suggestions to make the remote learning aspect successful: be vigilant of the distance of your child from the microphone; consider headphones if your child is a soft-speaker.Feedback Guide for ParentsGround feedback in observations.Example “I noticed when you were talking to my child, you often addressed me and not them.”Discuss specific suggestions for improvement.Example “Make eye contact with the child only once you’ve built a rapport with me as the parent.”We suggest using the keep/start/stop method (tell learner what they are doing well, communicate areas for improvement, discuss action steps moving forward).When assessing the student, suggestions to consider include:Was the student respectful? Give examples and/or suggestion on how to improve respectfulness if applicable.Did the student communicate effectively with the child and parent? Give examples and/or suggestions on how to improve this.What are some strategies as a parent that you use to communicate effectively as a child? May discuss how a video encounter is different than a real-life encounter and comment on tips you use or have seen used in the clinical setting that are helpful.Was the student able to create a rapport with you and the child in a developmentally appropriate way? How was that rapport created? Did they use developmentally appropriate language? Were they culturally sensitive?Competencies Patient Care: Assess child development. (PC1)Practice-Based Learning & Improvement: Solicit and incorporate feedback, and actively reflect on one's experiences and continued learning. (PBLI3)Interpersonal & Communication Skills: Demonstrate effective rapport and communication with children (using a developmentally based approach) and families to provide therapeutic, supportive, culturally sensitive, and language appropriate care. (ICS1)Professionalism: Demonstrate respectful treatment of all patients, families, staff, and colleagues, and effective collaboration and communication with others. (P2)III. SUGGESTED DEVELOPMENTAL TASKSGross Motor:Observe child’s gross motor skills. If the child is mobile (and depending on developmental level of the child), ask the child to walk, run, jump, stand on one foot, climb up/down stairs, throw and kick a ball, skip.Ask the child (or parent) if the child can ride a tricycle or bicycle.Fine Motor:Ask the child to draw a picture. Observe how the child holds the crayon/marker. Can the child scribble, draw a line, circle, square, triangle, person?Ask the child to stack blocks. How many can the child stack?Ask the parent if the child feeds himself/herself with fingers or utensils.Ask the parent if the child can dress himself/herself. What can they do? Buttons? Zippers? Tie shoes?Ask the parent if the child can use scissors.Expressive Communication:Observe the child’s speech and language. How many words is the child using (can also ask the parent)? Is the child combining words? How many? Is the child using phrases or sentences? How much can you (as a stranger) understand of what the child is saying?Is the child using non-verbal gestures? Signs?Does the child initiate joint attention with caregivers or others? Receptive Communication:Ask the child to do something simple (e.g. pick up a toy). Can the child follow your instruction based only on your verbal command? What if the parent uses a gesture to indicate what you are asking the child to do (ordinarily, the student would gesture, but it might be more challenging over Zoom)?Ask the child to do a multi-step command (e.g. “Give the toy to your parent and pick up the book”). Can the child follow your commands without you having to repeat each part separately? Cognitive Development/Learning:Ask the child to point to various body parts on themselves (e.g. head, nose, mouth). How many can the child identify?Ask the child to point to different colors, shapes, letters, or numbers (depending on what the parent has available). What is the child able to identify?What type of puzzles (if any) can the child complete?Can the child write his/her name?Social-Emotional Development:Observe if child responds when you or their parent calls their name.Ask parent how the child likes to play. Does the child engage in pretend play? Parallel play? Cooperative group play? Can the child follow rules in a game?IV. DEVELOPMENTAL MILESTONES**Please note that these developmental milestones are estimates, and that not all typically-developing children will meet each of these milestones at the time given.Motor DevelopmentA) Gross MotorFirst unassisted steps: 1 yearRuns with coordination: 2 yearsJumps with both feet off the ground: 2 yearsStairsClimb up stairs, two feet per step with hands held: 18 monthsClimb up and down stairs holding on to rail/wall/hands: 2 yearsClimb up and down stairs, one foot on each step: 3 yearsThrows ball overhand: 18 months - 2 yearsKicks ball: 2 yearsRides tricycle: 3 yearsStands on one foot: 4 yearsRides bicycle: 5 yearsSkips: 5-6 yearsB) Fine MotorPincer grasp (pick up small objects between thumb and index finger): 1 yearPoints with index finger to ask for something: 15 monthsFeeding:Feed self with fingers: 1 yearBegins to scoop with spoon: 18 months Uses spoon well: 2 yearsUses fork to spear food: 2.5 yearsStacking blocks:4+ blocks: 2 years6+ blocks: 3 yearsDressing:Helps dress/undress: 18 monthsStarting to dress/undress: 3-4 years (items might be backwards)Button/unbutton medium-sized buttons: 4 yearsDrawing:Imitating scribbling: 15 monthsScribble spontaneously: 18 monthsDraws lines: 2 yearsDraws circles: 3 yearsDraws cross: 4 yearsDraws square: 4 yearsDraws triangle: 5 yearsCuts with child scissors: 3-4 yearsDraws a person:Head and one other body part: 3 yearsWith 2-4 body parts: 4 yearsWith 6 body parts: 5 yearsLanguage/CommunicationExpressive CommunicationNumber of words used independently (not including mama, dada, or other names, count all words in all languages as separate words):Mama, dada, and one other word: 1 year3 words: 15 months50 words: 2 yearsCombines words:Two-word phrases: 2 yearsThree-word sentences: 3 yearsFive- or six-word sentences: 4 yearsStories: 4 years Uses future tense: 5 yearsIntelligibility to a stranger:50%: 2 years75%: 3 years100%: 4 yearsUses nonverbal gestures or signs:Simple gestures such as shaking head “no” or waving “bye-bye”: 1 yearPointing to show things child wants or to get attention: 15-18 monthsProvides name, age, sex, address:First name, age, sex: 3 years Last name: 4 yearsAddress: 5 yearsReceptive CommunicationUnderstands “no”: 1 yearFollows commands:Follow simple commands with gestures (e.g. “pick up the toy” while pointing to toy): 1 year Follow a one-step command without a gesture (e.g. “sit down”): 15 months Follow a two-step command (referring to unrelated steps, such as “put your cup on the table and bring me a book” not “pick up a book and bring it to me”): 2 yearsCognitive Development/LearningIdentifies body parts:Identifies two body parts: 18 monthsIdentifies five body parts: 2 yearsCompletes puzzles with 3-4 pieces: 3 yearsUnderstands what “two” means: 3 yearsCounts 10 or more objects: 5 yearsWrites some letters: 5 yearsSocial-Emotional DevelopmentPlays peek-a-boo or pat-a-cake: 12-18 monthsPretend play:Simple pretend play (e.g. feeding doll): 18 months Make-believe with dolls, animals: 3 yearsPlay:Parallel play: 2 yearsGroup play: 3-4 yearsGames:Taking turns in game: 3 yearsFollow simple rules: 4 yearsV. RESOURCES CDC Developmental Milestones. . Accessed April 13, 2020?Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents [pocket guide]. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017. Accessed April 13, 2020 ................
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