Training based on the acquisition of competencies is a reality in pediatric emergency departments. This training option, centered on the learner, their clinical practice, and the interaction with the environment (both the emergency team and the patient and their family), facilitates the durability and good comprehension of the acquired knowledge. The fact that the training takes place “at the bedside” allows for the creation of connections between the acquired theoretical knowledge and real clinical practice, which consists of more nuances and peculiarities than those usually found in “textbooks.” Even so, the importance of obtaining a solid base of theoretical knowledge on which to later adapt clinical practice and modify it according to updates must be underlined.

The Union Européenne des Médicins Spécialistes (UEMS), author of the European Training Requirements (ETR), states that “the quality of medical care and expertise are directly related to the quality of the training received, the competencies acquired, and their continuous improvement, updating, and development.”

It is for this reason that, to ensure good training, we must also ensure a good assessment of competency acquisition.

Various tools exist that can help us evaluate different types of knowledge in different situations, although all with similar objectives. It is important to remember that the objective of the evaluation is essentially formative, so it must allow the learner to identify areas for improvement, establish plans to achieve it, objectify an evolution, and allow for setting new goals until the full acquisition of the competency is reached, thus enabling a summative assessment (if necessary).

Regarding the different types of tools, direct observation of clinical practice by a trainer with subsequent feedback is one of the most recommended tools. It allows for the real-time assessment of an interaction with a patient and their family and makes it possible to evaluate both the performance of the history taking and physical examination, as well as communication, organizational capacity, and even teamwork. A validated form such as the mini-clinical evaluation exercise (mini-CEX), which consists of scales to assess each of the competencies, can be used. The subsequent feedback must be collaborative: the observer and the observed discuss the performance, identify strengths and areas for improvement, and set goals for the next observation. This tool has a high level of satisfaction among both students and educators.

Another type of tool that can be used for evaluation is simulation, especially in those clinical situations that are infrequent and require teamwork. Simulation can be used to assess theoretical and procedural knowledge, but also to assess other competencies necessary in emergency medicine, such as effective communication, resource management, and leadership. Learning is again extracted from the feedback given after the simulation activity, which has the objectives already mentioned.

Regarding the assessment of procedural skills, a direct observation of the procedure can be performed, evaluating whether all necessary actions, previously described in a checklist, have been carried out. This action is known as Direct Observation of Procedural Skills (DOPS) and is easily adaptable to the different procedures performed in the emergency department. As previously mentioned, this observation must be followed by feedback with an assessment to identify areas for improvement.

Finally, a 360º evaluation of the learner can also be useful and interesting, i.e., an evaluation carried out by different professionals (the learner him/herself, nurses, pediatric consultants, and residents) in which different competency capabilities are assessed. This evaluation provides different perspectives, improving the quality of the information and reducing bias, although it can be difficult to implement. An example of a validated 360º evaluation tool is the mini-PAT questionnaire, which assesses teamwork, communication, and performance in clinical practice.

In conclusion, it should be highlighted that there are currently several tools available to assess the acquisition of competencies, and others not mentioned, such as the Objective Structured Clinical Examinations (OSCEs) or the discussion of clinical cases. Most have in common the need for subsequent feedback with the evaluated person, since an evaluation without a subsequent explanation will not be useful for the learner’s improvement. To achieve this, it is necessary to be able to count on protected places and times to be able to give and receive this quality feedback and with professionals trained to provide it. Finally, it should be emphasized that the word “learner” has been used at all times and not “resident,” “MIR” (Medical Intern Resident), or any other; the reason for this choice is that it is evident that all staff working in pediatric emergencies are in constant training and should be able to give and receive feedback to/from their colleagues about the competencies developed in the workplace in a safe, assertive, and empathetic manner.

Funding

No funding was received for the research, authorship, and/or publication of this article.

Author contribution

Iris Alonso Sánchez: Writing - review & editing, Writing - original draft, Conceptualization

Conflicts of interest

The authors declare that there are no commercial or financial conflicts of interest for this research.

Ethical disclosures

This work (original article, clinical trial, human/animal research, etc.) complies with research regulations and has the approval of an Ethics Committee. The author provides the corresponding official document or approval code.

Use of artificial intelligence tools

I declare that no artificial intelligence tool (such as ChatGPT, Copilot, Gemini, or others) has been used in the writing, analysis, or review of this article.

References

1. Curriculum Development Special Interest Group of the Paediatric Section of the European Society of Emergency Medicine (EUSEM). European Syllabus for PEM 2018.
2. Sociedad Española de Urgencias de Pediatría. Plan de formación en Urgencias de Pediatría para el MIR de Pediatría. Disponible en: www.seup.org.
3. Buckley C, Natesan S, Breslin A, Gottlieb M. Finessing Feedback: Recommendations for Effective Feedback in the Emergency Department. Ann Emerg Med. 2020;75(3):445-451.