DOI: 10.4103/jehp.jehp_1805_25 ISSN: 2277-9531

Pediatric clinical examination training in Morocco: Identifying priority learning challenges and measuring competency development among medical students

Azzeddine Laaraje, Abdelilah Radi, Abdelhakim Ourrai, Amale Hassani, Rachid Abilkassem, Amale Thimou Izgua
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BACKGROUND:

To systematically assess learning difficulties, competency development, and educational needs during pediatric clinical examination training among medical students in the MENA region, providing evidence-based insights for curriculum optimization.

MATERIALS AND METHODS:

This cross-sectional study included 122 fourth-year medical students at the Faculty of Medicine and Pharmacy of Rabat, Morocco, during mandatory pediatric clerkships (July-August 2025). A structured questionnaire assessed learning difficulties using hierarchical ranking with weighted scoring, competency progression through pre-rotation and post-rotation self-assessment using 4-point Likert scales, and educational factors including facilitating elements and unmet needs. The questionnaire underwent rigorous validation through pilot testing (n = 15) with subsequent linguistic validation for French-Arabic bilingual context, ensuring content validity and cultural appropriateness through expert panel review and cognitive interviewing with representative students.

RESULTS:

Managing uncooperative children emerged as the most critical learning difficulty (54.1% ranking it first, weighted score 2.38), followed by performing technical procedures (weighted score 1.99). Significant competency improvements were observed across all domains: clinical examination (mean change + 0.94, Cohen’s d = 1.34, P < 0.001), child communication (+0.79, Cohen’s d = 1.07, P < 0.001), and parent interaction (+0.51, Cohen’s d = 0.73, P < 0.001). Hip examination and primitive reflexes showed highest difficulty persistence rates (defined as the proportion of students who initially found an examination difficult and continued to report difficulty at rotation completion) of 75.0% and 78.9%, respectively. Repeated patient practice demonstrated strongest correlation with competence gain ( r = 0.42, P < 0.001). Pre-rotation practical training and supervision were identified as primary unmet needs (56.7% each), significantly predicting reduced satisfaction (OR = 0.45 and 0.52, respectively, P < 0.01).

CONCLUSION:

Behavioral management training should be prioritized in preclinical pediatric curricula. Large effect sizes validate experiential learning effectiveness. The competency progression metrics provide practical benchmarks for medical education resource allocation and curriculum evaluation in MENA contexts.

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