Pediatric Trainee Communication in a Resource-Limited Setting: Caregiver Ratings, Resident Self-Assessment, and Literature Context

Effective doctor–caregiver communication is essential in pediatric outpatient care, yet evidence from low-resource settings is limited. We conducted a cross-sectional study in outpatient pediatric clinics in a major referral teaching hospital in a resource-limited urban setting, including all trainee pediatric residents in the city. Consecutive eligible caregivers completed the Arabic Communication Assessment Tool (CAT) after consultations until 10 per resident were obtained (n=230), and residents completed session-level self-ratings (n=23). CAT items were dichotomized as “excellent” versus “less than excellent,” and caregiver ratings were compared with resident self-ratings; published CAT studies were descriptively reviewed to provide contextual comparison. The pooled caregiver “excellent” proportion across items was 37.4%. Ratings were highest for spending the right amount of time (53.0%) and lowest for encouraging questions (24.8%), involving caregivers in decisions (25.2%), discussing next steps (27.8%), and checking understanding (29.6%). Residents’ self-ratings were generally lower in these same domains, although overall pooled differences were not significant. Higher caregiver-rated “excellent” scores were associated with uninterrupted encounters, shorter waiting times, follow-up and repeat encounters, and resident-perceived appropriate workload, while higher caregiver education was associated with fewer caregiver-rated “excellent” scores; ratings showed little variation by resident year or prior communication-skills training. These findings identify clinic processes and specific communication skills as priorities for further evaluation in efforts to improve caregiver-rated communication quality.