Development and validation of a self-efficacy scale for clinical decision-making in general paediatrics.

Paediatric primary care in Canada and elsewhere is changing. General paediatricians are now caring for an increasing number of children with complex medical conditions (1,2) and are acting as consultants to other providers of paediatric care (3–5). Although solid knowledge and skills in the area of care to the medically complex child is warranted, competence in the management of basic and common general paediatrics problems encountered in both the hospital-based and the ambulatory care setting remains essential to provide effective consultation expertise. Developing clinical decision-making skills in general paediatrics is challenging for residents enrolled in tertiary centre-based paediatric residency programs. Recent surveys of graduates found that they were comfortable managing acutely sick children in the inpatient setting (6–9), but believed themselves to be ill-prepared to deal with several common ambulatory general paediatrics problems (7,8,10,11) (unpublished data, Henin C, 2006). The belief in one’s ability to make appropriate management decisions when faced with problematic situations is known as ‘self-efficacy’ (12–14). The low self-efficacy of newly graduated paediatricians in managing general paediatrics problems is concerning because low self-efficacy is linked to the decreased performance of tasks (12–16). Low self-efficacy toward a task could also negatively impact its chances of success (12) by decreasing how much effort is invested, persistence in the face of adversity and assurance when approaching that task (13). While previous studies have explored constructs of self-efficacy in specific contexts, roles or tasks within the realm of clinical medicine (10,16,17), none have focused on clinical decision-making skills in general, and none have investigated the domain of general paediatrics. The goal of the present study was to develop and provide evidence for the validity of a General Pediatrics-specific Self-Efficacy (GPedsSE) scale to evaluate self-efficacy specific to clinical decision-making in general paediatrics. If successfully validated, this tool could be one of the measures used to monitor the development of residents’ clinical decision-making in general paediatrics.