Pediatric Communication Skills Snapshot
Learner Name
Date
Observer
Patient/Parent Interaction
Introduces self and role
Yes
No
Addresses patient and caregiver appropriately
Yes
No
Uses age-appropriate language
Yes
No
Information Gathering
Elicits concerns from patient and/or caregiver
Yes
No
Uses open-ended questions
Yes
No
Active listening
Observed
Not Observed
Empathy and Support
Responds empathetically to patient/caregiver concerns
Yes
No
Acknowledges emotions
Yes
No
Education and Explanation
Explains information clearly
Yes
No
Checks for understanding
Yes
No
Comments
Strengths
Areas for Improvement