Dear All

Thank you participating in the session today.

In RRR we discussed:

• UTI – Collection of specimen and Investigations
• Delayed Puberty – Constitutional
• Abdominal pain – Functional

The Communication scenario was of a needle stick injury to medical staff and consent for blood specimen after a very traumatic initial experience at phlebotomy. Dr S was the Role Player. Dr L took the hotseat while Dr R & Dr N had the examiner hats. Dr L made a very good attempt and covered most points. Chaperone, Bleep were well covered. There was some confusion with time keeping hence the end was a little abrupt. The examiners made very good observations explained with observations.

The Learning points are:

• ‘How is the child today?” for admitted children is a good ‘opener’.
• It allow rapport building, checking prior knowledge and RP’s agenda.
• Mention your ‘task’ with in first 2 minutes / in introductions
• Make your ‘task’ as a ‘Request / help from parents’.
• Do NOT beat around the bush – say it and then ‘be quiet’.
• Note & Respond the RP’s questions / queries
• Positive doctor – unless information is to contrary
• You can assume Results are normal / mildly abnormal unless stated.
• Remember there is a silver lining in EVERY situation
• ‘Silence and Pause’ are vital parts of Communication skills
• Do not forget 30 seconds Rule
• Summarize at 6 minutes

We will practice clinical station at next session as requested by members.

Please visit www.mrcpchonline.org to add your comments or points I may have missed.

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Phases of shock
• Joint pains in a well child
• Early asthma – diagnosis & management

In the Development station we practiced observing assessment of two children with different tasks:

• Fine motor assessment in a 3 year old boy with Rt hemiparesis.
• Development age assessment in 3 years old with Trisomy 21.

Dr D verbalised the exam with Dr L being the examiner for first case and Dr r verbalised and Dr S was the examiner in the second case. They both made very good attempt and described what they will do. Their summary was also accurate.

The Learning points are:

• Do not forget your Introductions & consent
• General observation in first 15 seconds
• Structured Examination technique
• Stick to it – do not get fazed by ‘child’
• Proceed in the four domains or one domain in details
• Speech is receptive & expressive
• Scissors use – seek permission
• Push child till task they are unable to demonstrate – upper limit.
• In Summary – ‘I was unable to demonstrate particular ‘task’ and not ‘Child could not do”.
• Remember ‘Opportunistic examination’.
• Presence of mind is most essential.

Please visit www.mrcpchonline.org to add your comments or points I may have missed.

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Constipation – causes.

Dr Sonia joined the session at request of some members to answer questions on what actually happens in the examination circuit. There was a very interactive sessions of almost the full session and virtually all possible questions were discussed.

The Learning Points are:

• You need to be dedicated in your preparations
• Practice – Practice – Practice is the Guru Mantra
• Structured examination is a MUST.
• Prepare a Template for each station and practice with it
• Clinical examination at least – you should be able to do at Spinal level.
• Verbalise – you will improve your presentation and Development station is ‘virtual’.
• Video station – concentrate on different aspects when reviewing
• Video – your mind will want to focus on what you have already noticed!!
• There are a few mandatory ‘phrases / information’ you have to say at each station
• Video yourself practicing each station – you will be surprised.
• Stay Calm – Stay Calm

Please visit www.mrcpchonline.org to add your comments or points I may have missed.

Anil Garg

Dear All

Thank you for participating in the session.

In RRR Dr Shishir discussed:

• Chronic Fatigue Syndrome
• H Pylori
• Tics

The Development station was a 4 year old with evidence of left hemiparesis. Task we practised were both Fine motor assessment and then Gross motor. Dr R was in the hotseat for Fine motor assessment while Dr J took the hotseat for Gross motor. The both made very good attempt at assessment and completed the task in the required time. 

The Learning points are:

• Development station is ‘Virtual’ with no Child physically present.
• Information is provided by video as a basic guide.
• Consider your communication skills – introduction, permission and rapport
• Imaging the set up – and lead the scene.
• Structured exam – practice – practice – practice
• Choose the tools appropriately
• Initial observation followed by sitting down across a table – if appropriate.
• Instructions need to be simple and accurate – non confusing
• Handedness is very important to determine
• One tool at a time and REMEMBER to REMOVE the tool after task before next tool
• ‘Push the child to level they cannot demonstrate – to determine upper age limit
• MDT – know the members and their roles
• Know how to refer child to various health professionals

Nest session we have a member, who recently became a Member of RCPCH, will join us to answer queries on nuts & bolts of exam as organized at present

Please visit www.mrcpchonline.org to add your comments or points I may have missed.

Anil Garg

Dear All

Thank you for participating in our Double session today.

In RRR we discussed:

• GMFCS – classification
• Development deficit – domains
• Screentime – effects on children

Development – AG presented Do’s and Don’ts for this station. What to focus on in the history and why social history is very important. Dr Leuvenya gave new timeline for the station:

• 4 mins to review information
• 9 mins for History from Role Player
• 1 mins for Summary
• 9 mins for Assessment
• 3 mins for Discussion

Dr M was in the Hot seat for history and Dr L was for Assessment. 4 years old NH is reviewed for parental concern of being slow in fine manipulation as compared to peers. Both made very good attempts at the respective parts on the station. Examiners Dr D and Dr M made appropriate comments on parts that could be done different.

The Learning points are:

• History should be systematic and structured
• While waiting 4 minutes: note down skeleton on what you need to ask
• Check ‘other’ domains briefly to assess if also deficient
• Time management is VERY important
• Confirm activities child can do now.
• Social and family history
• Know Milestone ‘inside out’ till of 5 years
• Use One Tool at a time
• Push ‘child’ to point they cannot do – gives upper age range.
• Mention – removing each after you are through with it
• Summary – give your impression followed by supporting evidence
• Know Management options

Please visit www.mrcpchonline.org to add your comments or points I may have missed.

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Acute Renal failure – causes
• Acute Liver Failure
• Acute otitis media – complications

We started our Autumn module after a successful Summer module. 

AG introduced the  current Clinical Examination. The exam has been changing gradually after the massive make over during Covid. 

It is back to almost Pre-Covid ‘structure / layout’. Children are back in the examination clinical stations as are Role players in relevant stations. However in the Development Station you will meet a Role player for history but will not have a child to interact with for assessment. This is the persistent change that we expect will change over the next few diets.

Dr Shishir gave important advice on types of scenarios in Communication one might get. Important to practice Ethics, Gillick competence etc for India also as you should be caught out at the exam. A general template can be followed to get good outcome at the exam. Social history has significantly more importance than usually given in ‘ Overseas / Indian’ exams – hence pay attention.

We will continue with History station at next session.

Video recording on Clinical exam will be available online soon at http://www.mrcpchonline.org

Anil Garg

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