Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Oedematous 4 year old
• Ambiguous genitalia – new-born
• Central cyanosis – new-born

AG gave a Power Point presentation discussing the Clinical stations in the exam from 2023. The exams are expected to move to Face to Face with children. This is a major move from Online exams during the Covid pandemic. We then had question answers on specific aspects of the clinical stations.

The Learning points are:

• Develop a differential diagnosis of 3 early
• Structured format of your examination technique
• Explain what you will be doing – avoid Pain – stop.
• Opportunistic examination with infants and young children
• General examination is essential at ALL stations
• Ht & Wt Centiles – not actual cm & kg
• Consider asking for Parent’s help
• Consider Chaperone with older children
• ‘What will I see if the ‘dress’ was not removed’ –

Please visit http://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:

• Anorexia nervosa
• Coeliac disease
• Altered sensorium – 9 yr old

The H&M was a review of a 7 year old with an afebrile seizure when on holiday abroad. Referred by GP for review. Dr Shisher was moderator. Dr S was in the hotseat. Dr A very able Role Player. Dr D & Dr S wore the examiner hats. Dr S, good introduction and took very good history and covered most of the important details. A few points were lacking and highlighted by the examiner.

Learning points:

• Address the Role Player by name – not ‘Mum’ or ‘Dad’.
• Avoid Medical jargon
• Use the information provided carefully but take as accepted
• Work out a differential diagnosis to explore
• Seizures come from two sources: Brain or Heart
• Read and refresh all medical emergencies
• Summarize at 9 minutes – brief
• This will highlight what you may need to ask or elaborate further
• Do not lose your calm
• Practice will keep ‘Brain connected’ during ‘hotseat / Exam’

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 we discussed:

• Kawaski disease
• Autism – main features
• Asthma management follow OP review

The History station was of a 21 days old neonate presenting with lethargy, poor feeding and failure to gain weight. Dr A took the hotseat, Dr P was the Role Player and Dr R & Dr A wore the examiner hat. Dr A made a very good attempt with good introduction, allowing RP to put her concerns across and getting the details. In discussion there were some lapse due to the pressure of being in the hotseat.

The Learning points are:

• Be careful of your Communication skills & words used
• Acute management is very important
• Revise ALL Hypos.., Hypers.., Status.. conditions
• Have them on your finger tips
• Even with an obvious diagnosis – explore other options briefly
• 9:4 minutes go very quickly – hence time management is vital
• Summary at 9 mins needs to be very brief
• Antibiotics for neonate – do not forget

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:

• Chronic diarrhoea with Failure to Thrive
• Haemolytic Uraemic Syndrome (HUS)
• Necrotising Entro-Colitis (NEC)

The History was of a 12 year old presenting for annual review for her Tachycardia with breakthrough symptoms in past few months. Dr A took the Hotseat, Dr A was a very able Role Player as mother and in Double role of being Young person. Dr P was with Examiner hat and Dr Shishir was our host today – he was moderator. Dr A had a very good attempt but there were some gaps in the information gathered due to extensive information gathering in other areas costing him time. Some of the gaps in information was picked up others.

The Learning points are:

• Paraphrase the information provided to begin and build on it.
• Do not go very deep in establishing the given diagnosis
• Recent worsening – 3-6 months – need to explore
• “What do you do to feel better?” is a good question.
• More important to gather information regarding treatment
• Compliance. Other Drugs – recreational.
• Failure of treatment can be due besides not taking is ‘out growing’
• Drug level is a very good way to confirm compliance
• Other relevant conditions: Thyrotoxicosis, Anxiety etc
• Do not get into Communication Mode
• Acknowledge questions and Park as appropriate
• Be careful of your Language – ‘Kid’ is not appropriate for a child
• Do NOT forget the various other facets of history.
• Make a note of points to ask in the 4 minutes while reading information provided
• Do not beat around the bush and repeat same questions.

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:

• Short stature
• Asthma management
• Henoch Schönlein Disease

The main session was changed to a Video station as Dr P, our RP, was busy at work hence we changed to Video station scenario. The video clip was of a 2 day old new born, with evidence of seizure activity, oxygen via headbox and virtually no movement of left arm. Dr D opted for the hotseat. Dr P picked all the relevant clinical clues and asked appropriate questions coming up with good differential diagnosis. It is important to remember ANTIBIOTICS for an unwell neonate as Sepsis can never be ruled out and ignoring it can lead to death.

The Learning points are:

• Watch the video very carefully
• Try and focus on different aspects to one you have noted during first view
• Differential diagnosis: mention most common FIRST
• Structure your answer – in broad categories first as far as possible.
• Examiner may ask details on one of them
• Sepsis – never forget as a possible cause
• Communication with parents is important
• DOCUMENTATION – mention you will write down in the notes – definite mark
• Law states: If NOT written – assumed it is NOT done. Medicolegal catch
• The last point you should adopt in your Clinical practice – if not so already

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:

• Anaphylaxis – discharge planning
• DKA – complications
• UTI – sample collection

For the main session we had a change of schedule. The History and Management scenario was substituted for a Power Point presentation on History & Management by AG. We covered different aspects of history at various exam stations and the emphasis required to get optimal results. PP presentation will be able online to view.

The learning points are:

• Remember the Guru Mantras we discussed.
• History & Management: generally involves a crisis in 3-6 months & can also be acute first time presentations
• Developmental history: trying to find out aetiology and what child can do.
• Video station: Closed questions for specific ‘diagnosis’
• Clinical: few at some tasks e.g. MSK
• Communication: little relevant questions to aid addressing concerns
• Summarize at 9 mins – to refresh what you have covered and what further to cover
• Read information provided & Listen carefully to Role player
• Do not turn it into Communication station: Acknowledge & Park queries
• Be a ‘Positive & Reassuring doctor’ & NOT a ‘Doctor of Doom & Gloom’
• Talk to the point – need not give Rationale for every statement.

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

Anil Garg

Dear All

Dr Pamela has shared the Following important section for History and Management station when an adolescent / teenage is the Role player or subject. You will need to phrase the questions in your own ‘language’ and local / reginal context.

Teenagers: HEEADSSS

“This is a standard set of questions that I asked everyone. Please do not be alarmed. These are just questions that I asked everyone. “

• Home and relationships: How is home? How is relationship with your family?

• Education/employment: How is school? How are you with your friends? How is work?

• Eating: How is your eating habit?

• Activities and hobbies: Do you have any hobbies?

• Drugs/alcohol/tobacco: Do you take drugs, drink alcohol or smoke?

• Sex and relationship: Are you in any relationship with a partner? Are you sexually active?

• Self harm/depression: Do you feel sad? Do you harm yourself?

• Safety and abuse: Is there anyone harming you?

Today in RRR we discussed:

• Hemarthrosis
• Acute ataxia
• Cystic fibrosis: DD – Immune deficiency

H&M was with a 66 yr old young person with Diabetes who is referred back by GP for weight loss and being tired. Dr J took the hotseat, DR D and Dr A took the examiners hats. Dr J covered all the important points but important to address Role players presenting concerns – else they will keep coming back. Adolescent history points mentioned above are important.

The learning points are:

• Address Role player’s concerns
• Need not discuss in great detail ( communication scenario) and can park them
• Teenage females: always ask Menstrual history
• Following ‘+ve’ screening test – confirmation is essential
• Summarize at 9 minutes – will refresh for you what has been covered
• Management of Chronic diseases in Multi Disciplinary
• Use MDT members – you CANNOT KNOW EVERYTHING
• Carbohydrate count – get dietician advice
• There isn’t a specific dose of Insulin – do check compliance

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:

• Fragile X
• Haemolytic Uraemic Syndrome
• Vomiting in an infant

The Communication scenario was a new born baby noted to be dusky at 4 hours of age. Registrar’s – (candidate’s) clinical assessment is the likely diagnosis is Transposition of Great Arteries (TGA). Task is to explain to mother and get consent for urgent treatment and transfer toa surgical unit. Dr A was a very good role player as the mother. Dr P and Dr P wore the examiner hat and Dr D was in the hotseat. The attempt was good and most points were covered in the attempt. There were a few questions that came up:

• Should we discuss with Consultant before or after speaking with RP?
• How to avoid medical jargon?
• Why it happened i.e. the malformation / defect?

The Learning points are:

• Read the stem VERY carefully and note all the information provided.
• Keep your explanations simple.
• You can escalate your ‘complexity’ depending on response.
• Do not for 30 sec rule – hence keep them brief
• Get a chaperone – ward sister is generally very good
• Do not bring in details that do not add to communication
• Too many details only create confusion.
• You should speak to RP first and then inform Consultant in this scenario
• Sometimes Medical jargon cannot be avoided else discussion can reduce to ‘Baby talk’.
• With use of Medical terms – ALWAYS explain what the term means.
• We do not know why it happened. Sometimes nature ‘goes wrong’. Development of a human baby from a single cell is an extremely complex process that we do not understand. It is NOBODY’s fault.Do
•  NOT give wrong information.
• Always be a positive and reassuring doctor – NOT Doom & Gloom

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

Anil Garg

Dear All

Thank you participating in the session today.

In RRR we discussed:

• Epilepsy – types grouped into
• Bronchiolitis
• Status Epilepticus – management

The Communication scenario was of an 11 month infant admitted with neck stiffness likely due to meningitis. Task was to explain to parent diagnosis and to obtain consent for investigations, including Lumbar puncture and treatment. Dr A was the Role player and was very convincing. Dr P took the hotseat and was doing well when she had to leave to manage an actual child admitted with convulsions. Dr P took over and completed the task well. Dr D and Dr J had Examiner’s hat and provided structured feedback and marks.

The learning points are:

• Read the task VERY CAREFULLY.
• Every word is there contributing to the overall picture.
• Paraphrase the information provided and come to task quickly
• Give Role player to set their agenda
• Do NOT follow YOUR agenda. Be careful.
• It is not ONLY about completing the task.
• 30 seconds rule for speaking.
• Dialogue vs Monologue.
• Use pause to break your ‘speaking’.
• It needs practice so work hard with colleagues

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:

• Infective Hepatitis
• Respiratory Distress Syndrome – Newborn
• Floppy newborn

The Clinical station was Communication scenario was of a 6 yr old referred for parental concerns regarding decreased activity and excessive TV watching. Dr P was a very able Role Player in Mother’s role. Dr A took the hot seat and Dr A & Dr J had the examiner hat. The attempt was good. We need to remember our limitations and that we work with other professionals who are more able than us in specific fields hence we should use them Dietician, physiotherapist etc.

The Learning points are:

• Read information carefully as there is a lot of information given.
• Watch your body language – EYE contact is a MUST.
• Sound confident.
• Opening statement after introductions: paraphrase info given.
• Concentrate on cues given.
• Do NOT slide into History Mode from Communication mode.
• Do Summarise at 6 minutes
• Involve Role Player in the discussion – DIALOGUE
• Do not get into monologue.
• It is about SHARING information – not telling everything you know.

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

Anil Garg