Dear All

Thank you for attending the session today. I send learning to most of our alumini so to keep in touch and remind them Paediatrics is a life long learning journey and MRCPCH is not the end. Your contribution is always welcome to guide our current and future members.

In RRR we discussed:

• Acute Liver Failure: causes & Investigations
• Abdominal mass with hepatospleenomegaly
• Choanal atresia

The Video station depicted a 7 year old boy thought to be day dreaming by parents and a video they have brought showed periodic absences. Dr P was in the Hotseat and Dr T & Dr A wore the examiner hat. Dr P noted the clinical signs, history questions were appropriate and examination was also good. Discussion got a little confused due to Hotseat syndrome. There is always room for improvement.

The Learning points are:

• Phrase questions ‘succinctly and be precise’.
• ‘How long has he had these episodes and have they been increasing?’
• Seizures is a common topic hence read up carefully and in detail
• What advice to give parents.
• Activity restriction till ‘seizures’ are controlled – not 2 years
• Drugs / medication can be started without EEG in cases.
• Diagnosis is based on history & observations and not only on EEG
• EEG is often normal inbetween seizures
• EEG is abnormal in 1% individuals with no symptoms!!

General questions: In Clinical station – Should you describe your examination finding as you go along. Depends on your & exainers preference but my advice is Talk to the child explaining what you are going to do as you go along. This will keep the child engaged and examiner will also know what your are doing.

Practice to finish a systemic exaination in 5 minutes.

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:

• Vulvovaginitis in 3 yr old
• STI – Sexually Transmitted Infection
• ADHD

We started on Video station today. AG presented the nuts and bolts and Do’s & Don’ts for the Video station. 2 stations with video clips and discussion with examiners at both. We then had a video of a relatively well looking 6 month old presenting with vomiting for 24 hours. There was evidence of repaired meningomyleocele and Ventriculo-Peritotenal shunt. Dr A took the hot seat with Dr P & Dr P took the examiner hat. It was a good attempt but could be done better. Examiner gave relevant feedback. Read up Hydrocephalus – with open fontanelle and later on in older children.

The Learning points are:

• Video slpis are normally approx a minute long
• Concentrate on different aspects when reviewing video 2^nd time.
• Have a Differentail diagnosis of 2-3 after watching Video
• History questions should help refute or support your DD.
• Examination has to be for specific findings with similar aim
• Common thing common – when considering diagnosis
• Do not jump to conclusion with in first few seconds
• Keep an open mind – else heading for trouble
• Do not argue with the examiner if they offer a different diagnosis
• Management is essential and first few steps need to be clear

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:

• Obesity – complications
• Purpura
• Antenatal diagnosis by USS

The Communication scenario was of a newborn with severe birth asphyxia requiring cooling, task was to explain to parent and take consent for transfer to tertiary unit. Dr A was our Role player and Dr A took the hotseat. Good attempt but with some limitations due to internet connection. Dr P stepped in and made a good effort. Most points for good communication were covered but there is always room for improvement.

The Learning points are:

• Situational awareness for introductions – try not to use standard phrases
• Check prior knowledge of Role Player before getting into your stride
• Avoid medical jargon – if necessary – explain
• 30 sec rule – Max talk for 30 secs – can be less
• Dialogue and NOT a monolgue
• Explain Normal first and then the abnormality
• Do not be a passimist – be Positve and factually correct
• Summarize at 6 mins – only a few sentences are needed
• Acknowledgewhat Role Player is saying – answer if possible

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

Anil Garg

Dear All

Thank you for joining the session today. We have had a longr than expected break due to reasons beyond my control. We will make up for the lost time in the next few weeks.

In RRR we discussed:

• Radiation effects – post malignancy treatment
• Delayed puberty – consider Extreme exercise
• Laryngomalaica – floppy larynx

Communication scenario was discussion with Role player (Grandparent) explaining Unexplained bruising of a 2.5 yr old grandchild and further management plan. Dr T took the hotseat and AG was the roleplayer. Dr T made a very good attempt and covered most important points. There is always room for improvement. ‘Examiners’ gave very constructive feedback.

The Learning points are:

• Use correct ‘anatomical descirption’ Laryngomalaica is ‘weakness’ of cartildge and not of muscles of larynx.
• Communication is Dialogue NOT a monologue
• In you use medical terminology (jargon) – explain it in simple words
• Do not speak for more than 30 seconds (maximum)
• Consider 30 sec limit as ’30 mph speed limit’. You can drive slower than 30 but should not exceed the limit!
• Use your duty as per ‘law’ or Guideline’ to avoid making issues personal with Role player.
• Describe Normal before talking of Abnormal: Normal bruise vs abnormal bruising.
• Summary at 6 mins is essential but needs only few sentaneces

We will continue with communication scenario on Thursday.

Please visit www.mrcpchonline.org to add your comments or things i may have missed.

Anil Garg

Dear All

Thank you for particpating in the session today.

In RRR we discussed:

• Newborn ‘blood’ screening
• Gastroenteritis – conditions mimcking
• Hypoglycaemia – post neonatal period

The Clinical station was Communication. Scenario was discussion with mother of a newborn baby who is mucusy and likely diagnosis is Tracheoesophageal atresia with fistula. Dr L was our very able Role Player. Dr A was in the hotseat and later swapped the seat with Dr A. Dr Amdae a very good attempt and covered most points. Dr A2 took over and covered few points that could also be covered. After feedback from Examiners Dr AG took the hotseat with Dr L still in RP mode to demonstrate how he would do it. The feedback was constructive and positive.

Learning points are:

• Communication is a Dialogue and not a Monologue
• Set the scene, chaperone and uniterrupted time.
• 30 secs bits of information with RP acknowledgement / response
• Try and avoid ‘Hi’ as a greeting – Good morning / afternoon is better
• It is about Roleplayer’s agenda and not yours
• What Role player knows or has noticed – concerned about?
• However – the Task has to be addressed / completed
• Do not need to give all the information of subject
• Share responsibility with other specialists.
• Coordinate care with other specialists – imply you know and have done previously
• You are unlikely to know Full details of likely treatment

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

Anil Garg

Dear All

Thank you for particpating in the session today.

In RRR we discussed:

• Respiratoy distress in newborn
• Child with Liver Disease – management
• Mesles – complications.

In Communication station – Dr A was our Role Player for a Teenager who had taken a Paracetamol overdose. Dr A was in the hotseat with DR L & Dr A with the examiners hat. Dr A made a good attempt but there were learning points that were discussed and then the roles were reversed. Dr A was in the Hotseat and Dr A in RP mode. The examiners gave very valid observations and feed back.

The Learning points are:

• We need to practice more
• Important to learn phrases to use and those to avoid
• Try and not be judgemental
• Establish rapport
• Confidentiality is essential.
• Watch your communications skills – remember – Dialogue vs Monologue.
• Be aware of our mannerisms – things we say or act without realizing!

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:

• Napkin rash
• Coeliac disease
• Failure to Thrive

AG discussed Do’s & Don’ts of Communication station.

• How are you marked,
• What tasks are given,
• Situational awareness,
• How to set the scene,
• Eye contact – an essential tribute,
• Summarise
• Safety netting.
• 2 minutes Shishir’s Rule
• 30 sec bytes – AG Rule

We had update on the exam experience, how to prepare, what we are doing well and how to practice for your exam in the near future.

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:

• Pubic hair in 3.5 yr old
• Enuresis
• Neonatal seizure – management

The Clinical station was carry on from our session on Tuesday. We covered the Developmental assessment of 3.5 yr old, History was taken on Tuesday. Dr D was in the hotseat and did a good examination. There are a few points ‘examiners’ mentioned. Do not waste time on repeating the same task – better to move on and come back.

Learning points are:

• Choose the toys you will need
• Check Environment for ‘artefact’ wheel chair, splints etc
• One ‘tool’ as a time – remove from view before next
• Opportunistic examination
• Sit on floor at level of child.
• Time management is very important
• You instructions should be CLEAR & PRECISE.

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

Anil Garg

Dear All

Thank you for joining the session today.

In RRR we discussed:

• Delayed puberty
• Iron Deficiency Anaemia
• Recurrent vomiting

The Development was on request for members sitting the exam within the next few days. The scenario was a girl with features of Trisomy 21. Parental concerns were slow development as compared to her siblings. Task to take focused history – we could only cover this and not the verbalizing of the exam – which we will cover at our next session. Dr S took the hotseat and made a very good attempt at tackling the task. Details of symptoms were explored however important domains could not be covered due to time limitations.

We had a brief PowerPoint presentation by AG on ‘History in the Clinical Exam’. What emphasis is required for different stations you will be ‘taking history’.

Learning points are:

• Developmental Concerns – Aetiology is implied – need identification.
• Check what the child can do now.
• Any regression?
• Comorbidities & Medications
• Social history
• Impact on family members -how mother coping?
• EHCP – Education – Health – Care Plan
• Living Allowance: Disability, Mobility
• Main Stream schooling – as far as possible

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:

• Rickets
• Meningitis in neonate
• Increased Intra Cranial Pressure

The Clinical station was a Video station. The Clip showed a boy with history of hospital admission following a viral infection and with high stepping gait. Dr P was in the hotseat, while Dr S & Dr D wore the examiner hats. Dr P identified the clinical signs and formulated appropriate questions to ask and targeted examination. Examiners were able to add the missing links. Breathing difficulty vs respiratory support, muscle to and deep tendon reflexes.

The Learning Points are:

• Develop a differential diagnosis – do NOT stick with ONLY one.
• Take all the information provided in developing your DD
• Investigations – it is reasonable to check specific results from medical records – this is something you will do in your clinic
• Mention Investigations with expected results.
• Hotseat has a seriously detrimental effect on the brain!!!
• Be prepared – Practice – Practice – Practice.

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

Anil Garg