Thank you for participating in the session on communication.

I took the plunge and attempted the scenario which we had discussed previously of a newborn baby who is noted to be dusky at four hours and the clinical assessment is that he may have a cyanotic heart disease likely to be transposition of the great arteries. Dr Tamal was and excellent role player and did get across his anxiety very well. He was however, satisfied in the end.

The second scenario we did was of a one-year-old admitted following a febrile convulsion due to otitis media. The following morning during the ward round he was felt to be better and fit for discharge. However his father who had just arrived, was not happy with the medical decision and wanted the child to have a CT scan as he had found on Google. Maria was an excellent role player but technology did let us down in getting a clear understanding of communication between role player & candidate.

Learning points:

• Ensure you have Good internet connection.
• Vitally so as you can opt to take the exam from home now.
• Technology failures on your end are unlikely to get sympathy from RCPCH – I am guessing.
• “Will the child die?” is a common question – practice how to respond satisfactorily to it.
• No medication can completely eliminate the chances of future convulsions
• Tepid sponging / Cooling – can be different in context of different countries / climates
• After introductions – keep QUIET and give parent /RP chance to get across everything they want to say – DO NOT interrupt.
• This will also give you information of their prior knowledge.
• Then pick up salient points – from THEIR perspective and address them

Add your comments or points I may have missed.

Video recording of the sessions are available to participants.
Anil Garg

Comment

A real learning treat today.
Specially, the middle part management, and the succinct summary .
Enriched.

Dr TL

08 June Kolkata

Communication role player expected to cry.

Offer tea/coffee/water (usually available) or at least a tissue.

Take regards from the bottom of my heart ,Sir.

We need a teacher like you to captain us so that we can have a flawless sail to the reach our cherished destination.

Pranams.
🙏🙏
Tamal.

Happy teachers day to a wonderful teacher😇😇

Dr AJ

I found guidance, friendship, discipline, and everything in one person. And that person is you. Happy Teachers’ Day!🙏🙏🙏🙏🙏

Dr UP.

We have received tremendous support from you all and have filled all our seats – 14 in total – for the Interactive Zoom Sessions. We limit the number so as to be able to provide individual attention to each participant.

Our online modules on Communication, History & Management, Video, Development and Clinical stations are available.

For Interactive Zoom sessions we have a waiting list and will consider a second session to start soon. Please register your interest.

Anil Garg

We started with a PowerPoint presentation on communication station, what it entails, where the marks are, the do’s and don’ts.

This was followed by a scenario of talking with parents of a new born baby, 4 hours old, noted to be dusky, clinical examination suggestive of Transposition of Great Arteries (TGA).

Task was to discuss your concern with parents and answer their queries and address their worries and concerns. Misbah, Anish and Tamal did the role play and hot seat.

The learning points were:

• Read the information given VERY CAREFULLY.
• Do not assume information not written.
• Anxious parents – clearly elicit their concerns first before ‘jumping’ in with your ‘plan’
• Go about in a systematic manner in establishing diagnosis
• Remain clam, take 5 seconds to collect your thoughts and then reply if not sure
• remember to visualise: WHAT I WOULD NORMALLY DO.
• Dusky babies are not normally time critical transfers hence be systematic.

Add any point I may have missed or to add your comment.

Video of the session will be available in for 2 weeks – if you could not attend or wish to review.
Anil Garg

Thank you for attending and making today’s session so lively and interesting.

We discussed a scenario in which a 21 day old baby presented with lethargy, poor feeding and weight loss. Serum Na: 110 mmol/l. Ankita was the role player and Anurag took the hot seat. The history and communication were appropriate. Consanguinity needs to be confirmed if there is suggestion of a recessive condition.

The differential diagnosis could be done better and appropriate management can only be correct if our differential diagnosis is on track.

Learning points:

• In a neonate with lethargy and poor feeding NEVER forget sepsis
• Differential diagnosis should be most likely first
• If results or information suggests a life threatening condition – MANAGE that first
• In this child sepsis and hyponatremia have to be priority in treatment
• Frequency of medications – can make an educated guess and ask for confirmation.
• Is it drug x – Hydrocortisone and other – Fludrocortisone
• Role player is likely to clarify even if they have not given the name on drugs first
• Investigations to support or rule out your differential
• Discuss with your consultant

If there are points I have missed or comments you wish to add.
Anil Garg

Misbah had shared with me the information college had given regarding changes to the new exam.

It is reassuring to learn that there will be no change to the history and management, communication and video stations of the exam.

Changes are to the clinical stations and the development station.

There will be three clinical stations instead of four. They will be two short clinical stations and one extended clinical station.

The extended clinical station will have a scenario given followed by time for history and examination. The examination will be virtual hands-free.

It will be very important for the candidate to practice vocalising what they have been doing intuitively and in autopilot since they qualified.

This would be followed as before with summarising, differential diagnosis and management planning.

The development station will be on similar skeleton framework and the candidate would be expected to describe how they would be conducting the developmental assessment.

The rest of summarising the evaluation of differential diagnosis of developmental age and the discussion will be as before.

Any change causes anxiety but if we stand back and look at the new format it is more of old then off new. You will be expected to do differently only for a very short portion of the particular station and this will improve with practice till the actual date.

We agreed to:

• Read Hutchison’s Clinical methods for systemic examinations.
• Write out bullet points of one system each
• Positive and negative signs to identify in a given scenario
• We will share & practice
• Wait for RCPCH details on the clinical station
• Start on our rolling Course systematic template from 1 September.

We practised skills so we could do them in our sleep – NOW we need to learn to talk in our sleep!

add a comment or any point I may have missed.
Anil Garg