Thank you for your participation in today’s video station session.

We looked at two clips one was of a six-year-old with rash with Toxic Epidermal Necrolysis (TENS) and second of a 12 yr old with Generalised seizure like activity (NEAD). Dr A, Dr Y and Dr S – took the hot seat as there were some internet connection issues. Findings were discussed. Discussion was very generally good.
Learning points:

• Watch a few videos of True Epileptic seizures so you are sure of what a generalized seizure looks like!
• Know the management well.
• Be confident of your observations.
• Do not ask for information already given.
• Some noted the clinical signs but did not mention as not sure
• NEAD is a frequent symptom and needs to be tackled appropriately
• Learn how to address Functional disorders
• Do NOT forget the 30 sec rule
• When asked ‘What will you do?” – Do NOT mention What you will NOT do!

Anil Garg

Thank you for participating in the session today and making it so interactive.

We reviewed two video clips one of a nine month old baby with respiratory distress and the second of a thin looking 12-year-old boy with a gastroscopy and a central venous access and alopecia.

Dr DS and Dr S took the hotseat. Observation of clinical signs was good and discussion followed smoothly hence we were able to see 2 scenarios.
Learning points:

• See the video clip carefully – sequence of clinical signs is very important
• Sequence will affect management of the case.
• Do NOT use abbreviations when describing. Very easy to mis-hear on the net and lead to confusion.
• History and examination pointes have to be very ‘crisp’.
• Do not ramble in your presentation.
• Acute asthma – check BTS guidelines
• Sudden significant deterioration – think of pneumothorax
• Avoid painful stimuli / tests if possible in respiratory compromised children till help is available.
• Saturation monitors do NOT substitute for Electrical heart monitoring.

Visit www.mrcpchonline.org to add your comments or points I may have missed. Video of session will be available for 2 weeks.

Anil Garg

Thank you for participating in the session today. My apology that the breakout rooms did not work as I had planned and will check with our IT guru and learn where I went wrong.
We saw Video clip of a 14 year old girl with a rash. The distribution of the rash was consistent with Shingles.
The learning points are:

• Keep mind open during FULL video
• Do not get biased by only one point – very likely to miss other significant clues.
• If a diagnosis is ‘barn door’ obvious. Do not need to work on a differential
• Instead be ready to support your diagnosis with clinical findings
• Neuropathy and Neuralgia and not interchangeable.
• Gabapentin is used in Neuralgia – post herpetic in this case
• Key words are very important in describing the findings
• Learn various types of venous access – how they look.

It you will like to add any other points or comments – you can do it here.

Anil Garg

Thank you for participating in the video session today and making it so interactive and interesting.

The video clip was of a two day old baby who was noted to have abnormal movements. Dr A was the first in the hotseat. He got most of the clinical signs. Few clues not picked up were – no movement of right upper limb, HIE due to difficult delivery with meconium and ? fracture of clavicle. Discussion was a little more tricky.

Causes & management of neonatal convulsions is something done by all but under spotlight we tend to wilt a little.

Learning points:

• work out a DD while watching the video and noting signs
• Watch the whole clip – do not shut your mind after first few signs
• DD should guide your history and examination questions.
• Keep things simple – common conditions are seen more frequently
• Be brief and specific with your questions. Ideally closed questions.
• Speak slowly – this need a lot of practice – start now.
• Read NICE guidelines for common conditions.

Add your comments or any points I may have missed.
Anil Garg

Thank you for participating in the session today.

We started on the video block with a PowerPoint presentation of what to expect in the exam and how you will acquire marks. The videos clip was of a full term baby referred for appearing jaundiced. Dr S and Dr F Dr V & DR A took the hot seat into discussions which were very useful.

The landing points are:

• Watch the video clip carefully – try and ‘focus’ on different aspect each time you see it
• In the video station after seeing the clip and identifying the clinical signs …
• You are expected to ask 1-2 focused history and examination questions to help you build full picture
• If you do not ask – examiner will not tell you
• Starvation and dehydration are important causes in neonatal jaundice
• Read up neonatal jaundice as it is a common topic and can be asked.
• You need to be fluent with the first 3 to 4 courses of jaundice in a newborn
• Be prepared to discuss physiological jaundice how and why?
• Family history of previous siblings with jaundice: ABO & Rhesus – still important
• Common things common – mention them first before moving to rare causes
• Keep it simple
• Practice – Practice – Read – Read – Practice – Practice

Add your comments or any points I may have missed.
Anil Garg

Thank you for participating in the session today.  We discussed the scenario of a teenager who was pronounced brain-dead following the RTA and a request for organ donation. We did the scenario again as I was not really happy with how we had left it at the last session. Dr Y took the hot seat and Dr AG what is the role player. The scenario was done very well and in time. The feedback from the observers and examiners was also very appropriate and useful. I was pleased following decision as it demonstrated you are picking up the points from the sessions as intended and hopefully in the exam you will be able to nail the task given. 

We then discussed the Video station with suggestions on how to approach and manage the various domains.

Learning points:

• Avoid addressing Role player ‘Mum or Dad’. confirm who they are and how to address.
• Bad news – give it and then say ‘You are Sorry’
• Try not to be sorry before you have said what you are sorry for!.
• Do NOT beat around the bush – get over the ‘difficult bit of information’.
• Do NOT forget the 30 sec rule – else you will sound like a monologue.
• Summarize at 6 minutes or next best opportunity after knock of time
• Silence – 15 sec if needed – is a good method to demonstrate Empathy and sensitivity
• Try and bring something +ve in scenario – if possible
• Refresh your knowledge of NICE guidelines for common emergencies. 
• All Hypos.. – Hypers… / Status Epilepticus , Asthma.
• Use your phones to record speaking a scenario and check how you can improve.

Add your comments and points I may have missed – visit www.mrcpchonline.org

Anil Garg

Thank you for your participation in the session today – a rather serious and difficult task.

Scenario was of a 14 year old who is diagnosed as brain dead following a severe Road Traffic Accident.
Task was to speak with parents to update them of clinical diagnosis and ask for organ donation.

Anil Garg was role player. Dr D took the hotseat first and following feedback and general advice Dr S took the hotseat again.The task proved difficult but both candidates made a good attempt.

The learning points are:

• Bad news – be blunt and mention it AND then keep quiet for information to sink in.
• Do NOT speak till the role player comes back with a response – a query or exclamation – are you sure!!
• Respond then as appropriate.
• EMPATHY is a much talked word – practice it and also LOOK the role
• Body language is VERY important more so on line.
• It is important to mention ‘the task’ in first 2 minutes but be aware of CONTEXT.
• All communication is context related
• Speak slowly and USE pause / Silence to emphasize information you are giving
• Bad news – we give bad news everyday – hence practice to improve our style

Add your comments or any points I may have missed.
Anil Garg