We discussed increased visit to accident and emergency for convulsions in a seven year old girl with developmental delay.

Learning points were:

• Think of a differential while reading the information outside

• This will guide you in your questioning but be open to change track if the information provided so demand.

• Remember the broad headings for history and try and cover them all, this may limit your ability to go in great depth in all.

• Check the current issues and the social impact on the child and family.

• Social history is very important and usually has the clues to how to proceed

• Be empathic, do not use jargon

• A brief summary at nine minutes with the open question of is there anything you would like to tell me that I have missed.

SOCIAL HISTORY IS VERY IMPORTANT IN CHRONIC DISEASE AND IT’S MANAGEMENT.

TAKE IT AFTER PRESENTING ISSUES.

Good session today.

Discussed development station as it causes Problems of time management and the ability to complete the task.

• The station has the maximum marks of 12.

• Listen to the opening statement very carefully

• Check for parents concerns and expectations from the consultation

• Do not forget your communication skills in the station.

In communication station it is important to keep the information simple and escalate as per the response from the role player.

Getting too detailed into the information being given consumes your time, difficult to understand for the Role player and may compromise your ability to complete your task.

Keep it Simple. GURU MANTRA.

We had a revision of history station two video stations in preparation for the exam next week.

The history was of a child 21 days old presenting with a sodium of 113 mmol and weight loss. Video Scenarios were one of a child with nephrotic syndrome and the other with congenital heart disease and congestive heart failure.

Learning Point:

• Think of differential diagnosis while reading the instructions or watching the video
• Think of two or three different diagnoses, you do not need a longer list
• Ask relevant questions to the differential in the history
• Examine for a finding that will help you differentiate the diagnosis
• Justify what you feel is the differential diagnosis with the findings you have
• Do not ask the same information again that has been provided to you in the sheet
• Try and not make the history station into a communication station you’ll be wasting your time.

Discussed Development station with scenario of age assessment of 5year old.

There were problems of time management in trying to do the assessment and getting relevant history.

Important learning point was not to get too bogged down in details of history of developmental details.

Concentrate on other aspects of task also.

We discussed a scenario involving a five week old baby with pyloric stenosis and significant electrolyte disturbance with severe alkalosis.

The learning points were:

• Stick to the task given and mention it following introductions

• Ensure the information you gave is factually correct.

• Don’t get into zone where you are not sure of your facts

• Accept you do not know and arrange to come back and see after checking the information

• Read the task very carefully and stick to it, it is very easy to go down a different route and spend all your time without completing the task.

• If the role player is resisting the suggested intervention then instead of Trying to convince them or ask them an open question

• “Why are they not complying or what are they concerned about?”

Learning points from today’s session are:

• Be clear with explanations without jargon.

• Communication is about getting through and connecting with the other person

• It is not about your full medical knowledge of the topic.

How would you continue the discussion with a teenager who is an asthmatic and has got worse symptomatically since starting to smoke. The teenager admits knowing that smoking makes the symptoms worse.

This is in the realm of social medicine instead of acute therapeutic medicine.

There was nothing new in the learning points But these are the points we forget under stress of the exam. 

Practice, Practice, Practice

Today we had a discussion on the clinical examination in Ahmedabad over the weekend with some of the candidates.

It is always difficult to judge once performance in the exam and we tend to remember the very worst of our performance and the mistakes that we did.

However it was very heartening to learn that the candidates found the exam very fair

Working together in our regular interactive zoom sessions, online modules & intensive course helped them.

Some of the cases seen were typical – vsd and the atypical cases & scenarios we had discussed – breaking bad news

We keep our fingers crossed and hope for the best outcome.

Anil Garg

Yes sir the west syndrome which was discussed was useful…exactly same type of case was there in vedio station…even though the neck flexion of Salam spasm was not there in the vedio is was discussed as in the same way of your class of west Syndrome.

Dr SK 19 January 2020

Thank you so much for your help sir.

Last few months I wasn’t studying/practising properly at all.

Your sessions did spur me on. (Full thanks to you sir for arranging sessions at an appropriate time)

One class does not make a major diff but each class you attend you learn a little bit more and become a little bit better.

Dr RM 19 January 2020

We practised communication skills With participants who are preparing for the exam later in April or July.

We went through a template I have developed to keep control of the scenario situation And address the tasks as mentioned.

The scenario template will be applicable to all domains of communication tasks that are likely to be asked e.g. negotiations with a parent, breaking bad news, professional discussion with a colleague, critical incident.