Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Delayed Puberty – causes
• Epileptic seizures – various ‘types’.
• Congestive Heart Failure – Symptoms & Signs

Dr AG gave a presentation on Communication Station – How, What, Do’s, Don’ts and what is expected of you to get full marks. It is the most important skill with 26 or 82 marks in the whole exam.

The communication scenario was a 1 year old admitted and had a very difficult cannulation with traumatised parents. Due to needle stick injury to medical staff consent for further blood sample is required from parent. Dr A was an excellent Role Player and Dr S took the hot seat. Dr M & Dt T had the examiner hats. Dr S made a good attempt. The start was good but then it went south and towards the end seemed like a ‘fight’ as commented by one member. Remember we have to find positives for all making it a Win – Win situation. Our examiners suggested how the scenario could have been approached. We accept it is easier commenting from the sideline and the hotseat is a very difficult place to be.

The Learning points are:

• Introduction and Rapport is essential.
• Rapport is easier when positives are discussed initially.
• Listen to the Role player and get to their agenda – point of view.
• Do not get flustered when Role player gets ‘upset’
• Let them vent their feelings – listen quietly – note main points
• Step back and defuse the situation
• Task is important but a Dialogue is more important
• Win – Win: when there are positives for both parties
• If I expect all with no benefit for the other – unlikely to comply.
• Avoid medical jargon – ‘transmissible disease’
• Request is a ‘favour’ and not a right which patient has to comply.

Video recording of the session will be available for members.

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

Anil Garg

Dear All

Thank you for participating in the session today.

We had 3 members, Dr S, Dr J and Dr S joined us today to give us feedback of their recent experience of the exam. They all were of the opinion that Exam was very well organised and fair.

They had taken the exam in Kolkata and New Delhi.

Spread of cases was as expected, most cases had been fully or partly discussed in last 3 months hence it was no surprise and they could perform to their best. Everything did not run to their complete satisfaction but that is always the case. We keep our fingers crossed for the results.

Their update of the exam and AG’s presentation of the exam lad foundation for next three months. There were no changes suggested to our strategy. It provided sense of confidence and ability to think on the spot.

We will cover all stations with special emphasis on Communication as 26 of a total of 82 marks are assigned to Communication across the exam.

The Learning points are:

• Essential to have GOOD nights rest prior to exam.
• Stress will cause to function below your best.
• Keep Calm during the exam.
• Station you have completed has NO effect on the next station.
• Do not carry the baggage with you.
• Actively participate during the sessions
• Practicing ‘imaginary in head’ will not transform to action in exam
• Use 3 mins provided Well.
• Have Study group and partners
• We are not practicing Paediatrics but how you filter the information
• RRR – use as basis for reading up and Communication.
• Practice – Practice – Practice.

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

Anil Garg

Hello sir . Fortunately I passed it. Got less marks in 2 stations but did decently in others. So everything worked out in the end. Thank you sir for your mentorship. I had texted previously also in the wtsapp group after results .

Dr A K Mandal

Dear sir 

I have cleared MRCPCH 

Thank you for your guidance.

Dr N Meshram

Please join to get an update on the current MRCPCH Clinical Exam.

Anil Garg is inviting you to a scheduled Zoom meeting.

Topic: Anil Garg’s Zoom Meeting
Time: Nov 28, 2023 02:00 PM London

Join Zoom Meeting
https://us02web.zoom.us/j/2191937091?pwd=b3haeEJCR2xNc2ViQTdsTkVrTzRPQT09&omn=86452097282

Meeting ID: 219 193 7091
Passcode: autumn

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• GMFSC – assessment
• Neuro – Surgical interventions in ‘Cerebral Palsy’
• Gross Developmental delay: Workup

Dr A gave an update on DCH exam she had ‘written’ a few days ago. DCH is less difficult than Membership exam however all exams are difficult and taxing. Domains tested are similar in both exams: Communication, History, Clinical systemic examination, Development. Practice with our group for MRCPCH was very helpful.

We discussed Development assessment in our session. 4 year old with concerns regarding fine motor activities. Task to assess age by fine motor assessment. Dr S took the Hotseat with Dr A & Dr AG with examiner roles. Dr S completed the task well covering most of the skills. 

There are a few Learning points:

• Vision & Hearing – ask in History. Do not need to test yourself.
• Correct with aids – spectacles or hearing aids – if needed
• General observation is must – here also
• Start with Dexterity – offer crayon / cube to both hands
• Non Dominant hand vs ‘CP affected’ hands ‘behave’ differently
• push the ‘child’ to task they cannot perform – upper age limit
• Appreciate and encourage their action / response
• In exam without children and with Examiner it may feel Odd – but do it
• Write points in 3 mins while waiting – unlikely to get time during assessment

Dr Anamika gave the following mnemonic for assessment tools:

3 Bs, 2 Cs & 1 S:

Book : Board: Beads – Cubes – Crayons – Scissors

to be used not necessarily in the same order.

In History for station – useful tips:

• Time when concerns were first noted: age birth vs specific age
• Focus appropriately. Screening questions to cover other aspects.
• NICU admission – usually prolonged – hence do NOT get into treatments and investigations
• ASK: What were you told at time of discharge.

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:

• 3 day old baby with irregular respiration
• Haemolytic Uraemic Syndrome
• Update of recent exam

Dr A joined us and gave an update of the experience of recent exam. ‘Examiners were very nice, not like examiners we have seen in our ‘Indian exams. they were quite friendly except for one. Much better than Dr AG’. We also had an update of how the various stations were covered, the good – the bad and not so bad’.

The Clinical station was a 4 year old who presented with difficulty in walking and frequent falls. Task was Neurology examination of Lower Limbs. Dr J took the hotseat and covered the examination well but took much longer than the scheduled time. Discussion was good. Dr S made good observations.

The Learning points are:

• Examination should be slick and methodical
• Time is limited – practice to finish in 5 minutes
• Introductions and permission
• Request Exposure the part to be examined at start
• Get to level of child – you will be kneeling or squatting on floor
• In Neurology exam remember 6 Ss
• Symmetry – Squint – Shunt – Spine – Scars – Shoes
• Start with standing -Walking – sitting – couch

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:

• Pneumocystis carinii infection
• PUO
• Pneumothorax

The Video scenario was of a 6 months with new movements noticed by mother over last few weeks. There was a weight gain from 50^th to >91sr centile. Dr S, Dr A Dr J had the options to tackle the video with observations, history, examination and management in turn due to their proximity to examination with support from other members.  The observations of clinical signs was accurate however integrating the full information provided needed prompting.

• The Learning points are:
• Read the information provided VERY carefully.
• Each word has relevance.
• After watching video you should have 2 – 3 differential diagnosis
• Common things Common – logical order.
• Questions need to be ‘closed’  with  yes and no answers
• Confirmation of diagnosis – investigations with expected results
• Managment – broad principles first and can expand as discussion progresses.
• Discussion with parents is part of management 
• Documentation is essential – “Not written is not done!”

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

Anil Garg

Dear All

Thank you those who were able to attend and make our double session successful.

In RRR we discussed:

• Failure to Thrive in 6 month old: possible aetiology
• Enuresis: Aetiology and basic management
• Hydrocephalus: causes and management

In our first session we concluded and discussed How to of unexplained Injury to 2.5 year old carried over from last session. Video clip of AG & Anne was viewed and points discussed. There was discussion on a scenario of Brain Death. Video scenario was of a 6 month old presenting with vomiting for 24 hours, there was evidence of a repaired meningomyelocele and a Ventriculo-Peritoneal  shunt. Dr A toot the hot seat with Dr A and Dr J contributing to the history, examination and discussion. In the second session after a short break the Video clip was of a 6 month old presenting with Failure To Thrive, Clinical signs of a bright infant – tachypnoea, sub and suprasternal recession, Nasogastric tube, hepatomegaly. Dr U took the hotseat. She identified the signs and had a good discussion.

The Learning points are:

• Read the information provided very carefully.
• Watch the Video carefully 
• focus on different aspects when reviewing.
• Formulate differential diagnosis of 3 by this time.
• Do NOT go in with only One diagnosis
• Ask History questions to support or refute a diagnosis.
• Examine – focused again with above aim for diagnosis
• Most likely diagnosis should be first. 
• Avoid rare causes you have not seen yourself.
• Keep it simple.
• Do not just list investigations
• Investigation with explanation of what you are expecting
• Discuss / inform your consultant.

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

Anil Garg