RRR — Communication – Consent for Lumber Puncture

Dear All

Thank you for participating in the session today.

In RRR – suggested by Dr P & Dr M – we discussed:

  • GERD – 9 month old with failure to thrive.
  • Microcephaly with Developmental delay in 9 months old
  • Chemotherapy – complications

The Communication scenario was of a 11 month old admitted following a convulsion with suspected diagnosis of meningitis. Task was to speak with parent – explain and ask for permission for Lumber Puncture. Dr A was an excellent Role Player who was consistent with all three ‘trainees’. Dr M was in the hotseat followed by Dr P followed by AG.

The Learning points are:

  • Rapport is important – Respond to RP’s concern.
  • ‘Is he (child) well?” Till you address the point – RP will keep coming back.
  • ‘He is stable at present. He needs urgent treatment and should be well following treatment’. Do NOT give wrong reassurance or information.
  • Specific anatomy – meningitis is infection of ‘covering of the brain’ NOT infection of Brain or fluid round the spine.
  • Not agreeing for a test in NOT an ‘offence’.
  • Not agreeing for treatment – if essential – is an offence and can trigger Safeguarding.
  • Give downsides of RP’s choice – long treatment with unnecessary drugs.
  • ‘We are both on the same side – want the best for the child’.

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

Anil Garg

RRR — Communication — RTA & Organ Donation

Dear All

Thank you for your participation in the session today.

In RRR we discussed:

  • UTI in children Diagnosis
  • Brain death
  • Breast Feeding – advantages & disadvantages

The Communication scenario was discussion with parent of a child admitted with severe head injuries following a Road Traffic Accident. Request for organ donation. Dr J was superb Role player bringing out all the emotions to play. Dr P and Dr M took the hotseat. The scenario was done well and there were was very appropriate comments & feedback from nominated examiners.

Learning points are:

  • Read the introduction very carefully and keep the task in mind.
  • After introductions check Role Players understanding to the point of discussion …
  • Avoid monologue – Role player to speak instead of you initially
  • 30 Sec Rule is GOLD
  • Address their concerns and points raised
  • Avoid jargon
  • Communication is MORE of a Listening Station
  • When you TALK – you are more likely to make mistakes!!
  • Be aware of your ‘cultural annotations’ …
  • ”Are you OK?” after giving Bad information
  • When giving Definite diagnosis … ‘Do NOT think.’
  • Be Empathic
  • It is not about letting RP know ALL that you know.
  • ‘Ray of Hope for some even in this ‘grave and sad’ time.

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

Anil Garg

RRR — Communication Scenario … Unexplained injury

Dear All

Thank you for participating in the session today.

In RRR we discussed:

  • Immunisation schedule and child surveillance
  • Asymptomatic Bacteriuria
  • Secondary enuresis

Communication scenario was of a 2.5 yr old child admitted with unexplained bruising. to discuss concerns and management plan with carer. Dr M took the hotseat and Dr I was an excellent Role Player who was in angry mode. Dr M made a very good attempt and the feedback as examiners from Dr S & DR S was very relevant and picked up all the points. Other colleagues also gave good observation points.

Dr Sumit gave very useful tips. ” We would like to do the tests to know what has caused …. to the child. You would also like to know what has happened to ‘child’ – wouldn’t you?’ It is a very useful sentence that may be used during communication in a number of scenarios.

The learning points are:

  • Read the information provided very carefully. Notes names – if provided.
  • Let the Role Player have their say and note their points. Let them take their time.
  • Ask who all look after child first instead of ‘accusing’ of causing ‘injury’.
  • Do NOT be afraid to mention ‘ Unexplained Injury’ / ‘Non Accidental Injury’
  • Do NOT beat around the bush.
  • Child needs to have SAFEGARDING PROCEDURES & PLACE OF SAFETY.
  • Cannot be allowed to go home – by LAW.
  • Know what investigations are required in NAI settings.
  • ASK of siblings at home – may need to be cared for – BROWNIE POINT+.
  • Summarize at 6 mins – three to four sentences are usually enough.
  • In RRR – simple things are common
  • Read up and check local guideline at your OWN work place.

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

Volunteer for Role Player for next week.

Anil Garg

RRR — Communication Scenario

Dear All

Thank you for joining and participating in the session today.

In RRR we discussed:

  • HIV – transmission & prevention
  • Head injuries – effects / damage
  • Urticaria

The Communication scenario discussed today was of a 10.5 year old child with trisomy 21. There a number of comorbidities and his parent had come with a number of concerns. Dr S was in the hot seat. Dr J was a superb role player. Dr S made a very good attempt. Dr P and all others gave feedback from an examiner perspective.

 The are learning points are:

  • Read information provided VERY CAREFULLY
  • Do not create finding NOT mentioned.
  • Basic communication – be aware of your ‘habitual’ speech – ‘yes – yes’…
  • Do not call role player ‘mother’ or ‘father’ in introductions.
  • Address them as Sir / Mam – What can I call you?
  • Let the RP – speak and give all their points before interfering.
  • Note their concerns and then address them one by one.
  • You do not need to give details explanations.
  • remember 30 sec rule. Do not make it a MONOLOGUE.
  • Long monologues – you will be providing unnecessary information
  • Likely to make mistakes – unnecessarily.
  • Avoid jargons
  • Do NOT forget to Summarize at 6 min knock

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

Anil Garg

Conclusion of Winter session – Looking to Spring Session

Dear all

Thank you for participating in the session.

We discussed what we had covered during the winter session.

Comm8
Video8
Dev1
H&M2
Clinical8

We had covered all the stations as advised by the participating members.

Besides the specific stations of the exam we also covered 85 rapid random reviews and had over 120 learning points shared amongst us.

We then discussed the new exam which is going back to the old exam with the caveat that Covid does not spread and allows the children to attend.

There were PowerPoint presentations for both by AG available online.

We will commence with communication scenarios from next week.

Visit www.mrcpchonline.org to add your comments or suggestions.

Anil Garg

RRR — Video Station – unsteady gait following viral infection

Dear All

Thank you for participating in the session today.

In RRR we discussed:

  • Hearing loss in children
  • Anaemia
  • Abdominal migraine

The video scenario was of a 7 year old with h/o viral infection requiring 4 week hospitalisation. Reviewed in OP 4 weeks after discharge – demonstrating wide based, unsteady, high stepping gait. Dr V took the hotseat with Dr I and Dr S as examiners. Everybody contributed to the discussion and it was a very interesting session.

Learning points:

  • Focused history in video station is not like in history station
  • Develop a differential diagnosis with all cues in initial information & Video clues
  • ‘Was the child absolutely normal prior to current illness’ is a very useful question.
  • Questions specific to support or refute your DD – formulate them.
  • Give positives & Negatives when discussing diagnosis with examiner
  • Structure your answers in category – you will communicate your thoughts better.
  • In Video station – a lot of diagnosis are POSSIBLE – you have to choose most LIKELY

We have concluded our winter course / session. On Thursday we start Spring session. We will start with Communication – the most important skill for the exam.

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

Anil Garg

RRR — Video Station

Thank you for participating in the session today.

In RRR we discussed:

  • Failure To Thrive
  • NAI and Place of Safety / order
  • Chickenpox exposure to a child with Leukaemia

The Video station scenario was of a 14 year old admitted for ‘regular’ admission for assessment & treatment. Grade four clubbing of fingers & toes + O2 supplement. Dr P took the hotseat. Clinical signs were picked up. Discussion with questions and examination required help. It was a useful presentation exercise.

Learning points:

  • Develop a differential diagnosis. DO NOT work with ONE diagnosis only.
  • You may reach your One diagnosis by history question & examination.
  • History & examination has to be Specific – almost a closed question.
  • Summary – give your impression / Differential and then support by finding
  • Do NOT narrate you finding and not mentioning your ‘diagnosis or DD’.
  • Specific common investigations first.
  • Involve your consultant before speaking with any other team

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

Anil Garg

RRR — Video Station

Thank you for participating in the session.

In RRR we discussed:

  • Shock
  • Rheumatic fever
  • Cerebellar tumour

The Video station was of a 6 week old baby with respiratory difficulty and getting oxygen.

Dr S took the hotseat and did a very good attempt at recognising the clinical signs and with clinical reasoning. A few minor points were helped by Dr I along with current management guideline.

The Learning points are:

  • Have a differential diagnosis of the condition
  • Signs of deterioration in clinical condition
  • How will you monitor deterioration of a child
  • What instructions will you give the nurse / junior
  • Think for 5 seconds – organising your thoughts before replying
  • Observation is key – be very careful
  • Try and ‘see’ different aspects when reviews the video clip.

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

Anil Garg

RRR — Video Station ….. How to?

Dear All

Thank you for participation in the session today.

In RRR we discussed:

  • signs of Physical abuse in children
  • Jaundice of newborn
  • Febrile convulsion

In the Clinical station we discussed how to attempt the Video Station. AG discussed a PowerPoint presentation highlighting the Do’s, Don’ts and why of the Video station.

The Learning points are:

  • Watch the video carefully
  • Concentrate on different parts when you review it.
  • Do not get ‘blinded’ by an obvious sign – there may be other points of note.
  • Develop a differential diagnosis of 3 after viewing videos.
  • Have differential even if One diagnosis seems obvious.
  • Questions need to be specific and 2-3 only
  • Examination also has to be very SPECIFIC -not general
  • Investigations – mention with expected results – NOT just a list.
  • All candidates will have ‘same’ viva questions

Visit www.mrcpchonline.org to add your comments or any points I may have missed.

Anil Garg