RRR — Clinical Station: Other

Dear All

Thank you for participating in the session today.

In RRR we discussed:

  • Lymphadenopathy – hodgkins
  • Addison’s disease
  • Chronic tonsillitis

The Clinical station was – OTHER. 6 year old has come for regular follow up. Task was to examine his eyes. Universal cues were: Normal looking boy, decreased movement of left eye. Dr D took the hotseat and made a good attempt at the examination. Dr D, DR J and DR W were with Examiner hat. Examiners picked up the good points and things to improve. There was definite room for improvement.

The Learning points are:

  • Eyes check: Start with Acquity of vision
  • Test EACH eye separately
  • Colour vision can be checked asking to name colours in a picture
  • Check movement in each group / muscle as appropriate
  • Field of vision by confrontation test
  • When discussing investigations – mention with expected results

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

Anil Garg

RRR — Clinical Station: Abdominal examination

Dear All

Thank you for joining the session today.

In RRR we discussed:

  • Ambiguous genitalia
  • Haemophilia
  • Tuberous sclerosis

The clinical station showed a 6 year old with h/o repeated transfusions. Task was examination of Abdomen. Dr P took the hotseat and was soon Dr N swapped the hotseat. There were number of points which could be done different and we struggled for time. These were picked up and pointed by DR R, Dr W and DR J who wore the examiner hat.

The learning points are:

  • Note the cues present watch carefully
  • Be systematic – EXPOSURE – Inspection, Palpation, Percussion & Auscultation.
  • Do not be ‘haphazard’.
  • Time management is vital
  • Slick examination technique is a must
  • Verbalize your examination
  • Confirm cues observed by your examination questions
  • Consider examiner has not seen the video cues.
  • You have to get Dependent cues. Don’t ask – Don’t get.

Please visit www.mrcpchclinicals.org to write your comments or points I may have missed.

Anil Garg

RRR — Clinical Station Do’s & Don’ts & How.

Dear All

Thank you for participating in the session today.

In RRRs we discussed:

  • Fragile X Syndrome
  • Pulled Elbow
  • Dehydration assessment

For Clinical station – AG first presented Do’s & Don’ts of the Clinical stations. What to do and what should be done differently. DR U then reviewed a CVS station and summarised. It is very easy to get into difficulty by going into details that are not required and not being systematic.

The Learning points are:

  • Watch the video cues very carefully
  • Concentrate on different ‘signs’ besides one you have noted in first view
  • All signs shown have relevance – note and mention
  • General physical examination is part of EVERY station
  • Spend 30 – 45 sec to look around and note any splints / medication
  • General well being / growth / any obvious abnormality
  • PAIN – be aware and check at start of examination
  • Practice to verbalize your examination
  • Offer a differential diagnosis if cannot narrow down to a single
  • Mention investigations with expected results
  • Do NOT just give a list of investigations.

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

Anil Garg

RRR — Video Station: Convulsion 2 day old

Dear All

Thank you for participating in the session today. Some of our colleagues are going to be in the real ‘hotseat’ tomorrow and in the following few days. We wish all of them Best of Luck and nerves for the exam. We are confident you will do well.

In the RRR we discussed:

  • Neuroblastoma – LL paresis in 6 month old
  • Pyloric stenosis
  • Shock – types

The Video was of a 2 day old baby having a seizure. Dr A took the hotseat and picked up most of the clinical signs demonstrated. History questions were relevant and examination made useful points. However it is important to have a differential diagnosis to work through.

The Learning points are:

  • 2-3 differential diagnosis after completing video watching
  • Watch video carefully and focus on different signs
  • Do not get locked into most obvious finding
  • Common differentials
  • Questions to support or refute your differential
  • Do NOT ask vague broad questions – likely to get vague reply.
  • ALWAYS ask for Br weight and Current Wt in newborn or weight loss
  • Management – top 3-4 bullet points
  • Acute problem – sort out first. Convulsion – stopping is top priority.

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

Anil Garg

RRR — History and Management: Na 113

Dear All

Thank you for participating in the session.

In RRR we discussed:

  • RSV prophylaxis
  • Meningococcal sepsis
  • Syncope / fainting in 5 year old

The History station was of a 21 day old baby admitted with poor feeding and lethargy for 1 week with a Na:113. Dr A took the hotseat and Dr N was a very good Role Player. There was fair bit of time left at the end of Dr A’s history taking and we had candidates taking the exam in a next few weeks take supplementary question for 2 mins each. Dr A then summarised well. Discussion on how to manage the condition and advice to parents.

The learning points are:

  • Have a Differential diagnosis based on information provided
  • Write down heading of history points on your sheet
  • Open questions first – do not interrupt
  • Go through the history systematically
  • Closed questions to ‘close’ the ‘session’ / task
  • Even if diagnosis ‘obvious & in your face’ – cover other DDs
  • Linked questions to get information for drugs
  • Sick day plan
  • Birth weight & current weight are MUST for neonate
  • Probably more important than Vital signs – as likely to forget.
  • Treat Emergency first before calling others – if appropriate
  • Brain block can happen – do NOT panic

We will cover Video Station at next sssion.

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

Anil Garg

RRR — History in Clinical Examination

Dear All

Thank you for your participation in the session.

In RRR we discussed:

  • Failure to thrive – vs Short stature
  • NAI  & Place of safety
  • Stridor

AG presented ‘History’ in the Clinical exam. Although there is one designated station for History & Management, your skills of taking a good history are explored in Development, Video and Clinical stations also. HE discussed some important do’s and Don’ts and pitfall to avoid.

Learning points:

  • Focused History – you do NOT have time to ask everything
  • H&M Station: Usually Chronic cases but can have Acute presentations
  • Development – establish diagnosis & current functionality
  • Video use questions to support or rule out your DD
  • Open and Closed questions appropriately
  • Summary for Role Player & Examiner are different
  • Do not say all as Examiner has been listening to you
  • Present with you diagnosis with supporting evidence
  • Differential diagnosis- if the case is such
  • Test of your Communication  Skills

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

Anil Garg

RRR – Communication – History Station

Dear All

Thank you for joining the session. We had a slightly different format. There was only one ‘R’ and the other two Rs were replaced by Communication scenario – Drug error repeated. AG was the candidate and Dr S was the RP. There are no0 rights or wrongs to these scenarios but some will get more marks than others. Practice to make them ‘your own’.

The RRR was:

  • Rhesus disease. What and how?

The History scenario was on a child of 11 years with Coeliac disease. Mother is anxious about a planned school trip. Dr J was our RP and had developed the scenario. Dr P was in the hotseat and took a very balance history. Very good input by all others.

The Learning points are:

  • Drug error – practice how you will like to be addressed
  • Do not forget 30 sec rule and 2 min Shishir’s rule
  • History – be systematic
  • Explore RP’s concerns else they will not move forward
  • Park queries – Do Not go into Communication Mode
  • Details vs concerns is a balancing act
  • Remember it is Focused history – you CANNOT cover EVERYTHING
  • History could be of Acute condition – need to get to diagnosis
  • Or Chronic condition – needing exploring precipitating cause
  • Social history is very important – do NOT omit.
  • Control of nerves is a very crucial part of exam

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

Anil Garg

RRR — Drug Error

Dear All

Thank you for participating in the session on Thursday – my apology in writing the Learning points a little late.

In the RRR we discussed:

  • JIA
  • Red eye
  • Oral contraceptive request by 13 yrs old

The Communication scenario was of a wrong drug being administered to a patient following an allergic reaction to transfusion. 12 year old child is in side room with parent. Dr M was the RP and Dr S took the hot seat. It is a difficult scenario but it is important to note all the information that is provided. WE had a discussion on the hows & whys and the learning points are:

  • Note what information is provided
  • What is the setting, who you will speak with, who else is present
  • SITUATIONAL awareness is very important
  • ‘ Sensitive – Confidential’ information needs to be given in ‘private’
  • Not if front of other people – unless specifically asked
  • Move to private space – get a ‘witness’ / chaparone
  • Medical errors are ‘common’ need to be dealt with sensitively
  • Datex or Central ‘Error’ reporting system is available in most units
  • Involve your seniors
  • Do NOT sound obstructive – CANNOT give you NAME
  • Consultant will see you asap – and will discuss details
  • Gillick competence – read p and be aware

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

Anil Garg

RRR — Communication — Audit

Dear All

Thank you for participating in the session.

In RRR we discussed:

  1. Evidence Based Medicine
  2. What is Evidence: Audit vs Research
  3. 3 yr old with sudden collapse for viral infection

The communication scenario was discussion with a Junior medical colleague to help with an Audit project. Dr S was an excellent RP and Dr n was in the hotseat. Most of the points were covered. There was some confusion between audit & research.

The Learning points are:

  • Check prior knowledge of RP
  • Research is for New knowledge vs Audit: checking against known
  • If wrong information is mentioned – mention it. 
  • Use of Oral hypoglycaemics in children!
  • Tiem management if very important
  • Prepare simple example of an Audit project to discuss prn
  • Differential diagnosis: Common things first
  • You need not have worked in UK to be successful at the exam
  • Check guidelines on NHS & RCPCH website

If there are points I have missed or for your comments visit www.mrcpchonline.org.

MRCPCH Clinicals Onlineworking together to reach your goalwww.mrcpchonline.org

Anil Garg