Dear All

Thank you for participating in the session today.

I would like to begin with Congratulating 8 members who have confirmed that they have become Members of the RCPCH. We are proud of their success and wish them a very bright future as caring paediatricians.

In RRR we discussed:

• Poisoning – causes in children
• Thrombocytopenia – purpura
• Diabetes – symptoms & signs

The Communication scenario was of a 2.5 years old admitted with multiple bruises. Mother had left abruptly after leaving the child in hospital accident and emergency. Dr F was again our very able Role Player. Dr J & Dr S had the examiner hats while Dr A took the Hotseat. A very good attempt was made at talking with the Role Player, most points were covered but over all discussion could have been done differently. Examiners did pick up what could be done different.

The Learning points are:

• Read the provided information carefully and use it as your support
• Remember – a dialogue will get you the necessary information
• Give Role Player chance to speak to get their agenda – do NOT follow yours
• Remember the task and mention with in first 2 minutes
• You do not have to tell all you know of the condition
• Child care involves certain legal duties – do check local T&Cs
• A child should not be discharged into an environment of potential harm
• IN UK – the law provides for Childs needs come first
• This can take you out of ‘US & Them’ conflict with parents
• We both want and work for the Child’s best interests
• If Role Player gives a piece of information – DO NOT ignore it
• Summarize at 6 minutes

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:

• Asthma – OPD management
• Circumcision – indications
• Headache – causes

The Communication station was a scenario of 12  yr old diagnosed with Leukemia due for a bone marrow examination. Diagnosis in not revealed to the 12 year old parents request. A  colleague nurse has come to discuss her concerns. Dr S was our Role Player – a very ‘soft & kind’ person. Dr F took the hotseat with Dr J & DR A taking the Examiner hats. Dr F attempted the task very well and covered most points. Examiners gave valid feed back. The under pinning theme of this scenario is Ethics and 4 pillars medical doctors should follow while taking ‘difficult’ decisions. There is usually no absolute right or wrong answer to such scenario. Candidates approach is judged.

The Learning points are:

• Medical ethics is an part of curriculum – update your kno0wledge.
• Need to get to and explore Role Player’s agenda.
• If the Role player returns to same point more than TWICE – ‘Hidden agenda’.
• Do not continue with your agenda.
• You must explore why the RP is stuck on that ‘point’.
• Use your tact to explore and get RP to open up.
• Use simple language – avoid jargon
• Medical ethics – 4 pillars – look them up.
• Hot seat is scary – practice makes perfect

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. We had a Double session and I will post the feedback and Learning points in 2 separate posts.

In RRR we discussed:

• Spastic diplegia – aetiology and DD from Hemiplegia
• Biliary atresia – diagnosis and complications of treatment
• Facture humerus in 6 month old – Differential

The Communication scenario was discussion with parents of 4 month old premature baby born at 26 weeks. Parents want a ‘hospital’ type apnoea monitor. Dr J brought Role player to life projecting the concerns of a worried frustrated mother. Dr S took the Hotseat, Dr A & Dr A had the examiner hats. Dr S attempted the scenario very well and completed the task covering relevant points. Examiners made good observations and gave appropriate feedback on how interaction could be improved. Other members also gave useful tips.

the Learning points are:

• Read the information provided very carefully
• Remember 2 minutes and 30 seconds rule
• Avoid Monologue – has to be a Dialogue
• Situational awareness
• Chaperone, protected time away from disturbance
• Get to Role Players agenda – check their concerns
• Do NOT give inaccurate information – if not sure – say will check
• Explain physiology is simple terms – avoid Jargon.
• ‘Corrected gestation’ explain in common simple language
• Break through symptoms – treatment failure: compliance
• Optimize dosage of treatment being given
• Use Video recording as management option
• Beware of what you are saying – we all have our ‘habits & pet phrases”.

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:

• Haematuria in a 3-years old
• Pulled Elbow
• Jaundice in first 24 hours

The Communication scenario was on a child admitted with Febrile convulsion, otitis media noted and ready for discharge. Mother wants a CT scan. Dr A was an excellent role player who brought a concerned and worried mother alive. Dr J was in the Hotseat with Dr S & Dr L having the examiner hats. Dr J made a very good attempt and covered most points and aspects expected in a communication scenario in the exam. Hot seat makes one forget what we wish to do hence practice, practice, practice.

The Learning  points are:

• Be prepared for the stress & Exam nerves.
• Read the Introduction / statement VERY carefully
• Note down important bit of information: name, age, diagnosis etc
• Remain Calm
• Do NOT forget 2 minute & 30 second rules
• Chaperone, Partner & Bleep – remember
• 30 seconds is like Speed limit – it is the maximum time
• Make sure it is a dialogue – not a monologue
• Use pauses to emphasize information and let Role Player speak
• You do NOT have to tell everything you know of the condition!!
• Be positive doctor
• Summarize at 6 minutes – it will also remind you of what else to cover

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:

• Maternal drugs harmful to foetus
• Neonatal abstinence – management
• Kawasaki disease

We started with Communication for our group preparing for Feb / Mar ’24 examination.AG gave a PP presentation on What & How of Communication station and how to tackle it. We then had a scenario of newborn with Oesophageal atresia and tracheoesophageal fistula. Dr A took the hotseat while Dr V was a very able Role Player. Dr B, Dr n, Dr J had the examiner hats. Dr A made a very good attempt and covered most of the necessary points. The examiners made very valid observations and Dr Shishir gave valuable feedback and tips.

The Learning points are:

• Remember 2 minutes & 30 seconds Rules
• Read the information provided very carefully
• Imagine the baby / infant and relate to him / her
• Keep ‘cool’ and look confident
• Have a Chaperone
• Be a Positive attitude doctor
• Use simple language
• Avoid medical jargon
• Try and avoid Prefix of  ‘unfortunate’, ‘Bad news’
• Just give the information
• Explain Normal first followed by Abnormality
• Passive observation is much easier than the Hotseat

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:

• Ambiguous genitalia – What & classify
• VSD – moderate – advice to parents
• Jittery neonate – diagnosis & causes

We had the opportunity to get an update on the recent clinical exam from Dr R. on 

• How the exam runs, 
• advice candidates receive at the centre,
• Given a paper on which notes can be made
• languages that can be spoken
• Cases that were seen
• How RPs reacted

Dr Shishir gave his assessment of the activity in the exam and tips on how to practice for the February ’24.

The Learning points are:

• RRR – are the syllabus and should be read
• Scenarios are Common and not rare
• We have covered almost all in past 2-3 months
• You need to be ‘fast’ to complete the station
• Develop a template and use it
• Practice – Practice – Practice!!!
• Fluent examination technique
• Look and sound confident

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.

We broke away from our regular pattern of RRRs and discussed Q&As raised by our members who will be in the ‘Real Hot Seat’ over the weekend.

Questions were relevant to how to tackle some tricky situation is the exam.

• A colleague is noted to come under influence of alcohol on more than one occasion, ward sister is told you. How will you proceed / what will you do? Suggestion: As your colleague – can be ‘more friendly than with patients. Can give a name and sit with a cup of coffee to discuss the issues. Let them open up and encourage talk with the consultant on their own – you do not need to tell on their behalf. However do not let Patient Safety be compromised.
• How to refuse a medically unnecessary investigation being demanded by parent / role player? Suggestion: Instead of being us & them and opposing – think of ‘negative’ effects of the test asked. Pain, radiation, GA, duration of treatment etc. Put it to parent that they would not like their child to ‘suffer’ the side effects. No parent would like to put their child through pain!
• Clinical station: if not clear of the task – Clarify. Do not proceed on the wrong ‘path’.

In Communication do not ignore: parent’s name or name / age / gender of child if given.
Do not address Role player as ‘mother’. They are not your mother. ask their name or how they would like to be addressed.

We then practised Eye station again with Dr R in the Hotseat and Dr Shishir in the Examiner seat. Good attempt with some tips for securing more marks. We then had a clip of MSK examination on how to do it in < 6 minutes.

The Learning points are:

• Do NOT forget 30 secs rule. Remember 30 sec is not lower limit but the maximum speaking time before pause.
• Eye check: Visual acuity / Field of vision / Movements / Accommodation and Light reflex, fundoscopy.
• MSK ask the screening questions – difference from Neurology.
• Listen to task carefully
• Tiem management very important
• Use your template and cover all points noted.
• Too much information will not get you more than allocated marks in plan.
• Missing will get you no marks for that part.

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

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Hemophilia – advice to parents
• Cong Heart Disease – advice to parents
• Diabetes – why worse in adolescents

The Clinical station was decided as other on request from members. The Task was to examine eyes of 6 years old Bahadur – who has come for a routine Follow Up. Dr D took the hotseat with Dr J and Dr T with examiner hats. Dr D made a good attempt but got lost in fine details and hence could not complete the examination by 6 minutes. Dr t tried but gain ran short of time. In my opinion they spent too much time on introductions and getting to the eye examination. Dr S gave a brief outline of structured approach to examination of the Eye – Vision.

Dr Sumit joined us and he gave some very sensible tips for the exam: ‘Exam is ‘filtering’ Safe, Sensible paediatrician to be Registrars & You DO NOT have time to cover everything. Need to be focused. Develop a Performa for each station and know it to the level of being able to do it at your Spinal level or in your sleep.

The Learning points are:

• Brief introduction
• Systematic and structured approach
• Omit non essentials
• If using ‘glasses’ do not get into details of optics – let them be used.
• In General physical remember 4 Ds: Dysmorphism / Dimensions / Devices / Distress 
• Dimensions is: Ht / Wt / OFC 
• RCPCH has examination templates – do check them out.
• Use time in-between stations to Recalibrate & Reset yourself

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

Anil Garg

Dear All

Thank you participating in the session today.

In RRR we discussed:

• UTI – Collection of specimen and Investigations
• Delayed Puberty – Constitutional
• Abdominal pain – Functional

The Communication scenario was of a needle stick injury to medical staff and consent for blood specimen after a very traumatic initial experience at phlebotomy. Dr S was the Role Player. Dr L took the hotseat while Dr R & Dr N had the examiner hats. Dr L made a very good attempt and covered most points. Chaperone, Bleep were well covered. There was some confusion with time keeping hence the end was a little abrupt. The examiners made very good observations explained with observations.

The Learning points are:

• ‘How is the child today?” for admitted children is a good ‘opener’.
• It allow rapport building, checking prior knowledge and RP’s agenda.
• Mention your ‘task’ with in first 2 minutes / in introductions
• Make your ‘task’ as a ‘Request / help from parents’.
• Do NOT beat around the bush – say it and then ‘be quiet’.
• Note & Respond the RP’s questions / queries
• Positive doctor – unless information is to contrary
• You can assume Results are normal / mildly abnormal unless stated.
• Remember there is a silver lining in EVERY situation
• ‘Silence and Pause’ are vital parts of Communication skills
• Do not forget 30 seconds Rule
• Summarize at 6 minutes

We will practice clinical station at next session as requested by members.

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:

• Phases of shock
• Joint pains in a well child
• Early asthma – diagnosis & management

In the Development station we practiced observing assessment of two children with different tasks:

• Fine motor assessment in a 3 year old boy with Rt hemiparesis.
• Development age assessment in 3 years old with Trisomy 21.

Dr D verbalised the exam with Dr L being the examiner for first case and Dr r verbalised and Dr S was the examiner in the second case. They both made very good attempt and described what they will do. Their summary was also accurate.

The Learning points are:

• Do not forget your Introductions & consent
• General observation in first 15 seconds
• Structured Examination technique
• Stick to it – do not get fazed by ‘child’
• Proceed in the four domains or one domain in details
• Speech is receptive & expressive
• Scissors use – seek permission
• Push child till task they are unable to demonstrate – upper limit.
• In Summary – ‘I was unable to demonstrate particular ‘task’ and not ‘Child could not do”.
• Remember ‘Opportunistic examination’.
• Presence of mind is most essential.

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

Anil Garg