Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Constipation – causes.

Dr Sonia joined the session at request of some members to answer questions on what actually happens in the examination circuit. There was a very interactive sessions of almost the full session and virtually all possible questions were discussed.

The Learning Points are:

• You need to be dedicated in your preparations
• Practice – Practice – Practice is the Guru Mantra
• Structured examination is a MUST.
• Prepare a Template for each station and practice with it
• Clinical examination at least – you should be able to do at Spinal level.
• Verbalise – you will improve your presentation and Development station is ‘virtual’.
• Video station – concentrate on different aspects when reviewing
• Video – your mind will want to focus on what you have already noticed!!
• There are a few mandatory ‘phrases / information’ you have to say at each station
• Video yourself practicing each station – you will be surprised.
• Stay Calm – Stay Calm

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.

In RRR Dr Shishir discussed:

• Chronic Fatigue Syndrome
• H Pylori
• Tics

The Development station was a 4 year old with evidence of left hemiparesis. Task we practised were both Fine motor assessment and then Gross motor. Dr R was in the hotseat for Fine motor assessment while Dr J took the hotseat for Gross motor. The both made very good attempt at assessment and completed the task in the required time. 

The Learning points are:

• Development station is ‘Virtual’ with no Child physically present.
• Information is provided by video as a basic guide.
• Consider your communication skills – introduction, permission and rapport
• Imaging the set up – and lead the scene.
• Structured exam – practice – practice – practice
• Choose the tools appropriately
• Initial observation followed by sitting down across a table – if appropriate.
• Instructions need to be simple and accurate – non confusing
• Handedness is very important to determine
• One tool at a time and REMEMBER to REMOVE the tool after task before next tool
• ‘Push the child to level they cannot demonstrate – to determine upper age limit
• MDT – know the members and their roles
• Know how to refer child to various health professionals

Nest session we have a member, who recently became a Member of RCPCH, will join us to answer queries on nuts & bolts of exam as organized at present

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

Anil Garg

Dear All

Thank you for participating in our Double session today.

In RRR we discussed:

• GMFCS – classification
• Development deficit – domains
• Screentime – effects on children

Development – AG presented Do’s and Don’ts for this station. What to focus on in the history and why social history is very important. Dr Leuvenya gave new timeline for the station:

• 4 mins to review information
• 9 mins for History from Role Player
• 1 mins for Summary
• 9 mins for Assessment
• 3 mins for Discussion

Dr M was in the Hot seat for history and Dr L was for Assessment. 4 years old NH is reviewed for parental concern of being slow in fine manipulation as compared to peers. Both made very good attempts at the respective parts on the station. Examiners Dr D and Dr M made appropriate comments on parts that could be done different.

The Learning points are:

• History should be systematic and structured
• While waiting 4 minutes: note down skeleton on what you need to ask
• Check ‘other’ domains briefly to assess if also deficient
• Time management is VERY important
• Confirm activities child can do now.
• Social and family history
• Know Milestone ‘inside out’ till of 5 years
• Use One Tool at a time
• Push ‘child’ to point they cannot do – gives upper age range.
• Mention – removing each after you are through with it
• Summary – give your impression followed by supporting evidence
• Know Management options

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:

• Acute Renal failure – causes
• Acute Liver Failure
• Acute otitis media – complications

We started our Autumn module after a successful Summer module. 

AG introduced the  current Clinical Examination. The exam has been changing gradually after the massive make over during Covid. 

It is back to almost Pre-Covid ‘structure / layout’. Children are back in the examination clinical stations as are Role players in relevant stations. However in the Development Station you will meet a Role player for history but will not have a child to interact with for assessment. This is the persistent change that we expect will change over the next few diets.

Dr Shishir gave important advice on types of scenarios in Communication one might get. Important to practice Ethics, Gillick competence etc for India also as you should be caught out at the exam. A general template can be followed to get good outcome at the exam. Social history has significantly more importance than usually given in ‘ Overseas / Indian’ exams – hence pay attention.

We will continue with History station at next session.

Video recording on Clinical exam will be available online soon at http://www.mrcpchonline.org

Anil Garg

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Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Ambiguous genitalia
• Persistent stridor in 6 month old
• ABC – often mention but What & How?

The Clinical station – we started on History and Management Dr P in the Hotseat and Dr S with Role player Hat. Scenario background was review of 10 yrs old child with worsening asthma symptoms. Discussion with parent to ascertain their concerns and answer their questions. Dr J and Dr V had the examiner hats. Dr P made a very good attempt at obtaining the relevant history and gave a neat summary to examiner. There were a number points that could have been asked noted by the examiners and other Group members.

The Learning points are:

• It is FOCUSSED history – you cannot cover everything
• Read the information provided VERY carefully
• Plan bullet points for your history in the 4 minutes while waiting
• Structured history – do not be haphazard
• Presenting Concerns – essential to identify
• Family dynamics
• Social history – essential.
• Find out Local support where you practice and answer questions in context
• You should try and UK ‘support’ to your local practices – difficult!
• Remember: Worsening symptoms most likely is due to Noncompliance
• People do not own up to noncompliance with first ‘inquiry’.
• Summarize in few sentences at 9 minutes
• When summarizing to Examiner – present like a post graduate
• Your impression with supporting facts from your history exercise.

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

Anil Garg

Dear All

Thank you for your participation in the session today.

In RRR we discussed:

• Indications for admission following h/o head injury
• Thyrotoxicosis
• Seizure of 20-30 min without regaining consciousness

The Video clip was of a 4 month old infant with rash on the face with golden crust and involvement of eyelids and right hand. Dr A was on the hotseat with Dr J and Dr P taking the examiner hats. Dr A made a good attempt and picked up the clinical signs depicted. Differential Diagnosis was not quite in keeping with ‘Common things common’. Some rare diagnosis were mentioned. Infected ‘eczema’ in a young infant is most likely due to Cow’s Milk Protein allergy in UK. Family history and other relevant questions can be asked. Management again – mention the most important intervention first. Examiners made very relevant observations and rest of the group contributed. Cow’s milk protein intolerance is not a common problem in India but it needs to kept at near the top of the list.

Learning points are:

• Acute management has to be mentioned first i.e. abort seizure!
• Stabilize
• Differential diagnosis – Common is Common
• If you have NOT seen the ‘condition’ most unlikely needs to be included
• History and examination need to be based on your DD
• Management – broad principle and key important first.

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:

• Polyhydramnios – causes
• Nephrotic syndrome – complications
• Polyarthritis – causes

The Clinical station we discussed was Video Station. Clip was of a 14 month old with findings of tachypnoea receiving Oxygen and seeming distressed. Dr D had the hotseat while Dr R and Dr S had the examiner hats. Initial discussion among all the differential diagnosis were: Bronchiolitis / Pneumonia / Viral wheeze / Foreign body / Congestive Heart Failure. Dr D asked relevant questions and asked appropriate examination findings. Management could be done different. However in discussion and feedback all points were brought forward.

The Learning points are:

• Video station is tougher than it appears
• Read the Stem very carefully – every word is important
• Do not confuse gender of child / Role player in Communication
• Watch video – concentrate on different aspect when reviewing
• Develop a differential diagnosis
• Do NOT go in with ONLY one diagnosis
• Frame History questions (3/4) to support or refute your DD
• Same process for Examination findings
• Practice to frame questions in ‘specific language’
• In Management – Mention what you will DO – as that is asked
• Not what you will NOT do i.e. investigation, medication etc
• Inform your Consultant as earliest appropriate opportunity

In discussion AG updated on a Communication scenario – With drawl of care. Try and remain a doctor with positive attitude and try and find a positive silver lining in the time of misfortune and extreme sadness.

Please visit www.mrcpchonline.org to add your comments or points I may have missed. Do like if you so feel.

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Precocious puberty
• Cyanosis in a newborn
• Asthma – Outpatient management at discharge

The Video station was of a clip of a 2 day old baby in a headbox having features suggestive of on going convulsion – facial twitching, lip smacking, tonic clonic movement of left arm. Dr T took the hotseat. We did not have any specific examiner hats today.

We probed initial diagnosis after viewing the video clip by all members and unanimous impression was that the baby is having a fit. If the diagnosis cannot have a Differential diagnosis then we need to look at the causes of that diagnosis. Dr T made a good list with top three differential. We then proceeded to history questions followed by specific examination finding to check for. Discussion was ‘What will you do next?” followed by few other management questions.

The Learning points are:

• Watch the Video very carefully
• Concentrate on different aspect when reviewing
• Develop 3 differentials to discuss
• Common things first – if you have not seen it – unlikely to be relevant
• Support with your finding you ‘final’ diagnosis
• Discuss management of ‘child / condition seen in Video
• Acute condition needs to be controlled first
• In OP management plan – write out a Treatment Plan
• Written plan is relevant to all Chronic conditions

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 covered a lot of ground today starting with RRR followed by Communication scenario with Dr P as RP and AG being the candidate, discussed Video Station – what to expect, Dos & Don’ts and then in the end managed to squeeze in a video clip of a 2 day old baby to be discussed at next session on Tuesday.

In RRR we discussed:

• Disadvantages of Brest feeding
• Neonatal seizures – causes
• VSD – symptoms & signs

Communication was repeat of previous scenario – Newborn with birth asphyxia requiring cooling – to discuss with parents. Dr P was the Role Player while AG took the Candidate role. The points identified by members are:

• Confirm and check identity & relationship of RP
• Initial rapport – congratulation – check about partner
• Pause with body language to convey your engagement in process
• Optimistic approach and factually correct – no false promise on prognosis
• Realistic Optimism
• Address concerns of RP – not your agenda
• Explained Cooling and need in simple language
• Very simple language – no jargon
• Dialogue – not a monologue
• Let RP verbalize their concerns
• Do not get anxious

Video station approach, Formulate Differential diagnosis, Questions to ask and broad management principles.

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

Anil Garg