Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Acute Asthma management
• Myocarditis in 3 month old
• VACTERL Association

Communication scenario was discussion with mother of a 15 year old young person with Trisomy 21 about her concerns. Dr T was in the Hotseat with DR P and Dr A having the examiner hats. Dr L was an excellent Role Player. Dr T attempted the scenario well. There were some learning points most important being moving from your agenda to Role player’s agenda. Dr P & Dr A gave good assessment and marked the ‘performance’. Dr Shishir gave a good over all assessment highlighting important points Dr Sonia had mentioned in the previous session.

The Learning points are:

• Read the Task very carefully 
• Get Role player’s concerns by making them speak first
• Let RP speak for as long as they want – Do NOT interrupt
• If you interrupt – you will miss out on important information
• Do not speak in more than 30 seconds bytes
• Avoid monologue
•  Give positive reinforcement – examples which have been good
• Admit ignorance – Do Not Bluff – examiners are experts at detecting
• Do not need to tell all you know
• Do not repeatedly say ‘I understand’ – ‘I understand’
• Use body language to acknowledge your engagement in conversation
• Avoid medical jargon

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

Anil Garg

Dear All

Thank you joining our session today.

In RRR we discussed:

• Asthma – differential diagnosis
• ADHD
• Chest pain

Communication scenario was talking with a 15 year old explaining Bone marrow investigation and any other question s RP may have. Dr P took the hotseat while DR D and Dr r had the examiner hats. Dr Shishir from Kuwait and Dr Sonia from Mumbai joined to guide the group with their observations and tips. Dr P did a good ‘job’ of the scenario approaching it in a logical, sequential manner. She worked well with the RP – Dr S, managing a good rapport, addressing most queries in a way that would have satisfied the examiner on the day. there is always room for improvement – hence Dr P could have used more ‘Pauses’ to emphasize the points and give RP opportunity to ask questions. Few jargons slip in hence it is important to be aware of them.

Dr Sonia highlighted the importance of follow the basic guidelines for Communication station to get definite marks even if one is not very sure of the ‘procedure’ . Accept your ignorance.

The Learning points are:

• Build rapport – how? practice with simple easy ice breakers
• Pause – use to good effect
• Chaperone in hospital settings is generally a good practice
• Get to RP’s agenda and do not follow yours.
• Describe the procedure – most RPs will worry about pain – address it.
• Be aware of when NOT to give advice about support groups!
• On the Web – every condition can either kill you or can to 100% cured!
• Leaflets are a reasonable way forward till next meeting / review.

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

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Trisomy 21: late complications
• Neonatal sepsis: clinical features
• Recurrent wheeze in 3 year old – causes

The Clinical station we discussed was of Communication: newborn baby noted to be dusky at 4 hours by ward sister in postnatal ward. Possible diagnosis ? TGA. Discuss with parents. Dr R took the hotseat, Dr P & Dr L took the examiner hats. Dr R made a very good attempt and covered most of the important points. Dr Shishir provided examiner feedback with practical tips.

The Learning points are:

• Read the stem / information provided VERY carefully
• Each word has been written with relevance
• Plan your strategy for first 2 minutes – Shishir’s Rule
• Read the task and mention in first 2 minutes
• Use SIMPLE language – else describe medical words used
• Build rapport by starting with points of common interest
• Chaperone – always consider and have in hospital settings
• 30 second rule – Information in small bytes
• Give Bad news – mention in clear words – follow by pause.
• Wait for response of Role Player and then respond accordingly
• Describe Normal before describing Abnormality
• Summarize at 6 minutes – almost a must

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.

Dr Swaty joined us today and gave an overview of her recent exam experience. Her opinion was Communication is a very important skill to have to get to your aim in the exam.

In RRR we discussed:

• Lond term complications of treatment for malignancy
• Children with Special needs
• Hearing loss in 5 year old

In Clinical Stations we started on Communication scenarios. 15 year old with two episodes of anaphylaxis refuses to carry Epipens – discuss. Dr P was an excellent Role Player. Dr J took the hotseat while Dr T & Dr S had the Examiner hats. All had to observe carefully and comment. Dr J did a very good attempt at the station – considering it was her first occasion in the hotseat. She finished with almost 2 minutes to spare. Dr T noted and commented on some points that she would do different and gave a mark of 6/8. Dr S made observations on Introductions and marked as 5/8. There were some points mentioned by Dr Shishir and AG.

The Learning points are:

• Have plan but only for first 2 minutes: Shishir’s rule
• Rapport building – always talked about but how to build rapport?
• Follow Role player’s agenda and NOT yours
• Do not use medical jargon – if must – explain.
• Guage RP’s prior knowledge / understanding
• Respond to RP’s queries as soon as – else they will keep going in circles
• Do NOT speak in more than 30 sec. bytes
• Check for response from RP.
• DIALOGUE and NOT a MONOLOGUE!
• Summarise at 6 minutes
• Thank RP at the end.
• Listen to the Questions VERY carefully else you will go down the wrong path
• Utilize all the time – if significant time left – likely you have missed a part.

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:

• Rickets in a 5-6 year old – causes as history station
• Recurrent Abdominal pain 9 year old
• Acute Liver Failure – causes

Moving on to clinical stations we discussed the Communication station. AG present a PowerPoint presentation on fundamentals of communication, How to prepare and attempt the station. 2 stations, role of examiners & role players. Do’s and Don’ts. How we practice in our Interactive Sessions.

The Learning points are:

• Read the information provided very carefully – each word counts!
• Note Names and roles provided in the information
• Plan logical sequence to address task
• Aware of your body language – Eye Contact a ‘must’.
• Plan for first 2 minutes: Shishir’s Rule
• Speak in 30 seconds bytes ONLY – check for response! AG rule
• Dialogue and NOT a Monologue
• You do not have to say everything you know.
• Park queries AFTER acknowledging them – if appropriate
• Communication VS History Stations – Remember the difference.
• Be a Positive & Reassuring  Doctor
• All want the truth but do not want to be depressed.

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

Anil Garg

Dear All

Thank you for joining the session today.

I would like to start by Congratulating two members who have become Member of Royal College of Paediatrics & Child Health at the last diet in UK. Two of three were able to satisfy the examiners on the day while one could not convince them – we will sit together to review, reflect, aim and take the first step again.

In RRR we discussed:

• Breast feeding  advantages & disadvantages
• Supra-Ventricular Tachycardia
• Tall stature – causes

The Video station, a clip of a 2 month old with evidence of respiratory distress receiving oxygen via nasal prongs. We did not have any person in the hotseat – instead we discussed the differential diagnosis after the initial information and the following cues noted after watching the video. The discussion was good and Dr Shishir suggested points to make the history questions specific and examination targeted. We did not discuss full management of the infant under discussion.

The Learning points are:

• Be focused and relate to ‘child’ under discussion
• Work out differential diagnosis
• Initially Categorise broadly
• < 6 month infant – always consider Sepsis in diagnosis & management
• Remember – sepsis – will kill if left untreated.
• Seriously ill child – even with bronchiolitis – consider antibiotics
• Always discuss with your consultant – for Exam scenario.

We will start on Communication at our next session.

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:

• Signs of shock
• Precocious puberty
• Toxic shock syndrome.

We practiced the Video station with a slight difference with suggestions from the participating members. After the initial information provided prior to seeing the video we asked each member to work out a short 3-4 ‘diagnosis’ they would consider (while waiting for entering the station). We then watched the video for 3 minutes and then each member got the opportunity to give their observations and modified Differential diagnosis with information gathered so far. We then followed on to History they would like to gather and Examination they would like to conduct. The ‘final’ list of Differential was presented and the discussion with examiner carried out as in the usual fashion.

Dr Shishir had the examiner hat and also provided tips on how to use the information gathered to develop a Differential suggesting on how to best use the information provided.

The Learning points are:

• How to check Ventriculo-Peritoneal shunt for blockage
• Read precocious & delayed puberty
• 8 yrs & 13 years Girls: 9 yrs & 14 years Boys
• Lumber puncture in repaired meningomyeloceles is not possible
• Our new method provided better learning outcome.

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:

• Devices in Asthma treatment (inhalers)
• Polyarthritis – causes
• IUGR vs Low Birth Weight – complications

The Video station – was a clip of 6 month old presenting with Failure to thrive. clinical Cues – alert, pink, tachypnoeic, some intercostal recession, mark parallel to rib cage, right hypochondrium, NG in situ. Dr S took the hotseat and was able to pick out the cues. History and examination needed some more structure. Dr L and Dr N had a good attempt. Dr Shishir was at hand to guide and suggest points to focus on.

The Learning points are:

• Develop a DD after the initial information and watching Video.
• DD should guide your questions for further history & Examination.
• Formulate your question: precise & succint
• Examination needs to be specific – not full system & vague.
• If you note ‘something’ on video and are not sure – Clarify with examiner.
• You will not be marked down but will not go down a wrong path
• Better to ask than to assume and be wrong!!

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:

• Gonadotrophin deficiency
• Encopresis
• Jittrey baby

The Video station – clip was of a 14 year old girl with rash on her abdomen. Dr N took the hotseat and identified most of the clinical cues. Dr T mentioned the cues that had been overlooked. Diagnosis was ‘obvious’ of Shingle with left dermatological spread. The rash did seem severe – erythema and papular. Management was covered adequately.

The Learning points are:

• Watch the video carefully – do not miss a frame.
• Keep the bigger picture in mind.
• Develop a differential diagnosis by the time you have finished watching the video.
• If diagnosis is ‘unrefusable’ then think of 3 causes!
• Formulate History questions to support or refute your DD.
• Examination – think broadly first. Common things common.
• Pain – should be alleviated first. We forget to tell.
• Jittrey babies are common DD of irritable baby with fits.

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:

• Rash – DD – HSP, ITP, Malignancy
• Haemolytic anaemia
• Teratogens – proven

The Clinical station we discussed today was – Video. AG gave a brief PP presentation of the basics, what and how – to do, what to ask, what to examine and how to proceed. Dr S took the hotseat. Video showed a teenage girl having convulsive movement followed by post ictal phase in school with review in A&E. Dr S picked up the clinical signs demonstrated and developed an appropriate diagnosis. Dr Shishir was the examiner. He asked what did Dr S observe – details of the convulsive movements. It was noted the movements were not tonic clonic as first thought but were asynchronous. Differential then also included Non Epileptic Seizure. Discussion was detailed.

Learning points are:

• Always develop as Differential diagnosis even if confident of diagnosis
• Keep an open mind. Get bias out of your thinking.
• Watch the video very carefully.
• Concentrate on different aspect on second look at video.
• Look at the ‘child’ as a whole.
• Note the sequence of events in video.
• Munchausen by proxy – do keep in mind.
• True Epileptic seizure is always associated with abnormal EEG
• Sleep deprived EEG is a common investigation.
• History – work through HEADSS.

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

Anil Garg