Dear All

Thank you for participating in the session today.

Dr L gave a brief synopsis of ADHD – Hyperactivity & Attention deficit. What are the diagnostic criteria, how to manage children, when to use pharmocological agents and which with their significant side effects.

Clinical stations were agreed. At start we agreed the time line for the session – a presentation on the nuts & bolts of the clinical station and then a detailed discussion on individual stations:

• Cardiovascular
• Respiratory
• Abdomen
• Neurology
• Eye
• MSK

We had a Q&A with Dr Sonia, who has returned to join us as Faculty after clearing her exam in February diet from  Banglore. She gave practical tips on what happens during the exam and how to respond and clerify doubts. Better to Clarify than to go down the wrong ‘avenue’ and then get a ‘0’ at the end.

The Learning points are:

• Check for Pain and reassure you will stop if activity painful
• Follow: Inspection – Palpation – Percussion – Ausculation
• General Physical examination is a must for every station
• Mention any obvious abnormaility – even if of a different ‘system’
• Don’t comment / mention – what you know ‘nothing’ about!
• Growth chart – be prepared to PLOT Wt & HT – if asked – (practice)
• Expose the part – else exaniation will be incomplete
• When in doubt of task – Clarify
• Practice at least 2 hours per day till exam in May with study partners

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

Anil Garg

Dear All

Thank you for joining the sessions today.

In RRR we discussed:

• Coeliac disease – diagnosis (H-E-I)
• Anorexia Nervosa
• Anaphylaxis – Emergeny management

Video station was of a 7 year old boy with history of 4 week hospital admission and walking with an abnormal, high stepping, broad based gait. Dr A took the hotseat with Dr P, Dr A & Dr P taking the examiner hots. Dr A was good, got the diagnosis and discussed management as appropriate. There were a few history and examination points that could be improved. Exminers contributed to building the complete picture.

The Video discussion, having gone well, finished ‘quickly’. We took the opportunity to discuss ‘Examination’ of Gait and lower limbs. How and where to position oneself, how to follow a logical sequence to examination. It will help in Clinical station.

Next week we start with Clinical Stations.

The Learning points are:

• Read the information very carefully. Every word counts.
• Watch whole ‘body’ and not only legs.
• Paucity of movement of upper limbs can be vital.
• In history ask – ‘When was the concern first noted’.
• Fully expose the part you have to examine.

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

Anil Garg

Dear All

Thank you for joining the session today.

In RRR we discussed:

• ITP
• Cystic Fibrosis
• Diabetes Insipidius

The Video station depcited a 2 day old with obvious conculsion – eyes flickering, mouth twitching, left arm jerking, right arm flaccid, lying immobile. Baby in headbox. Dr P took the hotseat whle Dr A U& Dr P got the examiner hats. Dr P picked up most of the clues in the clip and had the diagnosis and knew the managemnt. Some clues were picked up by others ie headbox and ‘immobile’ right arm. There are alwayspoints we can learn.

The Learning points are:

• Start working on differential diagnosis from initial information and have it ready by the time you have finished seeing the video.
• Do NOT see the same bit, you have noticed’ on the video on review
• Focus of different part of the screen – there can be other clues.
• History questions need to help you with your Differential diagnosis.
• Be precise and exact with your words for the information you are seeking
• Do not ask unnecessary questions
• Listen carefully to information being given
• If not sure – better to Clarify than going down the wrong path!!
• If a child is fitting – no point checking for the tone – waste of a question.
• Read up ALL the emergeincies, Hypos & Hypers, Status…
• Know the first few managment options well – know current guidelines.
• Be ready to back up your answers if required

We then also discussed the change to differential diagnosis if the video was of a baby 28 days old.

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

Anil Garg

Dear All

Thank you for attending the session today. I send learning to most of our alumini so to keep in touch and remind them Paediatrics is a life long learning journey and MRCPCH is not the end. Your contribution is always welcome to guide our current and future members.

In RRR we discussed:

• Acute Liver Failure: causes & Investigations
• Abdominal mass with hepatospleenomegaly
• Choanal atresia

The Video station depicted a 7 year old boy thought to be day dreaming by parents and a video they have brought showed periodic absences. Dr P was in the Hotseat and Dr T & Dr A wore the examiner hat. Dr P noted the clinical signs, history questions were appropriate and examination was also good. Discussion got a little confused due to Hotseat syndrome. There is always room for improvement.

The Learning points are:

• Phrase questions ‘succinctly and be precise’.
• ‘How long has he had these episodes and have they been increasing?’
• Seizures is a common topic hence read up carefully and in detail
• What advice to give parents.
• Activity restriction till ‘seizures’ are controlled – not 2 years
• Drugs / medication can be started without EEG in cases.
• Diagnosis is based on history & observations and not only on EEG
• EEG is often normal inbetween seizures
• EEG is abnormal in 1% individuals with no symptoms!!

General questions: In Clinical station – Should you describe your examination finding as you go along. Depends on your & exainers preference but my advice is Talk to the child explaining what you are going to do as you go along. This will keep the child engaged and examiner will also know what your are doing.

Practice to finish a systemic exaination in 5 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:

• Vulvovaginitis in 3 yr old
• STI – Sexually Transmitted Infection
• ADHD

We started on Video station today. AG presented the nuts and bolts and Do’s & Don’ts for the Video station. 2 stations with video clips and discussion with examiners at both. We then had a video of a relatively well looking 6 month old presenting with vomiting for 24 hours. There was evidence of repaired meningomyleocele and Ventriculo-Peritotenal shunt. Dr A took the hot seat with Dr P & Dr P took the examiner hat. It was a good attempt but could be done better. Examiner gave relevant feedback. Read up Hydrocephalus – with open fontanelle and later on in older children.

The Learning points are:

• Video slpis are normally approx a minute long
• Concentrate on different aspects when reviewing video 2^nd time.
• Have a Differentail diagnosis of 2-3 after watching Video
• History questions should help refute or support your DD.
• Examination has to be for specific findings with similar aim
• Common thing common – when considering diagnosis
• Do not jump to conclusion with in first few seconds
• Keep an open mind – else heading for trouble
• Do not argue with the examiner if they offer a different diagnosis
• Management is essential and first few steps need to be clear

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:

• Obesity – complications
• Purpura
• Antenatal diagnosis by USS

The Communication scenario was of a newborn with severe birth asphyxia requiring cooling, task was to explain to parent and take consent for transfer to tertiary unit. Dr A was our Role player and Dr A took the hotseat. Good attempt but with some limitations due to internet connection. Dr P stepped in and made a good effort. Most points for good communication were covered but there is always room for improvement.

The Learning points are:

• Situational awareness for introductions – try not to use standard phrases
• Check prior knowledge of Role Player before getting into your stride
• Avoid medical jargon – if necessary – explain
• 30 sec rule – Max talk for 30 secs – can be less
• Dialogue and NOT a monolgue
• Explain Normal first and then the abnormality
• Do not be a passimist – be Positve and factually correct
• Summarize at 6 mins – only a few sentences are needed
• Acknowledgewhat Role Player is saying – answer if possible

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. We have had a longr than expected break due to reasons beyond my control. We will make up for the lost time in the next few weeks.

In RRR we discussed:

• Radiation effects – post malignancy treatment
• Delayed puberty – consider Extreme exercise
• Laryngomalaica – floppy larynx

Communication scenario was discussion with Role player (Grandparent) explaining Unexplained bruising of a 2.5 yr old grandchild and further management plan. Dr T took the hotseat and AG was the roleplayer. Dr T made a very good attempt and covered most important points. There is always room for improvement. ‘Examiners’ gave very constructive feedback.

The Learning points are:

• Use correct ‘anatomical descirption’ Laryngomalaica is ‘weakness’ of cartildge and not of muscles of larynx.
• Communication is Dialogue NOT a monologue
• In you use medical terminology (jargon) – explain it in simple words
• Do not speak for more than 30 seconds (maximum)
• Consider 30 sec limit as ’30 mph speed limit’. You can drive slower than 30 but should not exceed the limit!
• Use your duty as per ‘law’ or Guideline’ to avoid making issues personal with Role player.
• Describe Normal before talking of Abnormal: Normal bruise vs abnormal bruising.
• Summary at 6 mins is essential but needs only few sentaneces

We will continue with communication scenario on Thursday.

Please visit www.mrcpchonline.org to add your comments or things i may have missed.

Anil Garg

Dear All

Thank you for particpating in the session today.

In RRR we discussed:

• Newborn ‘blood’ screening
• Gastroenteritis – conditions mimcking
• Hypoglycaemia – post neonatal period

The Clinical station was Communication. Scenario was discussion with mother of a newborn baby who is mucusy and likely diagnosis is Tracheoesophageal atresia with fistula. Dr L was our very able Role Player. Dr A was in the hotseat and later swapped the seat with Dr A. Dr Amdae a very good attempt and covered most points. Dr A2 took over and covered few points that could also be covered. After feedback from Examiners Dr AG took the hotseat with Dr L still in RP mode to demonstrate how he would do it. The feedback was constructive and positive.

Learning points are:

• Communication is a Dialogue and not a Monologue
• Set the scene, chaperone and uniterrupted time.
• 30 secs bits of information with RP acknowledgement / response
• Try and avoid ‘Hi’ as a greeting – Good morning / afternoon is better
• It is about Roleplayer’s agenda and not yours
• What Role player knows or has noticed – concerned about?
• However – the Task has to be addressed / completed
• Do not need to give all the information of subject
• Share responsibility with other specialists.
• Coordinate care with other specialists – imply you know and have done previously
• You are unlikely to know Full details of likely treatment

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

Anil Garg

Dear All

Thank you for particpating in the session today.

In RRR we discussed:

• Respiratoy distress in newborn
• Child with Liver Disease – management
• Mesles – complications.

In Communication station – Dr A was our Role Player for a Teenager who had taken a Paracetamol overdose. Dr A was in the hotseat with DR L & Dr A with the examiners hat. Dr A made a good attempt but there were learning points that were discussed and then the roles were reversed. Dr A was in the Hotseat and Dr A in RP mode. The examiners gave very valid observations and feed back.

The Learning points are:

• We need to practice more
• Important to learn phrases to use and those to avoid
• Try and not be judgemental
• Establish rapport
• Confidentiality is essential.
• Watch your communications skills – remember – Dialogue vs Monologue.
• Be aware of our mannerisms – things we say or act without realizing!

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:

• Napkin rash
• Coeliac disease
• Failure to Thrive

AG discussed Do’s & Don’ts of Communication station.

• How are you marked,
• What tasks are given,
• Situational awareness,
• How to set the scene,
• Eye contact – an essential tribute,
• Summarise
• Safety netting.
• 2 minutes Shishir’s Rule
• 30 sec bytes – AG Rule

We had update on the exam experience, how to prepare, what we are doing well and how to practice for your exam in the near future.

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

Anil Garg