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

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

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

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

Dear All

Thank you participating in the session.

In RRR we discussed:

• Recurrent wheeze in 4.5 yr old
• Nephrotic syndrome
• Stridor in 2.5 yr old.

The Communication scenario was addressing concerns of parents of a 4 hour old baby noted to be dusky with possible diagnosis of heart disease. Dr D took the hotseat while Dr S was concerned Role player. Dr D conducted herself very well even with an upset father. Other colleagues gave relevant comments.

The Learning points are:

• Communication is about RP’s agenda – NOT yours.
• Follow Shishir’s 2 min rule and speak with 30 sec AG’s rule
• Check RP’s understanding of what is ‘going on?’
• Examine the child with parents to discuss abnormal cues
• Much better than drawing on a piece of paper in most circumstance
• BE reassuring – I have managed similar conditions before
• “With treatment child should be fine.”
• Read the scenario very carefully
• Focus on the task
• Develop a differential on initial information and think broadly.
• Do NOT apologize too many times – seems odd when you are the observer.
• What is going on is NOT your fault or doing
• You do feel for the ‘parent’ and hence feel Sorry / empathic for them.
• Work in small groups and practice, practice & Practice

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. Dr MF & Dr SS were in the drivers seat with Dr AG & Dr ST as keen observers.

In UK it is traditionally believed that passing the MRCPCH exam is easier than passing the Driving Test. Dr ST has done us proud in achieving both is first attempt – Congratulations Dr ST.

In the RRR we discussed:

• Kawasaki Disease
• Constipation in 2 year old
• UTI – investigations in a 2 year old

Communication scenario was discussion with a Medical student about a baby with Neonatal Abstinence. Dr M was an excellent Role Player with Dr A taking the hotseat and making a good attempt at dealing with the issues. We discussed what and how to address certain points and then Dr S had an opportunity to practice the same scenario. There were very relevant observations from most present.

The Learning points are:

• Shishir’s Rule of 2 minutes to organise your thoughts
• AG rule of 30 seconds to avoid monologue
• Be technically correct: ‘baby in womb is not connected to mother’s circulation by umbilical cord’
• Explain in simple terms – be specific do NOT beat around the bush
• What causes ‘abstinence?’ – discontinuation of drugs – nothing else.
• Investigations – know for WHAT – do not just give a list.
• Think laterally also – recreational drug addiction – HIV / Hep B etc
• What to do in case parents REFUSE permission for treatment.
• Be mindful of what you say – there can be a disconnect between your ‘Thoughts & Speech!”
• You get marked for your SPEECH and not your thoughts.
• Practice regularly – watching others makes one feel ‘safe’
• Hotseat and exams – nerves take over and one is liable to be confused.

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 this week. Dr Sumit was our moderator – I would like to thank him for his help an support. Due to technical reasons we could not record the session on Tuesday.

In RRR we discussed:

• Intra Ventricular Haemorrhage in a neonate
• Turner’s syndrome
• Worsening respiratory distress in 10 month old.

The video station demonstrated a boy of 6 years with a wide spread rash. Dr D took the hot seat and picked up the clinical signs. The questions asked were good and examination findings could be clarified more explicitly. Discussion was good.

The Learning points are:

• IVH – ventricular index, neurosurgical opinion
• SIADH – restrict maintenance fluids in ‘Respiratory’ conditions
• Observe carefully – try and focus on ‘different’ aspects of video
• Write them down, do not get engrossed in what you have already noted
• Think of a differential – most obvious first – try not to limit to ONLY one
• If a diagnosis stands out – mention that first
• Wrong order WILL make you lose marks
• Eczema herpeticum – uncommon but is a common exam scenario
• Secondary bacterial infection – Staph – is common hence treat
• Indications for acyclovir & avoiding contact following chickenpox
• Dr Shishir has circulated current guidelines – look them up
• Keep reading and practicing management of ACUTE CONTIONS
• All Hypos – Hypers – Status xyz
• Management: KNOW broad interventions – NEED NOT go into minute details
• Time management is important

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.

Dr S joined us from Kuwait today and offered specific and practical advice – having been in the RCPCH hotseat not so long ago.

Dr S advised to use: C-C-C-B-B-B in assessment.

In RRR we discussed:

• Problem Oriented History of a child at Development station
• Signs of spasticity & treatment options
• Support for 5 year old with difficulty of walking

the Clinical station we covered Development – Fine Motor Assessment. We saw a Fine motor assessment being demonstrated by a colleague. Dr A took the hotseat and made a very good attempt at assessment. There were issues on better summary and presentation methods. All the participants contributed to the discussion.

The Learning points are:

• Essential to have a systematic approach
• General observation is part of EVERY station
• Time is tight – practice to complete in scheduled time
• Choose Toys appropriately
• ONE TOY / TOOL AT A TIME. REMOVE AFTER USING.
• If you finish EARLY – likely you have MISSED some time.
• Vision & Hearing – need to be confirmed
• Hand preference EARLIER than expected needs to be ‘Reported’
• MDT: Know composition and WHAT each member does.
• Crayon – Colour matching – Cutting – Blocks – Books – Beads.

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 yesterday. Apology I could not send you update after the session.

Dr MF joined from Pakistan and gave specific and valuable ‘nuggets’.

In RRR we discussed:

• Speech & Language mile stones of 3 yr old
• MDT for 18/12 old with hemiplegia: who all in it?
• Education plan a 3 yr old child with Down’s syndrome

The Development we carried on from last session. AG presented how to and nuts and bolts & basics of Development station:

• History – what information to get: aetiology / family effects
• Summary – how to do a good job?
• Development assessment
• Discussion with examiner

We did not have a hotseat session but there was good group discussion.

The Learning points are:

• Need clarity of thought
• Speech has Receptive & Expressive components
• “Paraphrase question and then answer – give you time and easier
• Be systematic & organised during the whole station
• 2-3 screening questions for each domain
• Cannot ask details of domain you have to assess
• EHCP & SENCO – new acronyms – look them up
• Each case is different – do not just do a tick box exercise
• Summarize properly – do not just repeat what you have just done
• Give your OPINION – with supporting evidence

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:

• Cerebral palsy: What is and classification
• GMFCS – levels
• Burns in 1 year old – Accidental or non-accidental – history & exam

The clinical station was on Development. 4 year old presents with parental concerns of non being able to manage & do as they expect. Dr I was a very able role player, Dr A took the hot seat for history and Dr K took the hotseat for Developmental assessment. Dr A took a very comprehensive history covering all aspects important and presented it very succulently. Perhaps a little less time on gross motor and more on speech and vision may have earned some brownie points. Dr K attempted the assessment and made a good effort. There were a number of things we could improve and hence will discuss and demonstrate on Thursday.

Learning points:

• our grey cells have some unexpected functions on the hotseat
• practice does improve our control over our grey cells
• Focused history is asked for hence you will NOT be able to cover EVERYTHING
• Aetiology, social functioning & social support are important facets
• 10 minutes is a short time but adequate to get relevant details
• Have 2-3 screening questions for each domain
• Check for HEARING & VISION
• Else if child does not respond to your question – you will not know why?
• Listen to the question Examiner asks – respond to the query
• Questions asked for in history – Do Not start talking about examination

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

Anil Garg