Thank you for participating in the session.

In RRR we discussed:

• Shock
• Rheumatic fever
• Cerebellar tumour

The Video station was of a 6 week old baby with respiratory difficulty and getting oxygen.

Dr S took the hotseat and did a very good attempt at recognising the clinical signs and with clinical reasoning. A few minor points were helped by Dr I along with current management guideline.

The Learning points are:

• Have a differential diagnosis of the condition
• Signs of deterioration in clinical condition
• How will you monitor deterioration of a child
• What instructions will you give the nurse / junior
• Think for 5 seconds – organising your thoughts before replying
• Observation is key – be very careful
• Try and ‘see’ different aspects when reviews the video clip.

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

Anil Garg

Dear All

Thank you for participation in the session today.

In RRR we discussed:

• signs of Physical abuse in children
• Jaundice of newborn
• Febrile convulsion

In the Clinical station we discussed how to attempt the Video Station. AG discussed a PowerPoint presentation highlighting the Do’s, Don’ts and why of the Video station.

The Learning points are:

• Watch the video carefully
• Concentrate on different parts when you review it.
• Do not get ‘blinded’ by an obvious sign – there may be other points of note.
• Develop a differential diagnosis of 3 after viewing videos.
• Have differential even if One diagnosis seems obvious.
• Questions need to be specific and 2-3 only
• Examination also has to be very SPECIFIC -not general
• Investigations – mention with expected results – NOT just a list.
• All candidates will have ‘same’ viva questions

Visit www.mrcpchonline.org to add your comments or any points I may have missed.

Anil Garg

Dear All

Thank you for your participation in the session today.

In RRR we discussed:

• Problems of prematurity
• VSD – why diagnosis missed at birth
• Iron deficiency anaemia in a 3 year old

In the clinical station we had a 14 year old girl who came for routine FU and task is to examine her Respiratory system. Dr S was in the Hotseat and picked most of the clinical signs in a systematic examination. A few significant observations were missed and a finding not present was noted. The summary was well presented. We discussed how it could be improved.

Learning points:

• Systematic examination – is improving
• Examination of Upper respiratory tract is also part of examination – at least mention
• Categorise your answers and mention more common causes first
• Suppurative Lung Disease is a better opening diagnosis than Cystic Fibrosis
• Important to know various access devices used in children

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

Anil Garg

Dear All

Thank you for your participation today.

In RRR we discussed:

• Genetic counselling – Trisomy 21.
• Screening in Newborn
• Competent parent ( parenting).

The Clinical station was of a 1.5 yr old presenting with parent’s complaint of walking difficulty. Big head, scar in the cervical spine and normal walk for 18 month old. Dr I opted for the hotseat. The examination was thorough but could be streamlined better – a little more structured.

Learning points:

• Important to be structured
• Make an A4 sheet plan for each major domain / station.
• Complete the examination is 5-6 mins max.
• Do NOT upset the child. Step BACK if child upset.
• Make an attempt to calm the child BUT do NOT force yourself on the child
• It is not important to persevere with examination – more important your attitude.
• Technical Terms are NOT a NO NO but if essential – EXPLAIN what you mean
• Use CORRCT terms for description.

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

Anil Garg

Dear All

First let me congratulate two members who have confirmed to me their success in the last MRCPCH Clinical diet. We wish them success in their future career looking after children and hope they will join us time to time to advice on our preparations.

In our session today in RRR we discussed:

• Sudden cough
• Delayed puberty
• Inflammatory Bowel Disease

Clinical Station was CVS. 6 yr has come for a routine FU. To examine CVS. Dr S took the hotseat and made very good attempt. The scenario was over run and with practice it will improve.

Learning points:

• Do NOT panic
• OBSERVE – important
• Do NOT locked into a particular diagnosis.
• Consider a differential diagnosis of 2-3 – then work your way
• Concentrate on findings and TRUST yourself
• Do NOT try and box findings into a specific diagnosis.
• Practice, Practice, Practice.

Visit www.mrcpchonline.org to add your comment or points I may have missed.

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Heart failure – symptoms & signs – best arranged age wise.
• JIA
• Immunization – What is it and schedule?

We than had a PowerPoint presentation by AG on the Clinical station, how the changes to Face to face without children and next with children is to be implemented in Far East and next in UK diet. How to attempt the station was covered. Suggestions on how to practice each station – CVS, Respiratory, CNS, Abd etc on a day to day basis so as to improve fluency of your technique.

The Learning points are:

• Overview of the exam
• Consent from ‘child’ in the station – how to best attempt
• Make rapport with the child and parent
• General survey / physical exam – 30 sec at EVERY station.
• Expose the part fully – always – keeping ‘modesty in mind’.
• Systematic and fluent
• Always be compassionate – do NOT upset the child or parent.

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:

• TB – features & management
• Nephrotic syndrome
• Kawasaki’s disease

The Communication scenario was of a 1 day old baby with ambiguous genitalia born to a couple from Afghanistan. Dr S was a good role player. Dr M was in the hot seat and had a good shot at the task of informing parents of diagnosis and management. It was a difficult scenario and feedback peers was to the point.

The learning points are:

• Who all in general identify / assign sex of a child? Only doctors don’t!
• Check prior knowledge – give enough opportunity to Role player
• Ambiguous or abnormality – better to ‘demonstrate’ than to just ‘say’ abnormality
• Let’s see the baby together – the ‘Genitalia’ – does it look like boy or a girl?
• this will move scenario much further than in explaining.
• Can and should be used for any abnormality – can draw – if appropriate
• Do not use boy or girl in subsequent discussion – ‘child / baby’.
• Appropriate management – target next 7-10 days initially.
• Usually what we do in first meeting – More if asked by role player.
• Being a Role Player is an EYE OPENER. Get idea of what is expected from Hot Seat

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

Anil Garg

Dear All

Thank you for your participation in today’s session.

In RRR we discussed:

• Head Injury – effects / damage. Primary & Secondary
• Cystic Fibrosis – Clinical features / presentations – age wise

Scabies – symptoms, signs and management.

The Communication Scenario was of a 12 month old admitted with Febrile convulsion due to Otitis media. Father is insisting on a CT scan. Dr V was an able Role Player. Dr I took the hotseat. All medical & related technical related information was there and presented but how to could be improved. We practiced the scenario with reversed Roles after feedback of first attempt.

The Learning points are:

• Practice common words that are essential to Communication
• IT is NOT about saying ALL you know.
• Do NOT make it a monologue.
• REMEMBER 30 sec Rule.
• After introductions and open question 
• Let Role Player speak for as LONG as they like: DO NOT interrupt
• For particular procedure or Treatment: HIGH light SIDE / HARMFUL effects
• These may be used to discourage from their ‘demands’.
• Safety NET – offer to review by Open Access – if appropriate.

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

Anil Garg

Dear All

Thank you for participating in the sessions today.

In RRR we discussed:

• Assessment of Seriously Sick child – ABCD
• Chronic Fatigue Syndrome
• Anorexia Nervosa

The Communication Scenario was of an 11 month old admitted following a convulsion and a clinical diagnosis of meningitis. Task was to discuss with parent for consent for LP and further treatment. Father is not happy with LP. Dr M was a good role player (RP) acting as father and Dr V took the hot seat. Very knowledgeable with facts having some difficulty in putting it across to an adamant father.

Learning points:

• After introductions check what RP understands of situation.
• Do NOT be Jargonistic.
• Seizure vs ‘fit’ – consider appropriate terminology
• Respond to cues. Listen carefully.
• Is ‘child’ going to be OK? a very common question.
• Be honest and do not promise that is that is not ‘correct’.
• ‘Should be well with treatment’ is generally a good response.
• Most scenarios are not about technicalities of procedures.
• Lumbar Puncture is NOT mandatory for TREATING suspected meningitis.
• If RP refuses do NOT go round more than twice – look for alternative approach.

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

Anil Garg

MRCPCH 2022/2 ,MAY

This is to confirm that we have received approval from the RCPCH this morning and the format for the MRCPCH exams for the May diet will be as follows:

-Short Clinical – with real patients x 4 stations
-Development – scenario based with role player as per Covid adapted exam
-History – scenario based with role player as per Covid adapted exam
-Communication x 2 – scenario based with role player as per Covid adapted exam
-Video x 2 – Covid adapted exam

Therefore, the only change from the exams held in February 2022 is that there are now patients for the 4 short clinical stations. Further finer details on the domains to be marked e.g. whether the short clinical will include questions on management will be announced in due time once I get more information. There will be a lag time before this change is reflected on the website, so please DO NOT write to RCPCH enquiring about this. Give them a week or so to make the change, and you can check the website again for more information. I will inform again once I get more details on the domains to be marked for short clinical.
If you have any queries, please email me