Dear All
Thank you for support for the Summer session. Sessions were interactive and you all participated by being in the hotseat, role player, examiner or observers.
We had 28 sessions from 1st July to 5 October 21.

• Communication: 8
• Clinical Station:  7
• Video:                 5
• Development:     4
• History & Man:    3
• Exam review last diet: 1

I trust you found the distribution to your needs.  I note not all of you were able to attend all the sessions but did manage to see the recordings of the sessions.
Some of you will leave the Group as you have had your exams and I wish you all the success and pray for your success.

We will begin with Communication of Tuesday 12 October. Let me know if we should continue with the same distribution or change it.
Anil Garg

Dear All

Thank you for your support for our Summer course.

We started on 1 July and have completed 28 Interactive Sessions finishing on 5th October 2021. We covered all the stations of Clinical Exam: Communication, Video, Clinical, Extended clinical and Development and History & Management plus 2 sessions on recap of what you all asked for.
Next Session will begin with an open session updating on Changes of Virtual exam to New realities of Covid Adapted Exam. Different formats are being planned for different regions as on now. We will then start on Communication station.

If there are scenarios you wish to discuss – do let me know.
Look forward to continuing to work with you to reach your goals.

Anil Garg is inviting you to a scheduled Zoom meeting.

Topic: Anil Garg’s Zoom Meeting
Time: Oct 7, 2021 03:00 PM London

Join Zoom Meeting
https://us02web.zoom.us/j/2191937091?pwd=SFR2VHllclJsbUZCS1lkaUQ5M3BHUT09

Meeting ID: 219 193 7091
Passcode: Summer@

Anil Garg

Dear All
Thank you for participating in the session and making it so interesting.

In RRR we discussed:

• Bruising & Lymphadenopathy: ALL & DD
• Osteogenesis imperfecta: implications for NAI
• Meconium Aspiration Syndrome: causes and management

In History scenario Dr R & Dr M completed the discussion with examiner – summary presentation and then management.
Learning points:

• Discuss in Broad categories first – then go as directed
• Read DKA guidelines
• Add Potassium after urine output has been established
• Various types of Insulin
• Sick day – regimen
• Insulin pump – basic knowledge
• Technique of using ‘treatment’ – insulin, inhalers etc
• Examination of a child with seizures in a video station: no point doing tone
• Document your actions
• If it is NOT written – it is deemed NOT done.
• Speak with parents – to update them

Visit www.mrcpchonline.org to add your comments or what I have missed.
Anil Garg

Intensive Revision Course with updates for Exam formats in Hong Kong, Malaysia and UK.

Join us on 2-3 October 2021. Work with experienced faculty and small groups.

Visit http://www.mrcpchonline.org.

Dear All
Thank you for participating in the session and making it so interesting.
In RRR we discussed:

• 8 month old presenting with URTI like symptoms and breathing difficulty. Management of Acute Bronchiolitis
• Rickets: Causes, diagnosis and management.

We then had a PowerPoint presentation by AG on the History station with tips on do’s and Don’t’s. What all to ask and be careful not to get into communication station mode.
The History station was to take history from parent of 7 year old with 2nd afebrile fit. Dr M & Dr I were in the hot seat at the two sessions and made good attempt. There are always learning points and the only time that matters is the Exam time – others are all learning opportunities. Everyone else also contributed to the history – points they would like to have included – more importantly – How to ask the questions!
We could not finish the discussion with examiner due to time constraints – will do it on Thursday

Learning points:

• Be empathic – if bad news being described – acknowledge difficulty to role player / parent
• Do not ask to repeat information given – as will be considered NOT paying attention
• H/O chickenpox in immunocompromised children
• HEADSS – in Teenage / adolescent
• Questions should follow a logical sequence
• Look at the role player – do not bury your head in the paper.

Please visit www.mrcpchonline.org to add you comments or any point I may have missed.
Anil Garg

Thank you for participating in the session.
In RRR we covered:

• 5 Ss in Neurology examination
• Painful Rt knee in 7 year old
• Rett syndrome

The Development station we practised summarizing history and presenting to the examiner. This was followed by Verbalizing the exam. There were difficulties. We watched a video of fine motor examination and practised again. Dr C and Dr K were in the hot seat.

• Stay calm
• Speak SLOWLY – pause after points to get DEPENDENT cues from examiner
• If you do not pause – you will NOT get the answer
• Be precise with your words when giving instructions or questioning RP / Child
• Well structured examination is a must.
• Give your diagnosis at start of summarizing – DO NOT narrate findings
• Findings have been given by examiner a few minutes ago
• Support your diagnosis with findings if required.
• Practice, Practice, Practice.

We have start with History and Management scenario from Tuesday.

Visit www.mrcpchonline.org to add your comment of any point I may have missed.

We have INTENSIVE REVISION COURSE ON 2-3 OCTOBER 2021.

Anil Garg

Thank you for participating in the session today. We covered Development.
Rapid Random Review:

• DLA – Disability Living Allowance: Care & Mobility
• GMFCS score.
• Autism. Features & Play group age.

In the Clinical station we took development history of a 4 year old with concerns about ‘fine functions’ of his parents. Dr M & Dr A were role players while Dr A & Dr M took the history. Time was short and ran out before all the details could be covered.
We will Verbalize the examination at the next session.
Learning points:

• 3 main domains for Autism diagnosis
• Levels play to assess age: Parallel / Imaginative / Pretend
• Learn to phrase appropriate questions
• Check Hearing & Vision or ask
• Development history is about determining aetiology / cause of illness

Please visit www.mrcpchonline.org to add your comment or any point I have missed.
Anil Garg

Dear All
On 9th we had only one session – 3:00-4:00 pm hence there was no link for 6:00-7:00 session.
In RRR we discussed:

• Cow’s Milk Protein allergy – diagnosis & management. Types of milk.
• Clubbing – causes. Hyperthyroid is an unusual cause note for neck swelling
• Ambiguous genitalia – causes and management

In the Development station scenario was a 3 year old girl with Trisomy 21 – parents concerns of ‘being slow’. Dr I was in the hotseat for history and then we watched a video of assessment for developmental age.
Learning points:

• Time management is very important
• History has to be focused
• Do not ask much of what child can do for domain to examine
• Read ambiguous genitalia as is a common scenario.
• Know various types of milk used in CMP.
• Summary should be compact and brief.

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

Thank you for participating in the sessions today. We covered Development station. Dr Urmila covered the station with her special interest.
RRR:

• ADHD
• Small for dates baby – cause, effects and management
• Anaphylaxis – What, How to recognize and treat plus discharge planning / advice

Development we covered basic do & don’t of this station with how to focus on history and then how to conduct the examination. Summarize and discuss with examiner. Scenario was developmental age by gross motor assessment of a child with age of around 2-2.5 years.
Learning points:

• Time management in history & points to cover
• Structured examination.
• Can ask of domain asked to give a sense of development BUT not for things that can be discovered on examination.
• General examination is VITAL for this station
• OBSERVE the child and comment on posture, movement, behaviour
• Concise summary

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

Anil Garg

Thank you for participating in the session today.
In RRR we discussed:

• Acute respiratory distress in 2 year old: Differential diagnosis & management
• HIE: How to diagnose and management
• Obesity: diagnosis & common causes

The Clinical station was on a child on treatment with cytotoxic medication.
We discussed the various iv access used in children: Hickmann line , Portacath, PICC, Intraosseous
Learning points:

1. Good to learn about different ‘lines’
2. ABC – describe in brief
3. TOBY – criterion for cooling in HIE
4. CRT – 5 sec pressure
5. PEG button
6. Peritoneal dialysis catheter

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