Dear all

Thank you for participating in the sessions. We had two sessions 3 to 4 and 6 to 7 pm after break of a few weeks.

In RRR – rapid random review we discussed: 

• Diabetic Ketoacidosis – diagnosis & management
• Discharge from ear in 5 year old
• Raised Intracranial Pressure in 6 year old – aetiology

The clinical scenario was off at 16-year-old who had taken a few tablets of paracetamol and then presented to a and E with a friend. Multiple old cut marks were noted on her left forearm. The task was to discuss her concerns and your management plan. DR S & Dr H were in the hot seat while Dr a & Dr A provided excellent Role play. Examiners provided to the point feedback.

Learning points were:

• Read the scenario VERY CAREFULLY
• Note down important facts – name, timeline and task
• Address the Role player appropriately
• Do not be judgemental
• Explore concerns
• Respond to RP’s questions or cures
• Need to be reassuring – Paediatric patients seldom dies hence say so.
• NOT we need to wait for results to give a prognosis.
• Do NOT assume investigations have been done – if not mentioned
• Read current guidelines for ALL HYPOs – HYPERS & STATUS xx conditions

Vist www.mrcpchconline.org to add your comments or anything I may have missed.
Anil Garg

Dear all

Thank you for participating in the session today and making it so interactive and interesting.

In rapid random review  – RRR – we discussed:

• Neonatal screening: think of Neonatal examination, Hearing besides blood spot test.
• Loss of consciousness: Seizure, Syncopal, Reflex Anoxic, Non Epileptic
• Brainstem death: pre-requisites, how. Organ donation

The clinical scenario was of a 2 1/2-year-old admitted with multiple bruises of different ages. Her auntie comes to collect her not knowing the possibility of non-accidental injury.  Task was to discuss your concerns and plan with Role player. Dr H was an excellent Role player and Dr A took the hotseat. DR I & DR S – being the examiners. The scenario was attempted well and there are a few learning points.
Learning points:

• Read the TASK VERY CAREFULLY.
• Do not confuse background scenario info with TASK
• Note down important information – name, age, relationship
• Confirm identity and how to address the Role Player.
• Remain calm – follow 30 second rule – allow RP to join in conversation
• Respond to RP’s queries – DO NOT ignore them
• ACCURATE information – if not sure – say will check and come back
• In UK – health professional have a Legal duty to protect children – likely to be same world over
• Look at the camera to make eye contact ‘every now and then’ need not stare all the time

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

Thank you for participating in the session today. I realised that changing and chopping the time schedule for the meetings is confusing and hence from next week we will have the regular sessions at 3:00 – 4:00 pm and the second one as required when asked by one of you who cannot attend 3 to 4 session due to work or other commitments.

Today we discussed in:
RRR:

• 5 year old with burns – how to approach & manage
• Partial seizures
• Portal hypertension – haematemesis

Communications scenario rows of a 2 1/2-year-old girl admitted with suspected non-accidental injury. Dr I was the role player – rather gentle and Dr H was in the hot seat.
I missed recording the whole session hence we will repeat the scenario of Thursday.

Learning points:

• Do not forget the 30 sec rule
• Introductions – ask how to address other person
• Investigations for suspected NAI
• Differential diagnosis for bruising
• Social service only when confident of the diagnosis – not on suspicion only
• Place of safety – Law states for a child with unexplained injuries needs to be kept safe.

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

Dear all

Thank you for participating in the session today and making it interesting. We had two new colleagues who joined us.

We have added a small new section on “how I might do it….” This is a brief attempt at the communication scenario discussed previously taking the feedback in mind and how it could be done. The candidate or role player of previous scenario is the role player and I AG would attempt to be the candidate.

RRR:

• Three week old baby presenting with vomiting for 7 to 10 days with 10% dehydration – previously thought to be GORD
• Paracetamol overdose important investigations and management
• Pain-free limp in a six-year-old

Communication scenario was get consent for treatment and transfer of a newborn baby with severe birth to asphyxia requiring calling therapy. Dr S was the role player and Dr D took the hot seat. It was a good attempt but effects of the hot seat could be seen.

The learning point are:

• Avoid jargon and if you do have to use a technical word explain what it means
• Do not avoid/ignore role players concerns
• Explain in simple terms as far as possible
• Come to the task as soon as reasonably possible otherwise you may get lost in details.
• Avoid using terms like damage/further damage.
• Important to read a common current therapies for common conditions.

If there are any points I have missed or comments you wish to make please visit www.mrcpchclinicals.org

Anil Garg

Message: Dear Sir : how can join your activities , I had see your wonderful videos and I get also one of your useful enjoying publications ( MRCPCH CLINICAL EXAM A PRACTICAL GUIDE …Garg / Paul ) ….I am preparing for MRCPCH clinical oversea , how can attend the weekly activities. Best regards Dr.IG / pediatrician DCH/ Iraq

Thank you Dear Sir Dr Anil : for welcoming,  it was useful interactive session today , we enjoy and get valuable notes  , it is worthy to have more communication skill session really I have to .., I  hope to share role-player next session with my colleagues with your kind instructions. 

Thank you for participating in the session today and making it so useful.
Rapid Random Review – RRR:

• Development of a 9 month old child with Trisomy 21
• Spherocytosis – haemolytic anaemia
• Encopresis – why and management

In the Communication scenario discussion with a student nurse who is unhappy about information of diagnosis of Leukaemia being withheld from young person on parents’ request. Dr S was an excellent Role Player and Dr S made a very good attempt. discussion was about Ethical frame work under which Medics practice.
Learning points:

• Important to know basic guidelines of all paediatric domains – not ONLY acute illness
• Remain calm. Dr S was superb at keeping cool and managing communications
• If do NOT know the topic – ask the RP what they know of it / have read
• LISTENING is VERY important – be on ‘listen out’ or Look out for visual clues
• Role Player always have an agenda and you need to be able to get to it
• Read Ethics: Autonomy – Beneficence – Non Malevolence – Justice / Fairness to all

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

Nice session Sir, covered both information giving and Ethics in 1 scenario.

Another challenging task is Negotiation against patients wish like new test, medicine, agreeing for admission or procedures or how to refuse their unnecessary demands like unwanted tests or procedures or admission vice a versa. Dr H

Thank you for your participation and making the session so informative.

We started with RRR:

• Epiglottitis – differential and management – minimal disturbance and seek airway support
• Abdominal Pain 5 yr old
• Transient Tachypnoea of Newborn. – TTN

We then practice Communication of Treacher Collins Syndrome – Dr A was the role player and I demonstrated how I would attempt the scenario.

The communication scenario of the day was –  A 2 day old baby with rhesus incompatibility under phototherapy. Task was to Getting permission for Exchange Transfusion from parent. Dr F took the hotseat and Dr A was the role player. Scenario was attempted well. Appropriate comments from Examiners.
Learning points:

• Do not to give too much information – keep it basic to start
• Do NOT ignore questions / concerns mentioned by role player
• If you do not have an answer – ‘Will check and come back’.
• NEVER GIVE A WRONG ANSWER – knowingly – admit you do not know
• In Critical illness – Reassure
• “With treatment we expect the child to make full recovery’ – will need monitoring
• Open with checking what role player knows or has been told.

If there and comments you wish to add – visit www.mrcpchonline.org

Anil Garg

Thank you for participating in the session today and making it interesting and useful.

In the rapid random review we discussed:

• Familial short stature – ‘question to parents “How tall were you at that age’? Bone age.
• Chronic fatigue syndrome  – Diagnosis of exclusion – Physio regime – Depression
• Healing loss in a six-year-old – Glue ear / Post meningitis / Congenital

The clinical scenario for communication was to speak to parents of a new born baby born with absent external years and a small Jaw – Treacher Collins syndrome. Dr A was an excellent role player and Dr A was in the hotseat with Dr A & Dr S as examiners proved targeted feedback with examples.
Learning points were:

• RRR topics very useful and good guide to reading for more information
• Respond to concerns of the role player – do not ignore them
• Write down the name of parent or child so you can address them appropriately
• Avoid jargon
• READ the task and information provided CAREFULLY – EACH word has significance
• Be a POSITIVE doctors – not one of doom & gloom
• Be reassuring to role player.
• It is acting and I am not good at it – need to practice.

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

Dear all

Thank you for your support for our Summer course. 

After the initial introduction two days ago today was the first closed session. After getting to know each other and where we felt confident and areas we wanted to improve on we started with the communication station.

In the first part we had a PowerPoint presentation highlighting the dos and don’t of the communication station.We then had in communication scenario of a drug error and explaining the error to a parent. Dr S took the hot seat and was the candid it. Dr A & Dr F were the examiners and we had observers why Dr E what was the role player. The scenario went well. Feedback was to the point with examples of what was said.

The learning points were:

• Situational awareness is very important and we need to be aware of how to manage.
• Arrange to move to a quieter please all of you from a child when breaking bad news.
• Remember at the end of the consultation to check with her and how child should be informed.
• Check the introduction and do not call parent as mummy or daddy.
• Ask for their name or how would addressed.
• Consider a chaperone who could be the ward sister when task is – breaking bad news.
• Use simple words and avoid jargon e.g. administration of drug vs drug is given
• Do not move from Communication to History mode.
• Plan for the first two minutes of your communication scenario and for the rest be led by the role player – Shishir’s rule.

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

We start our Summer session from 1 July.

Look forward to your participation.

Link to an OPEN session.

Anil Garg is inviting you to a scheduled Zoom meeting.

Topic: Anil Garg’s Zoom Meeting
Time: Jun 29, 2021 03:00 PM London

Join Zoom Meeting
https://us02web.zoom.us/j/2191937091?pwd=a0tvc1cyeVVmOExXa1pIc3RvOHZjZz09

Meeting ID: 219 193 7091
Passcode: Spring

Anil Garg

Thank you for your support for our Spring Course.

We had

30 Interactive Zoom Sessions 

(Present X2) 

What we covered:  

• Rapid Random Review topics                             70 
• Communication Scenarios                                   06 
• Video Scenarios                                                   06 
• Development scenarios                                       03 
• History & Management                                        02 
• Extended Clinical Scenarios                                03 
• Clinical Scenarios                                                 06 + 03 
• Q & A session                                                       01

   One to One sessions:                                            15

From feedback of the current exam we covered almost all topics that came up – may not have been in the same scenario as we practiced but the information was there with you to make appropriate replies.

Nerves played a crucial part and do improve with practice.

We now have a 2 week break and will start the Summer course from 1st July. Please send your feedback and suggestions as what you will like discussed.

Anil Gargwww.mrcpchonline.org