Thank you for participating in the session today.

Random Rapid Review:

• Septicaemia – causes, clinical reasoning of hypovolemia
• Management of Meningococcal shock
• Febrile child – common aetiology and management

Dr A & Dr K – Dr V & Dr S took the hotseat for recollecting and presentation.

Hypovolemia is due to maldistribution of fluid due to capillary leak into third space and NOT due to Dehydration.

Ensure Airway by way of intubation if have to give resuscitation fluids more than 30-40 mls/kg. (Check current guidelines)

Common causes of Seizure in a febrile 2 year old:Febrile seizure,Meningitis, Encephalitis

In the Clinical station – scenario of a 9 year old girl with clinical findings of Neurofibromatosis-1 seen for yearly review. What all will you examine.Dr C & Dr V took the hotseat and covered most of the points. Very brave to step forward – remember June & September are not far away.

Learning points:

• If diagnosis is obvious – Say it and be prepared for ‘more detailed’ discussion
• Have a Differential diagnosis following Universal cues
• How to approach clinical station – Have a system in your mind to proceed, Dr V & Dr S
• Systematic approach is mandatory
• Can give a very brief ‘Over view’ of what you wish to examine
• Do NOT just a list what you want to do to examiner
• Ask and wait for reply to your query
• Use other Specialists to help in management
• Hotseat is Stressful like in the Real Exam but you do NOT forget afterwards.
• 30 second Rule – DO NOT forget with EXAMINER also!!

Add your comments or anything I may have missed.
Anil Garg

Thank you for participating in the session today.

We discussed a CVS scenario: 18 month old seen for parental concern. Universal Cues were: Cyanosis, clubbing, median sternotomy, stoma bag and a murmur clip. Dependent cues had to be ascertained. Dr M & Dr S took the hot seat and covered most of the clinical signs. Discussion was fair.

Random Paediatric Review:

• Mendellian inheritance & Cystic fibrosis
• Coeliac disease
• Arrhythmia
• Hepatitis

Learning points:

• Read common topics
• Common topis are also difficult to explain – contrary to what we think
• Verbalise and be systematic
• Speak slowly and remain calm
• Brief summary with +ve & -ve points – Do Not repeat the whole examination

Do read up the topics from Random Paediatirc Review so as to know the details and also make Neuronal Links for rapid recall – a necessary skill for success in the exam.

Add your comments or points I may have missed.
Anil Garg

Thank you for participating in the session today.

In the random paediatric review we covered:

• Oesophageal atresia & TOF
• Diabetes Mellitus – How is affects adolescence
• Staph & Strep infections – Local and Toxin mediated effects
• ALL – presentation & side effects / complications of treatment
• Evidence Based Medicine

Clinical Station was CVS. 7 year old with Pink, webbed neck, median sternotomy a murmur in URSA – systolic and diastolic. Good attempt by Dr A who completed the examination in under 6 minutes and all points were covered by team effort. Dr S took the hotseat when all other  ducked below the parapet – brave effort.

Learning points:

• Timing is very important
• Universal cues – watch carefully – ‘Everything’ is shown for a reason
• Practice how to communicate our thoughts effectively
• Need more practice with murmurs
• Need to vocalize the exam – practice – practice

Add your comments or anything I may have missed.

Anil Garg

Thank you for participating in the session today.

We have started a new 15 to 20 minutes component to our zoom sessions incorporating quickfire random paediatric topics. This we would like to try out as review of recent results suggests that basic paediatric knowledge was lacking. We will practice talking on 2 to 3 topics picked at random from a basic paediatric book and discussing some of the various aspects of the topic that comes up. 

The aim is to learn from each other and also to improve rapid recall of knowledge we already have under stress especially in the exam.

Today we came across and discussed:

1: What affects sugar levels in diabetic children

2: Ambiguous genitalia

3: URTI – Blocked nose, Croup, epiglottitis, tracheitis

4: Myocarditis.

5: Short stature

6: SVT

The session was approved by all present with suggestion to continue and have a fuller evaluation in a few weeks.

Anil Garg

Thank you for participating in the session today.

Scenario was of discussion with FY1 results of a 6 weeks old baby admitted with diagnosis of Pyloric stenosis with dehydration, metabolic alkalosis,  Hypochloremia and hypernatremia.Dr S and Dr P were excellent role players and Dr A, Dr P, Dr N and Dr S took the hotseat.It was well attempted.

Learning points:

• Clarify the agenda if in doubt. Check with role player
• If you spend all your time on the wrong track – there are NO marks
• Be careful & aware and specific about terminology
• Metabolic alkalosis is not caused by blood.
• Communication is a DIALOGUE not a MONOLOGUE
• Do not give a ‘lecture’ – remember 30 seconds Rule
• Speak slowly.

Add your comments or anything I may have missed.
Anil Garg

Thank you for participating in the session today and making it so informative. The scenario was of a 15-year-old diabetic who has microalbuminuria and needs to be started on a new medication. Dr K & Dr H were role players (RP) and was very good – ideal patient. Dr H & Dr S were in the hotseat and remained calm and addressed the concerns and tackled the given task.
Learning points:

• Appropriate introductions: If you ‘know’ the ‘person /RP’ introduce accordingly
• Not like a unknown stranger – it will seem odd.
• Rapport building and then mention the task
• Do Not forget 30 sec rule
• Bad news – PAUSE – keep quiet for 5 secs – let RP come in ask a question / comment.
• Keep it SIMPLE but AVOID baby talk
• Jargon – if used – explain what it means and in context
• Summarize at 6 minutes – do not need to say ‘I am now summarizing’
• Summarize in 30 sec.
• ‘Failure’ of treatment – commonest cause ‘NON Compliance’ even if denied at first – check & confirm.
• Compassion & empathy – keep in mind and demonstrate
• Do not confuse Communication & History & Management
• Pick up ALL information of concern and signpost appropriately & Stick to Task.

Please leave your comments or any points I may have missed.
Anil Garg

Thank you for all for participating in the session today.  The scenario was of a 12 year old given Adrenaline by error. Task was to inform and explain error to parent. Dr D & Dr D took the hotseat in the two sessions and Dr B and Dr V were excellent role players.
The scenario and task was felt to be difficult but a huge learning opportunity.

Learning points:

• Simple language
• Be aware of ‘What you say & How you say “
• Speak slowly and let Role player finish before responding.
• Stay calm and follow the 30 seconds rule
• Appropriate apology but do not over do the apology
• Busy in ‘Clinic’ sounds better than busy in ‘Meeting’ – if waiting to meet ‘Consultant’.
• Accept ‘Human error’.
• Errors can never be ‘completely eliminated.
• Medications vs drugs
• PALS / Datex / Incident Reporting form / Error Reporting / Root Cause Analysis
• Understand the concept of above
• Hot seat and Examiner perspective are very helpful in understanding the approach

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

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

The scenarios of a young person coming to the hospital with a friend having taken some tablets at home. The young person would not engage with the candidate only repeating ‘I want to die’ ‘what’s the point of further tests?’ Dr A was a brilliant role player and Dr S took the hot seat. It is a tough station and engaging and breaking the ice with the role player who is the key to succeeding at the station. Dr K took the hot seat next and for our discussion we addressed how such a scenario could be tackled effectively.

Learning points:

• Don’t beat around the bush and if stuck in a rut think out of the box
• Explore role players agenda
• Do not talk too much – 30 sec rule – remember to give Role player opportunity to speak
• As doctors & team for Physical well being there are teams for mental well being to help
• ‘Psychiatrist’ intervention may get a ‘why response’
• Dry medical facts in detail are generally not required
• In teenager – suicide / drug over dose – CRY for HELP – act according with ‘Medical covered’
• Respect confidentiality of Teenager vs information to parents

Please add your comments or points I may have missed.
Anil Garg

Thank you for joining the first session of the Spring course.
I would like to welcome all the new members and thank you for being up so late at night to attend our session. We had a PowerPoint presentation discussing the Communication station, how, why, do use and don’ts. We then had a Communication scenario of discussing feeding with a mother who had gone into labour unexpectedly and 30 weeks with a growth retarded fetus. Dr S was the role player and Dr A. took the hotseat.  The scenario was very well done and the most important point of note was that doctor he followed the role players agenda and not only her own all the instructions that were given.
Learning points:

• Introductions – Name and relationship to ‘child’ if appropriate.
• Observe the ‘Good flow & fluency’. Slow clear speech.
• Confidence and attitude of Dr A.
• Convey the message in simple words.
• Remain calm.
• Be on the ball – do not wander around.
• Mother & baby contact – make feasible as early as possible.
• Be accurate with information given
• Do not be a doctor of Doom & Gloom.

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

hank you for joining in the session today and making so interesting. 

We started with getting introduced to each other so as to be able to work as a more cohesive group. The common thing we all struggle with is being confident in our presentation and successfully convey our thoughts do the role player or examiner.

We then discussed a clinical scenario of getting consent for the procedure.  Dr C took the hotseat with Dr S & Dr H taking on the examiner caps. The father was reluctant which made it a little challenging. Very good attempt and relevant observations.

Learning points:

• Got into flow of ‘station’ as first time.
• Need to peak ‘slower’ – a trait I think from our subcontinent – not for all though.
• How to counsel parents when refusing advice.
• CANNOT delay treatment. Discuss options of choice.
• Use correct Anatomical description.
• Be confident in your own competence
• LPs, Venepunctures etc you should be confident and comfortable to perform
• Mention Task as early as possible – first 30-60 seconds

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

Anil Garg