Thank you for participating in the session today. 

We discussed starting a new medication for renal protection for a 15-year-old diabetic. Dr P was an excellent role player who displayed controlled emotions as well as stipulated in the role-played information. Dr R and Dr A took the hot seat and there was definite improvement in the second attempt.

Learning points are:

• Be aware of the Context of scenario – where & why it is happening.
• Communication is a TWO way process
• Avoid MONOLOGUE. Do not forget the 30 sec rule.
• It is NOT a knowledge test – you do not have to tell all you know of the subject.
• Accuracy of information and over all disease profile – keep in mind.
• By 2 minutes you should have a reasonably good idea of Role player’s agenda.
• Try and avoid “Do You Understand” … sounds grating on ears.
• Park issues not central to task to be tackled later – do not ignore e.g. high HBA1C.
• Try and avoid technical terms but also do not make it Baby talk.
• Summarize at 6 mins in 30 secs and then carry on with unfinished agenda.
• It will also be a reminder to you to realize what you have completed and What still needs attending to.
• Bring other team members into care plan – Specialist nurse, Dietician – Need not be a One man Band

If there are other points you wish to add or I have forgotten.

Anil Garg

Thank you for participation in the communication scenario today. 11 month baby was admitted with features suggestive of meningitis. Task was to explain findings and get consent for LP and further treatment. Role players performed exceptionally well and we wondered if they had a brighter future in Bollywood / Theatre also.

The learning points are:

• Use correct anatomical description – Meningitis is not really a ‘brain’ it is of ‘covering of brain’
• Meningitis is often accompanied by encephalitis – meningo-encephalitis.
• Do not introduce new terms -‘Brain fever’ – it can mean different to different people
• Need to be empathic and build rapport with role player.
• Address role player’s concerns else they will not move forward.
• Role players should guide the agenda after 2 mins into scenario.
• Have confidence in your abilities and use them to reassure parent / role player
• You should be able to LP, venepuncture, drain a pneumothorax
• Remain calm in face of Angry or defiant parents who do not agree with you initially.

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

Dear all
Thank you for participating in the session today. The communication scenario was speaking to parent of a one day old baby with ambiguous genitalia. The family was from Afghanistan and had lost their first child. Dr A did an excellent role play of father and Dr R took the hotseat. The introduction was very good but following discussion could be better. After discussion Dr S attempted the scenario again. It was done well. Dr H & Dr R were in the hotseat in 2nd session with Dr A giving an excellent performance as parent.

The Learning points are:

• Communication is a DIALOGUE & not a MONOLOGUE.
• Speak less to ‘Hear’ more.
• Rapport building is crucial to moving further in scenario.
• Always congratulate arrival of a new baby – issues can be ‘fixed’.
• Be positive.
• Observe 30 sec & 2 minute Rules
• Be aware of your Language.
• Do NOT mix up ‘Him’ / “Her’ or Boy & Girl sounds more gentle when talking with role player
• Do NOT refer to baby as ‘IT’.
• Listen to concerns raised and ADDRESS them – do not ignore.
• When needing to describe an abnormality – briefly tell what is NORMAL.
• Apologise or be Sorry only once or twice – Do not over do it.

Add your comments or any points i have missed.
Anil Garg

Thank you for participating in our session today. We discussed a scenario of a six month old baby being brought to the hospital following an Acute Life Threatening Event (ALTE) at home. The task was to speak to the mother regarding safe sleeping practice. Dr A offered to be in the hotseat. Dr S & Dr S were the ‘examiners’ and Dr J an observer. Their task was to observe closely and ‘mark’ the performance while Observer had to give comments with specific examples of words used or actions not undertaken – as the case may be. All did a stellar job. I had to role play at the last minute due to unexpected duty for Dr P.
The learning points are:

• Read the Task VERY carefully – there are most cues you need to consider
• Mention the task as soon after introductions.
• Do not be side tracked
• Be careful of NOT turning into History taking mode.
• Follow the task – where marks are – BUT do NOT leave the Role player in the cold.
• Remember – it is their agenda – but bring them back on track after addressing their immediate concern.
• Body language is VERY important – more so on Virtual platform
• Eye contact – Do NOT read from a sheet on your table
• Look Professional – DO NOT present as if you have just rolled out of bed!!

Add any other points or your comments.

Thank you for participating in the session today have a first session of the winter course.

We started with a communication scenario in which Dr T role played a FY2 doctors and Dr S took the hotseat. Communication style was suitable. Some improvements are in the learning points.
I then had a PowerPoint presentation on Communication stations, tasks, skills and how to score maximum points.
Learning points:

• ACCURACY of information is paramount.
• Wrong information ‘trumps’ everything else you may do at a station
• You can correct Role player’s ‘wrong’ concepts and do not need to accept them at correct
• Arrange to check points you may not know and meet again
• Very likely – role player may give you a clue / lead
• Know who you will be speaking with and Greet appropriately
• Do not MIX Communication with H&M station
• Shishir’s 2-minute rule
• AG’s 30-second rule
• Write down the task – it will help keep your focus
• Be aware when turning into a Monologue!!

Add your comments and comments.

Anil Garg

Thank you for participating in the session today. We concluded the Extended Clinical Session from last Thursday.
Next week we will start our Winter Course. Communication – to start with.

3 month old with unexplained rib fractures and skull fracture is seen in A&E with his mother c/o crying and poor feeding for 48 hours. I role played a candidate and Dr N role played the mother. In the first 6 minutes we covered general presentation concerns, birth history and specifics relating to the ‘trauma’ findings on Universal cues. No history is perfect but do watch and let me know what you make of it. Dr Aloke was the examiner for Clinical examination and discussion.
We had updates on recent examination.
Learning points:

• Have a note pad and pen to write down cues signs, main history points
• You have to be VERY SPECIFIC in questions during examination
• Ask for weight & growth – and then say you will plot them
• You will not get useful ‘dependent cue’ with ‘vague’ question.
• Be VERY systematic in the examination
• With examiner – summary with + & – ve findings and a simple Differential diagnosis
• Management – wait for examiner’s questions.
• Do not be biased on diagnosis – work out a differential. There always is a differential
• Use Universal cues to guide your focused history

If there are any comments or points you wish to add please visit www.mrcpchonline.org

MRCPCH Clinicals Onlineworking together to reach your goalwww.mrcpchonline.org

Anil Garg

Thank you for participating in the Development Station session.

The session was conducted by Dr Urmila. She gave a detailed description of the current development station.
It has four components:Time spent ‘waiting’ 4 minutes to review the task and Universal cues.
1: Focused history – 10 + 2 mins
2: Virtual examination – 8
3: Discussion – 3 min.There may be a difference in timing and that can be confirmed by visiting RCPCH site. In practice – it will not matter to you.
Dr Urmila gave example of what to look out for in history and how to verbalize a ‘fine motor’ assessment examination.
I found it hard but then I am confident with practice you will make it look easy and simple.
Learning points:

• Use provided tools / toys – ONE at A TIME.
• Mention what you are going to use – instruct child to ‘perform task’ and then mention What you expect
• Do NOT give complicated instructions – you can confuse the child
• Also will NOT know if it is motor aetiology or cognitive concern
• Watch development Video and ‘Talk’ over it – like dubbing a screen clip
• Write out examination at the end of the day from a case seen during the day

Please send your feedback of the session to me. It is a difficult station to put online and your feedback will help improve it for your learning experience.

Anil Garg

Its been a great learning experience regardless of the exam prep indeed it focused on us being working as a better peadiatric doctor.

Following is my feedback for the course:

1:For me everything went really well as its teaching along with practising the station. Especially the communication scenarios we practised a lot of situations/settings.
Involvement of seniors/examiners is also very beneficial. Their feedbacks and presentations are invaluable.

I regret no joining from before.

2: Timing of the session , I believe is a bit short or may be they can increase in number /week
3: Number of participants is actually appropriate and I think we worked well as a group.(Everyone got a turn for each station.)
4: 6-7 pm GMT is appropriate (as I am in UK)
5: Neurology and MSK clinical stations how we are going to present in this covid adapted exam and if possible a scenario of an adolescent with self harm /self cutting or overdose(history/comm).

Also I believe we will be having a mock exam session as u did for the Nov. attempt. Please let me know when we are going to have it so that we prepare for it.

I tried to answer all the questions in feedback , Hope it was appropriate. Best Wishes,

Dr MK. London. 29 November 2020

It’s been a wonderful experience with your classes and have learnt so much from you regarding how to communicate with patient bystanders in our day to day life rather than for the exam alone.

Write exam: how to be meticulous with the minute of the details in a video station as well as how to approach clinical / communication station keeping the time constraints.
Regarding feedback :

1) communication skills and approach has improved.
2) We can make our session continuous without having a log out in between sessions.
3) We can have more extended clinical station sessions as it covers like 3 stations.
4) Video stations – more videos with discussion.
5 ) 5 students per sessions seems optimum
6)Communications scenarios may be sir which you feel is really difficult to tackle by the candidate like involving HIV positive mother .
7) Timing is convenient at present.
Many thanks for your guidance once again sir.
Regards

Dr SS Kuwait. 1 December 2020