Simulated exercise with a parent of a child non compliant with treatment.

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https://mrcpchonline.org/communication-station/communication-scenario-1-compliance-with-treatment/

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Today we discussed clinical stations in general and CVS in a little more detail using a Powerpoint presentation.

The Learning points are:

• Look at the surroundings to check for medications and any other aids
• Always EXPOSE the part of interest
• Ask for parents help in undressing
• Do NOT make the child cry or be upset.
• MOVE back till child settles
• Can pass CVS station without Auscultation also.

“What have you brought with you? Medicines, equipment?”

Opening statement after introductions.

AIDE MEMOIRE – General Examination

Today we repeated the history scenario from two days ago of a teenager with coeliac disease who has gone for a yearly review. For the past six weeks she has had abdominal pain and loose stools.

The history was more comprehensive do we missed out a few points and also the discussion could have been better.

The Learning points are:

• Develop differential diagnosis while reading the information – outside.
• This will give a frame work to ask questions
• Opening statement is vital to a good start.

A little like the OPENING batting score in a cricket match. Good score – good rapport – less anxiety and better for things / questions – players – to follow.

• Focused history vs Long case. In the long case – do not know the patient hence all parameters in details where as in FOCUSED history lot of information provided with an ‘acute’ deterioration – that NEEDS to be followed through.
• ‘Non compliance / Cheating on diet’ / medications needs EXPLORING – WHY – and NOT just a passover.

……………………………………………………………………………………………………………………………

“Hello Toby, Thank you for coming – i am Dr X. Have you come alone?

We have not met before but from your notes / letter from GP – I have gathered you have .XYZ

How can I help?

Today we discussed how focused history and management.The session started with a discussion and PowerPoint presentation of salient points for the history station.

In the PowerPoint presentation we discussed briefly how to avoid pitfalls and concentrate on getting the information. The cases are likely to be of chronic conditions with recent change causing the crisis.

The History was of a 15-year-old with coeliac disease for the last 10 years. There have been regular reviews but for the past one month she has abdominal pain with ‘loose’ stools.

Learning points were:

• Speak with Role player at a ‘level; indicated by age.
• Avoid jargon
• Do NOT confuse gender of the person speaking with.
• Work on differential diagnosis of presenting symptoms.
• Need NOT go into great details of each individual symptom.
• Do NOT omit Menstural history in Chronic disease
• HEADSS history
• Social implications of the disease on Patient & Family.

We could have done better!

Today had a 1:1 session with a candidate preparing for the exam in April in Nepal.

Some times it is difficult to get over our inhibition of talking in ‘public’ or in presence of others.

I would like to reassure all the doctors that we all communicate with patients virtually on a daily basis discussing their concerns and trying to allay their anxiety.

Exams are an artificial situation that cause undue stress and part of the deal, if I can call it that, is to manage your stress during those periods.

Non Accidental Injuries are Managed differently in different parts of the world hence it is important to know what is done in UK but equally important to know what is available locally in your unit. It is likely that certain NGO may be offering support to the Family and that should be mentioned in the exam situation.

Practice makes perfect. With practice it will be fine on the day.

Communication scenario: Discussion between A medical student who had witnessed a consultation with parents of a child involved in a road traffic accident and plan to be withdrawn care plus request for organ donation.

It is a common and difficult scenario. The learning points were:

• Communication scenarios have to be a dialogue and not a monologue

• Involve the rule player and respond to the verbal and non-verbal cues

• Give ‘role player’ time to respond

• Active listening and acknowledging

• Respond to the role players questions

• Remember it is their agenda and not yours.

• You DONOT have to tell everything you know!

• Acknowledge what you do not know and know how to escalate

• This will help Your anxiety also about NOT knowing all details of task

• Summarise on the warning knock or as appropriate

• Be sympathetic and saying what you also find difficult can build rapport

“Hardest part of our job is accepting when we have reached our limit and can do NO MORE’.

“KEEP IT SIMPLE”.

 

 

Our revision course is scheduled for 31st March to 5th April. We will cover the essentials. If possible join the regular sessions. Contact for details.

I feel I have passed 10 times today. Thank you all for your hard work and success. This is of 12 who have shared the result with me. Really proud of all of you for your efforts. For those who faced disappointment – do not lose heart.

Terrific results. 6 of 7 who have shared their results have Passed and are now going to be Members of the Royal College of Paediatric & Child Health. I wish better luck to ones who face disappointment.

Today we did a difficult scenario of a 14-year-old who was involved in a road traffic accident and has been recently pronounced brain-dead by two consultants. The task was to update parents with clinical condition and request for organ donation.

The learning points were:

• Remember in a communication station it has to be a dialogue and not a monologue

• Good practice to Mention that Ward sister is accompanying you as she knows young person better

• Opening sentences in communication scenarios are different and you cannot use the same sentence in every situation

• Do not use jargon

• Time management is very important

• Acknowledge the role players mood and act accordingly.

• Six minutes and nine minutes are not enough to complete the task and get consent from the parent necessarily. Don’t push it.

• If the role player is upset and crying – offer issues and keep quiet, give time to recover

• For organ donation it could be brought in:

“At this time of sadness Act of severe generosity can bring happiness and chance of a life to others”. 

A small clip of how?