Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Kawasaki disease
• Multifactorial inheritance
• Diabetes in children: long term aims of management

The Clinical station was of a 8 years old boy admitted 24 hours previously with respiratory distress. There was evidence of MDI use with spacer and audio clip of wheeze and rhonchi. Task was to examine his respiratory system. Dr R took the hotseat with Dr F and Dr S had the examiner hats. Dr R, remained clam and made a very good attempt of describing respiratory system examination. All major clinical signs were identified. There was over run on time and also there degree of back and forth’ in the procedure. Examiners picked out things that could be done different. Summary to examiner should be like that of a postgraduate trainee.

The Learning points are:

• Remain calm and do not be scared.
• Examination needs to be structured
• It needs to be fluent – as if you done it a 100s of time.
• General physical examination is a MUST – 30 secs – Observe.
• Start from periphery and move centrally.
• Examine both sides for Apex beat.
• Succent presentation to examiner – diagnosis first – if confident
• Marks are for Discussion also so do not waste time.
• Refresh BTS or NICE guidelines for Asthma management.
• Practice – Practice – Practice systemic examinations.

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

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• DDH
• HIV infection – mother
• Limp – causes: Painful & Painless

The communication was a task of speaking with a colleague nurse about non disclosure of information to a 12 year old as per parental request. Dr F was in the hotseat and Dr S was a very able Role Player. Dr F did a very good of tackling the task using Ethical pillars to support the discussion with colleague.

The Learning points are:

• Situational awareness – be aware of where, who and how?
• Do not follow your standard opening line
• A colleague – you can show familiarity
• If Role player fails to move forward with your explanation
• Throw back to RP – Is see you are ‘worried’ do you have any personal experience of the same?’
• Read up Ethics and pillars of ethics
• Gillick competence

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

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• SVT – presentation: Newborn and young child
• Prematurity – problems
• Shock: Signs & Symptoms: Compensated – Decompensated

Communication scenario was 4 year old, child with Coeliac disease has weight loss, Hb: 101gm/L and Strongly +ve endomyseal antibodies. Task was to speak with a parent. Dr S was in the hotseat and Dr U a very capable Role Player. Dr F & Dr A had examiner hats. Dr U made a very good attempt at the task. Few points were noted and explained by the  examiners.

The Learning points are:

• Check background – information provided carefully
• Note names of RP and child – if provided – try and NOT confuse
• Check RP’s prior information
• Let RP speak and do not interrupt
• Address their concerns or use information provided to Challange their action
• “You say child is sticking to gluten free diet but Tests are abnormal – suggesting otherwise
• If needed explain ‘disease’ pathology’ in simple words
• Remember you do not have to Tell / Say Everything you know!
• Avoid jargon

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

Anil Garg

Dear All

Thank you for participating in our rescheduled session on Saturday.

In RRR we discussed:

• 6 years old with difficulty in climbing stairs
• Floppy newborn
• Hyperbilirubinemia

We are starting our Spring Session and Communication being the most important we started with it. In Communication station – AG discussed the do’s and Don’ts for the station and how to best approach a given task. Dr U took the hotseat with Dr F and Dr AG being the examiners. Dr U completed the task well for his first attempt in the Hotseat.

The Learning points are:

• 30 sec Rule – Do NOT speak for >30 secs with out acknowledgement
• Remember – it is a Dialogue
• Keep your message as simple as possible
• Check prior knowledge of Role player
• 2 minutes Shishir’s Rule – plan for only first part not the whole 9 mins

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

Anil Garg

Getting a seat at the Clinical exam can be a longish wait.

Following feedback from members and to guide your preparations during this period of waiting we have commenced an One off enrolment for Indefinite period till you pass your exam.

This will take away the thought of ‘What will happen if I do not get a seat in 3 months or what if, God forbid, I am unable to satisfy the examiner on the day.

Our record is we have success rate of around 90% and not 100% as we aim for. Our members hard work makes it possible.

We offer One time Registration Full package for Indefinite period till your Pass.

Contact us at mrcpchonline.org

Dear All

WE ARE OFFERING ONE TIME REGISTRATION / FEEs TILL YOU PASS & BECOME MEMBER OF RCPCH. PLEASE CONACT US FOR DETAILS. Please inform your friends who are preparing for MRCPCH.

Thank you for participating in the session.

In RRR we discussed:

• Intussusception
• Haematuria
• Hirschsprung’s disease

We discussed a communication station – speaking with a parent concerned his child has meningitis as another child in his class. Child has URTI. Dr S took the hotseat with Dr Ag being the Role player and Dr F & Dr S had examiner hats. Dr S attempted the scenario well with good observation and feedback from the examiners.

The Learning points are:

• Introductions – do not confuse names, gender & relationship
• Check prior knowledge
• Do not assume background information provided – check RP’s understanding or concerns
• If RP keeps returning to same point – review your strategy
• Explain with Sign’s noted to convince RP of your point of view
• Ask RP – ‘What they would like done?’ often gives clues.
• Be accommodative to ‘parent’s concerns and options’.
• Do not offer ‘antibiotics’ if not indicated – would be penalized
• ‘Open Access’ for Review prn offers good way forward in reaching consent among all in the situation
• Avoid jargon

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

Anil Garg

Heard from Members who have made us proud. Congratulations to all.

Results are out. I have passed Sir, Thanks a million for everything Dr VK. Banglore

I have passed too really thankful for the guidance sir.. Dr SM

Sir I cleared the exam as well…sir thank you so much for all your guidance. Dr MN

I also cleared sir..thank you for all the guidance!!!Congratulations everyone… Dr AK Banglore

I too Cleared sir . Thank you so much Dr VP

I too passed sir. Thanks a lot Dr Nisha

I passed sir. Thank you so much for guidance Dr KD

I have passed sir

Thank you for guidance. DR KS Mumbai, Maharashtra

Good evening Sir

I have cleared the exam..Thank you so much for your guidance Dr UM Pune, Maharashtra

Our members have achieved success rate of >90%. Thanks for their efforts and hard work.

Anil Garg

Dear All

Thank you for participating in the session today.

A number of our members have completed Clinical exam in last two weeks and in the previous two sessions we had feedback. Exams were very well organised, Examiners were friendly but difficult to gauge their response, cases were straight forward. We had discussed almost all the topics in the last 3 months. Rapid Random Review and Hotseat are very helpful in preparing for the exam. Very reassuring.

In RRR we discussed:

• Kawasaki disease
• Haemolytic Uraemic Syndrome
• Paracetamol Overdose

Communication scenario was speaking with a 14 year old admitted 2 hours ago with Paracetamol overdose needing treatment who is refusing to engage with doctors. Dr T was in the hotseat, AG role played and with Dr S & Dr F with the examiner hats. Dr T handled the scenario well and was able to engage with the ‘Teenage’ Role player and move on with discussion of options for treatment and other management points.

The Learning points are:

• Teenagers are ‘difficult’ to engage – need to be patient
• Social circumstances and medical management are equally important
• Do not ignore social issues in management in over all plan
• You need not give great details of medical management – outline is usually enough
• Start with open questions and find point of concurrence
• Summarize at 6 minutes
• Be correct in information you provide
• n-acetyl cystine infusion does not reduce Paracetamol level

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

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Thrombocytopenia in newborn
• Acrodermatitis entropathica
• Q & As – exam in 3 days – what to carry to exam.

We discussed Clinical Station – Neurology on request of members sitting the exam in few days. AG discussed a PowerPoint presentation on How to, Do’s and Don’ts of Neurology station. We then had practice of LL Neurology  examination. Dr V was in the hotseat with Dr K and Dr A with examiner hats. Dr V did a complete neurology examination but ran short of time by about a minute. Dr A made appropriate assessment with feedback on Summary presentation and discussion.

The Learning points are:

• Have a template of ‘Examination technique’ in mind
• Follow your template
• Read the information & instructions provided carefully
• If in doubt – Clarify with examiner – do not go down wrong path
• Be Systematic in your exam – follow logical sequence
• PAIN – check and say will STOP if causing discomfort
• Expose part – General examination – Inspection – ….
• Kneel on floor to be at eye level
• 5Ss – Squint / Shunt / Spine / Scars / Shoes – Do not forget
• Keep an open mind
• Have Diagnosis or Differential diagnosis at end of your examination
• Upper Motor Neurone (UML) / LMN lesion because – give your findings
• Thank Child and Parent at end of your examination or when leaving room.

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

Anil Garg