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WESSEXDEANERY

MRCPCHEXAMGUIDE

DRPETACOULSON-SMITH

DRSOPHIEHILLIER-SMITH

DRLOUISEWEEKES

BASEDONAPREVIOUSGUIDEWRITTENBYDRCLAIREHEAD,DRREBECCAMOON,

DRROSADASACRANIEAND DRSEBASTIANGRAY

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CONTENTS

MRCPCHExaminationGeneralInformation.............................................................................2

PartOne:FoundationsofPractice(FOP)&TheoryandScience(TAS).....................................4

PartTwo:AppliedKnowledgeinPractice(AKP).....................................................................13

ClinicalExamination...............................................................................................................20

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MRCPCHEXAMINATION

GENERALINFORMATION

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MRCPCHEXAMINATIONS

ThewrittenMRCPCHexaminationscanbetakenatanytimeduringfoundationtrainingbut

areoftenstartedattheendofF2orthebeginningofspecialitytraining.Itisnotnecessary

tohavepassedanyoftheMRCPCHexaminationsbeforeapplyingforpaediatricsinWessex.

Onceinatrainingpost,itisanARCPrequirementforpaediatrictraineestoprogresswith

examinations.Currently,youneedtohavecompletedtwooutofthethreewritten

examinationsbytheendofST2toprogressintoST3,andALLpartsoftheMRCPCHexam

(writtenandclinical)bytheendofST3forprogressiontolevel2training(ST4-5).

Postgraduateexamsarenotoriouslydifficultanditisnotuncommonforcandidatesto

requiremorethanoneattemptononeoralloftheexaminations.Itisimportanttothink

aboutthiswhenconsideringtimeframesandprogressionthroughtraining.Therearethree

sittingsofeachexamintheyear.TheRCPCHdoesallowyoutotakethewritten

examinationsoutofsequence,so,forexampleifyouarestrugglingwiththeTheoryand

Science(TAS)examyouareabletoattempttheAppliedKnowledgeinPractice(AKP)exam

beforehavingpassedTAS.Allwrittenexaminationsmustbepassedbeforeyoucanapplyfor

theclinicalexamination.

TheRCPCHallowuptosixattemptstopasseachoftheMRCPCHexams.Ifyoudonotpass

anexamaftersixattemptsyouwillneedtoprovidethecollegewithevidenceofadditional

educationalexperiencebeforeyoucanattemptthatexamagain.Thisevidenceandsupport

wouldcomefromthedeaneryandyoureducationalsupervisor.

Ifyouarestrugglingwithaparticularexamandarerepeatedlyunsuccessfulpleasebe

reassuredthatyouarenotalone.Youarenotthefirstandwillnotbethelastpersonto

strugglewiththeseexams,anditinnowayreflectspoorlyonyourclinicalabilitiesasa

doctor.Pleasespeaktoyoureducationalsupervisorearlyifyouarehavingdifficulties.They

shouldbehappytosupportyouandcanreferyoutotheprofessionalsupportunitwhoare

abletogivemoretailoredexampreparationadviceandrevisionguidance.Formore

informationpleaseseetheWessexDeanerywebsite.

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PARTONE

FOUNDATIONSOFPRACTICE(FOP)

THEORYANDSCIENCE(TAS)

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PARTONE

PartOneconsistsoftwoexams-FoundationofPractice(FOP)andTheoryandScience

(TAS).Theseexamswerepreviouslyknownaspart1Aand1Bandarestillinformally

referredtoasthesebylotsofpaediatricians.Eachexamis2.5hoursinlengthandtheyare

heldonthesameday,withFOPinthemorningandTASintheafternoon.Theexamsare

independentofeachother,andcanbesattogether(whichisslightlycheaper)orseparately.

FOUNDATIONOFPRACTICE(FOP)

FOPisthefirstpartoftheMRCPCHexams.ItisalsosatbyGPtraineesaspartofthe

DiplomaofChildHealth(DCH).Thisexamisabouthavingagoodbasicknowledgeof

paediatricsratherthanhavingdetailedknowledgeaboutcomplexconditions.Itassesses

knowledge,understandingandclinicaldecisionmakingabilitiesofcommonpaediatric

syndromes,illnessesandemergenciesaswellasawarenessofsomeoftherarertopics.FOP

assessesthestandardofsomeoneenteringtheircorespecialisttraining.AsFOPissatby

GPs,thispaperalsocontainssomemoreGPfocusedandcommunitythemedaspects,e.g.

prescribingcontraceptivestoteenagers.

CommonthemesforFOP

• Sepsis,particularlymeningococcalmeningitis

• Cardiaclesionse.g.coarctationoftheaorta

• Non-accidentalinjury

• Commonsyndromese.g.Down’ssyndrome,Turnerssyndrome

• Developmentalmilestones

• Growthandnutrition

• Immunisationschedules

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THEORYANDSCIENCE(TAS)TheTASexamaimstotestthebasicscientific,physiologicalandpharmacologicalprinciples

uponwhichclinicalpracticeisbasedandtheprinciplesofevidence-basedpractice.The

focusofthisexamisnotongeneralknowledgeofaconditionoritstreatment,butonthe

specificsofanatomy,physiology,pathophysiologyandimmunologyunderpinningeveryday

medicineandthesideeffectsandactionsofdrugs.Thisexamisconsideredtobeoneofthe

harderexamsmakinguptheMRCPCHasitinvolvescomplexproblemsolvingquestions

requiringin-depth,oftenesotericknowledge.Trytothinkbacktothebasicscientific

principlestaughtinthefirstyearsofuniversityandbuilduponthose.Makesureyourevise

specificsincludingreceptorsandpathwaysthatdonotcomeupinmoreclinicalbased

exams,inadditiontostatisticaltestsandinterpretationofdata.

CommonthemesforTAS

• Renaldisorderse.g.Fanconi,Bartters,HUS

• Calcium,vitaminDandbonemetabolism

• Geneticsincommonsyndromesandgenetictesting

• Immunology

• Allergy,includinghypersensitivityreactions

• Statisticalanalysis(thisfeaturesheavily)

• Hormonesynthesisandaction

• Drugs,includingmechanismofaction,sideeffectsandeffectsofoverdose(most

commonly-antiepileptic,analgesia,antiemetic,antidotesforoverdose)

• Cardiaclesions

• Haematologyandoncology

• Diabetesinsipidus,includingwaterdeprivationtests

• Bloodgassesandventilatorsettings

• Gutabsorption

• Clottingdisorders

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PARTONEQUESTIONDESIGNThepapersarecomprisedof:

• 61Bestoffivequestions(4markspercorrectanswer)

• 14Extendedmatchingquestions(3markspercorrectanswer–totalof9marksper

question)

Multipletrue/falsequestionsarenolongerincludedintheFOPandTASexam

Therearenonegativemarksgivenintheseexams,soattemptallthequestions!

BESTOFFIVEThesequestionsaredesignedtotestjudgementandexperience.Asimplestatementor

shortclinicalscenarioleadsintofiveoptions.Allcouldbepossiblebutonlyoneis

completelycorrect,ormoreappropriatethantheothers.Thesearethereforethemost

difficultquestionstoanswerasitcanbehardtopicktherightoptionofthefiveoffered,

especiallyassometimesinatrueclinicalsituationyoumayactuallybedoingafewofthese

optionssimultaneously.

Eachquestionshouldonlycoveroneaspectofthetopic,sostemsmightbe:

• 'Whatisthemostlikelydiagnosis?'

• 'Whichinvestigationismostlikelytoleadtoadiagnosis?'

• 'Whatisthebestnextstep?'

• 'Whatisthebestadvicetogivetoparents?'

• 'Whatisthemostlikelypathogenesisofthiscondition?'

• 'Whatisthemostcommoncauseofthis?'

Thebestoffivequestionsaccountforthehighestproportionofmarksinthepapersomake

surethatyoucompleteallquestionsinthissection.Takeyourtimereadingandanswering

thequestionandifindoubtgowithyourgutinstinctratherthanoverthinkingthequestion

andsecond-guessingyourself.

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EXTENDEDMATCHINGThesearesimilartothebestoffivequestions.Astatementisgivenandthecandidatehasto

pickthecorrectanswerfromtheattachedintroductorylistoftenpossibleanswers.Again,

allcouldbepossiblebutonlyoneiscompletelycorrectormoreappropriatethantheothers.

Extendedmatchingquestionsareoftenaccompaniedbyresultsthatneedtobeinterpreted

togivethecorrectanswer.

Theseshouldalsoonlycoveroneaspectofatopicsuchas:

• Choosethemostlikelydiagnosisfromthefollowingresults

• Choosethebesttreatmentforeachofthesechildren

• Choosetheorganismwhichmatchesmostcloselyeachofthefollowingcase

scenarios

GENERALADVICETheFOPandTASexamsareallaboutpatternrecognitionwithcertaintopicsfeaturinghighly

eveniftheyareuncommonineverydaypractice.Doquestionsfromtheonlinebankstoget

afeelforthetypeofquestionsyouwillbeasked,whichtopicsareaskedaboutandwhat

answertheyareleaningtowards.Thatbeingsaid,itisimportanttoconsiderhowyourevise

asthiswaymaybecompletelydifferentfrommethodsyouhaveusedforpreviousexams.

TheTASwillrequireyoutodoplentyoflearning.Tryacombinationoftextbooksandonline

resourcessoyoudon’tgetboredofdoingthesamethingandmostimportantlyworkout

whatsuitsyourlearningstyle.ThereisacurriculumontheRCPCHwebsitewhichisbroken

downintosystemswhichcanhelpguideyourlearning,butthelearningoutcomesarevague

andbroad.ThesyllabusforFOPandTAScanbefoundontheRCPCHwebsiteatbyclicking

here.

Makesureyoulookatthelastpagesofthesyllabusasthisgivesaroughbreakdownofthe

proportionofthepapercoveredbycertaintopicsandwhichareasofthesyllabusare

proportionallymorelikelytocomeupinyourexam.

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MULTIPLECHOICEQUESTIONTIPSANDTRICKS:

• Readthequestioncarefully.Ifyouareansweringaquestionandyoumissoutthe

word“except”inthephrase“allofthestatementsarecorrectexcept”youwillput

downthewronganswer–youmayfindusingahighlighterintheexamtoannotate

questionsmaybehelpful

• Leavetimetocheckyouranswersattheendtomakesureyouhavereadthe

questioncorrectly

• Trustyourinstinct–ifindoubtyourinitialanswerislikelytobecorrect

• Answerswithalwaysorneverareusuallyfalseasrarelyinmedicinedoessomething

alwaysorneverhappen

• Bewareofdoublenegatives-notuncommonandnotinfrequentlybothmeanoften

• Answerscontainingnumberscanbetricky.Askyourselfwhatthenumbermeansin

thecontextofthequestion,forexampleifthequestionstates75%ofinfantswalkby

theirfirstbirthday,askyourselfdothemajorityofinfantswalkbytheirfirst

birthday?

PRACTICEPAPERSPracticepaperscanbefoundonRCPCHwebsitehere.Theseallowyoutotestyour

knowledgeandtrysimilartypesofquestionsthatwouldcomeupintheexamandenable

youtogetusedtotheexamformatonthecomputersoftware.Youwillbegivenascoreat

theendanditwillhighlightwhichquestionsarecorrectbutwillnotgiveanswers.Youcan

takethesamplepaperasmanytimesasyouwish,butthequestionsthatfeaturewillremain

thesame.

FOPANDTASRESOURCESBelowisalistoftextbooksandrevisionwebsitesthathavebeenusedbypaediatrictrainees

inWessexwhohaverecentlysattheMRCPCHexams.Thislistincludesonlyahandfulofthe

numerousresourcesthatareavailableandarebasedonopiniononly.Aswithmostthings

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relatedtopostgraduateexamsthesecancomewithquiteaheftypricetag.Weadvisethat

youtrybeforeyoubuyasmostoftheseresourcesareavailableinthelibrariesaroundthe

region.Itisalsoworthaskingyourseniorcolleagueswhetheryoucanborrowtheirs!.

BOOKSFORFOPANDTAS

LissauerandClaydon,IllustratedGuidetoPaediatrics(aka‘TheSunflowerbook’)

Thisisthetextbookmostofususedinmedicalschool.Somemayfinditoversimplified,butitcontainslotsofpicturesandincludessummaryboxesandtableswhicharehelpful.

Beattie,EssentialRevisionnotesinPaediatricsfor

MRCPCH

Comprehensive,large,referencetextbookbutnotparticularlyeasytostudyfrom(unlessyoulikelearninglists)anddoesnothaveahugeamountofcontext.

Sheldon,FromBirthtoFiveYears

VerygoodbookforearlychilddevelopmentwhichcomesupmainlyinFOP.

Levene,MRCPCHMastercourse–thishasnowbeensupersededby

LissauerandCarroll

MRCPCHMastercourseisendorsedbytheRCPCH.Itdoesnotcoverthecompletecontentoftheexam.Youwilleitherloveorhatetheformat,withamixtureofstandardtextandcasehistories.Brightandcolourful,butactuallycontainsnomoreinformationthansomeofthestandardundergraduatetextbooksandat£200itcertainlyisnotthecheapestbookaround.DoescomewithaCDofvariousexaminations,picturesandaccesstoawebsite.Howeverthewebsiteisnotveryuserfriendlyandhaslimitedcontent.Thepictureshoweverareusefulforpart2.Definitelyonetotrybeforeyoubuy!

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PaulGaon,PaediatricExams,ASurvivalGuide

Welllaidoutandlikedbymost.Itincludeslotsofexamplesofdatainterpretationsuchascardiaccatheterdata,lungfunctionandaudiogramsandthereforemoresuitedtotheappliedknowledgeinpractice(AKP)exam

BOOKSFORTAS

ClinicalcasesforMRCPCHTheoryandScience

ThisistheRCPCHofficialresourcetoolspecificallyfortheTASexam.Itcanbepurchasedat£25throughRCPCHwebsitehere.Itisbynomeansanextensiverevisiontooltobeusedinisolationbutcomprisesofnumerousclinicalcasesgivinganideaofthedepthofknowledgeexpectedandthetypesofquestionsasked.

LissauerandCaroll,TheScienceofPaediatrics:MRCPCHmastercourse

Wehighlyrecommendthistextbook!!

ThisbookwasreleasedinApril2016andistailoredtothecurriculumfortheTASexamination.Itisaneasytoreadgoodoveralltextbookwithnumerousdiagramsandexam-formatquestionsembeddedinthetext..andiflearnedcovertocoverwillleadtoexamsuccess.ThebookcanbeorderedthroughElsevierbooksandthelinkisontheRCPCHwebsitehere.Thebookcosts£199.99,whichincludesthee-bookallowingaccesstothecontentontabletsandphones.Asthisisanewreleaseitmaynotbewidelyavailableinalllibraries,butWessexDeaneryarelookingintopurchasingthisresourceforWessextraineestouse(currentlyhave1copyprioritisedforthoseresitting).Itisworthaskingaroundaspeoplewhohavepreviouslypurchasedthisbookandpassedtheexamareusuallymorethanhappytoselliton.

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Easterbrook,BasicMedicalScienceforMRCP

Part1

Bestbookforbasicmedicalscience.ItisdesignedforMRCPsodoesnotcontainpaediatricspecificdatabutcontainseasyshortsummariesonsciencetopicsthatcomeupandisagoodrefresherofthingsthatyoucanonlyvaguelyrecollectfrommedicalschool.

ONLINERESOURCES

• Pastest-goodvalueformoneyandeasytouse.Itonlycomesasajointpackagefor

TASandFOPbuthasgoodonlinelectureswhichareanicebreakfromquestions

alone.Pastestseemstohavemoreclinicallybasedquestionsandisthereforebetter

forFOP.

• Onexamination-Thesequestionsareconsideredeasierthantheonesintheexam

soaimforanaveragemarkofover70%(passmarkisaround60-63%intheexam).

OnexaminationwilldojointorseparateFOPandTASsubscriptions.TheTASspecific

questionsarethoughttobemoresimilartotheexamthanthoseonpastestforTAS.

• 123doc–Alesswellknownrevisionresourceandcheaper.ItdoesseparateFOPand

TASquestionsandliketheothershasagoodquestionbankwithadequatelydetailed

answers.

• RCPCHpracticepapers–foundonRCPCHwebsite.

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PARTTWO

APPLIEDKNOWLEDGEINPRACTICE(AKP)

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APPLIEDKNOWLEDGEINPRACTICE(AKP)

ThisexamwasformallyknownasPart2.Therearetwopapers,each2.5hoursduration,

whichtakeplaceonthesameday.Themarksarecombinedfromthetwopapers,each

papercarryingapproximatelythesameamountofmarks.Thepaperisnotnegatively

marked.

Theexamisconstructedof:

• Bestoffivequestions

• Extendedmatchingquestions

• Choiceofmany

Questionsmaybebasedon:

• Photographs

• Datainterpretation

• Casehistories

Beforeyoustartrevisingforthisexam,considerprintingtheexamsyllabusandworking

throughtheoutcomesintopics.

PHOTOGRAPHSANDIMAGES

Eachquestionisbaseduponphotographswhichappearasiconsandcanbeenlargedonthe

screen.Thephotographsarepreparedfromclinicalandretinalphotographs,radiographs,

illustrationsofinvestigationresultsandoccasionallyfrompathologicalmaterial.Candidates

areaskedtoidentifyabnormalities,orprovideadiagnosis,torecommendinvestigationor

treatmentoracombinationofthese.Bewarned,theimagesaresmall,youcannotzoom

andcanbealittlefrustratingtolookat!Considerthefollowinginyourstudies:

• Importantandcommonrashes

• Commondysmorphicsyndromes

• Commoneyeconditions(retinalpicturesandeyepathology)

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• PicturesandradiologyfromabooksuchasMRCPCHPart2byCreese,Powelland

Cartlidge(althoughalittleoutofdateformatwise)

• Googleimagesyndromes,rashes,eyeconditions,etcasyoureadaboutthem.

DermnetNZisgreatforrashes

• CXR,AXR,CTandMRIhead,abdominalCT,especiallyrenalimaging(DMSA,MAG3).

Looktotestyourselfandlearnaboutimagingonline,forexampleVirginiaRadiology

Neonatalradiologylendsitselfwelltotheexam.Makesurethatyouhavegonethrough:

• Lineandtubeplacement

• UVCandUAC

• Centrallines

• ETtubeplacement

• CXR

o Largebutnormalneonatalthymus

o Pneumothorax,pneumomediastinum,pneumopericardum

o Diaphragmatichernia,cysticadenomatoidmalformation(CAM),congenitallobaremphysema

o Hyalinemembranedisease,transienttachypnoeaofthenewborn,neonatalpneumonia,meconiumaspirationsyndrome

o Tracheal-oesophagealfistula,oesophagealatresia

• AXR:

o Meconiumileus

o Necrotisingenterocolitisandorperforation

o Atresias

• HUSS-wouldhavetobeobvious,forexample,grade4intracranialbleedorcystic

changes

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DATAINTERPRETATION

Eachquestionwillconsistofitemssuchassetsoflaboratorydataorgraphicaldata,for

exampleECGsintroducedbyashortstatementoftheclinicalsetting.Besuretoincludethe

followinginyourrevision:

BLOODRESULTS

• Differenttypesofanaemias

• Clottingdisorders(haemophillia,VWD,etc)

• HUS

• Calcium,phosphate,vitaminDdisorderse.g.hyperparathyroidism,hypoparathyroidism,

rickets,vitaminDdependentrickets,etc

• Renaltubulardisorderseg.Fanconi,Bartters

• CAH,Addisons

• DI-includingwaterdeprivationtests

BLOODGASES

Makesuretoknownormalvaluesforallaspectsofbloodgasesasthesearenotgiven!

ECG

Usuallyobviouse.g.completeheartblock,WPW,SVT,sinustachycardia

Thispaperishelpful:PaediatricElectrocardiographBMJ2002;234:1382-5

CSF

Makesureyouknowthedifferentfindingsinbacterial,viralandTBmeningitisandencephalitis.

SPIROMETRY

Withunderstandingofchangesinvaryingunderlyingdisease(particularlyasthma)

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EEG

• Hypssarrythmia

• 3Hzspikeandwave

• Encephalitis

• Temporallobeepilepsy

AUDIOGRAMS

Sensorineuralversusconductivehearingloss

CARDIACCATHETERDATA

Drawitoutasadiagram.

STATISTICS/CRITICALAPPRAISAL/STUDYDESIGN

Interpretationofpvalues,confidenceintervals

Mostappropriatestudydesigntoanswerquestions

CASEHISTORIES

Eachquestionwillbeacasehistorywithresultsofphysicalexaminationandinvestigations.

Thequestionsaredesignedtotestabilityindiagnosisandintheplanningofinvestigations

andmanagement.

Longcasehistoriesarepresented,oftenlastingseveralparagraphswithorwithoutblood

gasesorbloodtestresults.Itisimportanttohighlightkeypointsasyoureadthroughand

re-readthecaseseveraltimes.Casehistoriesincludecommontopicsandrarerconditions.

Youwillalmostcertainlycomeacrossafewthingsintheanswersthatyouhaveneverheard

of!

Eliminateanswersthataredefinitelyincorrectandyouwillprobablybeleftwithtwoor

threeanswers.Thetaskisthentopickoutthekeyinformationthatseparatestheconditions

–thinkaboutthiswhenrevising,lookatconditionswhichpresentsimilarlyandhowthey

differ.

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RESOURCESFORAKP

BOOKS

PaulGaon,PaediatricExams,ASurvivalGuide

Greattextbook,allyoureallyneedtopasstheexam.Welllaidout,focusesonknowledgetogetyouthroughtheexam,notforeverydaywardproblems.Includesexamplesofdatainterpretationsuchascardiaccatheterdata,lungfunctionandaudiograms.Nopicturesthough

MRCPCHPart2,QuestionsandAnswersbyCreese,Powell,Cartlidge

Outdatedintermsofformatbutgreatresource,especiallyforpicturesandanswers.

StephenStobel,TheGreatOrmondStreetColourHandbookofPaediatrics

andChildHealth

Goodphotographicmaterialinthisbook,containingmoreinformationonslightlymoreunusualdiagnosesthanfoundinothertextbooks.

ClinicalcasesforMRCPCHAppliedKnowledgeinPractice

BrandnewbookfromtheRCPCH,availabletoorderonline.

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ONLINERESOURCES

• www.pastestonline.co.uk–SeemstobethepreferredquestionbankforAKP.A

greaternumberofquestionsthanotheronlinequestionbanksbutveryfewhave

photographsordatatointerpretexceptforbloodresults.Casesaresignificantly

shorterthanthoseseenintheexam.Goodforknowledgeconsolidation.

• Googleimages

• www.onexamination.com–Limitedquestionbank,however,quitegoodfordata

interpretationandpicturesandwellaslongcasequestions.Theyalsogenerally

providegoodlinksintheirquestionfeedback

• ExampapersonRCPCHwebsiteforpracticingexamformat.Noanswersgiven

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MRCPCHCLINICALEXAMINATION

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CLINICALEXAM

Theaimoftheclinicalexamistotestyourabilitytoworkatthelevelofajuniorregistrar.

Youmusthavepassedallthewrittenexaminationsbeforetakingtheclinicalexamination.

Candidatesareexpectedtodemonstrateproficiencyin:

•Communication

•History-takingandmanagementplanning

•Establishingrapportwithbothparentsandchildren

•Physicalexamination

•Childdevelopment

•Clinicaljudgement

•Organisationofthoughtsandactions

•Recognitionofacuteillness

•Professionalbehaviour

•Ethicalpractice

EXAMFORMAT

TenOSCEstylestationsthatwilltestthecandidatesabilityin:

•Communicationskills

•Observedhistorytakinganddiscussionofmanagement

•Sixshortcaseassessmentsofclinicalexaminationfollowedbydiscussionof

diagnosisandmanagement

•Developmentalassessmentofachild

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•Acutepaediatrics(usuallyinthevideostation)

•Recognitionanddiagnosisofclinicalsignsandsymptoms

Candidateswillnormallybeassessedbyadifferentexaminerateachclinicalstation,so

performanceatonestationdoesnotinfluencethenextstation.Theclinicalexamination

stationsandcommunicationstationsare9minuteslong.TheHistory-takingandClinical

VideoStationsaretwenty-twominuteslong.Thereisa4minutebreakbetweeneach

stationwiththeentirecircuittaking152minutestocomplete.Thesequenceinwhicha

candidatetakesthestationsinthecircuitwillvary.Notethattheclinicalexaminationsmay

notbeyourstandardsystems(i.e.don’texpecttoalwaysexamineanabdomenin

Abdominal/Other)

CLINICALEXAMINATIONSTATIONS

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Station1ChildDevelopment

Station2CommunicationOne

Station3HistoryTaking&ManagementPlanning

Station4ClinicalVideo

Station5CommunicationTwo

Station6Cardiovascular

Station7Respiratory/Other

Station8Abdominal/Other

Station9Musculoskeletal/Other

Station10Neurology/Neurodisability

WHERETOSTART?

• Findoutwhoelseisduetobetakingtheexamandmakeastudygroup–youcan

helpeachother!

• Arrangeastudy/teachingtimetablewithlocalconsultantsandregistrars

• Startabout6-7weeksbeforetheexam.Anyearlierandyouwillburnout.

• Practice,practice,practice.ThereissomuchpathologytobefoundonG-Level.Goto

thewardsinsmallgroupsof2or3.

• ReadalltheinformationontheRCPCHwebsitetofamiliariseyourselfwithhowthe

examworks.Thereareguidelinesonwhatisexpectedwhenexaminingdifferent

systemsandhowthemarkingisperformedclickhereandhere.

ORGANISETEACHING

• Localconsultantsandregistrarsareoftenhappytohelpwithteachingsessions–

contactthemandseeiftheywillbehappytoarrangeasession.

• Organiseatimetableofteachingandifonlysmallgroupsareallowedthentakeitin

turns.Don’texpectonepersontoarrangealltheteaching.Trytohaveamixtureof

consultantsthatknowyouandthosethatdon’tprovideyouwithfeedback.

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• Consultantstocontact:

-IanRodd,Winchester–Generalexamtechnique

-SumitBokhandi,Poole–Cardiology,General

-EmmaGrainger-Allen,Southampton–Communication

-MikeHall,PrincessAnne,Southampton–Communication

-SaulFaust,Southampton–VideoScenarios

-DrLeahy,Southampton–Rheumatology+pGals

-DrHannahBuckley,Portsmouth–GeneralPaediatrics

-SebastienAustin,Portsmouth–GeneralPaediatrics

-AndreaWitney,Southampton–Neurology

Otherpeopletoconsideraskinginclude–GaryConnett,JustinDavies,ShumanHaq,

AntoinetteMacaulay,MarkTighe,KatrinaCathie,RoySievers,JamesGnanapragasam.They

haveallbeenhappytohelpinthepast.

GENERALEXAMTECHNIQUE

• Yourclinicalexaminationofallsystemsshouldbesowellpracticedthattheyare

automaticbythetimeyousittheexam.Thiswayyoucanfocusonpickingupthe

clinicalsigns,ratherthanwhatcomesnextinyourexamination

• Pickupasmanycluesbeforeyoutouchthechildi.e.cluesaroundthechildorbed,

scars,levelofnutrition,etc

• Thereareafewchronicconditionswithlotsofsignsthatlendthemselveswelltothe

exam,i.e.NF1,CF,postopcardiacsurgery,Marfans,glycogenstoragediseases-

knowthemwell!

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• Knowhowyouwillapproachanyeventualitythatmayarise.Forexample,doinga

cardiacexaminationonabouncy2yearoldoralowerlimbexaminationonachildin

awheelchair

• Decidewhetheryouwillpresentyourfindingsasyougoorattheend

• Practicepresentingyourfindingsslicklyinfrontofscaryconsultants.Itmakesyou

appearmoreconfident

• Donotpanicifthechildcriesorrefusesexamination.Benice,trydistraction,butdo

notupsetthechildfurther.Theexaminersrecognisethisisaproblemwithchildren.

Commentonwhatyoucanandstatewhatelseyouwouldideallydoandthatinreal

lifeyouwouldreturnlaterifpossibletocompletetheexamination.(Peoplehave

passedcardiologystationswithoutlisteningtotheheartofascreamingchild)

• Someofthestationswillbe“OTHER”examinationsi.e.thyroid,haematology,eyes,

skin,somakesureyoupracticesomemore‘obscure’examinations

• Rememberchildrenmaybeusedinexaminationsoutofcontext–i.e.childwithCF

usedforabdominalexamiftheyhaveascarduetomeconiumileus

• TheMSKstationcanbetrickyasoftenrequiresamodifiedexamination.Listento

whattheexaminerasksofyou.Adoptalook,feel,moveapproachandbefamiliar

withpGALS(SeearthritisUKwebsite).

DEVELOPMENTSTATION

• Getsomeonetoteachyouasuccinctapproachtoexamineeachofthe

developmentalareas

• Agoodwaytopracticeistospendanafternooninchildren’soutpatientswaiting

room-youwillseeamixtureofchildrenwithdevelopmentalissues

• Youmayormaynotbetoldthechild’sageatthestart.Youwillthenbeexpectedto

assesswhethertheyaredevelopingappropriatelyordelayedwithanapproximate

developmentalage

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• Thechild’sdevelopmentmaybenormal

• Often,youwillbeaskedtoexamineoneortwoaspectsofachilddevelopmenti.e.

finemotorandlanguageskills

• Forspeechandlanguagedonotforgethearing–tryclappingormakingloudnoise

behindchildforgrossassessment

• Forfinemotor,donotforgettomakeabriefstatementonvision/useofglasses

• Youcanmakecommentstotheexaminerasyouproceedsuchas“thisskillwouldbe

expectedofanxxyearold.”Thismaystopyouforgettingwhereyouareatwiththe

examination

• Makeitfun–thechildwillinteractwithyoubetterastheyarelikelytobeboredof

buildingtowersanddrawingcirclesifyouarethetwelfthpersontoexaminethem!

COMMUNICATION

• TheyareexpectingthecandidatetocommunicateinareasthatanST4might

encounter

• Themainfocusiscommunication,butyouwillbemarkedonyourknowledge

surroundingthescenario.Therearetechniquestogetaroundthis,forexampleifyou

areaskedtoteachamedicalstudentonatopicyouknowverylittleabout,linessuch

as“Ineedtocheckuponsomeinformation,shallwemeettomorrowtodiscuss

again,”orifaskedaquestionbyaparentthen“Iwillcheckandgetbacktoyou.”

Honestyisbetterthansayingsomethingthatisclearlyfactuallyincorrectand

demonstratestheapproachthatyouwouldhopefullytakeinreallife!

• ReadtheTaskbeforeyoustart!Therewillbecertainpointsthatyouneedtocover

intheallottedtimetogetthefullmarks

• Explainingsubjectstoamedicalstudentispopulare.g.problemsassociatedwith

extremeprematurity

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• Othertopicscommonlyare:

• Explainingadiagnosis

• Reasonforadmission

• Changeintreatment

• Conflictresolutionwithcolleagues

• Breakingbadnews

• Counsellinginthreatenedpretermlabour

• Communicationscenariosshouldfollowabasicstructureof:

1. Introduction

2. Whattheotherpersonknowsalreadyandwhattheywanttoknow

3. Explanationofwhattheywanttoknow

4. Clarificationofunderstandingandopportunitytoaskquestions

5. Whatyouaregoingtodonowandwhatyouexpecttheotherpersontodo

• Drawingdiagramscanbeausefulwayofexplainingthings

VIDEOSTATION

Designedtocovertopicsthatcannotbecoveredelsewhere.Normallytenshortclipswith

associatedquestions–thisstationistwentytwominutes.Itisa‘wildcardstation’-Thereis

littlepreparationyoucando!Favouritetopicsinclude:

• Gait

• Emergencies–acuteasthma,bronchiolitis,DKA

• Chestandcardiacsigns,etcusingarecordingstethoscopetoshowthesigns

• Lumpsbumpsandrashes.

• NAI

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• Mentalhealthpresentations

Makesureyoureadthequestionandwatchthevideo.Remembertoputtheheadphones

on(somepeopledoforget!)

• Youcanwatchthevideosasmanytimesasyouwant

• Youcannotgobackandchangeanansweronceyouhavesubmitteditbutyoucan

comebacktoaquestionyouhavenotanswered

HISTORYTAKINGANDMANAGEMENT

Outpatientstyle.Thirteenminutestotakeafocusedhistory.Thepatientthenleavesand

youhavenineminuteswiththeexaminertodiscussmanagementplanning–totaltwenty

twominutestocompletethisstation

Practiceapproachtocommonoutpatientscenariosandtheirmanagement

• Asthma

• Diabetes

• Constipation

• Enuresis

• Syncope

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RESOURCESFORCLINICALEXAMS

BOOKS

SJBedwani,MRCPCHClinical:

ShortCases,HistoryTaking

andCommunicationSkills

Excellentdescriptionsofbasicexaminations

andwhattoexpectincommonconditions.

Fantasticchapteroncommunication

scenariosandhowtoapproach.

RCasans,Communication

ScenariosfortheMRCPCH

andDCHClinicalExams

Awholebookfullofcommunication

scenarioswithadviceonwhatshouldbe

included.Excellentforpracticinginsmall

groups.

WHarris,Examination

Paediatrics

WrittenfortheAustralianpaediatricexams,

howeverremainsagoodtextforMRCPCH

withexcellentdescriptionsofexaminations

andinterpretationoffindings.

MarySheldon:FromBirthto

FiveYears

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REVISIONCOURSES

Clinicalrevisioncoursesareexpensive,butsomepeoplefindthemuseful.Manypeopledo

managetopassMRCPCHclinicalwithoutattendingclinicalrevisioncourses.Coursesdo

providetheopportunitytoseelotsofdifferentclinicalconditionsinashortspaceoftime

andmayprovidesomeexposuretoconditionsnotseenofteninWessex(e.g.sicklecell

disease).Theycanalsohelpbuildconfidence.

• TheTunbridgeWellsCourseisagreatforseeinglotsofchildrenwithsignsand

syndromesoveratwodayperiod

• TheImperialCollegeMRCPCHclinicalcourse(seehere)wasattendedandis

recommendedbyapreviousauthorofthisguideline.Thiscourseincludesafullday

dedicatedtocardiologywhichcanbeusefulifyouhavenotdoneacardiologyjob.

Coverscommunication,clinicalexaminationsandvideostations.Thiscourseis

expensiveandoftenfullybookedseveralmonthsbeforetheexamsobookearlyif

youwanttoattend.

USEFULWEBSITES

LondonSchoolofPaediatrics–Excellentvideosofexaminationtechniqueandwaysto

presentyoufindings,andlistsofcommoncases-clickhere.

Wewishyoutheverybestofluckinyourexams!