13/08/2023
Time management is key to passing the MRCPCH Clinical Examination. Hence you must manage every single second of of your exam station diligently. Between each stations you have 4 minutes.
Firstly know the timing for each stations:
A. Clinical stations - total 9 minutes
Before entering the station you have about 3 minutes to gather your thoughts, to reset your mind.
6 minutes to examine patient.
3 minutes to discuss about patient.
In the ideal situation, allocate 5 minutes to examine patient including stop examine and turn to examiner and mention..."to complete my examination I would like to"... then carry on to discuss the diagnoses and reasoning. Do not wait for the bell. This will show you are in control of the time. If the bell ring, carry on. The bell marks you have 3 minutes left.
B. History station - 22 minutes
13 minutes to take history.
9 minutes to discuss the management.
You have 3 minutes reading time to draft your history and management before entering the station.
For the history part, you have a full 13 minutes to gather HOPI, systems review (to help you narrow down your diagnoses), relevant past medical/surgical/birth, drug/allergic/vaccination history, social/family history, development/schooling history. You must gather adequate information in order to proceed for further discussion. You will be given a warning 9 minutes into taking the history (i.e. 4 minutes remaining for history). To demonstrate competency, you must pick up the patient's agenda/concerns. Do not wait for the last 4 minutes to gather this. You must address as you ask your history. This help to establish rapport and with good rapport patient will reveal more. By the end of 13 minutes you should have a good idea on the 4Cs: Causes, Conditions, Complications, Concerns.
The 9 minute discussion will involve the diagnoses and management. Structures you diagnoses and reason them. In terms of management divide according to acute and long term management. You can think of management in terms of investigate for aetiology, to assess complications and response of treatment. Divide according to blood investigations, imaging etc. Start with least invasive then work towards the gold-standard investigation. Some conditions do not require investigation to diagnose as they are diagnosed clinically. However investigations are perform to exclude other diagnoses. Hence it is important to mention clearly if the condition does not require investigation as it is diagnosed clinically. Moving from investigation is the treatment which is from acute to long term treatment. Mention about stabilising patient if appropriate and move towards definitive treatment. Aim to tackle each and every issues raised by patient. Discuss about medical and appropriate referrals. If MDT approach is required, mention about this. Mention about long term follow-up plan and if appropriate the prognosis of the condition. (There is 3 minutes warning before the end of the station).
C. Development - 22 minutes
Preparation 3 minutes
9 minutes history (6 minutes + warning + 3 minutes)
1 minute to summarize findings from history
9 minutes verbal examination (end of 9 minutes warning given)
3 minutes discussion (including management)
D. Video stations
3 minutes preparation
3 minutes to watch videos
6 minutes to Q&As (describe the video, what further history to ask, clinical examination to perform, likely diagnosis and 2 differential diagnoses - first 3 minutes + management of the condition - final 3 minutes)
E. Communication skills
3 minutes preparation
9 minutes to discuss (6 minutes + warning + 3 minutes)
Address all the concerns - 4 to 5 concerns
It is my pledged that once I passed my MRCPCH clinical, I will teach for free. May this benefits you!
