Clinical Examination Skills in Paediatrics

For MRCPCH Candidates and Other Practitioners

A. Mark Dalzell, Ian Sinha

• Publisher: Wiley-Blackwell
• Year: 2019
• Print ISBN: 9781118746080
• eBook ISBN: 9781119238935
• Edition: 1
• Topic: Medicine
• Subtopic: Pediatric Medicine

Examining children presents unique challenges for trainees and new doctors in paediatrics. Paediatric patients vary greatly in age and development, often find it difficult to describe their symptoms, and can behave unpredictably in clinical settings. Clinical Examination Skills in Paediatrics helps MRCPCH candidates and other practitioners learn effective history taking and fundamental examination techniques.

Clear and concise chapters–with contributions from a team of paediatric specialists–demonstrate the clinical examination and questioning techniques used in daily practice. Emphasis on the intellectual processes involved in decision making assists both trainees preparing for a formal examination as well as new clinicians faced with a difficult diagnostic problem. Topics include cardiovascular and respiratory examination, examining a child with a neuromuscular disorder, musculoskeletal examination, and taking history from a child with diabetes and a rheumatological condition.

• Includes access to a companion website containing high-quality videos that demonstrate techniques, procedures and approaches
• Features commentary by experienced practitioners which offer observations and deductions at each stage of the examination process
• Offers tips for communicating effectively with the patients using appropriate lay terms
• Helps translate the symptoms and signs experienced by patients into medical-speak
• Covers all the skills tested in the MRCPCH Clinical exam

Clinical Examination Skills in Paediatrics is the perfect study and reference guide for paediatrics trainees, MRCPCH candidates, foundation doctors, allied healthcare professionals, and anyone looking to improve their clinical and communication skills in paediatrics.

Chapter 1
Rules of engagement (with the clinical examination and the examiners)

Richard E. Appleton

The clinical examination and the examiners are now far better structured, prepared, and significantly more objective than even a decade ago. For each examination, the examiners’ performance is critically evaluated both for consistency of the marks they award all the candidates in the station they examine and for consistency with their fellow examiners for each candidate. However, examiners, like candidates, are human and will, on occasions, be subject to their own idiosyncrasies and the effect of their environment, such as the phases of the moon, background radiation, and blood sugar level. With this in mind, the following guidance should help to prepare you for, and minimise the effects of, these unforeseen ‘examiner moments’.

Do

• Be prepared.
• Be smartly dressed. Ties are unnecessary, and short sleeves are more acceptable and more comfortable for you to examine in.
• As soon as you enter the examination room/cubicle/bay – use your eyes and ears before ‘hands on’.
• Be polite and courteous.
• Know – and show you know – how to talk with children.
• Even 20–30 seconds talking with the child will demonstrate to the examiner that you are treating the child as a person, not an object to be examined. It will also help you to establish a rapport with the child – which may prove very helpful for the rest of the examination.
• In the day(s) before you sit the examination think of topics of conversation that might help you to establish a rapport with the child.
• Do what the examiner asks in terms of a running commentary during your examination. If the examiner specifically asks for a running commentary as you examine the child – then do as the examiner asks! If the examiner doesn’t specify – then do whatever you feel more comfortable doing.
• In the Communication station – remember, remember, remember: it is a dialogue and not a monologue. Listen to the role‐player; ensure they understand what it is you will do, and then do this during the nine‐minute station. Check that the role‐player has understood what you have discussed with them as you proceed and certainly before the two‐minute warning. If you can use diagrams/drawings to better communicate the specific topic – then do so.
• Allow time for summing up and discussion (with the examiner; with the role‐player in the Communication scenarios); this should be no later than the two‐minute warning in the clinical station as the final two minutes should be for the examiner to ask you questions on your findings – including the differential diagnosis, investigations, and management.
• Be honest. If you don’t know an answer, be truthful and don’t try to blag/waffle/lie as this will be more detrimental to your mark than saying, ‘I’m sorry, I don’t know.’
• Be confident but not arrogant.

Do not

• Wear dirty, badly creased, or threadbare clothes or shoes – it gives the wrong impression.
• Wear dresses/blouses with low necklines or gaping buttons – it certainly will give the wrong impression.
• Ignore the child as you examine them – or their parent/carer.
• Be rude to the child or their parent/carer.
• Be rude to, or aggressively challenge, an examiner.
• Force the child to co‐operate.
• Make up signs that aren’t there.
• Cheat (text/phone your mates before/after your examination to share scenarios etc.). This is immoral and carries a heavy penalty.

Chapter 2
Tips for the communication station

Andrew Riordan

This station is not really testing your knowledge – that’s tested in other parts of the exam. This station tests your ability to communicate. The standard the examiner is looking for is that of a ‘competent registrar’. Most of the marks are given for the way you say things, rather than what you say.

The station runs as follows.

Read the scenario

Before you enter the room you get the chance to read about the scenario. Read it carefully, then read it again. Think about what sort of scenario it is: explanation or negotiation.

Enter the room

There are three people in the room: the examiner, a ‘parent’, and you.

The examiner

The examiner introduces you to the ‘parent’ and then sits in the corner writing on the mark sheet. The examiner is unlikely to do anything else.

The ‘parent’

The ‘parent’ may be a real parent, an actor, or a member of the hospital staff. They have a long list of questions that they want you to answer. They may have a particular thing that they want to ask about.

You

Take a breath, relax, and go for it.

Introduction

Say ‘My name is …’ and describe your role from the scenario (‘I am the paediatric registrar on call’).

Check who the ‘parent’ is, and agree the aim of the scenario (‘You wanted to talk about …’ or ‘What was it you wanted to talk to me about?’).

Let the ‘parent’ ask their questions

There are broadly two types of scenario.

Explanation

Try to give a c...

Table of contents

• Cover
• Table of Contents
• List of contributors
• How to use this book
• About the companion website
• Chapter 1: Rules of engagement (with the clinical examination and the examiners)
• Chapter 2: Tips for the communication station
• Chapter 3: Translating into medical‐speak
• Chapter 4: Cardiovascular examination
• Chapter 5: Respiratory examination
• Chapter 6: Respiratory examination in a child with neurodisability
• Chapter 7: Gastrointestinal examination
• Chapter 8: Examining a child with a renal transplant
• Chapter 9: Examining a child with cerebral palsy
• Chapter 10: Cranial nerve and ocular examination
• Chapter 11: Examining a child with a neuromuscular disorder (focusing on Duchenne muscular dystrophy)
• Chapter 12: Musculoskeletal examination
• Chapter 13: Examining a child with endocrine problems
• Chapter 14: Examining a child with diabetes
• Chapter 15: Examining a toddler with motor delay
• Chapter 16: Examining a toddler with speech delay
• Chapter 17: Examining a child with autism
• Chapter 18: Taking a history from a child with cardiovascular disease
• Chapter 19: Taking a history from a child with asthma
• Chapter 20: Taking a history from a child with cystic fibrosis
• Chapter 21: Taking a history from a child with inflammatory bowel disease (Crohn disease and ulcerative colitis)
• Chapter 22: Taking a history from a child with renal transplant
• Chapter 23: Taking a history from a child with diabetes
• Chapter 24: Taking a history from a child with a rheumatological condition
• Index
• End User License Agreement