How to organise the paediatric MRCP (UK). Part II. Clinical examination.

Responsibility for the organisation of postgraduate examinations in paediatrics will soon transfer to the new Royal College of Paediatrics and Child Health (which will award the MRCPCH). The whole philosophy of how and when to examine is currently under debate, so it is appropriate to review recent experience with the current clinical examination, the Membership of the Royal College of Physicians (MRCP (UK)).The present clinical part of the examination includes a long case (60 minutes for candidates to take a history and examine the patient, and 20 minutes with the examiners), a selection of short cases (as many as are seen within 30 minutes), and a 20 minute oral. Each candidate is seen by a separate pair of examiners for each of these three components. All paediatricians will be familiar with the mental stress experienced by candidates for postgraduate clinical examinations, such as part II of the MRCP (UK). However, most will probably be less aware of the perspective of those on the ‘other side of the fence’, including the organisers of the clinical examination, the examiners, and, very importantly, the children and families who act as ‘patients’, all of whom may face anxieties and diYculties for a variety of reasons. The host examiner and registrar take responsibility for the smooth and fair running of the clinical examination, which depends on their eVorts and interactions with the patients, guest examiners, and candidates. In recent years, the Royal Colleges of Physicians have found it increasingly diYcult to find suitable venues with paediatricians willing to host postgraduate examinations. Traditionally, most examinations have been held in teaching hospitals, but competition from undergraduate examinations and an increasing shortage of suitable patients in specialised units has led to a move to hosting the MRCP (UK) in district general hospital paediatric units. Newcastle has hosted the MRCP (UK) part II clinical examination once each year since 1990, but only one day each year has been held in Newcastle itself, with one or two days being in other units in the Northern region, often up to 60 miles away. Even small district general hospitals have suYcient patients for one day (12 long cases and about 24 short cases), and if they only host the examination once every five or six years, patient and host ‘fatigue’ are unlikely.We would certainly recommend that even smaller units oVer their services for the examination. It is usually an enjoyable and memorable experience, and who knows, a future president of our new college may be able to say that he or she passed their MRCPCH in South Shields— after all, Baroness Lloyd once worked there! Several recent papers in the Journal of the Royal College of Physicians of London have discussed various aspects of the MRCP general medicine clinical examination, from the point of view of the organising registrar, the examiner, and the patient. However, the specific aspects of the MRCP part II unique to the paediatric clinical examination have not been addressed. In this paper, we describe our experience in organising the paediatric option of the MRCP part II clinical examination. We discuss those aspects of the examination and its preparation that are diVerent for the paediatric option, and the steps that we take to try and ensure that everything proceeds in as uncomplicated a manner as possible, for the candidates, examiners, and patients. Finally, we report the results of a questionnaire designed to document the experiences of children and parents attending the examination.