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AimsPassing the MRCPCH Clinical exam is an important milestone in paediatric training, marking the transition of paediatric trainees from junior to senior training. Support for candidates varies by hospital, depending on the availability of tutors and the workload of each department.The COVID-19 pandemic led to redeployment of staff, increased workloads, and changes in the format of the MRCPCH clinical exam, switching from in-person to virtual examination. Candidates had to adapt to all these challenges simultaneously. We identified that providing additional support to candidates was critical to their preparation, maintaining their confidence, and ensuring their success, whilst also improving their welfare during this difficult period.MethodsWe designed the 5-week West Midlands Paediatrics (WMP) exam preparation programme which included these core elements:• Weekly consultant-led communication teaching• Weekly buddy group teaching and peer mentorship• Online resources: specialty lectures by Grid trainees available via YouTube• IMG focused workshops and seminarsTo improve accessibility, all sessions were conducted online via Zoom or Microsoft TeaAll mentors were provided with a bank of cases and questions based on a weekly theme to reduce the preparation time required to facilitate sessions.ResultsFollowing the initial implementation of the programme, feedback was collated from 24 traineesConsultant Teaching• 88% of candidates found the consultant teaching useful.• Candidates appreciated getting feedback from consultants who are also clinical examiners and the opportunity to practice the exam in real time.• Most candidates said having more sessions would ensure each candidate gets individual feedback following the practice sessions.Buddy Group Teaching• 80% of candidates found the buddy group teaching useful• Candidates found that this provided another platform to practice and gain feedback and learn from different candidates in the groups.• Candidates felt it could be improved by providing more support with issues such as work-life balance and well-being.• Some trainees also reported difficulties accessing the buddy group sessions due to conflicting schedules.Teaching strategy• 92% of candidates said they would like more specialty and case-based teaching• 38% of candidates would like more lecture-based teachingCandidates found the following resources most helpful:• Consultant Teaching• Buddy group and mentorship• YouTube lectures and Video resourcesPass Rate66% of candidates passed the MRCPCH Clinical exam following the programme.Mentor Recruitment88% of candidates said they would be happy to become mentors after passing their clinical exam.Candidates recommended hospital-based mentoring and mock exams as other ways to improve the preparation programme.ConclusionThe WMP exam preparation programme is a useful and valuable aid to revision for candidates preparing for their exaAs the MRCPCH clinical examinations move back to in-person sittings, adaptations may have to be made to the programme to ensure that it continues to provide support for our post-graduate learners.

AimsCourses for the MRCPCH clinical exam have been available for many years throughout the country. Prior to the COVID-19 Pandemic, these courses were held in person, requiring trainees to travel and to pay to attend.Due to the change in the format of the MRCPCH clinical exam, from in-person to virtual, we designed and implemented a virtual course for candidates undertaking the clinical exam. This was a collaborative initiative led by consultants and paediatric trainees. The course was conducted over Zoom and was free for attendees.MethodsFocus group meetings were held with clinical tutors and trainees to obtain key information on important areas to consider when planning the course. A timetable was prepared using the information discussed. The course was structured as a mock-OSCE and planned to occur a fortnight before the exam. This was to allow candidates to benchmark their performance, but also allow enough time for candidates to utilise feedback to adjust their practice.The course covered the following areas: communication skills, neurology, rheumatology, abdominal system, respiratory system, cardiovascular system, development, endocrinology, and the approach to the random case.Each area had a consultant overseeing the station who was assisted by senior registrars and junior trainees to write scenarios and facilitate the sessions.The course was run over 2 days and candidates were allocated to the stations. Pre- and post-course questionnaires consisting of multiple choice and free text questions were used to collate feedback from the participants.Results20 candidates attended the course.Pre-course Feedback Summary (n=20 candidates)The core learning themes candidates wanted to cover included• Development• Communication• Management of Specialty cases• Tips on presentation and formulation of differentials.Post Course Feedback Summary (n=16 candidates)• 100% of the candidates would recommend the course to a friend or colleague.• 100% of the candidates received very or extremely valuable feedback from the Facilitators.• 100% of the candidates had the opportunity to participate• 100% of the candidates agreed/strongly agreed that the course was well organized.• 93.75% of candidates found the course a lot/a great deal useful.Candidates found the following opportunities most useful:• The opportunity to practice and receive feedback from senior team members and to observe other candidates’ techniques.Candidates learned the following from the course• A good idea of the structure of the exam• A systematic approach to cases and formulation of differential diagnosis• Clearly listing out all of the findings from cues.• Improved confidence and communication skills• Presentation of clinical findings and management planning.Candidates felt we could improve the course by doing the following• More breakout rooms to enable candidates to practice• Planning adequate breaks• Recording and Password-protected access to the material for later.• Extending the course to 3 daysConclusionThe virtual MRPCH course was a valuable aide to revision. Candidates greatly benefited from the virtual environment, not only because it mirrored what candidates would face, but because it increased accessibility. Working collaboratively ensured a comprehensive programme was created to address the trainees’ needs and to help improve the confidence of candidates taking the clinical examinations.

AimsInternational medical graduates (who obtained their primary medical qualifications outside the UK and EEA) face various challenges not only in adapting to a new culture and language but also navigating a work environment consisting of new pathways, policies and frameworks.IMGs also face significant challenges in career progression compared to the average UK doctor (differential attainment). It is therefore important to recognise any areas where these gaps may exist in the current paediatric training structure and bridge these gaps in the way of mentorship, provision of educational programmes etc.MethodsWe conducted an online survey using a semi-structured online questionnaire which consisted of multiple-choice and free text questions to collate information on key concepts such as:• Demographics• Outcomes of the trainees at the MRCPCH Clinical examination• Number of Attempts required to pass the MRCPCH Clinical Examination• Challenges faced and potential strategies to improve outcomes of IMG’s at clinical examination.ResultsThe survey was anonymously filled out by 16 paediatric junior doctors who had taken part in the virtual MRCPCH Clinical Examinations.Demographic Information• 75% of the respondents were in training posts and 25% in non-training posts• 62.5% of the respondents were at SHO Level and 37.5% of respondents were at registrar levelSummary of results1. 56% of Respondents had passed the Virtual MRCPCH clinical examination2. IMG’s reported 2 attempts as the average number of attempts before passing the exam.3. 1 out of 16 respondents reported challenges in passing their exams leading to delays to their progression classed as outcome 3 at ARCP.4. 62.5% of candidates attended revision courses and (75% of which reported it was useful)5. Between 31.25% and 50% of respondents expressed difficulties in the following domains: communication; formulation of a diagnosis and a structured approach to the management.6. Respondents also reported issues with work-life balance; confidence and difficulties in obtaining leave as other factors which may have also impacted performance7. Improving outcomes: respondents reported the following strategies.• Revision with a partner, buddy group, and mentorship consisting of candidates or senior colleagues of different backgrounds.• Revision sessions hosted by senior colleagues and consultants.• Practice and Feedback• Routine day-to-day inpatient and outpatient assessment of patients; communication with parents and patients; attending handover and discussing patient’s case summary and management plan and exam-based support at the workplace.ConclusionThe RCPCH 2017 census concluded that IMG’s account for 32% of paediatric consultants in the UK and suggests that emphasis on recruitment of IMG trainees is important to sustain the workforce in the future. A clear understanding of the challenges IMG’s face in progressing through the RCPCH clinical examinations is key to helping close the performance and progression gap. These results can also be extrapolated to provide support to IMG’s to close the gap in other areas including as GRID application, Consultant application etc.