How to prepare for the MRCOG part 2 examination. Lucy Higgins.
How to pass the MRCOG 1st. time |
Introduction.
Lucy Higgins won the gold medal in November 2011, which was no surprise to me.
To come top of the 1,200 or so who sat the exam is a remarkable achievement.
Her advice is comprehensive and practical.
Make sure you go through it early in your preparation.
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I, like Elaine, am at a loss as to exactly how to get the gold medal.
In fact, I was pretty certain I’d failed both parts.
I guess that in itself is a good first tip; even if you think it has gone badly, don’t give up or despair!
Plus, after the exam, I really did
feel like I was actually a better doctor for having done all that work – it's
not very often that you get that feeling.
Having read through Elaine’s tips many a time myself, I don’t want to waste your time by repeating the same things.
So hopefully what I will write now will add a little to her
pearls of wisdom.
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·
Clear your to-do list in
advance; get done whatever you need to get done for the ARCP or whatever other
targets and deadlines you have on your plate.Try to say “no” to new tasks
unless they are irresistible
·
Plan when to take the exam;
there seems little point in trying to sit the exam when there are other major
life events going on at the same time like weddings, young babies or house
moves.
·
Never underestimate how long
it can take to get the letter confirming your training – start collecting them
as soon as possible. You can have your training confirmed before you decide to
sit the exam, the approval remains active.
·
Don't leave it to the last
minute to put your application in; you don’t want an unexpected postal strike,
freak storm or simply a black hole in the post office to ruin your chances of
getting to sit the exam. Send your application forms in well in advance and
preferably by recorded delivery!
·
Don’t mistake the deadline
for approval of training for the deadline for applications and vice versa; it
has tripped up many a good candidate.
·
Find a revision buddy. It is
useful to meet every now and again with other people working for the same exam.
It helps you to see what level you’re performing at, and you can share your
expertise and learn from them too.
·
Book your study leave and
courses ASAP. I took time for a week long written revision course, two weeks
personal study before the written exam, two single day OSCE revision courses and
a week before the OSCE. I did have to use some annual leave time as “study
leave”. I don’t think more courses help though, they are not designed to teach
you the topics, but to put you through your paces answering essay questions and
MCQ/EMQs and discussing your answers.
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What do I NEED to do and what would I LIKE to do?
·
Work out what you need to
cover. My “reading list” was to get through every guideline and SAC etc on the
RCOG website, and the relevant ones on NICE, FSRH and BASHH websites, to read
the relevant supplementary info in one core textbook (I used the latest Luesley
Baker), CMACE and Survive Sepsis and to go through the last 3 years of TOGs and
OGRMs. Between you and me, I barely got to the TOGs and OGRMs but I made sure
I’d skimmed all the titles to look for topics I really knew nothing about and
for popular themes.
·
Work out how long you will
need to cover it. I started to go to Tom’s sessions in the November before my
September written exam. At first, I wasn’t doing extra work for the exam, but
the sessions helped me to structure my essays and get into the “senior doctor”
and “paranoid doctor” thinking that stood me in such good stead for the exam. I
started “book work” in the March (6months) before the written exam and put in a
couple of hours most nights until June when I started to do more.
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How do you work best? Some
people, like Elaine, do well with lists. Others, like me, do not. For the exam,
I condensed all the guidelines and other topics into a spider diagram on a
single side of A4 paper. This worked well as I could cover parts of the page and
test myself on what was underneath! When writing essays, I also found that I
could remember that there were e.g. 6 prongs to the diagram and from that I
could make sure all major topics were covered.
·
I kept a list of “last
minute” topics right from the word go. These were the topics that I knew would
only stay in my head for a limited amount of time e.g. cancer staging,
paediatric gynaecology. If you try to make the list at the end you’ll have
forgotten what you have forgotten!
·
Reward yourself for making
progress; revision can be soul destroying but whether its getting to the end of
one “lump” of revision topics or realising that you managed that last patient in
clinic so much better because you just knew what you were meant to do, it all
counts.
·
Think of all that time that
you “waste” every day – put it to good use and then you can use more of your
free time to enjoy life. The daily commute to work can be more productive if you
listen to Tom’s podcasts or drive in with a friend testing each other. The wait
in clinic whilst the last patient is still in scan can be filled by writing an
essay plan about the last patient you saw and talking it through with a senior
colleague. The 10 minutes waiting for handover whilst the day team finish their
last section can be filled by copying down the labour ward board to practice
“managing” another time at home and why head straight out into rush hour traffic
when you could spend an hour doing practice MCQs and EMQs on www.busyspr.com
then sail home in half the time and half the petrol?
·
Practice practice practice.
Don’t let the exam be the first time you have written 4 essays, each on a single
side of A4 in 26 minutes. It’s like being in “The Cube”. And don’t write about
the topics you’ve just read or that you think you know. You can get ideas from
past papers, books and from Tom’s sessions. I tried to write 4 essays at least
once a week. But do get them checked – I was wasting half the space and probably
half my time “setting the scene” and not picking up any marks whilst missing all
the “senior doctor” marks, learn the technique ASAP.
·
You also need to be getting
through 3 MCQs a minute and doing each EMQ in less than 2 minutes. In practice
these are merged into the same 2 exam papers so if you are quicker at one, then
you can spend more time on the other. But the basic technique for both is the
same; answer the ones that you KNOW quickly and move on. Don’t waste time
pondering something you don’t know and miss “easy” marks by not finishing the
paper. Get the easy marks first and then go back.
·
Read the question carefully;
you can pick up marks by following some simple rules. “Always” is ALWAYS FALSE.
“Never” is NEVER TRUE. “Usually” means “more often than not”. “Can” means “it
has been seen at least once or twice”. “Diagnostic” or “pathognomonic” means
“required in the definition of the disease”. Beware of double negatives! And for
MCQs my own personal rules are that its easier to make up a question that is
true than to think of a believable false answer so I’d say “true”, but also that
if a question has many parts, the chances are higher that at least one of those
parts are wrong and so I’d say “false”.
·
NEVER read the EMQ option
list. I mean NEVER. Read the stem and then each branch question. Decide what
your answer is and find it on the list (the list is usually alphabetical or
numerical). Only if you don’t know what your own answer is, and you’ve answered
ALL of the other questions you already know, then you can skim the option list.
The trouble is, they are designed to put things in there to tempt you, things
that sound sensible or that sound like the answer you want to give but mean
something completely different. At the end of the day however, if you don’t
know, you can normally whittle it down to maybe 4 options and guess from there.
·
Arrange for extra experience
in the things that you don’t get to see or do often e.g. risk management, case
reviews, CNST, oncology MDTs, fetal medicine MDTs, shadow the neonates SHO/reg,
go to colposcopy and PMB clinic, follow a couple through IVF, sit in on the
cardiac obs clinic, the renal obs clinic, the diabetic obs clinic...
Essentially, all the stuff that’s not covered very well in the books!
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As Elaine has said, remember
that this is a CLINICAL exam. Whilst rare things are common in exams, for the
most part you will be writing and answering about things you do every day. You
will have seen or done the vast majority of what you are being asked, or
something very similar, so just choose what you think is the safest, most likely
option.
·
Don’t dwell on a bad
experience. Maybe you think you’ve flunked 2 of the 4 essays, ran out of time on
the “easy” one you left until last or have never even heard of “blue spotted
cat” syndrome. Just sat through a whole MCQ and EMQ and at the last minute
changed 10 answers you’ve now realised were right in the first place? Don’t
panic. Each part of the exam is only a fraction of the marks, and in many
respects your success depends on how everyone else does too. It is frustrating,
but the exam is very unpredictable.
·
Remember that the “easy”
essay question will have a very high pass mark, and therefore requires more
detail and more senior doctor thinking than the “impossible” essay question. In
my exam there was a question on the management of severe preeclampsia with a
pass mark of 15, and another on the management of acute atrial fibrillation in
undiagnosed mitral stenosis with a pass mark of 9…
·
Read the question. If they
ask about the management, don’t waste time talking about what causes it. If they
ask about the antenatal complications, don’t talk about postpartum haemorrhage.
If the question is more open ended, have a system; e.g. fetal and maternal risks
in each of preconception, first trimester, second trimester, third trimester,
early postnatal and long-term health. For gynaecology, conservative, medical,
minimally invasive surgical and major surgical and themes of contraception and
fertility running throughout.
·
The lady with “blue spotted
cat” syndrome wants to become pregnant? Well you would encourage preconception
counselling and early referral to the relevant MDT, ensure her disease was well-controlled on pregnancy-safe medications, consider whether the fetus is at risk
(does the dad have BSC syndrome too? Is it genetic? Should they be offered
genetic counselling, PIGD, CVS or amnio), might it affect her chance of fetal
anomalies (early FMU scan), preeclampsia (more frequent BP and urine checks) or
growth restriction (clinical vs. sonographic fetal growth monitoring), if she
needs a Caesarean or other surgery, the MDT need to optimise her baseline
health, consider if she is at risk of excessive bleeding, whether the surgery
needs to be MDT… you can see how you can easily pick up marks for general
principles even without knowing anything about it.
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This how we all felt after
the written exam and before our results. You know you should be happy its all
over but you can’t help wondering what would be worse – to fail and have to do
it all over again in 6 months? Or to pass have to do it again in 9 weeks? Try to
make the most of the time between the exam and results. See you friends and
family, get that hair cut, go on holiday – whatever it is, you deserve it and
you need to recharge your batteries before embarking on the next part
·
Don’t let it all go though.
Whilst I didn’t do any book work during this time, I spent a bit of extra time
thinking about each consultation I undertook, how I could have said things
better, how I could say things quicker, what words made the patient at ease,
which put them on edge. I got quite a few case-based discussions done on cases
I’d seen, which allowed me to discuss how to tackle that scenario in the exam.
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The OSCE
·
Congratulations, if you’ve
got this far, there’s about a 3 in 4 chance you’ll be wearing a silly hat whilst
your mother cries at graduation in just a few weeks. Its just going to take a
few more weeks of work…
·
The only way to prepare for
the OSCE is with a friend or two. They don’t have to be taking the exam, in fact
its quite good to practice with a non-medical neighbour or friend so that they
can pick you up on even the slightest use of jargon. If you’re practicing with a
friend, give REAL feedback – if they said something that raised your eyebrows,
explain why, if you think they did something really well then tell them and
start doing that yourself!
·
If you grandma doesn’t
understand what you’re saying, neither will the “patient”.
·
Book work is still important
though, as Elaine says you do still need to go over what you learnt for the
written exam.
·
OSCE books are good for
practice scenarios, but invariably I found that the advice on how to pass the
exam within those books was either bizarre or so obvious it was painful to read.
You don’t need to spend a lot of money on books – clinics, on-calls and
discussions with senior colleagues will generate enough topics to practice on.
·
Arrange to meet a theatre
scrub nurse at the end of a busy list to go through all the instruments in the
trays and how to assemble the various ‘scopes. Know how to name all the bits or
at the very least learn how to describe them and what properties of an
instrument make it the right choice for a particular task e.g. do you want long
or short, straight or curved, crosshatching, lines or no grip…
·
Dig out those labour ward
boards and practice prioritisation.
·
Find a first year or GP
trainee SHO and teach them how to do evacs, laparoscopy, FBSs, forceps, ventouse
or to manage a shoulder dystocia.
Use the basic practical skills book to check the basic steps you should include,
remember to emphasise SAFETY in everything that you do or teach.
·
Don’t forget the senior
doctor thinking; who has asked you to do this task, what authority do they have,
what clinical governance implications does the topic have, should it be audited,
do you need to produce associated documents like standard operating procedures
and protocols, or to set up training and a training register?
·
Read the patient information
leaflets available in your hospital and on the RCOG website. Learn the phrases
used to describe conditions. Notice what patient support groups exist so you can
drop this into conversation.
·
Go and chat to the woman
from PALS. Learn all about how to make a complaint and (where appropriate) offer
this information in the OSCE. It makes you look open and honest.
·
It's OK to say that you
don’t know something. The examiners can tell if you are making it up. But you
can still get points by being safe. You will speak to a senior colleague or the
expert in that field. You will arrange for her to be seen by the MDT. You will
bring her back in a couple of weeks to see how she is getting on and to let her
know what the experts have said. You will check in the BNF to see if there are
any contraindications to her taking that drug. She should always read the
information leaflet in the packet of medicines before taking it. If she has any
concerns you can be contacted on this number…
·
Travel down the night
before. You don’t want to get diverted, miss your train or get stuck somewhere
outside Milton Keynes (at any time, not least of all) on the morning of your
exam.
·
Dress to impress. Make sure
you look smart, appropriately covered and “work ready”. There is no point
wearing something that will make you uncomfortable. Also, a tip for the girls is
to take spare EVERYTHING. I managed to ladder my tights on the way down the
stairs to the exam, someone else broke the strap on their shoes and had to do
the exam in their trainers. This is not the start that you want!
·
You can mess up at least one
station and still pass; each one is just 10% of the mark. And you never score
NOTHING. So whatever you do, when the buzzer goes, forget what you’ve just done,
think about what you’ve got to do now instead. And if it’s the last buzzer,
think about how you’re going to celebrate!
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And the final tip, is that this exam is NOT the be all and end
all. Its easy to feel that it is, but in the grand scheme of things it is just
one more hoop to jump through, and if it doesn’t work out for you this time,
just think how much more you know now than the others who are just starting to
prepare.
Thanks again to everyone who helped me and my friends through
the exam. The biggest thanks of course goes to Tom and Valerie for their
patience, generosity and endless supply of cake and biscuits! Thanks also to the
teams at St Mary’s and Royal Bolton Hospitals for putting up with me, teaching
me and supporting me through everything I (thought I) had to do to pass and for
believing in me.
You CAN do it and you WILL do it
Good luck
Lucy
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