How to prepare for the MRCOG part 2 examination. Lucy Higgins.

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How to pass the MRCOG 1st. time

List of contents.

  1. introduction by TMcF

  2. preamble by Lucy

  3. preparing to prepare

  4. what do I need to do and what would I like to do

  5. "vising" and revising

  6. the exam

  7. limbo land

  8. the OSCE

  9. final thoughts


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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How to get the gold medal

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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Preparing to prepare

·    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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“Vising” and “Revising”

·    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 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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The exam

·    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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Limbo land

·    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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·    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 finally.

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



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