How to pass the MRCOG first time!

Home Page MRCOG page Search the site for a word or phrase.

Most of the advice in this section is from Tom McFarlane.

But the best  is from Elaine, who won the Gold Medal in 2010, Lucy, who won it in 2011 and Gemma who won in in 2013.

And from Anupama Singh who won the Vijaya Patil medal in the May 2013.

This is awarded to the Indian doctor with the highest mark in the exam.

Also the experience of Asma, who has not worked in the UK and passed in 2010, giving the perspective of the "overseas" candidate.

This is gold-dust.

In fact, it is better.

It is priceless and you would be really stupid not to go through it in detail.

Ignore my stuff, if you will, but not theirs!

You must plan how to prepare:

    how you are going to read and what

    how your are going to remember it - what revision system will you use?

    plan you last-minute revision - the stuff that goes straight out of your head - start planning now

There are links to lots of books.

I am in the process of updating the links for the books.

The links were to the RCOG Bookshop as it stocked almost all of them.

Unfortunately, the RCOG shut the bookshop in 2012 and the links now need to be updated.

This will take me a time to do, so you will need to use a search engine to locate some of them.

List of contents.

  1.     you must be eligible to sit the exam

  2.     apply to the College in good time and check they got your application

  3.     allocate adequate time for preparation

  4.     prepare thoroughly & find a "study buddy"

  5.     teaching as learning

  6.     know the format and syllabus 

  7.     what to read

  8.     develop techniques to enable you to read constructively

  9.     learn and practise techniques appropriate to each type of question

  10.     practise writing essays

  11.     try to spot essay topics

  12.      master CTG interpretation

  13.      plan your last-minute revision and build a list of difficult-to-remember topics

  14.     book study leave for the week before the written exam 

  15.     OSCE skills:

  16.            hone your communication skills

  17.             make sure you have the necessary practical knowledge 

  18.             prepare all the known types of station

  19.            go on an OSCE course 

  20.     Go on a course for the written exam

  21.     consider your special requirements if you haven't worked in the UK

  22.     other sources of information

       

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1.    Apply to the College in good time & check they got your application.

The College publishes a  calendar on its website.

This gives the dates of forthcoming exams and where you can sit them.

It gives the closing dates for getting your training and certificates approved:

    1st. October for the March exam and

    1st. April for the September exam.

It also gives the closing dates for applying to sit the exam:

    20th. December for the March exam and

    1st. July for the September exam.

The College rejects all late applications and won't listen to any excuses.

But it has an unreliable system for booking people in.

In a recent round of exams I had one DRCOG trainee and one MRCOG trainee who were refused permission to sit the exam.

This was on the basis that they had applied late.

Yet both had applied in good time.

One had even had her cheque cashed by the College!

My advice is to check a week or so after you submit your application that you are definitely on the list.

I have enquired of the College about this problem and am told that an improved system will be introduced shortly.

You would have thought that the simple answer would be to send confirmation of receipt to every applicant!

What's so difficult about that?

     

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2.    Allocate adequate time for preparation.  

Six months is an appropriate time for most people.

But be prepared to allocate most of your spare time to the task.

If you can make it twelve months, so much the better.

If you can’t prepare thoroughly, don't apply for the exam.

It is very depressing to fail and it takes time to pick yourself up and get re-motivated.

More importantly, you don’t want to sacrifice more than one six-month slab of your life to the exam.

The written exam is the hardest part with a much lower pass rate than the clinical.

So concentrate on the written exam; you will have enough time to prepare for the OSCE once you have passed.

I have started to put some OSCE stuff on the website.

And there are plenty of books and courses giving practice with the different types of OSCE station.

One thing you can think about and refine in the interim is your communication with patients, of which more below.

It is also worth while thinking about having a model for taking an obstetric or gynaecological history.

Practising the model will help you learn it and reduce the chance of you missing something important in a roleplay.

I have put a model for an obstetric history on the web page.

I'll do the same for taking a gynaecology history in the near future.

     

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3.    Prepare thoroughly.

If you don’t know enough, you fail!

Obvious and basic.

If you can find someone preparing to sit the exam at the same time as you, that can be very helpful.

You can prepare stuff to share and motivate each other.

If you arrange to meet a couple of times a week, it will make you work even if tired or fed-up.

 

You need to know the examination regulations.

 

You need to know about the new extended matching questions.

The College has some examples on its web site.

There are some examples in the DRCOG section of this web site.

Note that the page refers to the DRCOG, not the MRCOG.

So, the samples are useful, but the rest of the page relates to the DRCOG.

There are also some in the answer to the question on cystic fibrosis.

 

You need to know the examination syllabus.

 

Make sure you have enough knowledge.

Make sure you have read appropriately.

The essays are an impossible hurdle for many people.

The only way to get good at them is to write loads of them under exam conditions and then criticise them

You will then improve your technique.

We discuss a lot of essays in the tutorials and you can practise them and listen to the tutorial discussions.

I suspect that many people write their first essay under exam condition in the exam hall!

This is a certain recipe for failure, so don't be so stupid as to let it be you.

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Teach.

Take every opportunity to teach, medical students, junior colleagues, nurses, midwives etc.

You have to prepare and it will help you know and remember stuff.

Learn humility and practise honesty.

No one knows everything.

I almost never have a MRCOG tutorial session in which I do not find something about which I am ignorant or unsure.

It is good to admit that you don't know - but always make sure that you find out afterwards.

Your audience will appreciate your honesty and humanity.

No one likes liars or people pretending to be God-like.

 

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Know the format and syllabus.

This is so obvious I am almost embarrassed to mention it.

The exam consists of EMQ, MCQ and SAQ (Short Answer Questions - essays) papers.

You need to know the format and syllabus.

The format is here.

The syllabus is here.

MCQ paper 1 and EMQ paper 1 relate to modules 5, 6, 7, 13, 14, 15, 16, 17 & 18

MCQ paper 2 and EMQ paper 2 relate to modules 2, 3, 8, 9, 10, 11 & 12

There is now one SAQ paper with 4 questions - it used to be 8, but now there are more EMQs and fewer SAQs.

The RCOG has sample questions on its website:

     sample EMQs,

      sample MCQs, not that there are many of them,

     sample SAQs - this link takes you to the page with the RCOG's advice and the links to the sample questions and how to answer is at the bottom of the page,

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4.    Suggested Reading.

The exam committee's advice is here.

I don't agree with it as there has been a big shift from textbooks to guidelines and articles like those in TOG.

And some of it does not reflect what successful candidates are doing.

For example, most use James' High Risk Pregnancy as a reference resource only.

Most also use Catherine Nelso-Piercy's Handbook of Obstetric Medicine rather that De Sweit's book.

Apart from anything else, it is less than half the size.

Click here for my list of suitable reading materials.

The most important things to read are the RCOG  and NICE guidelines plus all the TOG articles for at least 3 years.

Note the box in the RCOG advice with links to more than Green-top guidelines.

There is advice on:

   clinical governance,

   consent,

   joint guidelines, etc. 

Read the clinical guidance from the Faculty of Sexual and Reproductive Healthcare.

The RCOG has scoring systems for previous essays on its website.

It is worth checking them out to get an idea of the thinking behind them:

Most successful candidates will tell you that the bulk of the exam is covered by these sources.

So, it essential that you know them thoroughly.

 

I advise my trainees to do the following:

  1. Get through all of the MCQs I have written - it's a good way to get you started - send me an e-mail to get the latest versions.

  2. Learn -don't just read - everything published by the College and NICE.

  3.     make out a card or cards for every RCOG Green-top guideline and NICE equivalent

  4. start planning your last-minute revision: how to do it and what to include

  5.     don't forget the RCOG stuff like clinical governance consent and other advice.

  6. Read all the "TOG" articles for the past three years.

  7. Read all the Obstetrics Gynaecology & Reproductive Medicine articles for the past three years.

  8. Make sure you do all the EMQs and MCQs in TOG & OGRM: even better make out cards - identical questions have featured in the exam.

  9. Go through the MCQs from the RCOG's book of past papers 1997-2001. I am told that questions from the book are often repeated.

  10. Keep an eye on the RCOG website: in the March 2010 exam teenage pregnancy and swine flu were on the website and featured in the essays.

  11. Practise essay-writing

  12. The above is the essential core of your preparation. What follows is helpful, but if you have not done the above, you are likely to fail and some successful candidates will tell you that the above is all that they did.

  13. "Key Clinical Topics in O&G" by Emma Crosbie et al would be excellent for revision as it condenses subjects to a page or two. You could add notes and use it as the basis for your last-minute revision. 

  14. Read at least one MRCOG textbook - at least go through the stuff that is not covered in your other reading..

  15. Read a textbook on obstetric medicine e.g. "Nelson-Piercy".

  16. Read selected fetal medicine topics from Handbook of Fetal Medicine.

  17. Read the papers I have written on stuff that is not well-covered in the textbooks.

  18. Know the Maternal Mortality Report - new edition, "Saving Mothers' Lives" published in December 2011. This is now being taken over by MBRRACE - make sure you keep up with the changes.

  19. Know the recent facts on Perinatal Mortality.

  20. Read a bit about statistics, etc. E.g. "how to read a paper" by Trisha Greenhalgttp. It is based on BMJ articles and you could find most of it on the BMJ website. There is also a copy of the 2nd. edition on-line which would be OK for your purposes. .

  21. Most importantly, read in an analytical and constructive way.

  22. Learn and practise techniques appropriate to the type of question.

  23. Read parallel subjects: genetics, neonatology, family planning etc.

  24. Most of the genetics you need is covered in the DRCOG MCQs.

  25. Practise writing short essays under exam conditions.

          This is the best way to get experience of finding the balance of making a plan and getting it down on paper.

         Also, I find that when I have not written at speed for a while, my muscles start to ache after a page or two.

          So it makes sense to get them in training for the ordeal of having to write at speed for several hours.

   

I would guess that you have now done about 95% of the necessary preparation.

And easily know enough to pass.

But do the following to get up to 100%.

 

  1. Consider subscribing to "StratOG".

  2. Use subsidiary sources of advice.

  3. Read as many of the small MRCOG texts on EMQs, MCQs etc. as possible.

  4. Read as many of the past MCQs as you can find - questions get re-cycled in the exam.

  5. Read  "Recent Advances", "Vignettes for the MRCOG" and "Progress in O&G".

  6. "High Risk Pregnancy" is a mini-encyclopaedia: read selectively from it.

  7. You need to know the management of the common emergencies.

  8. The "Oxford handbook of O&G" is portable and a basic summary.

  9. "Notes on O&G for the MRCOG" is excellent for revision.

  10. Know the key joint RCOG publications,

  11. Think of important subjects that are not routine in UK practice.

  12. HIV will always rear its ugly head.

  13. Use the RCOG series "Subject X for the MRCOG and Beyond" to fill in gaps.

  14. Keep up to date with HRT and other fast-changing subjects.

  15. Try to spot questions,

  16. Talk to colleagues who have recently passed the exam.

And keep practising essay-writing.

This is the bit of the exam that most people fail.

You will only get good at it by practising.

And the best way to do this is to write unprepared topics under exam conditions.

Then read the books and correct your effort at leisure to come up with a "model" answer.

Make out cards for all your model essays.

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a. It is crucial that you know everything the RCOG has produced: “Green-Top” guidelines etc.

You can access all of this in the section "Guidelines" on the College web page.

The RCOG web page also gives useful links to other sources of guidelines.

Similarly, NICE produces guidelines that you need to know.

There are loads of other guidelines.

Patient UK has links to loads of guidelines from the UK and elsewhere. 

You may find something useful there.

For example, the document on the menopause and HRT, although most of it can be found elsewhere.

Including this web site!

Don't waste time on esoteric material.

The RCOG and NICE advice is the stuff you need to know.

It must be known well enough for you to refer to it in the essays and use it to answer MCQs.

Keep an eye out for guidelines that are in the pipeline.

The draft guideline is usually put out for comment months before the final version is published.

The exam committee sets the exam questions six months in advance.

It will be aware of guidelines that will be published in the months before the exam.

These will be very tempting as sources of questions.

Details will be published on the RCOG web site.

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Talk to colleagues who have recently passed the exam.

What did they read?

What courses did they attend and how useful were they?

Make use of all learning opportunities within your department and further afield.

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b.  The next vital reading is:

        The Obstetrician & Gynaecologist, usually known as "TOG"

        and  Obstetrics, Gynaecology & Reproductive Medicine.

Many of the essay questions in any examination have been covered in recent issues of these journals.

Ideally, read all of the articles for the past three years.

TOG is a RCOG journal and standard reading for ages.

Members, Fellows and trainees get it sent them, so you have no excuse for not reading it!

It covers topical stuff is a nice, concise way, that is ideal for MRCOG preparation.

Similarly, Obstetrics, Gynaecology & Reproductive Medicine is excellent.

It aims to cover all key topics in a 3 year cycle, so try to read all the issues for the past 3 years.

It is beautifully edited by Ian Johnson, Prof. of O&G at Nottingham.

So you get short, punchy, up-to-date reviews that are exactly what you need.

Worth a subscription if you can't get it in your library.

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The College also publishes StratOG , designed to help with the examination.

There are 10 modules at £50 each, which I think is a lot.

There is an internet-based version: Stratog.net.

This launched on 19th. September 2007.

It is advertised as comprehensive and using all the latest web tricks and educational aids.

I had a look at a few sections e.g. the genetics section.

It contained the necessary information.

There were a few links to external sites and explanatory papers.

I think is meets the needs of the MRCOG candidate.

You'll need to make up your own mind about its value-for-money.

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c.  There are subsidiary sources of advice.

Khaldoun Sharif has a blog that keeps up-to-date with stuff of interest.

It's an obvious plug for his MRCOG course as it is to be found on the web page for his courses. 

However, this does not diminish its value.

He obviously puts in a lot of effort to keep it abreast of topics of current interest.

Some of these are likely to appear as essays or OSCE stations.

The Cochrane Collaboration gives access to their excellent reviews.

SIGN has published a couple of relevant guidelines.

The Department of Health, www.dh.gov.uk, and related agencies issue advice and information on current topics, such as:

     HPV immunisation,

     the national chlamydia screening programme: and chlamydia generally.

     fortification of flour with folic acid, 

     screening of neonates for cystic fibrosis, 

     screening of neonates for Medium Chain Acyl CoA Dehydrogenase Deficiency (MCADD),  

     varicella in pregnancy and varicella vaccine. 

The British Medical Association produces some data of relevance to the exam. 

E.g. its excellent document of June 2007 on alcohol and pregnancy. 

And its "Consent Toolkit".

Professional associations of other countries produce advice e.g. 

    the American College, www.acog.org.

    the Canadian Society of O&G  where you can access guidelines like the one on soft markers,

     the Royal Australian and New Zealand College of O&G where you can access guidelines like the one on prenatal screening. 

The Centers for Disease Control and Prevention has numerous documents on its web site: e.g. on immunisation in pregnancy.

CMACE publishes data on maternal and neonatal mortality and morbidity. 

OMIM is invaluable for looking up genetic conditions, 

Use these sources for data you can’t find elsewhere, but don’t get sidetracked into wasting time on obscure stuff.

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d.  A new maternal mortality report  was published in December 2007.

Its key statistics and recommendations are essential reading.

You can find the ten main recommendations here.

MCQ13 in the information booklet, MCQ paper 5, question 18 and MCQ paper 9, question 1 cover most of it.

You can get the report from CEMACH.

You can access the executive summary and the full report from the web site. 

CEMACH also publishes data on perinatal mortality. 

It has recently published a document on diabetes & pregnancy.

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e. Know at least one textbook thoroughly. 

"O&G: An evidence-based textbook for MRCOG" edited by Luesley and Baker and published by Arnold has become popular.

It is not perfect, but covers most topics.

It has a companion book of questions to check your retention of key facts: "MCQs and Short Answer Questions for MRCOG".

The standard textbook used to be "Dewhurst".

A new edition was published in 2007 edited by Edmonds and published by Blackwell.

I have not yet had the chance to fully evaluate every page.

But most of what I have read is good and it even includes up-to-date stuff like cffDNA.

There are other standard textbooks; it is a matter of individual preference.

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f. I like my trainees to go through all 13 of the MCQ papers I use for my DRCOG candidates.

The first paper is on this web site.

I like them to get through them in the early weeks of their preparation.

Their virtue is that they span most of the spectrum of MRCOG topics including some that are not well-covered in the textbooks.

For example, paper 2, question 40 gives you all you need to know about Fragile X syndrome and FXTAS. 

Some of the answers are MRCOG level, like the one on Fragile X and paper 1, question 1, which deals fairly exhaustively with MSAFP.

Others are obviously more DRCOG standard.

Click here for the list of topics covered by the MCQs.

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g. You need to read related subjects: genetics, family planning, neonatology, sexually-transmitted disease etc.

Many of these are dealt with in the College series "Subject X for the MRCOG and beyond".

 

Contraception.

This is best learned on a training course for the DFFP (now the DFSRH).

These courses are reportedly excellent and provide all you need to know for the MRCOG.

The Faculty of Faculty of Family Planning puts loads of good information and protocols on its web page.

It has lots of excellent guidance, for example:

   oral contraception use and cancer risk, 

    on first prescribing oral contraception,

    on emergency contraception,

    on missed pills,

    all of which topics are ideal essay or OSCE questions,

   and topics that are not directly about contraception - like vaginal discharge. 

This is a superb resource and you should make use of it. 

Other suitable texts (watch the date of publication) include:

Handbook of Family Planning and Reproductive Caree-5th-edition

Glasier & Gebbie

Churchill

Contraception Today

Guillebaud

Informa

Handbook of Contraception and Sexual Health

Everett

Baillière Tindall

Contraception Your Questions Answered

Guillebaud

Churchill

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The menopause & HRT are fast-changing and you need to be sure that you are up-to-date with the latest advice.

You can get this from the UK and American menopause societies, www.thebms.org.uk and www.menopause.org.

E.g. the use of:

    hormone replacement therapy

    alternative and complementary remedies 

    local oestrogen for atrophy of the vaginal skin.

The government issues advice via MRHA, "The Medicines and Healthcare Products Regulatory Agency".

The Chief Medical Officer also pronounces on the subject when something alters.  

You need to keep abreast of the latest advice from studies such as WHI, www.nhlbi.nih.gov/whi.

Alternatives to oestrogen are going to appear in the exam.

Suitable reading includes:

Menopause - What you need to know  Rees, Purdie & Hope RSM

Management of the Menopause - The Handbook

Rees & Purdie

RSM

Managing the Menopause without Oestrogen  Rees M. & Mander T. RSM

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Paediatrics.

You need to know resuscitation of the newborn and its latest protocol.

The best source of information is a paediatric registrar or consultant neonatologist.

It is well covered in Luesley & Baker and in the "Illustrated Textbook of Paediatrics" mentioned below.

Neonatal jaundice is a common topic.

See MCQ paper 7, question 12.

You could be asked about:

    examination of the newborn,

    management of congenital abnormality, from CDH through to ambiguous genitalia or diaphragmatic hernia

    and neonatal infection.

Suitable texts are:

Illustrated Textbook of Paediatrics

Lissauer T & Clayden G

Mosby Elsevier

Essentials of Neonatal Medicine

Levene et al.

Blackwell

Resuscitation of babies at birth Royal Colleges of Paediatrics and O&G BMJ Publishing Group

 There used to be "Neonatology for the MRCOG and beyond".

The RCOG bookshop says that a new version is awaited, but no date has been given. (October 2007)

It was worth buying before so I'm sure the new version will be too.

In the meantime I'd use whichever undergraduate textbook is in your library.

Or splash out and get the Illustrated Textbook of Paediatrics.

It has good sections on all the basics like:

    ambiguous genitalia,

    examination of the newborn,

    neonatal jaundice,

    neonatal resuscitation,

    problems of the IUGR baby etc.

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Sexually transmitted diseases will certainly feature.

The "ABC" book is adequate.

ABC of Sexually Transmitted Infections

Adler

BMJ Books

It would also be worth paying a visit to your local clinic to see what their procedures are.

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Genetics crops up all over the place.

Most of it is covered in the MCQs.

The text below amplifies the MCQs.

Medical Genetics for the MRCOG and beyond

Connor

RCOG Press

 

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The RCOG publishes a series of small books entitled “*** for the MRCOG and beyond”.

Subjects include:

    antenatal disorders,

    gynaecological oncology,

    gynaecological urology,

    haemorrhage and thrombosis,

    infertility,

    intrapartum care,

    medical genetics,

    psychological disorders,

    reproductive endocrinology.

They are invaluable for filling gaps.

They are excellent, but watch out for the date of publication: some will soon be pensionable.

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h. There are masses of books written specifically for the MRCOG.

Some try to cover all the components of the exam.

Some deal with only one part, e.g. essays or EMQs.

They give insight into the exam and most are reasonably priced.

John Duthie and Paul Hodges have produced a book: "EMQs for the MRCOG".

John & Paul have been on the College's EMQ sub-committee since the start.

You can't get closer to the College's EMQ database than that!

It gives lots of advice on technique, not just sample questions.

At £19.99, I reckon it to be a bargain!

Authors local to me have done the same:

"Extended Matching Questions for the MRCOG"  edited by Singh; published by PasTest.

Maneesh Singh is an ex-trainee of mine, so I must declare some prejudice.

It also means that I could not fail to give his book a mention.

However, I think the book is worthy in its own right and inexpensive!

I bought a copy!

I was recently (March 2009) given a copy of Justin Konje's latest book for the MRCOG to review.

SAQs, MCQs, EMQs & OSCEs for MRCOG Part 2.

I haven't yet had time to read all of it.

What I have read is excellent.

The bulk of the book deals with essay-writing and has load of examples.

This makes sense as the essays are the bit that most people fail.

The answers I have read are bang up-to-date, which is what you would expect.

My one criticism is that some of the answers are too long.

You would be hard-pressed to write them in the allocated time.

But they contain all the information you might need.

So, to use them, you would just extract the key facts and write your own, briefer answer.

I must admit that I have the same problem writing model essays.

It is difficult to change mindset from writing textbook-like answers to the stripped-down versions needed in the exam.

Overall, at £29.99 I think it is excellent value.

 

There are stacks of other books. 

I counted nearly 30 on the College Bookshop website!

You'll need to "pick and choose" unless you are rich and an Olympic gold-medallist at speed-reading.

Some of them are now a bit dated - I would give them a miss.

Have a browse before you buy and use your critical faculties.

The more you practise MCQs, EMQs and essays the better.

Remember to practise time-keeping too.

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i.   There are review books:

         the best known being "Progress in O&G" edited by Studd and published by Elsevier

       and "Recent Advances", edited by Bonnar and Dunlop and published by RSM Press.

Less well known is:  "Vignettes for the MRCOG" by Farquarson and published by Quay.

Its lack of fame is undeserved as it is first-rate.

They give short summaries of key points in an up-to-date fashion.

Ideally you should read the most recent two or three volumes of each.

Their role is being superseded to some extent by “TOG”, but they remain useful.

My view is that “Recent Advances” and "Vignettes" are the better, being more tightly edited, but this is a matter of opinion.

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Handbook of Obstetric Medicine. 4th. Edition  by Catherine Nelson-Piercy and published by Informa Healthcare is mandatory reading.  

At the back of the book is a very useful section with a table of common symptoms such as breathlessness, palpitations and abnormal findings like proteinuria and abnormal LFTs.

Differential diagnoses are given and appropriate investigations.

It is an invaluable section that is overlooked.

Go though it, make notes and add it to your last-minute-revision list.

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k.  High Risk Pregnancy"  by James et al and published by Saunders is superb but huge.

It should be consulted on an ad hoc basis.

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The  MOET handbook  is worth reading for the management of emergencies.

These are also dealt with in Emergencies in O&G" by Arulkumaran and published by OU Press.

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The "Oxford Handbook of O&G" by Arulkumaran and published by OU Press is popular.

It fits in a pocket, so can be carried at work for consultation and exam preparation when you have a spare moment.

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There used to be a book "Notes on O&G for the MRCOG" by gordon Stirrat, but is has not been re-printed recently.

It was portable and its great merit was that topics were dealt with almost as “key points”.

There is now a worthy, up-to-date successor: "Key Clinical Topics in O&G" by Emma Crosbie et al.

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l. I have produced some papers on topics not well-covered in the textbooks.

You need to be au fait with Clinical Governance,  CNST, Risk Management,  Protocols, Audit, etc. as practised in the UK.

This is particularly important if you have not worked in the UK, as the systems under which you have trained may be significantly different.

Similarly, you need to know about Consent and Complaint procedures.

The College has produced advice on Consent, accessible via its web page.

The GMC has done the same, but its advice is rather large.

You can find the College and GMC advice in the Consent section.

I couldn’t find a single comprehensive source for reading about Complaint Procedures, so wrote one.

A recent OSCE examination included a viva on electrodiathermy.

This was a killer and could feature in an essay or MCQ.

See the document on this web page for further information.

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You should know the basics of joint publications by the RCOG, RCM and DOH such as "Towards Safer Childbirth" and “Changing Childbirth”.

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You need to think of subjects that could crop up that are not met in routine practice, e.g. malaria or tuberculosis in pregnancy.

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You need to be well versed in HIV and pregnancy.

This web page has a summary sheet.

There are a number of web sites to keep you up to date:

    the British HIV Association, www.bhiva.org

    and The Health Protection Agency, www.hpa.org.uk.

There is an intercollegiate report, “Reducing Mother to Child Transmission of HIV Infection in the United Kingdom”, July 2006.

It can be accessed via the HPA web page.

There are a number of topics that are not easy to get full information on from the textbooks.

I have produced a number of papers on them - click here.

Make sure you read them all.

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5.    Read constructively.

The immediate conclusion from the suggested reading section might be that the task is impossible!

It is daunting, but not impossible.

It means that your reading has to be disciplined and efficient.

The volume of necessary reading makes it evident that you cannot read anything more than once.

Hence, you need a technique that allows you to capture all of the important information at the first sitting.

Ideally this should be in a format that facilitates revision.

You need all of the information securely stashed in your head and available for the exam.

You can’t just read and hope that everything relevant will stick.

People use all kinds of different systems.

There is advice from Asma, Elaine and Lucy about the systems they used.

As they all passed, these are systems of proven worth - make sure you read their advice.

I used cards – postcard-size or slightly smaller.

Big enough to contain the information you want, but small enough to carry in a pocket.

You go through them whenever you have a spare moment at work.

For example, you might make out a card on postmenopausal bleeding and the risk factors to elicit in the history.

On the front of the card you would write the title, “Postmenopausal bleeding” with a sub-text, “Risk factors to elicit from the history”.

There is a good summary on the SIGN page. 

You would then make out a list of all the things you feel should be included.

There would be obvious things such as:

    her age and the interval since the menopause - the older she is and the further from the menopause, the bigger the risk of cancer,

    the frequency and duration of the bleeding (the SIGN page says the pattern of bleeding doesn't help),

    associated symptoms like discharge or pelvic pain,

    a history of treatment for gynaecological malignancy or premalignancy etc.

You would include the increased risk with unopposed oestrogen and the reduced risk with continuous, combined HRT.

You would mention tamoxifen, which, used for > 5 years, increases the risk at least fourfold. (See SIGN page.)

Family history would include the possibility of the woman being from a HNPCC family (MCQ paper 1, question 13) etc.

Make sure you go to MCQ paper 1, question 13, it contains links to trials being run for HNPCC women in relation to endometrial cancer risk.

Once you had compiled your list on the back, you would count the items and put the number on the front.

When you use the card for revision, you read the front and have to try to recall all of the headings on the back.

There are several values to this system.

You have to read analytically to ensure that you have captured all of the important points in whatever you are reading.

Often when we are reading we are only half-concentrating.

You can’t do this if you have to make out cards.

You have to pay attention and decide what information you need to capture.

This helps you to remember it.

Then putting it down on paper helps to cement it into your head.

You also need to deal with stuff you don't fully understand.

You can't just put it off to another day.

Once you have made out your cards, you do not need to read the source again.

You should then revise the cards time and again until they are memorised and their contents are easily recalled.

If you come across some additional information, you amend the card.

You may well prefer to move from the dark ages and uses an electronic storage device.

So long as it is portable and you have regular backup in case it is stolen or crashes.

And the information must be stored and then presented to you in a way that tests your knowledge.

Don't fall into the trap of just copying large chunks of stuff from your computer into the organiser.

An important part of the process is that you write the stuff that you store.

     

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6.    Learn and practise appropriate techniques.

Whatever you are practising, essays, EMQs etc. learn to keep track of the time.

MCQs and EMQs are best practised using the books mentioned above.

Practise writing at speed for an hour or two.

Give yourself three or four essays and write them in one session.

You'll find that the muscles in your hand and forearm tire.

So they need to be exercised to get them fit for action in the exam.

 

MCQ techniques.

EMQ techniques.

Short essay techniques.

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MCQs.

With all the reading you do, make out MCQ cards.

Put the likely questions on the front.

And the answers on the back.

The technique for the MCQ paper is to go through the questions answering all those you are confident you know.

Then go back through, answering those you need to think about.

Finally, guess the ones about which you have no clue.

There is no negative marking.

So, by the Law of Averages, you should get half of them right.

Keep an eye on the time to ensure that you answer every question.

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EMQs.

With EMQs, read what the question is about and then the scenario.

You should then have a pretty good idea of what the answer is.

You can then read the list of options.

Don't read the list of options first.

You will waste time trying to remember points about things you half-remember.

E.g. Noonan's syndrome might be on the list.

And you will waste valuable time trying to recall its key features.

Yet it might not be the answer to any of the scenarios.

 

If the answer you thought correct is on the list, go for it.

Don't waste time going through the list to check that there is not a better answer.

 

If you are not sure about the answer, you need to decide which might be correct answers.

There will probably be one or two answers close to what you thought the answer should be.

The hard bit is deciding which is the best.

You might have to do a bit of lateral thinking.

A recent question was along the lines of a woman admitted at 28 weeks with significant hypertension and features of PET.

A question was whether she should first have a hypotensive drug or magnesium sulphate.

For most people it was a daft question as you would administer both.

However, it you think it through, the biggest risk to her health is intracranial haemorrhage from bleeding due to hypertension.

 

The most important thing is to do as many examples as you can find.

Get at least one book of EMQs.

I'd start with EMQs for the MRCOG part 2 by Duthie and Hodges.

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Essay writing.

The RCOG's advice about the SAQs is here - read it.

It has a few "worked examples" illustrating how they are marked. 

There is 1 paper with 4 essays.

You get one piece of A4 paper and 26¼ minutes for each essay.

The College now provides answer templates for the essays.

I think this helps considerably.

It steers you to the areas that will attract marks and keeps you away from those that will not.

Each section tells you the marks allocated.

This tells you how many points you need to make.

Paul Fogarty has written a short, sensible article on the short essays in "Obstetrics, Gynaecology & Reproductive Medicine".

He also provided a mock essay question on Hepatitis B with a marking scheme.

It is worth having a look.

Basically, a woman in Hepatitis B +ve at booking.

You have to discuss things in 3 sections:

    the immediate management,  10 marks,

    the management of the rest of the pregnancy and puerperium,  8 marks,

    other aspects outwith the pregnancy.  2 marks.

It would be a good exercise to write an essay using his question.

Then have a look at his marking system.

I have written a model essay on this subject too, based on his question.

Have a look at my effort and the things I have included that I think are important but that he ignores.

This illustrates the point that faced with the same question we would all produce slightly different marking schemes.

It is the job of the examination committee to consider all the different ideas of its members to produce the ideal question and marking system.

 

Writing at speed for several hours is difficult.

You need to practise regularly.

I find that my muscles get sore after half an hour or so.

Get a pen that you find comfortable to use.

It doesn't matter if it is a ballpoint or a fountain pen.

Fountain pens tend to lead to better writing.

So if your handwriting is poor, you might think of using one.

Remember, the examiners will try to read what you have written.

But if your writing is illegible, you will get no marks.

As an examiner I would spend several minutes trying to decipher difficult writing.

If I failed, I would pass it to another examiner.

If they found it to be illegible, then that section got no marks.

If people already find your writing difficult to read, you need to make an effort to improve it. 

 

You should prepare as many model answers as you can.

Do this under exam conditions first.

To get started, use one of the books with MRCOG essays.

Don't cheat by finding the topic in advance and having time to gather your thoughts!

Make sure you read the question carefully.

I once had a good trainee.

He wrote an essay on progestogenic drugs which, I am sure, was very good.

Unfortunately he had been asked to write an essay on anti-progestagen drugs.

He passed the next time!

Think about the information given.

Why does it mention dyspareunia?

What is the significance of her being 55 and so on?

Assume that every element of the question is relevant.

Remember: 26 minutes and one piece of paper.

You used to have to work out what the scoring system was likely to be.

Nowadays the template gives you this.

What are the key points you need to make to get all the marks for each section of the template?

 

The College has put ten short essay questions with their marking sheets on the web site.

Go to the web site.

Sign in as a trainee.

Go to "Examinations", then "MRCOG exam aids" and finally "Sample SAQs".

These give a good idea of how marking systems are made up.

 

When you have finished the essay, sit down with your reference books, College guidelines etc. and refine what you have written.

You can take as long as necessary.

Even better would be to do the exercise with a colleague who is also sitting the exam.

Between you, you are likely to think of all the scoring points.

The final product goes on a card.

Put the essay question on the front.

Put a number, denoting the number of key topics you have dreamt up, on the front.

Put the key topics on the back.

Remember that you have to fit the essay onto one piece of A4 paper in the exam.

And you have 26 minutes in total per essay.

So don't write a mini-textbook.

Few things will attract more than two marks.

The exception will be lists of investigations, treatment options, differential diagnoses etc.

If you mention a drug, include dosage, major side-effects and complications.

As most drugs are safe, it will mainly be dosage.

E.g. heparin and the need to check the platelet count or carbimazole and agranulocytosis.

Timing might be relevant: e.g. with clomiphene.

Resist the temptation to prattle on because you know something in detail.

 

If one of your prepared essays comes up in the exam, you have a head start.

It should not take more than a few minutes to read the question and adapt your model essay to the template given in the exam.

You should be able to get it down on paper and check it in less than 15 - 20 minutes.

This means that you will have extra time to deal with the topics that you have not prepared.

 

See the section below on “spotting” questions and prepare model answers for anything you think likely.

 

Many of the patients you meet in clinical practice will have problems that could form the basis of an essay.

Make a note of one or two cases as they present in each clinic and write essays.

 

In the exam itself, spend the first few minutes reading the question carefully and several times.

The examination committee will have worded it precisely to ensure that the subject can be covered in the time you have.

You could have a question on the investigation of a patient with PMB.

The wording of the question and the answer template will exclude treatment and there would be no marks for anything you wrote about it.

 

A classic essay question was the first one to appear in the exam about domestic violence.

The question detailed a woman attending the antenatal clinic with multiple bruises.

It went on to say that full medical and haematological investigation were normal and to ask about the management.

I marked this question and the pass rate was abysmal.

Most people ignored the advice about the investigations being normal and repeated all the tests they would do.

For which endeavours they got no marks!

I have never seen so many people score zero!

 

Do you need an introduction?

Only if it is going to get marks and the template includes it.

In the essay on PMB you might start off saying it is important.

You would quote the SIGN guideline which says that 5 -11% of women with PMB have endometrial cancer.

You could add that it could be malignancy anywhere in the tract.

Even ovarian cancer can present with bleeding, which it does in about 15% of cases.

You would not waste time and paper defining PMB.

 

Try to think of all the people who might be involved in the answer.

This might include:

    the family,

    future children,

    hospital staff,

    other patients (e.g. the woman with chickenpox in early pregnancy)

    and the general public.

 

Think of a timeline.

A useful model is a graph.

In a question relating to pregnancy, the timeline would be the X-axis.

Go through:

    pre-pregnancy counselling,

    pre-implantation genetic diagnosis,

    each trimester,

    each stage of labour,

    the puerperium,

    breast-feeding (very important if she is HIV +ve or taking drugs)

    the neonatal period and infancy,

    adulthood for the child (e.g. the effects of having IUGR)

    post-pregnancy: contraception etc.,

    subsequent pregnancy. 

You might even go on to her middle age as in the woman with gestational diabetes.

The Y-axis would be all the people involved:

    the patient,

    the fetus,

    her partner, 

    existing children,

    future children,

    other family members,

    staff,

    other patients

    and so on.

 

Conditions like thyroid disease should make you think about the effect of pregnancy on the condition and vice versa.

The Y-axis would also include protocols, audit, risk-management, debriefing, consent, complaints etc. as appropriate.

For example, risk-management in relation to epilepsy and pregnancy would start before conception.

Ensuring that all women with epilepsy know:

    the risks of pregnancy for them,

    the risks of pregnancy for the fetus, particularly congenital abnormality,

    the risk to the child e.g. the risk of having epilepsy or being dropped, smothered or drowned,

    and the need for pre-pregnancy counselling at least six months before conception.

It would include other advice such as that from the Maternal Mortality Reports.

This includes ensuring that family and work colleagues are trained in the management of a seizure.

You can make up your own graphs for both gynaecological and obstetric patients to ensure you don’t forget anything important.

 

Train yourself always to think laterally to get the extra marks, particularly by including:

    audit,

    risk-management,

    protocols,

    training: induction programmes, CTG and resuscitation training, fire-drills etc.,

    multi-disciplinary teams etc.

     

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7.    Spotting Essay Topics.

See also "possible essay topics".

This is a useful game.

Think of the poor exam committee. 

They have to dream up the questions.

Some topics are important and recur:

    management of cancer,

    terminal care,

    diabetes and pregnancy,

    management of obstetric emergencies and so on.

These will be dragged out of the database from time to time.

They will also try to include stuff that is new or topical.

They may have read about this in TOG or an editorial - see below.

So it is really important to have read TOG and the editorials in the leading journals for at least the past couple of years.

Khaldoun Sharif tries to keep up-to-date stuff on his blog.

Some of these topics are bound to find their way into the exam.

Nowadays the essays tend to be straight-forward clinical problems.

So, you are not likely to have an essay on pre-pregnancy counselling for Fragile X and FXTAS.

But you could in relation to cystic fibrosis.

Fragile X and FXTAS would be more likely to be in the MCQs or EMQs, being more esoteric.

And you could be asked difficult stuff, like the range of triplet repeats for normal, carrier and affected statuses. 

A topic that appeared in the last exam is not likely to reappear for a few years.

Most people will be aware of recent questions and have thought about how they would have answered.

So, it is useful to know the questions that occurred in the papers over the past couple of years.

The exam has to test you on all the basics and anticipates an awareness of things of topical interest.

TOG and the review books try to keep all the important and topical issues up-to-date.

So it should be no surprise that as many as half of any batch of essay questions will have featured in recent TOG articles.

Make sure that you have read the back issues from the previous two or three years.

Current topics appear as editorials and leading articles in journals such as the BMJ, Lancet, British Journal of O&G, etc.

It is worth spending an afternoon once a month in the library going through them for the past couple of years.

Make out cards on each topic.

The articles will generally give comprehensive answers that would make perfect model essays.

Now go to: "possible essay topics".

     

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8.    Practise CTG interpretation.

You need to be good at CTG interpretation.

Mainly to keep your patients and their babies out of harm and to reduce interventions.

But also to pass this exam.

There is advice from NICE.

And there are lots of books.

The Perinatal Institute has produced a free trainer and would advise you to use it unless you have an equivalent.

As this is such an important skill and one that is in daily use, I think it is great that the trainer is freely available.

         The RCOG with other bodies has produced eFM, "electronic fetal heart rate monitoring.

           NHS staff can use it free of charge.

           Others have to pay £100 per annum.

            This is a lot for one course, but it is a core skill and features regularly in the exam.

            It has sample sessions that you should have a look at to see if you feel it is worth the money.

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Difficult-to-remember topics & last-minute revision.

Start your planning now and book study leave.

I usually get a few sad e-mails in the weeks before the exam from candidates wanting advice about what last-minute topics to study.

Too late!

Some stuff just does not stay long in your head.

Mostly things that you do not deal with every day.

Make out cards well in advance or load them into whatever alternative revision system you are using..

Rehearse them like all your other cards.

But mark them in some way or keep them separately so that you can get all of them out in the days before the exam.

For example, use cards of a different colour or put a coloured sticker on these cards.

The important thing is to be organised.

There used to be a really useful book for last-minute revision called "Aids to O&G" by Gordon Stirratt, but the latest edition was a long time ago.

It was invaluable as it used key bullet points and even big subjects were covered in one or two pages.

 "Key Clinical Topics in Obstetrics & Gynaecology" edited by Emma Crosbie et al and published by Jaypee Brothers was published in 2014.

I know Emma well as she used to attend my MRCOG teaching and has lectured on a number of courses run by me, so I am not impartial when it comes to her book..

She gave me a copy a few weeks ago, asking my opinion - it is excellent.

It does not quite reduce topics to bullet points and it does not have all the topics you might get in a bigger book.

But all the important subjects are there and the chapters are very short.

I think a lot of people would find it invaluable for revision.

When  you study a topic, you could read the section in the book and annotate it.

You would then have a real aid to last-minute revision.

Topics.

1ry amenorrhoea. (MCQ4, question 6)

Ambiguous genitalia at birth. (MCQ9, question 5)

Precocious puberty. (MCQ6, question 22)

Vaginal discharge in a child. (MCQ1, question 23)

Adreno-genital syndrome. (MCQ6, question 23)

Staging of gynaecological cancer.

Treatment of gynaecological cancer.

Palliative care.

FIGO table of prognostic features in trophoblastic disease. (MCQ6, question 19):

    this may seem super-specialist,

    but there has been an essay on the subject

    and it is in the MCQ database

Maternal mortality: (MCQ5, question 18; MCQ9 question 1):

            main causes, direct and indirect,

                list them on your cards in order and with numbers, as some of these will stick,

            main causes internationally,

            ten top recommendations:

                these would make a perfect essay,

  the "Back to Basics" chapter, which would also make a perfect essay, 

            early warning systems.

RCOG: maternity dashboard. See RCOG website.

Complaint procedures. See document on the website.

Consent for specific procedures: RCOG website.

Malaria & pregnancy. (MCQ12, question 25), TOG: 2005; 7:1:5-11 and Malaria Site.

Tuberculosis & pregnancy. (MCQ12, question 21) and CDC fact sheet.

Infection in pregnancy: see TOG: 2009; 11:2:108-116 for a very good summary - exactly what you need!

WHI figures & HRT. (MCQ7, answer 17)

NICE & UK's National Screening Committee and screening for T21. (MCQ4, question 26; MCQ11, question 10):

 

    not just the recommendation re combined first trimester screening,

 

        you need figures about sensitivity, screen +ve rates etc.

 

Fragile X syndrome. (MCQ2, question 40)

   

    This has not yet appeared as an essay.

   

    But it will one day and cause havoc.

 

Drugs for PID.

 

Heart disease & pregnancy.

Inheritance of congenital heart disease.

  

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Book study leave.

Your last-minute-revision list will grow quite large.

Much of the detail will only stay in your short-term memory.

You need adequate time in the days before the written to go over it.

Make sure you have all the topics in note form - this time should be for revision, not new learning

Book your leave early so that you don't have problems in the run-up to the exam fighting for authorisation.

  

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OSCE skills.

Once you have passed the written exam, you know that you have the necessary knowledge.

The OSCE tests this knowledge again, mainly seeing how you would apply it in a clinical setting.

And how you communicate with patients.

As you have the knowledge, it is mostly about technique.

Use these links:

     hone your communication skills

     make sure you have the necessary practical knowledge

     prepare all known types of station

    go on an OSCE course

 

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8.       Hone your communication skills.

You should think about improving your communication skills in anticipation of the role-play stations.

And, more importantly, to make you a better doctor.

I like my trainees to use a set form of words when:

    introducing themselves to patients,

    encouraging patients to ask questions,

    explaining difficult concepts like recessive inheritance etc.

Start with the forms of words I have suggested.

They work for the exam.

Once you start using them with patients, you will modify them and end up with forms that suit you and reflect your style.

That's fine, so long as you are sure that they are an improvement on my suggestions.

You can find details on this web page.

Many hospitals have training in general communication skills and in dealing with specific problems like breaking bad news.

Get on these courses and start honing your skills.

Most importantly, practise the following:

speaking slowly: one of the most common problems is speaking too quickly,

introducing yourself to the patient,

avoiding big words and medical jargon,

explaining terms like recessive inheritance,

listening to the patient and picking up clues, both verbal an non-verbal,

good techniques for getting her to ask questions.

       

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Make sure that you have the necessary practical knowledge.

You don't want to be caught out by lack of practical knowledge.

Could you talk throught the steps taken in hysterectomy or vaginal hysterectomy?

Make sure you have assisted with enough cases to be able to discuss such topics in a viva.

Even better, do a few cases yourself.

Have you seen colposcopy, loop excision, hysteroscopy?

Can you demonstrate the use of Kiellands forceps?

Can you distinguish between a cystoscope and a hysteroscope?

Ask the gynae theatre sister to talk you through all the common surgical instruments, their names and what they are used for.

Can you tie proper knots and explain to a trainee how to do it?

Familiarise yourself with urodynamics.

And not just from the books.

Attend a clinic to see what is done.

Then attend a session with a uro-gynaecologist or urologist to learn how to interpret printouts.

The OSCE bank has a station in which you are taken through taking a history of a patient with urological problems.

You are then asked for the appropriate investigations.

When you say "urodynamics" you are given the printout and asked to come up with the diagnosis.

Get it prepared!

 

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9.       Going on a course.

Most people attend at least one course.

There is a huge array of courses.

If you live in the Manchester area, you are welcome to attend my weekly tutorials.

Even if you are only in the area on a short term visit, we will be pleased to see you.

There is no charge for the teaching.

 

It would also make sense to attend the North West MRCOG Course.

This is a six-day course with masses of essay-writing practice.

As the essays are the bit most people fail, this makes the course particularly attractive.

Varsha Mulik, who runs it, puts in a prodigious amount of effort and it shows.

I have taught on the course a couple of times and have been impressed.

 

You can find other courses via Google on the Internet.

They are also listed on the College web page: MRCOG Revision Courses .

A listing on the College web page is not a College seal of approval.

The College just lists any course of which it is informed.

So, if you are disappointed by the course you attend, don't blame the College!

I can't vouch for their quality apart from the ones run by the College itself - they are the only ones I have taught on.

The feedback I get about the others is that they range from OK to excellent.

I haven't heard of any really bad ones.

The RCOG's own courses are very popular.

I used to teach on these and they were well organised and "fit for purpose", as the jargon has it.

At the British Congress in 2007 I heard that their recent pass rates had been ~ 60%.

This is equivalent to the overall pass rate for UK graduates.

These are excellent results, as most of those attending have not worked in the UK.

The popularity of the College courses is reflected in the fact that they are fully-booked months in advance.

If you want to attend, book early.

Note that there are separate RCOG courses for the written and the clinical examinations.

 

The College now takes its courses to other countries.

You may find one that is a lot easier for you than coming to the College itself.

You will be able to find details, as they emerge, on the MRCOG Revision Courses web page.

 

There are other overseas courses already established.

Some are on the MRCOG Revision Courses section of the RCOG website.

You should be able to find others by "Googling" "MRCOG course + the country you want".

They ought to be of a similar standard to the UK courses.

Most, if not all, have UK Members and Fellows on their faculties.

This should help ensure that they keep abreast of changes in the UK.

However, with the abundance of talent available locally in most countries, they should eventually be self-reliant.

They will have two main advantages:

    the cost of attending them will be a fraction of the costs of coming to a UK course,

    the organisers will have particular knowledge of the differences between practice in the region and the UK.

Most courses in the UK don't focus on the needs of the doctor who has not worked in the UK.

Overseas courses will be able to do so with special insight.

Like all courses, the best thing will be to find someone who has attended and get their opinion.

 

There are on-line courses.

Evelyn, one of my trainees, used one of these, "RCOG Courses"  and passed the written exam.

She felt that she had gained a lot from it, especially in improving her essay-writing.

I don't have any information about any of the others.

 

Most of the UK courses are very expensive.

Despite this, they are not sufficient to get you through the exam on their own.

You need to do a load of other preparation.

If you are not prepared to do this, don't waste your money on a course!

 

If you go on a course, let me know what you thought of it so I can advise others.

 

If you have not worked in the UK, read the section on "special requirements" before booking a course.

     

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10.       Consider your special requirements if you haven't worked in the UK.

There may be differences in clinical practice between the UK and the hospitals in which you have trained.

However, most of these should be obvious from reading:

    RCOG and NICE guidelines,

    textbooks by UK authors,

    the papers I have written on topics that are not always well-covered in the textbooks.

 

Despite being on a tiny island, the RCOG refers to all non-UK doctors as "overseas".

England (forget other parts of the UK such as Scotland) remains the centre of the universe!

I look forward to the arrival of little green men from billions of light-years away who say they are doctors.

They will be able to apply for membership of the RCOG as "overseas" doctors.

.

The bigger differences are likely to be the patients and management practices.

Part 2 books written by non-UK authors are beginning to appear.

 

E.g. "MRCOG. A structured approach".

This is by Drs. Reddy & Ram and published by Orient Longman.

It is an excellent guide to the exam.

It has the particular virtue that the authors work in Chennai & Hyderabad in India, but know the UK system well.

 

In some countries patients expect the doctor to have a single diagnosis and treatment.

If a doctor gave them four treatment options, they might think the doctor did not know what they were about.

In the UK, many patients behave like this too.

But others will want to know the possible diagnoses.

Most will want to know the range of treatment options.

Some may have read up on the subject on the Internet or in the library.

This could make them genuinely expert on a subject, but could equally give them a load of daft ideas.

Most patients will expect to have a conversation with the doctor and be given a reasonable amount of information.

Doctors need to supplement oral information with the printed variety.

There are plenty of doctors to pick from, so patients can afford to be "choosey".

This makes communication skills and "bedside manner" particularly important.

 

You need to understand about consent, which could be an OSCE roleplay.

You also need some basic understanding of the structure of the NHS and how it links with other bodies:

    what is the role of the Department of Health? 

    what is the role of the General Medical Council? 

    what is NICE?  

    what is the Healthcare Commission? 

    note that the Healthcare Commission has a role in hospital complaint procedures.

    what are Trusts and what do they do?

    what services are provided by community services?

    what do social services do?

    how do hospitals, General Practitioners and social services interact?

It is important to have a grasp of Clinical Governance, Audit, Risk Management, Protocols etc.

 

If you go on a course, look carefully at the programme.

Make sure that there is adequate time allocated to these topics.

It is likely that "overseas" courses will deal with these areas more than those in the UK.

Time spent on these issues will be far more useful than, for example, sitting for hours doing MCQ papers that you could do at home!

I am sorry to say that many courses still waste valuable time on MCQs which means not doing stuff of vastly greater importance.

I don't allocate any time to MCQs in my MRCOG classes.

There are masses of books of MCQs in addition to the ones linked to this site.

Spending time on the technique for EMQs would be reasonable.

An ideal course would include time spent on:

    updating key clinical topics, particularly in sub-specialties e.g. chemotherapy & ovarian cancer or thrombophilia & pregnancy,

    (you don't want to waste time on standard topics like diabetes - cover these from the books,)

    updating clinical governance, audit, risk management, complaint procedures etc. using:

        didactic teaching,

        small group sessions writing essay plans or practising vivas for these topics,        

    practising communication skills in small groups using roleplays:

        doing OSCE circuits is great, but small group sessions are invaluable.

        in my training sessions we could easily spend an hour dealing with one roleplay,

        what are the key things to discuss?

        how would you explain Down syndrome?

        what is the best way of explaining the concept of screening?

        The aim of small group roleplay practice is to develop techniques so as to improve your performance.

        It also highlights areas that you need to improve - a tendency to use medical jargon or to speak too quickly.

        You don't need to go on a course to do this.

        You can do it with a colleague, relative or friend. 

        You be the candidate, they the role-player.

        Ideally have someone who is also sitting the exam to be there to comment.

    practising how to survive talking for 15 minutes in a viva,

    how to write short essays:

        exactly what is the essay about?

        what are the key points likely to be awarded a mark?

        how can you summarise these key points so they all get covered?

        will there be marks for mentioning protocols, risk management, multi-disciplinary working etc?

    technique for EMQs and MCQs.

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