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 website.

Return to "Suggested Reading".

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.

Return to "Suggested Reading".

b.  The next vital reading is:

        The Obstetrician & Gynaecologist, usually known as "TOG"

       Many of the 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 helpful, but not so important - OK if you have the time and money.

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

Return to "Suggested Reading".

The College also publishes StratOG.

I think it is quite expensive and don't use it much, but I am told that recent exams had identical question.

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.

Return to "Suggested Reading".    

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 questions in the written 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.

Return to "Suggested Reading".     

d.  MBRRACE took over the production of maternal and perinatal mortality reports.

It produced its first Report in 2014.

This will generate a lot of EMQs and SBAs.

Return to "Suggested Reading".

e. Use a textbook to fill in gaps. 

"Obstetrics & Gynaecology An Evidence-based Text for MRCOG" was published in its 3rd. edition in 2016.

The editors were Luesley & Baker, but are now Luesley & Kilby.

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".

I don't know when that will come out in a new edition.

The standard textbook used to be "Dewhurst".

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

It is now a bit out-of-date, though I am sure that a new edition will come soon.

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

Return to "Suggested Reading".

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.

The papers and answers are on Dropbox - send me an e-mail if you are interested and I'll link  you to them.

Return to "Suggested Reading".     

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 for written 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:

Return to "Suggested Reading".

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 British Menopause Society & Women's Health Concern recommendations on HRT from 2013.

And:

    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:

Return to "Suggested Reading".

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:

 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.

Return to "Suggested Reading".

Sexually transmitted diseases will certainly feature.

The "ABC" book is adequate.

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

Return to "Suggested Reading".

Genetics crops up all over the place.

Most of it is covered in the MCQs.

The text below amplifies the MCQs.

Return to "Suggested Reading".    

 

The RCOG stopped publishing in 2013 and most of its books are now produced by Cambridge University Press.

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

Subjects included:

    antenatal disorders,

    gynaecological oncology,

    gynaecological urology,

    haemorrhage and thrombosis,

    infertility,

    intrapartum care,

    medical genetics,

    psychological disorders,

    reproductive endocrinology.

They are invaluable for filling gaps but watch out for the date of publication: some will soon be pensionable.

Return to "Suggested Reading".

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. the written or the OSCE.

Some are now very old and of limited value.

I would give them a miss.

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

The more you practise the better.

Remember to practise time-keeping too.

Return to "Suggested Reading".

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.

Their role has largely been superseded by “TOG” and I doubt that modern trainees use them..

Return to "Suggested Reading".      

"Handbook of Obstetric Medicine"  by Catherine Nelson-Piercy is valuable for filling in gaps.  

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.

Return to "Suggested Reading".      

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.

Return to "Suggested Reading".      

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.

Return to "Suggested Reading".      

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.

Return to "Suggested Reading".      

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.

Return to "Suggested Reading".

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

Return to "Suggested Reading".      

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

Return to "Suggested Reading".      

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.

Return to "Suggested Reading".

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 cannot just read and hope that everything relevant will stick.

There is advice from Elaine and Lucy.

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, isk 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 cannot 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 do not fully understand.

You cannot 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.

Do  not 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.

Return to "List of contents".  

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.

Return to "Learn and practise appropriate techniques".

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.

Return to "Learn and practise appropriate techniques"

EMQs and SBAs.

Return to "Learn and practise appropriate techniques"

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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.

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.

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

Return to NW OSCE course.

Return to "Should I go on an OSCE course?"

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8.       Hone your communication skills.