how to pass the part 2 mrcog - volume 3 · part 2 mrcog examination change, the candidates are...

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© Dr Sudipta Paul, themedideas.com, 2012 1

How to pass the Part 2 MRCOG Examination - Volume 3

Dr Sudipta Paul

Important Notes from themedideas.com

This is an article for the Part 2 MRCOG Examination published by themedideas.com to help

the candidates improve their understanding of the Part 2 MRCOG Examination. It is not

guaranteed that the candidates would pass the Part 2 MRCOG Examination by reading this

article only. The discussions are not exhaustive on the topics covered. These aim to highlight

the important relevant aspects of the topics rather than every minute detail, which is outside the

scope of this article.

While every effort has been made to provide updated information, as format and style of the

Part 2 MRCOG Examination change, the candidates are advised to consult recent information

from the RCOG as well.

While every effort has been made to ensure the accuracy of the information, no responsibility

for loss or injury whatsoever occasioned to any person acting or refraining from action as a

result of information contained herein (questions and answers) can be accepted by the

themedideas.com.

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not save it on the hard disc/portable device, make copies, print, publish or e-mail it to

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by the themedideas.com.


Your preparation for the Part 2 MRCOG Examination

Level 3 analysis: How do you do well in the Test?

This article is the Volume 3 (the last volume) of "How to pass the Part 2 MRCOG Examination"

series that consists of three volumes. It discusses comprehensively the “Level 3 analysis: How

do you Plan, Prepare & Perform well in the examination?”

This volume provides a comprehensive coverage of the preparation, answering techniques and

tips for different formats e.g. EMQs, MCQs, SAQs and OSCEs to improve the candidates’

performance in the examination. The candidates must understand these thoroughly to learn the

rule of the game. In fact it is more important than just reading as you would benefit greatly from

these information and tips. It also includes in depth analysis of the answering techniques for

different components of the examination e.g. EMQs, MCQs, SAQs and OSCEs, and strategies

to maximise the marks obtained in the examination. These techniques have been used

successfully over the years to increase the efficiency of the preparation for the examination and

achieve higher marks. The candidates would definitely improve their performance in the

examination if they could implement these techniques appropriately. By following these

techniques they would have an edge over the other candidates taking the examination.

The format of the Part 2 MRCOG examination has changed significantly since March 2011.

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Dr Sudipta Paul

Since then the emphasis has shifted substantially from the SAQs to the EMQs primarily and

the MCQs to a lesser extent. This means that the candidates need to modify their approach

towards the examination. Several candidates, especially who have appeared in the

examination before, but have been unsuccessful, are frightened and confused about how to

prepare efficiently given the enormity of changes in the format.

This effort is meant to guide and help the prospective candidates prepare well so that they

would be in a better shape when they appear in the examination. Over the years, hundreds of

candidates have benefited by following these methods.

The candidates would also find it helpful to use the examination and trainee materials provided

in the MCQs, EMQs, SAQs, OSCEs, Examination, Career, Trainee and Health sections of

themedideas.com in the form of Banks, Tests, Articles etc.

Dr Sudipta Paul

MD, FRCOG, DFFP, CCST

Consultant Obstetrician & Gynaecologist

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Dr Sudipta Paul




A. The written Examination

I. The MCQ papers

(i) The facts

(ii) The preparation

(iii) The technique

II. The EMQ papers

(i) The facts


(iii) The technique

III. The SAQs paper

(i) The facts


(iii) The technique

B. The OSCE

(i) The facts


(iii) The technique

Ten Commandments for the Part 2 MRCOG Examination

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A. The written Examination

Introduction

* This is the first and a difficult hurdle to cross.

* The pass mark to qualify for the OSCE is variable.

* The pass rate is usually lower than that in the OSCE.

* The SAQs paper account for 90 marks. There are standard model answers for the SAQs and

the marks awarded depend on the number of correct points mentioned matching the model

answer. As it is not possible for the examinee to know the points in the model answer, it might

be difficult to obtain higher marks in the SAQs paper.

* The EMQs and MCQs papers account for 210 (120 + 90) marks. As these are objective,

higher marks could be obtained with proper preparation. It might compensate for lower marks

in the SAQs paper. Therefore, the aim should be to obtain as high marks as possible in the

EMQs and MCQs papers.

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Dr Sudipta Paul

I. The MCQ papers

(i) The facts

* The two papers contain 240 MCQs (120 in each paper with 45 EMQs).

* There is variable number of stems (topics) with variable number of responses to each stem

(usually 1- 5). The total number of responses is 240 (120 in each paper), each carrying equal

mark.

* The MCQ Bank is being updated continuously replacing outdated and controversial questions

by new standard questions (neither too easy nor too tough).

* There is no negative marking.


* There are few MCQ books on the market, but only a handful of them are useful. There are

MCQs available on the internet as well. You should search for them and read the ones that you

find useful.

* Remember common facts and figures, causes, clinical features, investigations, complications

and management of all important topics.

* Practise answering MCQs under an examination setting.

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Dr Sudipta Paul

(iii) The technique

* It might be better to answer the MCQs first before proceeding to the EMQs in the

papers as it is relatively easier to obtain marks in the MCQs if you knew the answer.

* Read the question carefully and answer it at its face value, do not try to find any hidden

meaning.

* Answering 120 responses on different topics in approximately 50 minutes (leaving 85 minutes

for 45 EMQs in the paper) is a brainstorming exercise that often leads to technical errors in

answering as you get only 25 seconds to answer each MCQ.

* In this circumstance, it might be worthwhile to answer the familiar MCQs first without wasting

time to think about the answers of the unfamiliar MCQs, then proceeding to the unfamiliar

MCQs later.

* It might be better to answer the sure shot MCQs in the first round, the familiar but less

certain MCQs in the second round and the rest in the third/ fourth round. It has got three

advantages –

Firstly, after the first round the standard of the MCQ paper would be obvious.

Secondly, it might reduce the number of technical errors in answering sure shot MCQs.

Thirdly, if the number of the MCQs in each round is noted it would give some idea about

your performance. It would be useful for future MCQ examinations.

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Dr Sudipta Paul

* It might be time-saving to mark the true(T) / false(F) answers on the question paper and

transfer them to the answer sheet later as then you do not have to switch between the

question paper and answer sheet for each MCQ. It distracts attention as well that might

lead to unnecessary mistakes. Be careful to keep at least 12 minutes (6 seconds per

MCQ) to do that or do it after each round, which is a safer alternative. Alternatively,

lightly block in your answers on the answer sheet as you go along, and then boldly mark

over them at the end.

* As there is no negative marking all the MCQs should be answered, as you have

nothing to lose.

* When guessing, always follow your first impression as it is more likely to be correct.

II. The EMQ papers

(i) The facts

* The two papers contain 90 Extended Matching Questions (EMQs) (45 in each paper

with 120 MCQs).

* It tests more complex understanding than the MCQs.

* It covers a wide range of topics than the short essays.

* There is no negative marking.

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* There are few EMQ books on the market, but only a handful of them are useful. There are

EMQs available on the internet as well. You should search for them and read the ones that you

find useful.

* Remember common facts and figures, causes, clinical features, investigations,

complications and management of all important topics.

* Write down the important aspects and the management of all common problems and

uncommon but important situations encountered at work. Try to implement it into your practice,

which would make it easier to remember and reproduce in the examination. The need for

adequate involvement in day-to-day patient management cannot be overemphasised as

the EMQs are usually clinical problem oriented.

* Practise answering EMQs under an examination setting.

(iii) The technique

* The most important aspect is to select the single answer that best fits. Apparently,

there might be several answers that are related to the question, and are not wrong, but

you must select only the most likely one (for that question) from the option list. The

answer would also depend on the other questions in that EMQs set. Therefore check

which of the related options fits best with which question.

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Dr Sudipta Paul

* It might be useful to select the possible answers first, and then try to exclude them.

The answer that cannot be excluded by any logic at all would be the most likely one.

* It might be worthwhile to answer the familiar EMQs first without wasting time to think about

the answers of the unfamiliar EMQs, then proceeding to the unfamiliar EMQs later.

* Read the question carefully and answer it at its face value, do not try to find any hidden

meaning.

* Answering 45 responses on different topics in approximately 85 minutes (leaving 50

minutes for 120 MCQs in the paper) is a brainstorming exercise that often leads to

technical errors in answering as you get only 1.89 minutes to answer each EMQ.

* It might be better to answer the sure shot EMQs in the first round, the familiar but less

certain EMQs in the second round and the rest in the third/ fourth round. It has got three

advantages –

Firstly, after the first round the standard of the EMQ paper would be obvious.

Secondly, it might reduce the number of technical errors in answering sure shot EMQs.

Thirdly, if the number of the EMQs in each round is noted it would give some idea about

your performance. It would be useful for future EMQ examinations.

* It might be time-saving to mark the answers on the question paper and transfer them

to the answer sheet later as then you do not have to switch between the question paper

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Dr Sudipta Paul

and answer sheet for each EMQ. It distracts attention as well that might lead to

unnecessary mistakes. Be careful to keep at least 10 minutes (13.33 seconds per EMQ)

to do that or do it after each round, which is a safer alternative. Alternatively, lightly

block in your answers on the answer sheet as you go along, and then boldly mark over

them at the end.

* As there is no negative marking all the EMQs should be answered, as you have

nothing to lose.

* When guessing, always follow your first impression as it is more likely to be correct.

III. The SAQs paper

(i) The facts

* The paper contains four SAQs (two Obstetrics and two Gynaecology) each carrying

equal marks.

* Most of them would be on practical problems faced in the clinics, wards, labour ward

and theatres.

* Each SAQ is usually broken down into two to four parts with individual marks.

* The parts of each question are printed on different areas of an A4 size page with

specified spaces to write, and the answers must be completed within those specified

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Dr Sudipta Paul

spaces provided on two sides of that page.

* Formal introduction and conclusion are not essential requirements.

* The answer would generally cover three broad areas that are checked (1) concept on the

topic (background to and context of the topic), (2) clinical acumen and (3) justification for the

proposed management.

* Marks would be awarded only for points included in the model answers.

* The total time for the paper is 105 minutes allowing 26.25 minutes per essay.


* There are few SAQ books on the market and you could get information on the SAQs from the

internet. Search for them and use what you find helpful.

* You cannot do the preparation by sitting in the library.

* First, make a list of all common problems and uncommon but important situations

encountered at work. Then go through the literature and discuss with a colleague who is

academically up to date. Also check the TOG (RCOG), the Royal College guidelines and other

recommendations (e.g. NICE). Write down the important aspects and the management of the

topics on your list. Try to implement it into your practice, which would make it easier to

remember and reproduce in the examination. The need for adequate involvement in day-to-

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Dr Sudipta Paul

day patient management cannot be overemphasised as the majority of the SAQs would

be based on clinical problems.

* Making a list has several advantages –

1. The actual workload would be known. It would be easier to make an efficient plan

regarding how to deal with the workload. It would also reduce the fear of the unknown that

would have appeared otherwise when the actual workload is unknown.

2. The most important topics would be evident. Therefore, the energy could be directed

towards the most productive areas that would increase efficiency (marks obtained per

unit / hour of reading or preparation). This is one of the important benefits of making a

list of topics according to the ranking of their importance in relevance to the

examination.

To learn in detail how to prepare a list of important topics for examination see

http://themedideas.com/career/examination/the-secrets-of-preparing-suggestions-for-any-examination/

3. As you go through the list you could assess your progress and modify your plan

accordingly, depending on your progress so far. With your progress recorded on the list it

is very easy to modify the plan in relation to the workload and time as you could assess how

long you have been spending to prepare each chapter or topic.

4. Once you have completed your preparation on all the topics on the list you

would feel confident that you have not missed any relevant topics in the syllabus. A

confident candidate usually performs better in an examination compared with an inconfident or

anxious candidate. The self-confidence would definitely boost your performance in the

examination.

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Dr Sudipta Paul

5. You could add the number of topics that have been completed and find out what

percentages of the total topics you have covered. You could vary this according to your

individual requirements and target marks you would like to achieve in the examination.

6. It is easier to recall information that is fed in a systematic order to the brain. This is a

very important issue. If you read the same number of topics over a period of same

duration, it would be easier for you to recall facts from your memory if you have read

the topics in a systematic manner (or in an order) compared with reading them without

any sort of order (haphazardly).

* Practise writing short essays in an examination setting within two sides of a page (A4

size) in 22 minutes leaving 4.25 minutes for revision. It is the best way to improve the

SAQ writing skills and performance in the examination.

* The majority of the candidates who fail, lack the skills of writing short essays in an

examination setting leading to poor performance in the examination.

(iii) The technique

* The most important factor is to consider all the SAQs with equal importance and

answer them properly. It would be almost impossible to compensate for two SAQs being

answered badly. The minimum optimum target should be to answer at least two SAQs

very well and one SAQ average to good that might compensate for a bad to average

answer for the fourth SAQ. If all the four SAQs could be answered well that would be the

best anyway.

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Dr Sudipta Paul

* First check the questions in the SAQ paper carefully and mark 1, 2, 3, 4 against the

questions as per the order you would answer them. This would reduce any possibility of

confusion later.

* It might be better to start with the SAQs you are familiar with the answer and answer

uncommon essays subsequently. If you started writing an uncommon SAQ first and had

taken relatively long time, it might create a lot of anxiety while writing, affecting the standard of

the answers of the common SAQs as well, along with shortage of time, later. On the other

hand, if you completed answering the common SAQs within a reasonable time, you would have

adequate time to think about the answers of the uncommon SAQs in a relatively free mind.

* It would be prudent to complete each SAQ in 22 minutes (total time = 88 minutes)

keeping 17 minutes (4.25 minutes per SAQ) for revision.

* Do not waste too much time for one SAQ because of the fact that you know a lot about

it as you cannot get more than 22.5 marks in one SAQ, but might lose a lot of marks in

other SAQs due to lack of time. In fact, it is unlikely that anybody would get 90% or

above marks in one SAQ, even if it is answered very well. By trying to do that several

marks might be lost in other SAQs if those are answered badly.

* It might be useful to give more time for the uncommon SAQs, as you have to think about the

answer. You should use your judgment regarding how much time you provide to each

individual SAQ.

* Read the questions carefully and identify the key points that you have to cover in your

answer. Beware of the fact that the questions might not always have a direct relation to

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Dr Sudipta Paul

the statement or topic mentioned. Consider each question under the statement or topic

mentioned separately as individual question and answer only what is being asked in

that part.

* Once you have understood what it is asking about, plan the answer and write it down.

Do not write “what you know” about the topic, answer the part of the question

specifically and write what it is asking for. How much you write would be guided by the

marks allotted against each question. A rough guide would be approximately 2 lines per

marks. First think about the points and style of the answer before you write anything.

The space is specified and limited. Therefore, there is not much scope of major

corrections. To be safe, you could write down the outline of your answer on a rough

paper first before you start writing the actual answer. This would improve the quality of

the answer and reduce the necessity of corrections to minimum (that would reduce time

wasted).

* Always, always, always answer the question. Probably the most common reason for a

poor mark is not answering the question, and writing whatever you know about the

topic.

* Always use common sense and think how you would manage the problem in your

practice. Even if you get an uncommon question that, at first thought, appears that you

do not know anything about at all, do not panic. Answer the questions you know first

then try to think about the uncommon question using your common sense, you would

be able to write something at least. Follow the basic principles of symptoms, signs,

investigations, diagnosis, treatment etc when you try to find answers for uncommon

topic.

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* Do not hesitate to mention that you (as a Registrar/Specialist Trainee) would involve senior

persons if you think it is appropriate. Do not ever forget to inform the Consultant if you are

dealing with a case of major obstetric haemorrhage!

* Do not start and finish abruptly.

* It would be wise to mention as many relevant points as possible because the points in

the model answers would be unknown. Scoring points may be missed if the relevant points

are not mentioned, but there is no negative marking for mentioning extra points. Be cautious

not to mention something irrelevant, not evidence based and unsafe. There should be a

balance between how much you write and the time it takes (there is page restriction as well).

This balance is also an important factor that is checked in the examination, as it is

relevant in clinical practice.

* Write a short essay, not several lines of relevant facts. Your message should be clear

to the examiner.

* Try to discuss critically using only evidence based facts as it is expected from a

candidate taking Part 2 MRCOG examination. If you have not worked in the NHS system

(UK) you should be extra careful not to write something that you usually do in your

practice but is not evidence based.

* Always revise what you have written before you leave. This is very important. When

you revise, not surprisingly, you would notice something you would like to modify. It

would be better to do that during the examination rather than repenting later.

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B. The OSCE

(i) The facts

* It consists of twelve 15-minute stations, making a three-hour oral examination in total

* There are two preparatory stations where the candidates are given some information (a short

paper, letter from the GP, case or investigation report, patient information leaflet, complaint

letter, research or audit report etc.), which would be used for critical appraisal at the following

station.

What is tested:

* Factual knowledge Clinical, audit, research, statistics, clinical governance

* Dealing with the patient Show respect as an individual, introduce yourself,

address formally, reassure, relieve anxiety, be honest,

be polite

* Attitude towards the patient Non-judgmental, non-patronising, empathetic

* Communication skills With the patient and/or relatives & with the examiner; be

simple, make direct eye contact, positive body language

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* Listening skills Be patient, be careful

* Analytical skills Clinical, audit, research, patient information leaflet

* Decision making skills Clinical

* Counselling skills Discuss pros & cons, be honest


* There are few OSCE books on the market and you could get information on the OSCE from

the internet. Search for them and use what you find helpful.

* There is no alternative to practical experience of managing patients.

* Be familiar with the investigation reports and their interpretations (such as ultrasound scan,

HSG, X-ray, urodynamics, CTG, fetal blood sampling, blood reports, laparoscopic and

hysteroscopic pictures etc.).

* Be prepared to answer about common instruments and operative procedures (such as

ventouse, forceps, caesarean section, fetal blood sampling, hysterectomy, pelvic floor repair,

laparoscopy, tension-free vaginal tape / transobturator tape procedure etc.).

* Make firm logical view about management of common problems, especially

emergencies (such as antepartum and postpartum haemorrhages, shoulder dystocia, cord

prolapse, severe pre-eclampsia and eclampsia, breech presentation in labour, delivery of

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Dr Sudipta Paul

the second twin, prelabour rupture of the membranes, preterm labour, ectopic pregnancy etc.).

* Thoroughly prepare all the counselling you might have to provide in day-to-day

practice (such as preconceptional, missed miscarriage, recurrent miscarriage, antenatal

screening for Down’s syndrome, fetal anomaly, perinatal death, sterilisation, hysterectomy,

laparoscopy, hysteroscopy, abnormal cervical smear, diagnosis of cancer, infertility etc.).

* Prepare how to prioritise different patients on the labour ward. This is quite difficult

even for the candidates working in the UK. During preparation, you need to make a list

with different types of patients, seen on the labour ward, arranged in chronological

order according to the urgency or seriousness of their conditions.

* Be prepared to express your views on topical controversial issues.

* Be clear about the basic principles of audit and research. Be familiar with the Cochrane

database and the way the statistics are presented there. You might be asked to plan an audit

protocol or critically appraise a paper.

* Candidates not working in the UK should collect information about the UK practice.

* Practise answering in OSCE setting with another candidate or a senior colleague.

(iii) The technique

* The OSCE is quite demanding, so sleep well the night before.

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Dr Sudipta Paul

* Dress well (and appropriately)

Male – Black, dark grey or dark blue suit; preferably white shirt and a matching tie.

Polished shoes (and clean socks!)

Clean shaved unless you keep moustache or beard

Neatly cut and combed hair

Neatly cut fingernails

Clean glass (if wearing any)

Suitable perfume (not too much)

Should not smell of cigarettes – Avoid smoking at least for an hour before

going to the OSCE and /or use mouth spray

Female – Suit, skirt or any traditional formal dress (any colour, but not too flashy)

Polished shoes and (clean socks!)

Neatly cut and combed hair

Neatly cut fingernails

Clean glass (if wearing any)

Suitable perfume (not too much)

Should not smell of cigarettes – Avoid smoking at least for an hour before

going to the OSCE and /or use mouth spray

* Reach in time.

* Take it as it comes.

* Look confident.

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Dr Sudipta Paul

* Always, always, always introduce yourself to the patient (actress) and the examiner.

* Always check patient’s identity unless specifically mentioned by the examiner.

* Always explain to the patient (actress) what you are doing or intend to do.

* Always be polite and listen to the patient (actress) and examiner carefully.

* Always avoid using medical terms as far as possible when talking to the patient

(actress).

* Always say sorry and apologise if the patient (actress) becomes upset.

* Always thank the patient (actress) once you have finished talking to her.

* Imagine the Examiner as your supervising Consultant, as if you were discussing

problems at work.

* Outline how you would manage the problem usually, and be ready to justify it.

* Use common sense.

* Be practical in your answer.

* Mention common things first.

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Dr Sudipta Paul

* Do not keep quiet and waste time as you would not score any marks by doing so. If

you do not know something say so and move to the next question.

* Do not say something completely irrelevant, not evidence based or unsafe (as per the

UK NHS practice). Whatever you say be prepared to justify it with evidence. Usually if

you say the right thing (evidence based and safe) it is very unlikely that the patient

(actress) or examiner would contradict you or interfare with your talking. Try to find cue

from what the patient (actress) or examiner says or from their body language. Although

they are not supposed to give you any lead they are human beings and their body

language would reflect their feelings if you take a wrong track. The other interesting

thing is that sometimes subsequent questions / discussions in the OSCE could not be

asked / introduced if the initial one leads to a totally different track. Therefore, there is a

possibility that they might try to bring you back to the right track.

* Do not be frightened if the Examiner disagrees with your views, as he/she might be

testing your confidence. Try to avoid argument, but do not change your answer

illogically just because the Examiner is not agreeing with you.

* Always remember that you have to show a standard of Year 4/5 Specialist Trainee

(Year 2/3 Specialist Registrar in the past) in the UK and tailor your answers to that. You

would sail through!

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Ten CommandmentsTen CommandmentsTen CommandmentsTen Commandments

fffforororor the the the the Part 2 MRCOG ExaminationPart 2 MRCOG ExaminationPart 2 MRCOG ExaminationPart 2 MRCOG Examination

1. Achieve the standard of ST 4/5 in your knowledge regarding the UK NHS practice

before taking Part 2 MRCOG.

2. Practical experience in patient care is more important than theoretical knowledge.

3. Keep up to date and implement your knowledge in clinical practice.

4. SAQs and OSCE questions are usually on problem based practical topics.

5. Practise answering SAQs, MCQs and EMQs papers and practise OSCE in an

examination setting.

6. It is relatively easy to obtain higher marks in the MCQs and EMQs papers than the

SAQs paper. Aim to obtain high marks in the MCQs and EMQs papers.

7. Sleep well the night before the examination (both written and OSCE).

8. Read the question before you write and revise before you leave.

9. Be democratic, give equal importance to all questions and use your common sense.

10. In the OSCE, respond to the examiner as you would to your supervising Consultant,

appear confident and make direct eye contact.

Paul S, 2013

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References

1. Paul S. The changing patterns of the Part 2 MRCOG Examination. Hosp Med 1999;

60:592-595.

2. Paul S. The job and the exam. BMJ Classified Career Focus 1999; 318:2-3.

3. www.rcog.org.uk

N.B. An extra mark scored by any other candidate taking the examination means you need to

get an extra mark to keep the difference in your performance with him or her the same. The

better the other candidates do the more your performance would be devalued. Therefore, your

aim should be to improve your performance, not others’, as then you lose the advantage you

get by planning efficiently.

Thank you for readingThank you for readingThank you for readingThank you for reading &&&&

Best of LuckBest of LuckBest of LuckBest of Luck for the exam for the exam for the exam for the exam

Plan & Prepare efficientlyPlan & Prepare efficientlyPlan & Prepare efficientlyPlan & Prepare efficiently

&&&&

You would surely getYou would surely getYou would surely getYou would surely get

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