How to pass MRCOG

by **mandible** Fri Apr 22, 2011 12:59 am

How to pass the MRCOG
As part of our series to help you succeed in the current postgraduate Royal
College exams, Sabina Dosani and Peter Cross give the lowdown on the
membership exam of the Royal College of Obstetricians and Gynaecologists
and interview examiners and candidates for their tips on passing it.
The MRCOG is in two parts. Part 1, held
in March and September, is the scientific
foundation of obstetrics and
gynaecology. It is a prerequisite to entering
specialist registrar training, consisting of two
multiple choice question papers, each lasting
two hours. Doctors can sit part 1 in their
house jobs or as senior house officers. The
pass rate is 25%. International postgraduates
from countries with comparable training—
for example, Singapore—may be exempt.
Part 2 is designed to test theoretical and
practical knowledge. Candidates are
expected to apply knowledge to management
of clinical problems and demonstrate
knowledge of practical procedures.
Part 2 is also held in March and September.
There are three parts:
+ MCQ paper: One two hour true/false
paper
+ Short answer questions: five on
gynaecology and five on obstetrics
+ objective structure clinical examination.
About 1000 people sit the written component,
which 250 pass. Those who pass take an
OSCE the following May or November. This
has a much higher pass rate, typically
85-90%.
There are no exemptions for part 2. Initially
the college thought that candidates
exempted from part 1 might be disadvantaged,
but it was found that either there is no
difference or people who have exemptions
do just as well if not better. Candidates must
attempt the part 2 examination within 10
years of passing part 1, otherwise they have
to pass part 1 examination again.
Cost
+ Part 1 £235
+ Part 2 £345
Who writes the questions?
Senior college members write questions
based on basic scientific principles and decades
of clinical experience.
Pass mark
MRCOG used to have a fixed pass mark of
75%, but this was abolished as some exams
were more difficult. Now a group of examiners
go through every question and work out
its difficulty before imposing a pass mark. If
an exam is easy, the pass mark goes up, if it is
harder, it goes down.
The candidate’s view
Prithi Jain is an SpR at Birmingham Women’s
Hospital. She did her medical training in
India and found part 1 very straightforward:
“Part 1 checks medical school knowledge. I’d
advise candidates to attempt all questions.
People tend to struggle with biochemistry
and physiology. I used Basic Sciences in Obstetrics
and Gynaecology by Dewhurst, which was
very helpful.
“For part 2 I prepared by working in the
United Kingdom for a year and a half. It
helped a lot, as British practice is totally different
from what we were doing in a developing
country. If you know the system and
how to communicate with patients [in the
United Kingdom] it helps a lot. These things
really matter in this exam.People who passed
the exam told me not to do more than one
course or you can get confused. I went on a
revision course at Birmingham Women’s
Hospital, which was fantastic. My colleagues
who passed last year went on it, and it helped
them a lot too.”
Books
“There are some excellent revision books. I’m
sure I passed the part 2 written because of
Justin Konje’s books. Another thing that I had
to get used to was learning to write short
answers. You have to write on just one page,
so be concise. I recommend spending five
minutes planning the question and writing
down everything that could be worth a
mark—for example, involving the paediatrician,
alerting the special care unit, calling the
haematologist—and then write your answer.
The OSCE is essentially an assessment of
what you do in clinic. If you are a good practitioner
you shouldn’t have any problems.”
Neerja Sharma also trained in India and
worked in the Gulf. She chose to work in a
clinical attachment in the United Kingdom,
“because I did part 1 before coming here,
and that was fine. But part 2 is strongly based
on UK practice, and you don’t get a good
idea about that from textbooks. During my
clinical attachment I attended the department’s
meetings and saw how things work.
Then, when I read around it, everything
made much more sense.
“I have spent all my annual leave for the
past two years preparing for MRCOG. The
book that helped me most was Gynaecology
by Robert Shaw. The new edition is fantastic.
For the short answers I used Justin Konje. It is
a clear descriptive book. My consultants in
Oman are all members of the college, and I
went to them for guidance. We talked a lot
about protocols, clinical governance, and
audit. It would help if there was always somebody
to answer my questions. You have so
much you want to ask, and if nobody can
help you take those doubts to the exam.”
College guidelines
Graham Hutchins is an SpR at Mayday Hospital,
south London. “Don’t sit the exam too
early,” he warns, “As a clinician you benefit by
doing it when you are part way through your
training. I’ve been on a couple of courses: the
Nottingham course and Whipps Cross
course, which is well thought of. I did a lot of
work for the written component. That separates
people out. I used college guidelines,
which are accessible on the web and if you
download those pretty much everything is
on there. I haven’t picked up a textbook.
Remember that OSCEs are what you do day
to day.”
The examiner’s view
Elizabeth Owen is chair of examiners. “People
fail part 1 if they haven’t got enough
knowledge of background sciences,” she says,
“Often they haven’t learnt it at medical
school. It is difficult for them to realise that
these questions are very relevant, they are
very fair, but they are quite scientific. They
need to focus on things like, ‘Where are the
blood vessels? Where are the nerves? How
does the heart work?’
It depends
“In obs and gynae, life is never true or false, it
always depends,” she continues. “ It depends
whether the woman is five foot tall, or it’s her
first baby or her third baby, it depends on her
blood pressure. So we are moving away from
true or false questions to using more clinical
scenarios and extended matching questions.
We have set up an EMQ subcommittee who
will spend 18 months developing questions,
and then we’ll introduce an EMQ element to
the written exams.”
Part 2
“Part 2 is based on UK practice,” says Elizabeth,
“Because 85% of candidates are not
from the United Kingdom, they don’t know a
lot of the areas we’re talking about. Because
they haven’t worked here, it is very difficult for
them to knowabout our system.Our college is
trying to help people from overseas understand
what is expected in the exam by setting
up courses throughout the world.”
Keep up to date
A lot of candidates struggle with the short
essays. Elizabeth suggests: “Keep up to date,
read college guidelines, and realise it is a test
of use of knowledge. These short answers are
not just writing an essay on this subject. We
ask doctors to justify management of certain
cases or debate pros and cons of various
treatments.
Work it out for yourself
“A lot of people from overseas are not
encouraged to question and debate. Didactic
teaching prevails, and young doctors are
told, ‘Don’t argue, this is the treatment. This is
what I do. This is the drug we use.’ If you
come from a country that has a very didactic
teaching style,go on a revision courses where
they practice short answers and have group
discussions. They discussions are about why
they answered they way they did and what
they should have answered in a different way.
In a textbook they don’t have the heading
pros and cons of. You have to work that out
for yourself.”
Sabina Dosani specialist registrar in child and
adolescent psychiatry
Maudsley Hospital, London
Peter Cross freelance journalist
London
Go to web extra on bmjcareers.com/
careerfocus for further resources and a list of
acronyms
career focus
228 BMJ CAREERS 5 JUNE 2004