Janice Rymer and Tony Hollingworth
x
Acknowledgements
We would like to thank the post graduate and examination departments at the Royal College of Obstetricians and Gynaecologists for their help and advice with the regulations and questions for the Part II MRCOG Examination.
We would also like to thank Naomi and Sarah at Hodder for their patience and encouragement at bringing this project to a timely delivery.
We would also like to acknowledge the influence of Roger Baldwin not only on our approach to learning and teaching but on many others who attended the Whipps Cross MRCOG course over the years. We would like to thank him for writing the foreword to this book.
xi
Abbreviations
CDH
congenital dislocation of the hip
CRP
C-reactive protein
CTG
cardiotocograph
DVT
deep vein thrombosis
IDDM
insulin dependent diabetes mellitus
MDT
multi-disciplinary team
MRI
magnetic resonance imaging
NTD
neural tube defect
SCBU
special care baby unit
TAH
total abdominal hysterectomy
TED
thromboembolic deterant
TOP
termination of pregnancy
TPR
temperature, pulse and respiratory rate
xii
Introduction
In the MRCOG Part II examination, knowledge is tested in the written paper by multiple choice questions and short essays. Clinical skills are tested in an objective structured clinical examination (OSCE) which replaces the traditional clinical long case and viva voce. The OSCE is designed to produce a valid and reproducible assessment of your skills. The MRCOG is a licensing examination and therefore the examination is not norm-referenced but criterion-referenced. This means that the minimum standard acceptable is decided before the test and you either reach that standard and pass, or you go below it and fail. This is much fairer than a norm-referenced examination where you may be disadvantaged if you go through with an experienced cohort of students or, likewise, you may be advantaged if you go through with a less experienced cohort.
Each candidate is exposed to the same set of scenarios. This means that the examination is reproducible and the marking is standardized. As you are exposed to 10
examiners, this improves the reliability of the examination.
The MRCOG Part II OSCE is a series of examinations based on clinical skills applied in a range of contexts where there is wide sampling with structured assessment and this improves the reliability. The OSCE currently consists of 10 marked stations and two preparatory stations. Each station lasts 15 minutes, and the dura-tion of the examination is 3 hours. One minute before the conclusion of the station (at 14 minutes) there will be a bell to conclude the station and to allow the examiner to mark it. When this bell goes, move to the next station and read the relevant information. All the information relating to the station will be posted outside it as well as on the desk at the station. Take as much time as you need to read the information. You need to ensure you have read the question thoroughly; once you have grasped it, proceed into the station. This may take a few minutes but you are in control of your time. Do not be rushed. If you have just had a difficult station, you may need an extra minute or two to recover. As the information will be outside the station, this means that you will be in control of your timing. If you need the time, take it and make sure that you are calm and composed before you enter the next station.
This is a professional examination and respect for patients is important. You must dress appropriately and be well groomed. You must be polite and friendly and must transmit an air of confidence and competence to both the role-players and the examiners.
At the stations where there are patients, introduce yourself by your full name (first name only is too casual) and do your normal greeting (this may involve a handshake). Speak slowly and clearly and make eye contact. As you would normally 1
INTRODUCTION
do, observe their body language, as the role-players may have been instructed to behave in a certain way.
Of the 10 stations where an examiner is present, the candidate has to perform a task and each task tests knowledge, skills, communication or problem-solving abil-ities. Depending on the type of station there may be a role-player, a patient, some form of imaging, a pelvic model or a clinical scenario. As the examination evolves, new types of stations will be brought in. Currently the examination may include the following areas.
History-taking
This is a core skill and is included in every examination. Each candidate should be able to score very highly, but surprisingly the marks for this type of station are consistently low. It is important to take a comprehensive history, not only of the presenting complaint but of all the past histories. One logical approach is to ask an open-ended question about the patient’s presentation and then comprehensively go through the presenting complaint; then go to past obstetric and gynaecology history and with the previous pregnancies note whether there were any problems, whether they were induced or spontaneous labour, whether there was a normal delivery and whether there were any intrapartum and/or postpartum problems. The weight and sex of the babies should be recorded. If there are any miscarriages or terminations, it is important to know whether evacuations were performed and whether there were any postoperative problems. A functional enquiry of all the systems should be undertaken, followed by medication history (which includes alcohol and recreational drug use), known allergies, family history and social history.
One must remember that the patient may have been briefed to be difficult or non-communicative.
When there is a role-player at the station, it is essential that you do not interact with the examiner who is there as an observer. If you do, this will completely break up the rapport that you have developed with the role-player. If you run out of questions and the consultation becomes silent, do not approach the examiner.
Good practice
●
Introduce yourself
●
Remain professional
●
Stay in control of the consultation
●
Ask if the patient has understood
●
Ask if she has any questions
●
Use diagrams/drawings if appropriate
●
Practise with a friend
●
A video of yourself is very useful
2
INTRODUCTION
Clinical skills
With this type of station any skill that you perform in the wards, in the clinics or in the operating theatre can be tested, depending on the feasibility of setting up the station. These stations should be easy as it is what you do every day at work. You just need to transpose yourself mentally into the situation and do what you normally do.
Counselling skills
These stations will have a role-player and may involve breaking bad news or dealing with an anxious or angry patient. The role-players have been well briefed to act in a certain way. It is essential that you avoid medical jargon. Clearly you need to be empathetic and compassionate in these situations.
Prioritization
The ability to set priorities in clinical work – this may involve a busy labour ward, calls you may receive from the ward or the rest of the hospital, operating list priorities.
Logical thought
●
The ability to design an audit, protocol, or information sheet.
●
Critique of a medical journal paper, protocol or a patient information pamphlet.