Author: Mr David Burch FRCOG

Applied clinical knowledge and exam technique

MRCOG Part 2: Virtual Revision Course

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Explanation next slideCopyrigh

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Miller’s triangle

1 stage: knowledge-facts, e.g. anatomy. Assess by true/false MCQ

2 stage: know-how, e.g. how do you investigate a symptom? SBAs and EMQs- the part 2 is a test of know-how.

If you succeed, you get a chance to show what you can do in the part 3 OSCE.

4 level (does) is assessed by workplace based assessments

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2019 core curriculum

14 “capabilities in practice” (CiPs) 10 are generic, professional competencies High level statements about what a doctor should be

able to do at the end of training 4 are about clinical expertise

Elective and emergency obstetrics and gynaecology

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Knowledge areas

15 knowledge areas have replaced the old core curriculum modules

Knowledge areas link to the CiPs as in table in the document

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Example: postop care

Knowledge Area 4 –Postoperative care CiP 

CiP Description 

1  The doctor is able to apply medical knowledge, clinical skills and professional values for the provision of high‐quality and safe patient‐centred care 

6  The doctor takes an active role in helping self and others to develop 

9  The doctor is competent in recognising, assessing and managing emergencies in gynaecology and early pregnancy Copyr

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Example: postop care

• Demonstrate an understanding of all aspects of postoperative care (immediate, short-term and long-term), including the ability to assess a postoperative patient, know the diagnosis and know how to deal with it

• Know how to prevent common postoperative problems

• Understand all aspects of surgery, complications and follow-up

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Part 2 exam

Diagnosis Investigations Management Epidemiology

All 15 knowledge areas but mainly elective and emergency obstetric and gynaecological clinical expertise

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EMQs and SBAs

SBAs Aetiology Natural history Epidemiology Statistics

EMQs Diagnosis Investigations Management

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Progression to the next examination can only occur once the previous examination has been passed.

MRCOG Exams

Part 1 Written examination to evaluate relevant basic and clinical sciences.

Part 2 Written examination that assesses the application of knowledge.

Part 3 clinical skills exam which assesses candidates' ability to apply core clinical skills in the context of the skills, as defined in the Part 2 MRCOG curriculum.

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Purpose of testing

• To ensure the prescribed syllabus is covered

• Highlight to trainees knowledge & skills required to be accredited

• Belief that it motivates trainees to study!

• Validate any ultimate qualifications

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Best answer questions

• Can be presented either as EMQ or SBA• Ideally they push trainee towards a judgment• In clinical practice there is rarely a completely right or wrong answer• Everyday you elicit a relevant history, possibly examine a patient and then suggest a diagnosis 

• Approach single answer questions in a similar mindset

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Organisation of an SBA

• Stem– A clinical situation 

• Lead in• Relevant question to probe applied knowledge

» Options– 5 options, all reasonable alternatives, 1 best answer

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The stem

» A clinical situation– a registrar should know how to manage– Plausible, realistic

» A story stopping at an appropriate point» What is the examiner looking for? 

– That may affect where the story stops– A question about diagnosis stops before one about 

treatment

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The stem and the choices

» A hunter walks South for a mile, West for a mile, North for a mile and is then back at her starting point. She then sees and shoots a bear.

» What colour is the bear?

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What is the central issue?            

Where in the world can you get back to the same place walking 3 sides of a square?

Where it isn’t a square, it’s a triangle! At the North pole, anywhere you go is south! Walk west for a mile, and you’re still one mile south of the

north pole What colour are the bears at the North Pole?

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Application

So what this example means is, what in the question stem is leading you to choose the answer?

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Clinical Scenario

• The initial stem of a question sets the context• Based on this, the question should point to a single best answer• Remember the information in the stem may well influence how you justify that is the “best answer” from those on offer

• Examiners frequently put in another potentially correct answer but to a slightly different scenario

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Technique with EMQ/SBA

• Carefully read through the stem, especially when it is  a clinical scenario• Then read the question below• Attempt to answer the question immediately without looking at answer list

• Check to see if your initial answer is there!• Re‐read question for any “discerning features” that might influence a correct answer

• Cautionary evidence for/against reviewing questions from MRCGP exams!

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UK practice within the NHS

• UK trainees have significantly less experience in surgery and clinical numbers than most IMGs

• Clinical practice tends to be protocol driven to support consistent practices and outcomes

• We routinely monitor our compliance with an evidenced based protocol by regular audits

• All protocols expect patient involvement in their care based on explanation, informed consent and feedback  on their experience

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Context of MRCOG

• Exam is assessing application of factual knowledge of UK trained junior doctors

• You need to be aware of the context the exam is set in• Vast majority of candidates fail because they do not have the required clinical knowledge

• Overseas candidates can struggle with the context of clinical scenario

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SBA Revision Advice

• Look through the syllabus of MRCOG• Don’t ignore non‐clinical areas Teaching, Governance, Aetiology etc

• Work through past papers, Strat‐OG and TOG articles• Identify areas you do well in and more importantly concentrate on your poorly scoring areas

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Sources of guidelines

• RCOG website:  Green top guidelines,  Scientific Impact papers, Consent & good practice Strat‐OG tutorials,  TOG

• NICE guidelines• GMC website advice particularly on best practiceCopyr

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Further info

https://www.gov.uk/government/publications/cervical‐screening‐programme‐and‐colposcopy‐management

https://www.fsrh.org/home/ https://www.bapm.org/posts/109‐new‐bapm‐framework‐on‐extreme‐preterm‐birth‐published

https://bsug.org.uk/pages/information/guidelines/105 Further resources in specific modules

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The questions

• Are NOT past papers• Belong to the College 

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