MRCOG: How to pass first time & all tips & pastpapers (Daily updated site)

1- you must be eligible to sit the exam.

2-apply to the College in good time and check they got your application

3- allocate adequate time for preparation

4-prepare thoroughly & find a "study buddy"

5-what to read

6-develop techniques to enable you to read constructively

7-learn and practise techniques appropriate to each type of question

8-try to spot essay topics

9- OSCE skills:

10- hone your communication skills

11-prepare all the known types of station

12-Go on a course

13-consider your special requirements if you haven't worked in the UK

14-other sources of information

The College publishes a calendar on its website.

This gives the dates of forthcoming exams and where you can sit them.

It gives the closing dates for getting your training and certificates approved:

1st. September for the March exam and

1st. March for the September exam.

It also gives the closing dates for applying to sit the exam:

20th. December for the March exam and

1st. July for the September exam.

The College rejects all late applications and won't listen to any excuses.

But it has an unreliable system for booking people in.

In a recent round of exams (autumn 2007) I had one DRCOG trainee and one MRCOG trainee who were refused permission to sit the exam.

This was on the basis that they had applied late.

Yet both had applied in good time.

One had even had her cheque cashed by the College!

My advice is to check a week or so after you submit your application that you are definitely on the list.

I have enquired of the College about this problem and am told that an improved system will be introduced shortly.

You would have thought that the simple answer would be to send confirmation of receipt to every applicant!

What's so difficult about that?

Six months is an appropriate time for most people.

But be prepared to allocate most of your spare time to the task.

If you can make it twelve months, so much the better.

If you can't prepare thoroughly, don't apply for the exam.

It is very depressing to fail and it takes time to pick yourself up and get re-motivated.

More importantly, you don't want to sacrifice more than one six-month slab of your life to the exam.

The written exam is the hardest part with a much lower pass rate than the clinical.

So concentrate on the written exam; you will have enough time to prepare for the OSCE once you have passed.

I have started to put some OSCE stuff on the website.

And there are plenty of books and courses giving practice with the different types of OSCE station.

One thing you can think about and refine in the interim is your communication with patients, of which more below.

It is also worth while thinking about having a model for taking an obstetric or gynaecological history.

Practising the model will help you learn it and reduce the chance of you missing something important in a roleplay.

I have put a model for an obstetric history on the web page.

I'll do the same for taking a gynaecology history in the near future.

I advise my trainees to do the following:

Get through all of the MCQs on this web page - it's a good way to get you started.

Learn -don't just read - everything published by the College and NICE.

make out a card or cards for every RCOG Green-top guideline and NICE equivalents.

don't forget the RCOG stuff like clinical governance, consent and other advice.

Read all the "TOG" articles for the past three years.

Read all the Obstetrics Gynaecology & Reproductive Medicine for the past three years.

Make sure you do all the EMQs and MCQs in TOG & OGRM: even better make out cards - identical questions feature in the exam.

Read at least one MRCOG textbook.

Read a textbook on obstetric medicine e.g. "Nelson-Piercy".

Read the papers I have written on stuff that is not well-covered in the textbooks.

Know the Maternal Mortality Report - new edition, "Saving Mothers' Lives" published in December 2007.

Know the recent facts on Perinatal Mortality.

Most importantly, read in an analytical and constructive way.

Learn and practise techniques appropriate to the type of question.

Read parallel subjects: genetics, neonatology, family planning etc.

Most of the genetics you need is covered in the DRCOG MCQs.

Practise writing short essays under exam conditions.

This is the best way to get experience of finding the balance of making a plan and getting it down on paper.

Also, I find that when I have not written at speed for a while, my muscles start to ache after a page or two.

So it makes sense to get them in training for the ordeal of having to write at speed for several hours.

I would guess that you have now done about 95% of the necessary preparation.

And easily know enough to pass.

But do the following to get up to 100%.

Consider subscribing to "StratOG".

Use subsidiary sources of advice.

Read as many of the small MRCOG texts on EMQs, MCQs etc. as possible.

Read as many of the past MCQs as you can find - questions get re-cycled in the exam.

Read "Recent Advances", "Vignettes for the MRCOG" and "Progress in O&G".

"High Risk Pregnancy" is a mini-encyclopaedia: read selectively from it.

You need to know the management of the common emergencies.

The "Oxford handbook of O&G" is portable and a basic summary.

"Notes on O&G for the MRCOG" is excellent for revision.

Know the key joint RCOG publications,

Think of important subjects that are not routine in UK practice.

HIV will always rear its ugly head.

Use the RCOG series "Subject X for the MRCOG and Beyond" to fill in gaps.

Keep up to date with HRT and other fast-changing subjects.

Try to spot questions,

Talk to colleagues who have recently passed the exam.

And keep practising essay-writing.

This is the bit of the exam that most people fail.

You will only get good at it by practising.

And the best way to do this is to write unprepared topics under exam conditions.

Then read the books and correct your effort at leisure to come up with a "model" answer.

Make out cards for all your model essays.

a. It is crucial that you know everything the RCOG has produced: "Green-Top" guidelines etc.

You can access all of this in the section "Guidelines" on the College web page.

The RCOG web page also gives useful links to other sources of guidelines.

Similarly, NICE produces guidelines that you need to know.

There are loads of other guidelines.

Patient UK has links to loads of guidelines from the UK and elsewhere.

You may find something useful there.

For example, the document on the menopause and HRT, although most of it can be found elsewhere.

Don't waste time on esoteric material.

The RCOG and NICE advice is the stuff you need to know.

It must be known well enough for you to refer to it in the essays and use it to answer MCQs.

Keep an eye out for guidelines that are in the pipeline.

For example NICE published a new guideline on intrapartum care in September 2007.

This document has generated some excitement within the RCOG.

You get a hint of this from the published commentary.

Similarly, the RCOG is due to publish "Safer Childbirth" in the near future.

Details will be published on the RCOG web site.

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.

b. The next vital reading is:

The Obstetrician & Gynaecologist, usually known as "TOG"

and Obstetrics, Gynaecology & Reproductive Medicine.

Many of the essay 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 excellent.

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

It is beautifully edited by Ian Johnson, Prof. of O&G at Nottingham.

So you get short, punchy, up-to-date reviews that are exactly what you need.

Worth a subscription if you can't get it in your library.

The College also publishes StratOG , designed to help with the examination.

There are 10 modules at £50 each, which I think is a lot.

There is an internet-based version: Stratog.net.

This launched on 19th. September 2007.

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.

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 essays 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.

d. A new maternal mortality report was published in December 2007.

Its key statistics and recommendations are essential reading.

You can find the ten main recommendations here.

MCQ13 in the information booklet, MCQ paper 5, question 18 and MCQ paper 9, question 1 cover most of it.

You can get the report from CEMACH.

You can access the executive summary and the full report from the web site.

CEMACH also publishes data on perinatal mortality.

It has recently published a document on diabetes & pregnancy.

e. Know at least one textbook thoroughly.

"O&G: An evidence-based textbook for MRCOG" edited by Luesley and Baker and published by Arnold has become popular.

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".

The standard textbook used to be "Dewhurst".

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

I have not yet had the chance to fully evaluate every page.

But most of what I have read is good and it even includes up-to-date stuff like cffDNA.

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

f. I like my trainees to go through all twelve of the MCQ papers I use for my DRCOG candidates.

The first five papers are 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 co

f. I like my trainees to go through all twelve of the MCQ papers I use for my DRCOG candidates.

The first five papers are 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.

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 essay 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:
Handbook of Family Planning and Reproductive Caree-5th-edition
Glasier & Gebbie
Churchill

Contraception Today
Guillebaud
Informa

Handbook of Contraception and Reproductive Sexual Health
Everett
Baillière Tindall

Contraception Your Questions Answered
Guillebaud
Churchill

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 use of:

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:Menopause - What you need to know Rees, Purdie & Hope RSM

Management of the Menopause - The Handbook
Rees & Purdie
RSM
Managing the Menopause without Oestrogen Rees M. & Mander T. RSM

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:
Illustrated Textbook of Paediatrics
Lissauer T & Clayden G
Mosby Elsevier

Essentials of Neonatal Medicine
Levene et al.
Blackwell
Resuscitation of babies at birth Royal Colleges of Paediatrics and O&G BMJ Publishing Group

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.

Sexually transmitted diseases will certainly feature.

The "ABC" book is adequate.
ABC of Sexually Transmitted Infections
Adler
BMJ Books

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.
Medical Genetics for the MRCOG and beyond
Connor
RCOG Press

The RCOG publishes a series of small books entitled "*** for the MRCOG and beyond".

Subjects include:

antenatal disorders,

gynaecological oncology,

gynaecological urology,

haemorrhage and thrombosis,

infertility,

intrapartum care,

medical genetics,

psychological disorders,

reproductive endocrinology.

They are invaluable for filling gaps.

They are excellent, but watch out for the date of publication: some will soon be pensionable.

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. essays or EMQs.

They give insight into the exam and most are reasonably priced.

John Duthie and Paul Hodges have written an EMQ book.

John & Paul have been on the College's EMQ sub-committee since the start.

You can't get closer to the College's EMQ database than that!

It gives lots of advice on technique, not just sample questions.

At £19.99, I reckon it to be a bargain!

Authors local to me have done the same:

"Extended Matching Questions for the MRCOG" edited by Singh; published by PasTest.

Maneesh Singh is an ex-trainee of mine, so I must declare some prejudice.

It also means that I could not fail to give his book a mention.

However, I think the book is worthy in its own right and inexpensive!

I bought a copy!

I was recently (March 2009) given a copy of Justin Konje's latest book for the MRCOG to review.

SAQs, MCQs, EMQs & OSCEs for MRCOG Part 2.

I haven't yet had time to read all of it.

What I have read is excellent.

The bulk of the book deals with essay-writing and has load of examples.

This makes sense as the essays are the bit that most people fail.

The answers I have read are bang up-to-date, which is what you would expect.

My one criticism is that some of the answers are too long.

You would be hard-pressed to write them in the allocated time.

But they contain all the information you might need.

So, to use them, you would just extract the key facts and write your own, briefer answer.

I must admit that I have the same problem writing model essays.

It is difficult to change mindset from writing textbook-like answers to the stripped-down versions needed in the exam.

Overall, at £29.99 I think it is excellent value.

There are stacks of other books.

I counted nearly 30 on the College Bookshop website!

You'll need to "pick and choose" unless you are rich and an Olympic gold-medallist at speed-reading.

Some of them are now a bit dated - I would give them a miss.

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

The more you practise MCQs, EMQs and essays the better.

Remember to practise time-keeping too.

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.

Its lack of fame is undeserved as it is first-rate.

They give short summaries of key points in an up-to-date fashion.

Ideally you should read the most recent two or three volumes of each.

Their role is being superseded to some extent by "TOG", but they remain useful.

My view is that "Recent Advances" and "Vignettes" are the better, being more tightly edited, but this is a matter of opinion.

j. "Handbook of Obstetric Medicine" by Nelson-Piercy and published by Informa Healthcare is mandatory 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.

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.

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.

I like "Notes on O&G for the MRCOG" by Stirrat et al and published by Churchill.

It is portable and its great merit is that topics are dealt with almost as "key points".

This makes it great for revising topics you think you know.

It is also good for checking you haven't missed anything when making out cards.

It is now a little out of date, but the bulk of its contents will still be valid and a new edition will probably be along soon.

There are lots of other worthy books, but you can't read everything.

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.

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

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

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.