Table Of Content

Complete Revision Guide for MRCOG Part 3 Justin C Konje FWACS, FMCOG (NiG), FRCOG, MD, MBA, LLB, PGCeRt MeD eD Emeritus Professor of Obstetrics and Gynaecology University of Leicester, UK Professor of Obstetrics and Gynaecology Weill Cornell Medicine-Qatar, Qatar Senior Attending Physician Sidra Medicine, Qatar First edition published 2021 by CRC Press 6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487-2742 and by CRC Press 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN © 2021 Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, LLC This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. 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ISBN: 978-0-367-61168-2 (pbk) ISBN: 978-0-367-61169-9 (hbk) ISBN: 978-1-003-10445-2 (ebk) Typeset in Times LT Std by Deanta Global Publishing Services, Chennai, India Contents 1 Preface to Complete Revision Guide for MRCOG Part 3 1 2 How to Use This Book 3 3 An Overview of the Part 3 MRCOG Examination 4 4 Logistics of the Exams 6 5 Guidance on How to Prepare for the Part 3 MRCOG Examination 8 6 Overview of the Five Domains of Assessment 10 7 How to Fail the Part 3 MRCOG Examination 14 8 Examples of Possible Tasks under the Various Domains 15 9 What Are the Examiners Looking for in Each of the Tasks? 17 10 How to Prepare for the MRCOG Part 3: A Personal Perspective 30 11 Common Tips on Communication 37 12 Paper I 68 13 Paper II 127 14 Paper III 183 15 Paper IV 241 16 Paper V 301 Index 351 This book is dedicated to my wonderful, loving father – Papa Tabe Augustine Konje, who passed on to another world in December 2014. He sacrificed the pleasures of his life to see my siblings and I educated. His dream lives on. Complete Revision Guide for MRCOG Part 3 Preface to Part 3 1 Preface to Complete Revision Guide for MRCOG Part 3 In my preface to the Complete Revision Guide for MRCOG Part 2, I stated that ‘The Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) examination remains one of the most internationally recognised postgraduate examinations in the specialty’. Such an interna- tional appeal means that not only those who are trained in the UK sit this examination. Part 1 examination focuses on basic sciences and how these are applied clinically, while Part 2 focuses predominantly on knowledge and its clinical application. Part 3, on the other hand, aims to address important aspects of Miller’s education skills triangle – ‘knows how, shows how, and in some cases does’. It is therefore obvious that communication is central to this examination. Clinicians have traditionally been poor communicators, often talking down to patients. This is no longer acceptable as patients increasingly demand (and rightly so) to be involved in decision mak- ing about their care. For this to happen, there must be equity in understanding, and the clinician is required to ensure that this is achieved through communication, in as much detail as possible and to a level that will guarantee understanding. Without this, the concept of equity will be unachievable. In the Part 3 examination, therefore, communication is assessed in several domains. Of course, the clinician must first be knowledgeable to be able to communicate with the patients to allow them to make informed choices about their care. Finally, while communication is important, patient safety remains the raison d’être of healthcare. It should therefore be a given point that this domain is assessed in all the tasks in this examination. Uncoupling Part 2 into Parts 2 and 3 has allowed for a better assessment of applied clinical knowledge and communication skills. Part 3 examination consists of 14 tasks, each assessing one of the 14 core modules in the curriculum. Each task assesses specific skills, which may include all or some of ‘Information Gathering, Communication with Patients and Families, Communication with Colleagues, Patient Safety and Applied Clinical Knowledge’. Not all the tasks will lend themselves to assessing all these domains – for example, in the discussions with the examiner, it may not be possible to assess communication with patients and families. There is a general recognition that while candidates’ performance at the examination should be judged by experienced clinicians (the examiners), ultimately the simulated patient (who is in place of the real patient) should have a say on how good the candidate’s approach to dealing with patients is. Attempts to address this in the past included asking the simulated patients (role players) to award an overall mark for each of the stations. This has further evolved so that in the Part 3 examination, there are trained lay examiners who assess candidates, especially in the domains of communication with patients and families. This is important, as ultimately, it is the patients who are on the receiving end of our communication. While this is only incorporated in a few tasks at the moment, I foresee a time when most of the examiners will be lay members of the public. 1 COMPlete RevisiOn Guide fOR MRCOG PaRt 3 In the Part 2 MRCOG book, I generated four sample examinations; the same principle has been adopted in writing this book. There are four main sample diets, and in each of them, attempts have been made to cover all the 14 modules in the core curriculum. I must admit that I have left out some of the modules in one or two of the samples. This is probably because I take the view that it is better to include questions on the difficult modules than cover all the modules in each of the samples. At the end of the four diets, there is an additional chapter with random tasks, which should help with your preparation. I have kept to the concepts of all my books for the examination, once again giving general advice on how to prepare for the examination and also giving ‘tips’ on how to fail it. I must state here that the contents of the book, including the statements and interpretation of evidence, are personal, and I accept responsibility for inaccuracies and mistakes. It is important that you verify whatever information is in this book and also accept that there will be errors, some of which will be glaring omissions and others as a result of misinterpretation on my part. I hope that not only will trainees find this book useful but trainers and examiners will also find the content useful in guiding trainees and also help them generate good questions for examinations. When I embarked on writing the third edition of my complete revision guide, I envisaged this would be a quick project, but as I began to write, it was obvious that the tasks were far greater than I had anticipated. Furthermore, it was imperative to separate the two parts since these are now dis- tinct examinations. I am glad that this has finally been completed. I am hoping that any subsequent revisions will be less arduous than this. I would like to thank my family for resolutely supporting me throughout this project. They have endured hours and hours on end of me sitting in front of the computer at home, tapping on keys. I am sure that finally closing this chapter will be welcome to them. Thank you Mrs Joan Kila Konje, not only for being an adorable and the best wife but for also being very understanding, encouraging and not losing your cool too often. Thanks to my wonderful kids – Dr Swiri Konje, Monique Konje and Justin Jr Konje – for bearing with your dad and not complaining too much about ignoring you and not being in touch that often. I could not have wished for better children. I am truly blessed. I would like to personally thank Dr Wafaa Belail, who has not only been very encouraging but has provided very useful input into the contents of the book, read and suggested changes to the structure, edited the manuscript and contributed a chapter from a recent trainee’s perspective. She has been a great support, and I value her friendship and support. I would like to thank the publisher for being so patient with me. The manuscript was meant to have been submitted shortly after Part 2 was completed, but it has taken me almost one year to complete! Finally, I am most grateful to God, my creator and our Almighty Father in Heaven, for giving me the belief and patience. This would not have been possible without His blessings. 2 Complete Revision Guide for MRCOG Part 3 How to Use This Book 2 How to Use This Book This book is only a guide to preparing for Part 3 examination. It cannot replace face-to-face practice, especially in supervised clinical settings. As you prepare for the exams, I suggest you pay particular attention to the following: 1. Guidance on how to prepare for the exams 2. Tips on communication 3. How to explain various surgical procedures to patients 4. How to explain investigations to patients 5. First-hand experience of how I prepared for Part 3 exams by Dr Wafaa Ali Belail Hammad Once you have done these, you should go through each of the tasks diligently and identify the key expectations from candidates. These are only guidances and should be used as such. You should then take these into a clinical scenario or one with a simulated patient and put it into practice. If you are able to cover most of the points in each of the domains, you are most definitely on your way to passing the exams. Come back to these as often as possible, and by the time you have completed each of the domains and the additional tasks, you should be prepared for the examination. I hope that some of the layman’s explanations I have provided for various medical terminologies, including diagnosis, investigations and treatment, will come in handy in your day-to-day clinical activities. I wish you the very best of luck in your preparations and hope that you find the book useful. 3 Complete Revision Guide for MRCOG Part 3 An Overview of the Part 3 MRCOG Examination 3 An Overview of the Part 3 MRCOG Examination introduction This part of the examination assesses knowledge and how this is applied in clinical practice (i.e. clinical skills). The assessment is based on the 14 knowledge-based modules of the RCOG obstetrics and gynaecology curriculum. These modules are shown in Table 3.1, and more details can be found on the RCOG website (www.rcog.org.uk). The examination itself is undertaken in circuits of 14 tasks (stations) – each task lasting 12 minutes, of which 2 minutes is for an initial reading of the information for the particular task. In effect, the candidate has 10 minutes to perform each task. The total duration of the examination is table 3.1 Modules of Part 3 examination and their link to the corresponding core curriculum module Part 3 Module Name Corresponding Core Curriculum Module 1. Teaching 2 (teaching part only) 2. Core surgical skills 5 3. Post-operative care 6 4. Antepartum care 8 5. Maternal medicine 9 6. Management of labour 10 7. Management of delivery 11 8. Postpartum problems (the puerperium) 12 9. Gynaecological problems 13 10. Subfertility 14 11. Sexual and reproductive health 15 12. Early pregnancy care 16 13. Gynaecological oncology 17 14. Urogynaecology and pelvic floor 18 problems 4 An Overview of the Part 3 MRCOG Examination an OveRview Of the PaRt 3 MRCOG exaMinatiOn therefore 168 minutes, of which 140 minutes is for performing the tasks themselves. Each of the 14 tasks is assessed on the following five domains: 1. Information gathering 2. Communication with patients and families 3. Communication with colleagues 4. Patient safety 5. Applied clinical knowledge In most of the tasks, there is not a very clear demarcation between the various domains, as, for example, in assessing patient safety, your knowledge must be sound and the same will apply to communication with either the patient and her relatives or colleagues. However, an attempt is made to ensure that at least three or four of these domains are assessed for each of the tasks. 5