Starting Point for MRCOG Part 2

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This blog post is especially for those who are at the very beginning of their preparation for MRCOG part 2. If you have already decided to go 4 MRCOG and want to start off your journey towards your goal, then this post might be useful.

You will find many great pieces of advice about exam preparation on the internet. I have tried to provide an outline for the exam and an essential reading materials list so that you will have an idea of what to collect and how to start the preparation. Please keep in mind that the information given in this post is not ultimate & comprehensive. You must add more to it whenever you come across relevant stuff.

Starting Point 

The starting point for your preparation is to spend some time on the MRCOG part 2 section on the  RCOG website. Most of the information I am about to share is taken and summarised from the RCOG website.

MRCOG part 2 is a written exam that assesses basic clinical knowledge and its application at a level of UK ST5 trainee in obstetrics & gynaecology as defined in the RCOG curriculum.

You need to plan well ahead of time as you are required to fulfil some prerequisites before you can sit for the exam. There is a time limit and frame to take the exam after part 1. (Please visit the RCOG website for updated information)

Assessment of training

From August 2019, the Assessment of Training (AoT) will be a requirement for entry to the Part 3 MRCOG exam.

Candidates will no longer need to complete AoT before taking Part 2 MRCOG exam.

For the latest updates, kindly visit the following links:

AoT RCOG 

AoT FAQ

Exam Calendar

MROCG Part 2 is conducted two times per year in January & July at various locations across the globe.

Exam Format 

A computer-based written exam consisting of two papers covering different modules.

MRCPI Preparation Advice — Dr Saba Ansari

This post is about the MRCPI exam preparation. I would like to thank Dr. Saba Ansari (MRCPI, Dip MIS, FCPS) for taking out time from her very busy schedule to write this advice. She has done this exam in recent past and has very vast work experience in Pakistan as well as in UAE.

I had been getting quite a few queries for this particular exam. In my opinion, its always best to seek and follow advice from someone who has gone through the similar process. Dr Saba has very kindly agreed to provide further help if anyone needs it. You can leave your query in comments or can directly contact on her e-mail provided at the end of this post —  Thanks Rubab

MRCPI Preparation Advice

MRCPI (Obstetrics & Gynaecology)

Membership of the Royal College of Physicians of Ireland (MRCPI) is an internationally recognized qualification, well accepted by healthcare employers worldwide

In Ireland, passing MRCPI enables you to enter Higher Specialist Training

MRCPI is achieved through examination

All the up to date information is available on RCPI website. You must go through it when deciding to go for the exam. RCPI Ob/Gyn

Entry Requirements

• There is NO part one for MRCPI Ob/Gyn
• For MRCPI Part II Written, one must have one of the following qualifications:

MRCOG Part Two: 3 Ws & General Advice

This blog post is aimed to explore the 3 Ws of the MRCOG part 2 exam. It may ease your journey to get through this tedious and nerve-wracking exam. The first thing before embarking upon this journey is to know your 3 Ws.

Why do you want to take it?

What is the right way to prepare for it & What to study?

When is the right time to take it?

I hope if you keep reading this blog till the end you might clarify these Ws.

WHY DO YOU WANT TO TAKE IT?

This is the answer which has to come from YOU. You need to decide and know your WHY. Here I can help you decide by quoting just one sentence from RCOG website “MRCOG: A global exam. The Gold Standard Qualification in O&G”

WHAT IS THE RIGHT WAY TO PREPARE FOR IT & WHAT TO STUDY?

This is a long answer and I will try to explore this step by step.

Understand the exam:

The first step is to understand what is this exam all about and what is expected from you in MRCOG part 2 exam. It is to demonstrate that your knowledge is of a level of “Competent ST5 according to RCOG curriculum”. Visit the RCOG website and go through the MRCOG part 2 section in detail. It clearly mentioned the format of the exam, syllabus, modules tested and details of all topics in each module. Most of the candidates keep asking What to study? So RCOG website is the best and most authentic source to answer this. Do not forget it's a UK-based exam and you need to prepare according to that standard, regardless of your job status in practical life. For example, you might be working as a senior consultant in your workplace, but you need to think & act like ST5 for this exam. It is essential to understand how things work in the UK system being an overseas candidate is not an acceptable excuse.

Plan the exam:

Once you decide to sit for the exam, you need to plan well ahead of time with adequate preparation. It is generally recommended that if you are sitting for the first time, at least 6 months of dedicated study time are required and if it is your second attempt onwards, then 3-4 months are adequate. In my opinion, it all depends on your personal & professional circumstances. So there is no hard and fast rule. All you need to keep in mind is that MRCOG part 2 requires sheer hard work, serious commitment and an in-depth understanding of Ob/Gynae. This has to come from self-motivation and persistence to achieve your goal. You can seek guidance from others but all the hard work has to be ultimately done by you. 

The approach of the preparation:

You must decide your approach towards the exam. This is a fast-paced world of internet & technology. First, you need to decide whether you prefer to study in hard form or soft form, how well-versed you are with the latest technology and how much are you willing to invest in the latest gadgets. I suggest that for this exam it is a MUST to be updated in the required knowledge which is only possible if you are familiar with the proper and positive use of your smartphones & tablets (as almost all of us have it these days). Look at those gadgets with a new vision and as a potential source of your success. You do not need flagship devices but you must analyse what's best for you and how you can take maximum benefit from whatever device you have. This is the single most important change you will need to adapt in your approach towards the exam. Late Steve Jobs (CEO of Apple) played a very important role in my MRCOG journey :)

Gather the reading material:

Oophorectomy or Ovarian Conservation at Hysterectomy for Benign Disease

This blog post is based on the TOG article Oophorectomy or Ovarian Conservation at the Time of Hysterectomy for Benign Disease published in April 2022. This is one of the important and most debated aspects of the care of women undergoing hysterectomy due to benign conditions. This has almost always been a grey area in gynaecology, where clinical evaluation and judgment plays an essential role in the crucial decision to conserve or remove ovaries in women above the age of 40 years. This article provides the latest evidence related to this topic. 

I hope you will find this quick summary helpful not only the exam preparation but also for your clinical practice as well. 

Thanks.

To download the original article: Click Here

To access ALL TOGs: Click Here

Introduction

• When a perimenopausal or menopausal woman is undergoing a hysterectomy for benign conditions, one of the concerns is whether to remove or conserve the ovaries. Leaving the ovaries can be associated with the risk of ovarian cancer later in life. However, the removal is also associated with some ill effects. All this will be discussed as follows.

Ovarian cancer has poor prognosis

• Diagnosis of cancer at 70 years — associated with 80% mortality
• Incidence — increases with age 10 in 100 000 in 40s 50 in 100 000 in 50s
• > 50% of women diagnosed at the advanced metastatic disease
• The lifetime risk of ovarian cancer - 1.4% 
• With hereditary ovarian cancer syndromes risk is 25-50% for epithelial ovarian cancer
• BRCA mutation — associated with 90% of hereditary ovarian cancers but overall makeup only 10-15% of all ovarian cancers 
• If this high-risk group is excluded, then the incidence for low-risk women <1%

Non-inherited risk factors

• Obesity & PCO
• Ovarian endometriosis can transform into cancer in 2.5% of cases

Ovarian function in the menopause

• Ovaries continue their endocrine function
• After menopause, women with intact ovaries have higher amounts of androgens

Advanced Abdominal Pregnancy

This blog post comprises of important points taken from the TOG article ‘Advanced abdominal pregnancy’ published in July 2022. It is strongly recommended to read the full article to have a complete understanding of this topic as this post is just a quick summary.

To download the original article: Click Here

To access ALL TOGs: Click Here

Introduction

• Abdominal pregnancy — when implantation occurs within abdominal cavity / an extra uterine pregnancy in which all or most of the foetus develops within the abdominal cavity
• A rare form of ectopic pregnancy 
• Incidence ~1% of all ectopic pregnancies
• Associated maternal mortality  0-12% 
• Overall risk of maternal death 7x that of ectopic pregnancy 90x that of an intrauterine pregnancy
• Fetal survival >78%

Classification

Based on gestation at diagnosis

• Early Abdominal Pregnancy (EAP) - before 20 weeks
• Advanced Abdominal Pregnancy (AAP) - after 20 weeks

Based on site of implantation 

• Primary abdominal pregnancy — implantation directly occurs in the abdominal cavity
• Secondary abdominal pregnancy — when conception extruded from its primary site of implantation and re-implants in abdominal cavity (usually after ruptured ectopic)

Risk Factors

• Most have no identifiable risk factors
• Risk factors are same as any other ectopic pregnancy — tubal pathology, in situ IUCD, previous ectopic 
• Uterine anomalies & history of previous uterine surgery (esp CS) are associated with abdominal pregnancy
• AAP can also occur post scar rupture, previous myomectomy and post uterine perforation at surgical TOP, after IVF

Clinical Presentation

• Diagnosis is often missed & usually made after fetal demise
• Only 50% diagnosed before surgery
• High suspicion is key to pre-operative diagnosis
• No specific S&S of AAP

Symptoms 

• Commonest presentation — abdominal pain ± vaginal bleeding (pain often persistent & increases by fetal movements)
• Bloating & vomiting

Signs 

• None pathognomonic
• Reasonable sign of AAP - displaced cervix (anteriorly) 
• Others— severe anaemia, abnormal fetal lie, oligohydramnios, SGA 

Ultrasound 

• Abdominal pregnancy hard to diagnose with advancing gestation
• Any first-trimester scan should include - location of gestational sac in relation to cervix, endometrial cavity and uterus
• Intraabdominal pregnancy suspected on USG — extrauterine amniotic sac & an empty uterine cavity - foetus & placenta outside uterus, lack of uterine myometrium around foetus 
• Skills & techniques of sonographer matters