Common Pitfalls in MRCOG Part 2

The MRCOG Part 2 examination is a notoriously difficult postgraduate examination. Four out of five candidates will fail this exam at least once and some may have multiple attempts before they pass. Failing the exam is a distressing and depressing experience – not only do you feel bad for failing, you also know that you will have to resit the exam, meaning another six months of preparation. In addition, it can prompt a lot of reflection and worry as you may feel that you prepared as well as you could and be worried about what more you are able to do. In this section, we describe some common pitfalls for candidates and how to address them.

  • Insufficient depth of knowledge

This is the most common reason that candidates do not pass the MRCOG Part 2.   They may very well have done a significant amount of revision and read all the appropriate guidelines but they have not appreciated the depth of knowledge that is required.

For example, they may have revised a particular guideline and are familiar with the management of a particular condition. However in the exam, they may be asked a question relating to what management has the strongest evidence base to support its use. This requires the candidate to have knowledge of both the condition and its management and the RCOG classification of evidence levels and grading of recommendations. As a result, the candidate may either find the question unusually hard or may mistake the question as simple and straightforward. In either case, the candidate may get it wrong despite a good level of basic knowledge.

The key to overcoming this is to become familiar early on during revision with the kind of questions that will come up in the exam and adjust your revision accordingly. A good way of doing this is to use a high quality online revision website early during your revision to give you an idea of what is required.

  • Personal circumstances

Sitting for the MRCOG Part 2 examination is a substantial challenge at the best of times. Even the most able candidate will struggle to pass if there are difficult personal circumstances, such as illness, childcare issues or family problems. Part of the preparation for the exam is being able to commit the time and effort to revising. If there are other personal factors that mean you are unable to do this, then it is better to shelve the exam and address the personal circumstances first, rather than struggle to manage both and fail the examination.

  • Poor exam technique

Exam technique, as previously described, can be subdivided into preparation and execution. A common problems with preparation include insufficient time spent practicing the exam in the correct format and too much time spent reading and making notes. Towards the end of your revision, you should be aiming to do as many practice questions as possible, rather than spending time reading new guidelines or making new notes. Ideally this should have been done earlier but in the event that time is short, use an online revision website to help you revise, instead of panicking and trying to finish reading all the guidelines.

Common problems with execution include poor time management in the exam or mind-blank. Running out of time in the exam itself can be a sign of insufficient depth of knowledge. If all of the questions are hard for the candidate because of a lack of knowledge, then there is a knock-on effect that they all take longer to answer. This means that the candidate may start to run out of time. Alternatively, the candidate may spend too much time over-thinking each question and making it harder than it needs to be with the same end result of running out of time. Consider reading the section on exam technique to help with this.

Some genuinely able candidates will panic in the exam during what is undoubtably an intensely stressful experience. They may struggle to recall basic facts under this pressure and therefore end up failing due to inability to recall their knowledge. Often these candidates will pass on the second attempt as they have the ability and the knowledge to pass and can improve their exam technique second time round. If a candidate struggles with mind-blank on multiple occasions, they may benefit from addressing this with an educational psychologist to develop coping strategies and relaxation techniques to improve performance.

  • Unfamiliarity with UK practice

Many candidates attempting the MRCOG Part 2 are from overseas and may have received their training outside of the UK where practice may be considerably different. Whilst a period of training in the UK can be very helpful, it is not an option for everyone. One potential pitfall for overseas candidates is to conflate the everyday practice that they see and do with the RCOG evidence-based practice standards upon which the exam is based. For example, in some countries, it may not be standard practice to use forceps for operative vaginal delivery and this may not be the candidate’s preferred management option of choice in real life. However, in an MRCOG Part 2 examination question regarding the management of cord prolapse at full dilation with fetal compromise, the RCOG Green Top Guidelines on Operative Vaginal Delivery and Umbilical Cord Prolapse specify that it is reasonable to attempt operative vaginal delivery in this context and that forceps are less likely to result in a failed delivery than Ventouse. If a candidate discounts the answer option of forceps delivery due to their own experience of clinical practice, they are not answering the question based on RCOG evidence-based guidelines and therefore will be more likely to answer incorrectly and hence fail.

  • Multiple attempts

There are some candidates who have multiple attempts at MRCOG Part 2. They may feel trapped in a cycle of failure and be unable to identify exactly why they are failing. Almost all of these candidates are revising hard and trying to pass so it is not a lack of effort on their part. In our experience, these candidates need help and intervention to change their way of revising – working smarter rather than working harder. This is intensive and time-consuming but well worth the effort. Ideally, an experienced educational supervisor should sit down with the candidate and try to identify the cause of why they are failing. Often this will be multi-factorial – busy personal and professional life with young children where time to revise is short, revision where insufficient depth of knowledge is achieved, poor exam technique. Once the cause is identified, a targeted programme should be designed to help the candidate regain confidence and pass the exam. Educational psychology can also be invaluable in these circumstances.

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