Cambridge University Press 978-1-904-75256-1 - Your Essential Revision Guide: MRCOG Part One: The Official Companion to the Royal College of Obstetricians and Gynaecologists Revision Course Edited by Alison Fiander and Baskaran Thilaganathan Excerpt More information Introduction chapter 1 Taking the Part 1 MRCOG examination © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-904-75256-1 - Your Essential Revision Guide: MRCOG Part One: The Official Companion to the Royal College of Obstetricians and Gynaecologists Revision Course Edited by Alison Fiander and Baskaran Thilaganathan Excerpt More information © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-904-75256-1 - Your Essential Revision Guide: MRCOG Part One: The Official Companion to the Royal College of Obstetricians and Gynaecologists Revision Course Edited by Alison Fiander and Baskaran Thilaganathan Excerpt More information Taking the Part 1 MRCOG examination 1 | Introduction chapter 1 Alison N Fiander Introduction The Part 1 MRCOG examination underwent modernisation between 2005 and 2007. This chapter deals with the background to the changes and their implementation. It also discusses extended matching questions (EMQs) as forming a component of the examination since September 2007 and describes further changes to the examination format that come into effect from March 2012. Background The decision to modernise the Part 1 MRCOG in 2005 came after it was noted that pass rates were falling and that the examination was perceived as a difficult basic science hurdle tending to lack obvious clinical relevance. However, basic sciences are vitally important to the clinical practice of obstetrics and gynaecology and are therefore an essential element of the examination. While some subjects, such as surgical anatomy of the pelvis, are static, others are continually changing. For example, rapid advances in bioscience since the 1980s, including ultrasound, in vitro fertilisation, prenatal diagnosis, clinical epidemiology and evidence-based medicine, are already impacting upon clinical practice and need to be reflected in both the syllabus and in the examination. Advances in gene therapy and stem cell science will begin to impact on practice in the next decade and these also need to be taken into account. Set against this background, a working group was convened in 2005, chaired by Professor W Ledger frcog, to determine the fitness for purpose of the existing Part 1 MRCOG examination and to make recommendations regarding the syllabus, content and format of a new Part 1 MRCOG examination. The working group identified the need for a clearly defined syllabus, with a core knowledge at Part 1 MRCOG as a prerequisite for progressing to the Part 2 examination. The group also saw the need to map the basic clinical sciences in Part 1 MRCOG to the new core curriculum for training in obstetrics and gynaecology. The revised Part 1 MRCOG syllabus and examination is concerned with preparing a doctor to become a specialist in obstetrics and gynaecology in an age of new bioscience, as well as being an aid to direct learning. It acknowledges that the practising clinician must be able to evaluate and incorporate new scientific tools into clinical practice and advise patients of the utility of new techniques. It recognises that knowledge is the single best determinant of expertise in a subject. Findings of the Part 1 MRCOG working group The working group reviewed the undergraduate curricula of a sample of UK medical schools to try and see why candidates were finding the Part 1 MRCOG examination increasingly difficult. It found a tendency towards incorporation of basic sciences into integrated curricula with a move towards basic science being taught by clinicians rather than scientists and towards problem-based learning and an applied knowledge base. In addition, there seemed to be a trend towards an overall reduction in the basic science content of the curricula. These findings suggested that Part 1 MRCOG candidates, who should have been revising basic science in preparation for the exami3 © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-904-75256-1 - Your Essential Revision Guide: MRCOG Part One: The Official Companion to the Royal College of Obstetricians and Gynaecologists Revision Course Edited by Alison Fiander and Baskaran Thilaganathan Excerpt More information mrco g pa rt one / your e ssent i a l re v ision guide nation, were in fact studying some of it for the first time. The working group also reviewed the Part 1 MRCOG question bank and considered that some of the questions were out of date, while others lacked obvious clinical relevance or were somewhat obscure. The working group made the following recommendations: 6 To end exemption from the Part 1 MRCOG examination. 6 To define a detailed syllabus for Part 1 as part of the overall MRCOG core curriculum. 6 To update the question bank ensuring quality and clinical relevance. 6 To revise the distribution of questions and add new areas to be examined. 6 To include extended matching questions (EMQs). 6 To use standard setting to determine the pass mark. Implementation of Part 1 MRCOG working group recommendations ending part 1 mrcog exemption Exemption ended at the end of 2006 in recognition of the fact that the new Part 1 MRCOG examination formed an integral part of the overall core curriculum in obstetrics and gynaecology and that it was impossible to guarantee that the Part 1 syllabus was covered by other examinations. obscure questions and those lacking obvious clinical relevance to obstetrics and gynaecology were removed. New questions were developed, particularly in the new areas to be examined, and extended matching questions (EMQs) were added. distribution of questions A small reduction in the number of questions for certain subjects, such as anatomy, embryology, endocrinology, biochemistry and physiology, allowed an increase in other areas, such as statistics and epidemiology. New topics were also introduced, such as clinical trial design and analysis, molecular and cell biology, genomics and the regulation of gene expression. The following pie charts show the new distribution of questions for paper 1 and paper 2 (Figure 1.1), although this will vary slightly from sitting to sitting. The charts also indicate the new question areas that have been included in the Part 1 MRCOG examination since September 2007. figure 1.1 Distribution of questions in the Part 1 mrcog examination (these may vary slightly from sitting to sitting) a paper 1 ■ Anatomy ■ Embryology ■ Endocrinology ■ Microbiology/virology ■ Pharmacology part 1 mrcog syllabus ■ Statistics/epidemiology The aim of revising the Part 1 MRCOG syllabus was to make it clearer and better defined, to map it to the modules and domains of the core curriculum and to update it to include new bioscience topics such as clinical trial design, molecular biology and genomics. The Part 1 syllabus and other relevant information can be found on the RCOG website at: www.rcog.org.uk/ education-and-exams/examinations/exam-part-one. ■ Clinical trial design and analysis b paper 2 ■ Biochemistry/proteomics ■ Molecular and cell biology ■ Biophysics ■ Genetics/genomics/ regulation of gene expression part 1 mrcog question bank review ■ Immunology ■ Pathology As a result of the review of the Part 1 MRCOG question bank in 2006, out of date questions were updated and ■ Physiology 4 © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-904-75256-1 - Your Essential Revision Guide: MRCOG Part One: The Official Companion to the Royal College of Obstetricians and Gynaecologists Revision Course Edited by Alison Fiander and Baskaran Thilaganathan Excerpt More information a l ison n fi a nder ta king t he modernised pa rt 1 mrco g e x a min at ion Extended matching questions EMQs have been incorporated into the Part 1 MRCOG examination since September 2007 and at present contribute 20% of the examination marks. The examination comprises two papers, each of two hours duration separated by a break. Each paper contains 48 multiple choice questions (MCQs) each with five items (240 items in total) and 20 EMQs (1–3 items per option list). Figure 1.2 shows the current composition of the Part 1 MRCOG examination. The current value of each correct MCQ answer remains the same: one mark for each true/false answer. Each correct EMQ answer is worth three marks. Time management is important and it is suggested that the candidate spends approximately 96 minutes on the MCQs and 24 minutes on the EMQs. why? standard setting EMQs have been incorporated into both the Part 1 and the Part 2 MRCOG examinations for a number of reasons. They test understanding of a subject in greater depth than MCQs by assessing the candidate’s knowledge of the relationship between facts. Therefore candidates who have an in-depth knowledge will pass, while those who do not will fail.1 They also tend to define clinical relevance more quickly and reduce the inherent ‘clues’ of MCQ formats. EMQs have been used in the Part 2 MRCOG examination since 2006 and have demonstrated improved discrimination compared with MCQs in defining pass and fail candidates. Both EMQs and MCQs are computer marked with complete accuracy. 1 | Introduction inclusion of extended matching questions what? Standard setting to determine the pass mark is already undertaken for the Part 1 MRCOG examination. The aim of standard setting is to improve the fairness and validity of the examination and to set levels of competence required for success. Standard setting produces a criterion-referenced pass mark by assessing the difficulty of individual papers using a modified Angoff method. EMQs comprise three parts: a list of options or answers, a lead-in statement or instructions and 1–3 items or questions. This can be seen in the blank EMQ template in appendix 3. The option list is lettered to reflect the candidate’s EmQ answer sheet (appendix 4) and will often be in alphabetical or numerical order for ease of reference. The lead-in statement puts the question into context and tells the candidate what to do. The items are numbered to match the answer sheet. figure 1.2 Composition of the Part 1 mrcog examination how? ■ Paper 1 emqs = 20 items ■ Paper 1 mcqs = 240 items ■ Paper 2 mcqs = 240 items ■ Paper 2 emqs = 20 items paper 1 Anatomy, embryology, endocrinology, microbiology, virology, pharmacology, statistics, epidemiology, clinical trial design and analysis paper 2 Biochemistry, proteomics, molecular and cell biology, biophysics, genetics, genomics, regulation of gene expression, immunology, pathology, physiology The recommended way of approaching EMQs is to read the lead-in statement first, followed by the items. The candidate should think about the answer and then select the most appropriate option from the list. Reading the list of options first may be confusing, as the list will contain incorrect options and distractors. EMQs can be written with a single list of options or can be combined into a table format thereby increasing the number of elements of the syllabus examined by a single item, as well as looking at a candidate’s ability to link knowledge.2 The candidate is reminded to select the single option that fits best, even if they feel that there are several possible options. As with the MCQ paper, if two or more 5 © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-904-75256-1 - Your Essential Revision Guide: MRCOG Part One: The Official Companion to the Royal College of Obstetricians and Gynaecologists Revision Course Edited by Alison Fiander and Baskaran Thilaganathan Excerpt More information mrco g pa rt one / your e ssent i a l re v ision guide boxes are marked on the same question, no mark will be awarded, even if one of the options chosen is the correct one. It is therefore important to ensure that any mistakes are fully erased so that they will not be picked up by the computer. Although the candidate’s answer sheet will provide 20 possible answers, the option lists may not use all of these. Most option lists will provide 10–14 options. It is worth noting that EMQs have been allocated more time than MCQs in recognition that they take longer to read and consider. As with MCQs, there is no negative marking for EMQs so it is worth attempting every question. It is recommended that candidates practise both question formats before taking the examination. Examples of EMQs and MCQs for Part 1 MRCOG are given for each chapter in this book and can also be found on the RCOG website and in EMQs for the MRCOG Part 1.3 While the introduction of EMQs has been effective in increasing the depth of knowledge tested in the Part 1 MRCOG, from March 2012 they will be replaced by single best answer questions (SBAQs). SBAQs are similar in format to EMQs. They consist of a lead-in statement and five options from which the candidate is required to select the most appropriate answer. Given the lower scoring tariff for an SBAQ compared with an EMQ, this development will allow a greater range of knowledge to be tested within similar time constraints without compromising the profundity of knowledge being tested. Benefiting from the relative breadth of MCQs and the relative depth of EMQs in this way, the introduction of SBAQs will be instrumental in producing a more clinically relevant and more reliable Part 1 MRCOG examination. Multiple choice questions MCQs continue to form the major part of the Part 1 MRCOG examination. They allow wide subject coverage ensuring efficient use of examination time and perform consistently and reliably well. Appendix 5 shows a blank MCQ template with a stem or lead-in statement and then 5 items, each of which require a true (T) or false (F) answer. Appendix 6 shows an MCQ answer sheet. As with EMQs, the candidate is reminded that there is no negative marking and it is recommended that every question is attempted. Blueprinting Blueprinting ensures even subject and domain coverage and that the examination is neither too predictable nor unpredictable. It confirms that subject areas comprising core knowledge for the specialty are suitably covered to test trainees comprehensively. The new MRCOG core curriculum allows examinations to be blueprinted and maps the Part 1 MRCOG examination as a component part (together with the Part 2 MRCOG examination) of the overall process of assessment for future specialists in obstetrics and gynaecology. The Part 1 MRCOG examination has been blueprinted since 2007. Summary In summary, the Part 1 MRCOG examination has been modernised to ensure that it remains fit for purpose, assessing basic clinical sciences as relevant to the clinical practice of obstetrics and gynaecology. A new detailed syllabus has been developed and the question bank updated to ensure questions are relevant. Extended matching questions have been incorporated into the Part 1 MRCOG examination alongside traditional multiple choice questions The forthcoming introduction of SBAQs from March 2012, meanwhile, will further improve the examination's relevance and reliability. references 1. McCoubrie P. Improving the fairness of multiple-choice questions: a literature review. Med Teach 2004 ; 26 : 709–12. 2. Duthie S, Fiander A N, Hodges P D. Extended matched questions: a new component of the Part 1 examination leading to membership of the Royal College of Obstetricians and Gynaecologists. The Obstetrician & Gynaecologist 2007 ; 9 : 189–94. 3. Duthie J, Hodges P. EMQs for the MRCOG Part 1. London: RCOG Press; 2007. 6 © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-904-75256-1 - Your Essential Revision Guide: MRCOG Part One: The Official Companion to the Royal College of Obstetricians and Gynaecologists Revision Course Edited by Alison Fiander and Baskaran Thilaganathan Excerpt More information di a n a l awrenc e-wat t Anatomy chapter 2 Anatomy of the pelvis, femoral triangle and inguinal canal chapter 3 Anatomy of the bladder, ureter, urethra, anus and perineum chapter 4 Anatomy of the uterus, vagina, ovaries and breast © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-904-75256-1 - Your Essential Revision Guide: MRCOG Part One: The Official Companion to the Royal College of Obstetricians and Gynaecologists Revision Course Edited by Alison Fiander and Baskaran Thilaganathan Excerpt More information © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-904-75256-1 - Your Essential Revision Guide: MRCOG Part One: The Official Companion to the Royal College of Obstetricians and Gynaecologists Revision Course Edited by Alison Fiander and Baskaran Thilaganathan Excerpt More information Anatomy of the pelvis, femoral triangle and inguinal canal 2 | Anatomy chapter 2 Diana Lawrence-Watt Bones of the pelvis figure 2.1 Female bony pelvis The bones of the pelvis present an impressive skeletal ring between the heads of the femurs and the fifth lumbar vertebra. The pelvis consists of the sacrum and right and left hip, or innominate, bones. All three bones allow the pelvis to undertake its role of bearing the weight of the body as well as responding to the musculature that acts upon it. Each hip bone is formed by the fusion of three bones: the ilium, ischium and pubis. These bones unite within the cavity of the acetabulum, which receives the head of the femur. Fusion between the ilium and the pubis is also evidenced by the presence of the iliopubic eminence. greater and lesser pelvis The pelvis itself is arbitrarily divided into two regions, described as the greater pelvis and the lesser pelvis. The greater pelvis is formed by the iliac blades on both sides and by the base of the sacrum posteriorly. The lesser pelvis is the region that describes the true ‘basin’, having an inlet and an outlet as well as the muscular pelvic floor. The pelvic inlet, the boundaries of which are described as the pelvic brim, has obstetric significance in relation to measurements taken in obstetric practice (Figure 2.1). The pelvic brim consists of the promontory and ala of the sacrum posteriorly, the arcuate and pectineal lines laterally and anterolaterally respectively, with the anterior boundary of the inlet being formed by the superior pubic rami, the body of pubis and the pubic symphysis. A B C A Anteroposterior diameter from the midpoint of the sacral promontory to the upper border of the pubic symphysis, usually measured between the third sacral segment and posterior surface of the symphysis B Transverse diameter measured between two similar points on opposite sides of the pelvic brim C Oblique diameter measured from the iliopubic eminence to the lowest point of the contralateral sacroiliac joint Netter Anatomy Illustrations from www.netterimages.com © Elsevier Inc. All rights reserved. pelvic inlet and outlet As well as providing the bony elements of the birth canal, the lesser pelvis gives attachments to many ligaments and to elements of the pelvic floor. It also contains the pelvic viscera. The outlet of the pelvis is formed by four elements of bone: the coccyx posteriorly, the pubic symphysis anteriorly and the two ischial tuberosities laterally. The strong sacrotuberous ligaments stretch between the 9 © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-904-75256-1 - Your Essential Revision Guide: MRCOG Part One: The Official Companion to the Royal College of Obstetricians and Gynaecologists Revision Course Edited by Alison Fiander and Baskaran Thilaganathan Excerpt More information mrco g pa rt one / your e ssent i a l re v ision guide sacrum/coccyx and the ischial tuberosities, with the result that the outlet of the pelvis is described as rhomboid in shape. The inlet of the pelvis has a wide, transverse oval opening, whereas the outlet presents a more oval diameter in its anteroposterior relationship. These anatomical correlates are reflected during labour. The fetal head enters the pelvic inlet positioned with the longer, anteroposterior dimension across the widest and therefore transverse diameter of the pelvis. At the pelvic outlet, the fetal head is positioned anteroposteriorly in relation to the pelvic outlet, this being the widest diameter of both head and outlet. The shape of both the pelvic outlet and inlet are therefore important considerations in labour, because the cross-sectional shape of the birth canal differs at these anatomical levels. The shape of the pelvic outlet corresponds to three wide arches, formed by the subpubic arch anteriorly and the two greater sciatic notches posteriorly. Spanning across the posterior region on each side are the sacrotuberous and sacrospinous ligaments, which convert the sciatic notches into foramina. These foramina are occupied by muscles and important vessels and nerves. The presence of the sacrotuberous and sacrospinous ligaments and the mobile coccyx ensure that the posterior part of the pelvic outlet is a relatively flexible structure. fourth sacral segments and passing to the posterior superior iliac spine, may form a separate structure termed the long posterior sacroiliac ligament. Some of the fibres of the posterior sacroiliac ligament, when present, may also merge with the sacrotuberous ligament. The ligament of the sacroiliac joint that deserves most comment is the interosseous ligament, the strongest ligament uniting the hip bones to the sacrum. The interosseous ligament occupies the space between the bony elements at the back of the joint. It is covered by the dorsal sacroiliac ligament, from which it is separated by the dorsal primary rami of the sacral nerves and vessels. Consisting of deep and superficial strata, fibres from the deep layer pass from depressions on the sacrum to depressions on the tuberosity of the ilium. The most notable fibres of the superficial layers frequently form the short posterior iliac ligament, which spans between the superior articular process and the lateral crest of the first two segments of the sacrum to the ilium. The pubic symphysis forms a secondary cartilaginous joint that unites the two pubic bones via a fibrocartilaginous disc and the superior and arcuate pubic ligaments. The latter is separated from the urogenital diaphragm by an interval, through which the deep vein of the clitoris enters into the pelvis. pelvic articulations and ligaments pelvic articulations in pregnancy The articulations of the pelvis are the sacroiliac joint, the pubic symphysis and the joint between the sacrum and the mobile coccyx. Although the sacroiliac joint is described as a plane joint with very limited movement, the joint surfaces are anything but flat. In fact, they interdigitate by a series of depressions and elevations, fitting into each other to restrict movement of the joint and affording it great strength. The main ligaments of the sacroiliac joint are the ventral sacroiliac ligament, the dorsal sacroiliac ligament and the interosseus ligament. The ventral sacroiliac ligament should not be truly described as a ligament as it is in fact a thickening of the joint capsule. The dorsal sacroiliac ligament, consisting of quite weak bands of tissue, arises from the intermediate and lateral crests of the sacrum, which pass down to the posterior superior iliac spine and the inner lip of the iliac crest. The lower part of this ligament, arising from the third and In pregnancy, all joints of the pelvis afford a greater degree of movement than in the nonpregnant state. This movement is more pronounced in the sacroiliac joint, which can result in increased strain on the ligaments following pregnancy. Functional anatomy of the abdominal wall Supporting and compressing the abdominal contents are the muscles of the anterior abdominal wall: the external and internal oblique, transversus and rectus abdominis. The oblique muscles act in compression, their contraction being important in birth when expelling the fetus from the uterus. 10 © in this web service Cambridge University Press www.cambridge.org
© Copyright 2024 ExpyDoc
