1. Tips to pass MRCOG Part 3 in first attempt
Decode
MRCOG

2. MAY 2020 Total 858 Seats Application date - Thursday 19 March, 2020
EXAM DATES MAY,2020
London May
India Chennai May
India Kolkata May
UAE Abu Dhabi May
Singapore May
Results – Wednesday,10 June 2020

3. When to appear for the Part 3

4. Where to appear for the Part 3

5. Is my preparation being enough??????

6. Approach to the Exam Know the anatomy = before surgery
1 full circuit – 14 tasks
14 modules
4- 5 domains ( equal marks)
Global score

7. Core Modules Teaching Core surgical skills Postoperative care
Antenatal care
Maternal medicine
Management of labour
Management of delivery
Postpartum problems (the puerperium)
Gynaecological problems
Subfertility
Sexual and reproductive health
Early pregnancy care
Gynaecological oncology
Urogynecology and pelvic floor problems

8. Tasks Simulated Patient Task ( SPT) + lay examiner Task – 6+4
Structured Discussion ( SD) / Simulated Colleague Task ( SCT)- 4
12 minutes – 2min reading min performance
Candidate instructions – stuck on the table
Note pad + pencil

9. Approach to the Task Introduction Agenda & IEC Check knowledge
Information gathering & thanks for providing info
Offer management
Check understanding
Offer PIL
Close loop
Don’t forget to thank Role player & Examiner

10. Domains Patient safety Communicating with patients and families
Communicating with colleagues
Information gathering
Applied clinical knowledge

11. Materials
PIL – RCOG /NHS/ ACOG
Strat OG Videos
Recalls
CPD case studies
Guidelines Summary & algorithm
MBBRACE report

12. Key to success ... PRACTICE , PRACTICE, PRACTICE
Practice with study partner - Face to face/ Video call
Language is not a barrier
Online courses – Guide to go in right path
Live circuit course – Desensitise / expressions / body language

13. (Simulated Patient Task) ( lay examiner )
You will be assessed in the following domains
Information gathering
Communication with the patient
Applied clinical knowledge
Patient safety
You are going to meet 26-year-old Christenia Joseph, who herself was a case of Spina bifida, had surgery in childhood (now wheel chair bound) now pregnant came for counselling, attached are USG Scan (1) & VTE risk assessment protocol (2).
You will have 10 minutes in which you have to
1. Obtain relevant history
2. Offer her further management
3. Explain the result
4. Answer her questions if any 

17. Roleplayer instructions:
You are 26 year old Christina Joseph , it was unplanned pregnancy but happy to continue. This is your first pregnancy discovered at 20 weeks. You are wheel chair bound, operated for Spina Bifida at age of 7 years. You can walk only with aids, supportive husband and family. Your blood test and USG are Normal. You have difficulty in controlling urine (but manageable incontinence). You are regularly meeting your spine Doctor (attending the spine clinic). Your spine doctor yet to know you are pregnant. You are on folic acid, no family history of clots. You are really concerned about your baby is having Spina Bifida or not.
Eager to know how your pregnancy will be managed and mode of delivery and interested to know any complications associated. Non-smoker, non-alcoholic, no other medical or surgical history, not allergic to any medications. No personal history of clots, with BMI

18. Information gathering - planned pregnancy or not.
-Detailed structured history including Bowel & Bladder habits.
-Is she aware of site / level of nerves affected problems.
-Any pressure sores, skin ulcers, difficulty in breathing.
-Family history / personal history of clots. (VTE risk assessment)
-Current medication, her visits to spinal clinic.
-Social history / family support, medical and surgical history.
-BMI, smoking / Alcohol.
-Mobility restrictions.
-Is she on regular physiotherapy.
-post delivery support, support at home,( applied clinical knowledge.) 
Patient Safety:
-Allergy.
-Detail history to assess VTE risk & Explaining risk of VTE
-MDT care
-Explaining about autonomic dysreflex like episodes of constipation, labor pain, infection may trigger, when she should immediately consult and also symptoms of AD like tingling sensation, sweating, difficulty in respiration.
-24 X 7 contact number & PIL
-Friends or family members to accompany her to hospital / drive in need.

19. Communication with the patient
-Introduction
-Setting Agenda
-Asking her concerns and addressing it
-Acknowledging her problems / difficulties if any
-Being sympathetic
-Explaining how her ANC, labor and postnatal period is managed and risk associated positively in a sensitive manner without scaring the patient.
-Social support / family support
-offering PIL, support groups
-Allowing patient to raise questions / concerns
-Checking patient understanding and also checking her prior knowledge . 

20. -Effects of pregnancy on Spina Bifida.
Applied Clinical Knowledge
-Effects of Spina Bifida on pregnancy.
-Effects of pregnancy on Spina Bifida.
-ANC shared care consultant led care), spine Doctor/neurologist/ urologist, spine nurse, specialist midwife, obstetrician, anaesthetist, physiotherapist.
- Chances of Baby having Spina Bifida 4%.
-As pregnancy progresses, Bladder / Bowel symptoms might worsen, might need self catheterization.
- Increased weight leading to further restriction of mobility might be risk of GDM & VTE.
-Need to adjust her aids (adjusting wheel chair, toilet seat etc).
-Drink more water and fibre diet to reduce constipation.
-Explaining AD depends on level of nerve affected and when she should contact emergency and its number.
-Explaining VTE risk and prophylaxis.
-Mode of delivery might depend on other conditions get admitted early in labour. If no problem with pelvis you may deliver normally or any problem c-section might be required.
-Continous BP monitoring and FHR in consultant led care.
-Postnatal care ...weakness of pelvic floor muscle -physiotherapy might help, feeling depressed, contraception, VTE risk.
-Early evaluation by Anaesthetist -Depending on the level of injury there may be difficulty in giving regional anaesthesia in the birthing process due to weakened pelvic floor and abdominal musculature (should come near labour/mode of delivery)

21. Tentative Schedule EARLY PREGNANCY Jan 1st wk ANC Jan 2nd wk UROGYNEC
Jan 3rd wk
SEXUAL AND REPRODUCTIVE HEALTH
Jan 4th wk
MATERNAL MEDICINE
Feb 1st wk
ONCOLOGY
Feb 2nd wk
LABOR AND DELIVERY
Feb 3rd wk
PUEPERIUM/
EMERGENCIES
Feb 4th wk
TEACHING / FEED BACK
Mar 1st wk
CORE SURGICAL SKILL / POST OPERATIVE
Mar 2nd wk
MATERNITY DASH BOARD
INCIDENT REPORTING
RISK MANAGEMENT
AUDIT & BULLYING
Mar 3rd wk
INFERTILITY
Mar 4th wk

22. Skeleton of the course
Aim - To provide a friendly atmosphere & at the same time give constructive feed back by corrections in a positive & pleasing way
We expect full participation from the candidates - the key requirement
Classes will start from 1st week of January 2020
Only 4 candidates in a batch. Maximum 2 batches
Sessions are organized module wise
sessions covering entire syllabus
Each sessions lasting 2-3 Hours
Week prior to sessions - will provide syllabus of the module with study materials to prepare in advance

23. Contd… During sessions template of each module will be provided
All candidates will present cases during all sessions
Individual feed back after presenting the cases
If needed the candidate will be allowed to repeat the presentation
After each session home work will be assigned on daily basis to each candidate on modules covered
Home work will contain the recalls which will help the candidate to revise the module
As home work stations will be given, the candidates are requested to post their audios in the specific group after preparing nicely
Feed back will be provided through the group

24. Contd… Group activities will be organized
Candidates can post their queries in the group
If any candidate is facing any difficulty with any station individual attention - provided depending on the convenience of mentors
Month before exam, revision will be planned
During revision sessions, surprise stations will be provided to the candidates
Revision will be organized through the decode telegram group
24/7 support
Course Fee: INR 40,000/-

25. Structured Discussion Task
You will be assessed for the following domains
Patient safety
Communication with colleagues
Applied Clinical knowledge
Midwife has called you to see a primipara,. complaining of pain at Episiotomy site despite analgesic. Read the SBAR tool (1)carefully .
Your task is to answer set of questions asked by the examiner

26. SBAR tool (1)
Situation
Mrs Alison, delivered 6 hours back by outlet forceps c/o pain over the episiotomy site despite analgesic
Background
36 year old induced for postdates at 41 weeks
3 doses of vaginal PGE2 FOLLOWED by ARM and oxytocin infusion. Epidural analgesia for labour
1st stage-12 hours
2nd stage-3 hours. Outlet forceps at 2100 hours of a healthy male infant, birth weight 4.15kg
3rd stage-15 minutes
EBL at delivery 400ml
Episiotomy is sutured
Transferred to postnatal ward at 2300 hours
Not able to pass urine
Assessment
She is awake and responsive
Recommendation
I am very worried about her and want you to come and see her immediately

27. 1 How do you approach this case/ patient ?
Introduce yourself to patient
Note history( along with the given details )..,details about presenting complaints like onset duration of pain. details of labor. prolonged 2nd or 1st stage ,any Co morbidities ,medical or surgical , bleeding disorders or clots ,any other risk factors in her current pregnancy ,bowel and bladder symptoms
General history like allergy .
Examination Her pulse ,blood pressure, respiratory rate and saturation ,per abdomen contracted uterus or palpable bladder
Local examination at site of episiotomy any swelling ,per vaginal examination to rule out haematoma and retained swabs or any excessive bleeding
Keeping following differential diagnosis in mind like regular episiotomy pain, any psychological trauma / phobia, vulval or vulvovaginal haematoma, any perineal tears undetected, retained swabs  
 2. what is vulval haematoma and it's causes?
Bleeding limited to vulval region anterior to urogenital diaphragm and caused due to injury to branches of pudendal artery
Injury can be direct by episiotomy or needle or indirect from radial stretching of birth canal 

28. 3.How do you manage her further ?
Inv like FBC & coagulation screen as baseline values and repeated as required
crossmatch required only if clinical condition of patient demands so
Usg & imaging is required usually in patients with haematoma above pelvic diaphragm to know it's extension
Treatment .. conservative - less than 5 cms & Surgical - more than 5 cms
Monitor - meows chart ,Low threshold to use antibiotics, Thrombo Px 
4. Clinical governance ?
Though puerperal perineal haematomas are rare they can have significant maternal morbidity and if unrecognized rarely lead to maternal mortality.
Documentation & Debriefing
If significant blood loss then needs incident reporting and dvt prophylaxis depending on risk assessment
The speed of diagnosis and it's consequence depends on the level of awareness among midwives and other clinical staff hence debriefing the team and discussion with all health care workers about identification and management goes long way in reducing maternal morbidity and improving patient care

29. (Simulated Patient Task)
This task assesses the following clinical skills:
Information gathering
Communication with patients
Patient Safety
Applied clinical knowledge
You are a ST5 in subfertility clinic. Next patient Mrs Natasha 40 yrs old, previous 3 CS, referred by GP that during last CS, doctor told her it will be risky for her to have another CS, so they sterilized her. Now she came to know that people can have 5 or 6 CS without any complications. She thinks this was done unnecessarily. She thinks that NHS should fund her reversal of sterilisation.
In next 10 minutes, you will have to
Obtain relevant history
Provide adequate information
Address her concerns 

30. Allow her to drain her anger & assure her investigation will take place ( non blaming)
Appreciate her interest to have more babies
Get her permission to explain further
Divide into parts
Reversal of sterilization – what, how (CCG), success, need for old records
If successful – what risks ( CS & AMA)
Alternatives

31. Information Gathering
Events around the time of procedure
Detail about deliveries
Review her case records – type of sterilisation , duration
H/O STD (PID /tubal damage), Menstrual history( regularity),Partner history ( semen analysis) Previous surgery, PMH, social, BMI
Patient Safety
-Involves her in the decision process
- Provide her support for complaint - PALS
- Ask permission to access notes to know more about the incident
Involve consultant
Risk of ectopic, Placenta accreta & it’s risk, PET, SGA, GDM

32. Communication with patient
- Introduction
Absorbing her anger
Asses IEC
- Starts with assurance that it will be an open discussion
- Show understanding – I appreciate your wishes to have more child
Explain the facts in a non judgemental way & clear manner
Information in chunks & checks
PIL
Applied Clinical Knowledge
NHS will not be funding for reversal on routinely
more success 80%% if < 5yrs , clip method & tube length> 4cm, same part of tube- isthmo -Isthmic
Ask about alternatives like IVF ( NHS funding),surrogacy & adoption
Laparoscopy /HSG to know about the length of tube
Check Ovulation , FSH

33. All the best to achieve your dream

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