SBAs for the MRCOG Part 1

Technique and
Practice
© Royal College of Obstetricians and Gynaecologists
MRCOG part 1 committee
 It's not easy to write good
questions

• Not too easy

• Not too hard
• Must be from the blue print grid
• Must be clinically relevant but not Part 2
 It's not easy to write good
questions

• Must be relevant for an average ST1/ST2

• Must be underpinned with basic science
• Cover test
• Non-controversial
• Must have a single (best) correct answer
• Not based on local knowledge / processes
 SBA skills and tactics

• The writers really want you to get the question right

• There are NO trick questions
A poorly written question e.g. Which of the following is not
false with regard to left but not the right kidney when not
pregnant!
 Don’t sweat the easy stuff
• There are some very easy questions! (>98 % get it
right)

• From the table below what is the mean Hb

concentration

Hb (g/dl)

10.2 9.8 10.0 12.0 8.0

• A 9.8
• B 10
• C 10.2
• D 11
• E 12
(often the arithmetic flows into the answer)
 Easy question
(providing you do not over-think)

• Which of the following a nominal scale

 
• A Serial blood pressure in mm of Hg
• B Body mass index
• C Peak expiratory flow rates
• D ABO blood group
• E Grade of placenta praevia
 
• Answer D ABO blood group
 
• A nominal scale is a named scale but has no order.

Poor question as fails the cover test

 Re-written for cover test
• What type of scale is the ABO blood group
system?

• Ordinal
• Nominal
• Binary
• Interval
• Prunella
 Technique
(The dodgy fifth option)
• Technique
If one of the stems is unknown to you it is probably fake (sometimes it’s
difficult to think of a fifth option
e.g.:
– Chi cubed distribution test
– Power is the unequal standard deviations compared to the means
– Turkie’s survival curves

Try to answer the question with the cover test

• Knowledge
Stats know your scales!!
 Knowledge
• All questions are derived from the blueprint
grid

• Target your learning !!

• Don’t learn about logistic regression (because

I cannot ask you questions on it)
• If the answer to a question is not on the blueprint
grid it is unlikely to be the correct answer

• Look through the blueprint and think “What

components of the grid are easy to write
question for”

• Eg “ 2 X 2 tables, diagnostic tests”

 Easy question in lots of padding
(common is statistic questions)
• A sample of antenatal patients is sampled to quantify the number of reported episodes
of urinary incontinence in the pregnancy. There were 25 patients sampled of a
population of 3500. The number of episodes of incontinence per patient was 30 with a
standard deviation of 10.
What is the standard error of the mean. Please select the best option
A2
B4
C6
D8
E 10
Answer A 2
Standard error of the mean = Standard deviation / square root of n
SEM = 10 / square root of 25
SEM = 10/5
SEM 2
There is NEVER a complex maths answer in the stats
question
If the maths is complex then you have
the wrong answer
Dear Part 1 MRCOG committee
Please can I use a calculator for the MRCOG?

Dear Candidate
If you have ten fingers and ten toes you will not
require a calculator
 Formulae

• Sensitivity
•
• Power
Specificity
• + Predictive value • Understanding box plot
• - Predictive value
• Likelihood ratios
• Understanding histograms
• P values • Understanding forest plot
• Normal distribution
• Interquartile range • Which test to select
• Variance • Types of trial
• Standard deviation
• Standard error of the mean • ROC
• Mean, mode, median
•
• RR, OR, AR
Type I and type II error
• If TP=true positive and FN= false negative what
does the following equation represent
TP/(TP+FN)
• Select the best option.
 
• A Sensitivity
• B Specificity
• C Positive predictive value
• D Negative predictive value
• E Likelihood ratio
 
 Technique
• Use pen and paper
DISEASE

+ -
TEST + TP FP

- FN TN
A population of 100 women after a gold standard test
(laparoscopy), 4 are found to have rectovaginal
endometriosis. A preoperative MRI has positive results for
rectovaginal endometriosis in 3 of the 4 true positives and
another 7 positives without rectovaginal endometriosis.

Choose the best option that reflects the sensitivity of the

test.

A 10 %
B 25 %
C 55 %
D 75 %
E 93 %
 LAP + LAP -
MRI + 3 7
MRI - 1 89
4 96 100

LAP + LAP -
MRI + TRUE + FALSE +
MRI - FALSE - TRUE -
96 100
If P is set to <0.05 in a hypothesis testing trial there will be an alpha
error rate. Select the best option that reflects the average alpha error
rate with the defined P value.

A 1 in 25 trials
B 1 in 20 trials
C 1 in 10 trials
D 1 in 5 trials
E 1 in 3 trials

Answer

1 in 20 trials

Comments
The p value is the probability of an observation occurring by chance.
Alpha error is falsely rejecting the null hypothesis (no difference in the
two groups)
In a population of 110 women after a gold standard test
(laparoscopy), 10 are found to have rectovaginal endometriosis.
A preoperative endoanal scan has positive results for
rectovaginal endometriosis in 5 of the 10 true positives and
another 10 positives without rectovaginal endometriosis.

Choose the best option that reflects the specificity of the test.

A 50 %
B 60 %
C 70 %
D 80 %
E 90 %
 LAP + LAP -
uss + 5 10
uss - 5 90
10 100 110

LAP + LAP -
uss + TRUE + FALSE +
uss - FALSE - TRUE -
100 110

Specificity is the proportion of true negatives that are correctly identified

by the test
Since 10 patients have truly have rectovaginal endometriosis that leaves
100 truly negative. The endoanal scan had 10 false positives
100-10 / 100
90/100
0.9 = 90 %
In a population of 100 women after a gold standard test
(laparoscopy), 4 are found to have rectovaginal
endometriosis. A preoperative MRI has positive results for
rectovaginal endometriosis in 3 of the 4 true positives and
another 7 positives without rectovaginal endometriosis.
Choose the best option that reflects the positive predictive
value of the test.

A 10 %
B 20 %
C 30 %
D 40 %
E 50 %
 LAP + LAP -
uss + 3 7
uss - 1 89
4 96 100

Answer
30 %
Comment
True test positives/ total test positives
• A new antihypertensive is assessed by a randomised controlled trial
in pregnant women. The main outcome is blood pressure four
weeks after treatment.

• What test would you use to compare the mean blood pressures in
the groups

A Linear regression
B Two sample T Test
C R squared co-efficient
D Regression analysis
E Chi Squared

B Two sample T Test

 A different way of asking an easy
question
• With regard to diagnostic tests, If x represents the true
positive results and y represents the false negative results
what does this equation calculate
• X/X+Y

A Sensitivity
B Specificity
C Positive likelihood ratio
D Negative likelihood ratio
E Positive predictive value

Answer A Sensitivity
• With regard to a box plot. What does the box
represent

• A Inter quartile range

• B Range
• C Variance
• D Confidence interval
• E The Z score +/- 2 standard errors
 What is the WHO definition of
osteoporosis

A A spinal fracture or fracture of the hip with low calcium

B T score < - 1.0

C T score < - 2.5

D Z score < - 1.0

E Z score < - 2.5

 Category T-score range  % young women
Normal T-score ≥ −1.0 85%
Osteopenia −2.5 < T-score < −1.0 14%
Osteoporosis T-score ≤ −2.5 0.6%
T-score ≤ −2.5 with fragility
Severe osteoporosis
fracture[2]

C T score < - 2.5

With regard to vitamin D metabolism what food
is particularly high in D2?

A Bananas
B Beef
C Oily fish
D Soya milk
E Wheat

C Oily fish
Where is the body is the major production
of 1,25 (OH)2 D3 (calcitriol)
A Bone
B Kidneys
C Liver
D Lung
E Parathyroids

B Kidneys
 With regard to bound plasma calcium, what is the major carrier

A Neutrophils
B Calciprotein transfer molecule 1 (CTM 1)

C Haemoglobin
D Plasma proteins

E SHBG

D Plasma proteins
 What is the change in total lung capacity in pregnancy

A Decreased by 100 mls

B Decreased by 200 mls
C Increased by 100 mls
D Increased by 200 mls
E No change

B Decreased by 200 mls

 What coagulation factors are reduced in pregnancy

A III, IV
B IX, X
C V, VII
D XI, XII
E XI, XIII
Correct answer:
E XI , XIII
 
Any comments or feedback:
Main changes in haemostasis factors during pregnancy.
Platelet count ↓
II, V =
Fibrinogen,VII,VIII,von Willebrand factor,IX,X,XII ↑
XI, XIII =↓
Antithrombin =
 What factor shifts the O2 dissociation curve to the right (ie
reduces Hb affinity for 02)

A Decreased CO2 concentration

B Decreased hydrogen ion concentration

C Increased 2,3 DPG

D Increased sodium concentration

E Reduced temperature

C Increased 2,3 DPG

 With regard to ovulation, what is the fluid filled
space in a follicle called

A Antrum
B Blastocyst
C Lacuna
D Basal lamina
E Uniblastocyst

A Antrum
 Where is the body is calcidiol produced

A Kidneys
B Liver
C Parathyroids
D Skin
E Spleen

B Liver
 What proportion of primordial follicles undergo atresia
to create a primary follicle

A 20 %

B 50 %

C 90 %

D 95 %

E 99%

E 99 %
• Don’t be scared of the stats question

• Its only based on the blue print or the

essential revision guide

• Good luck!!!