ABOG Complex Family Planning common mistakes
ABOG Complex Family Planning · Understand the traps and how to avoid them.
Reciting US MEC category numbers by pattern-matching the condition name instead of the condition's specifics, e.g., labeling combined hormonal contraception as category 2 or 3 for a patient with migraine with aura rather than category 4, or treating 'migraine' as a single entity without separating aura from no aura.
Candidates learn the MEC framework abstractly and study uncommon conditions last, so under time pressure they retrieve the category attached to the diagnosis label rather than the qualifying features (aura, age ≥35 plus smoking, hypertension severity, breastfeeding timing, VTE history).
What to do instead
Build a one-page table keyed to qualifying features rather than disease names, and drill the category 4 'do not use' list (migraine with aura, ≥35 with smoking, hypertension ≥160/100, prior VTE, known thrombophilia, active breast cancer, SLE with antiphospholipid antibodies) until recall is automatic.
Recommending emergency contraception without adjusting for body weight or time since exposure, and without knowing that ulipristal requires a delay before starting hormonal contraception, or that the copper IUD is the most effective option.
Emergency contraception gets compressed into a few lines in general preparation, so candidates default to levonorgestrel 1.5 mg for every scenario and forget the practical follow-on counseling about when to start a regular method.
What to do instead
Memorize a four-branch decision table: time since exposure, BMI/weight, desire for ongoing contraception, and access to same-day IUD; pair it with the rule that after ulipristal hormonal contraception is delayed (about 5 days) whereas after levonorgestrel it can start immediately.
Quoting medication abortion regimens from the wrong indication or an outdated source, for example mixing the dose and interval used for early pregnancy loss with the abortion regimen, or stating a misoprostol repeat interval that belongs to a different route.
Several regimens circulate (label versus evidence-based, abortion versus missed abortion versus cervical preparation), and candidates blend them into a hybrid that no guideline endorses.
What to do instead
Anchor on one evidence-based set: mifepristone 200 mg orally followed 24–48 hours later by misoprostol 800 mcg vaginally, buccally, or sublingually, with the gestational-age limits and follow-up expectations attached; then explicitly list how the early-pregnancy-loss and cervical-preparation regimens differ.
Initiating medication abortion without confirming pregnancy location and gestational age, or proceeding in a patient with an unknown-location pregnancy without a defined serial hCG and ultrasound plan.
The visit is treated as a prescribing transaction, and candidates skip the diagnostic step because the patient is asymptomatic and the hCG is above the discriminatory zone.
What to do instead
Rehearse an unknown-location algorithm out loud (serial hCG, transvaginal ultrasound, discriminatory zone, ectopic risk factors, when to treat presumptively versus when to reassess), and state the location confirmation step in every abortion-care answer.
Normalizing post-abortion bleeding without applying quantitative thresholds, omitting RhD immune globulin in an Rh-negative patient without preformed anti-D, and failing to work through retained products, uterine atony, and cervical or uterine injury as separate causes.
Bleeding is an expected part of the procedure, so abnormal bleeding gets absorbed into 'expected,' and Rh status is treated as a formality rather than a checklist item.
What to do instead
Attach numbers to the answer (for example soaking two pads per hour for two hours, or symptomatic anemia) and use a fixed post-abortion checklist: vital signs, Rh status and immune globulin dose by gestational age, ultrasound findings, and the differential of hemorrhage causes with the next action for each.
Defending expectant, medical, or surgical management of early pregnancy loss with a single success-rate point estimate, and failing to match the recommendation to the patient's priorities such as time to resolution, avoidance of surgery, or desire for a pathology specimen.
Candidates memorize one number per option and then answer a values question with a statistics question, missing that the stem is testing counseling rather than efficacy ranking.
What to do instead
For each option, state a range with its drivers (gestational age, prior loss history, access to follow-up) and pair it with the patient preference it serves; when the stem signals a preference, make the preference the deciding variable and mention efficacy only as support.
Treating contraception as a separate future visit instead of addressing it during the index encounter - the peripartum admission, the post-myocardial-infarction stay, or the visit where a teratogenic medication is started.
Generalist training frames contraception as its own appointment, so in a complex-medical-management stem the candidate manages the primary condition and never closes the pregnancy-prevention loop.
What to do instead
Adopt a standing prompt for every medically complex stem: what is this patient's pregnancy intention, what method is safe now under the MEC, what can be started before discharge (including immediate postpartum IUD or implant), and what bridge is needed until then.
Missing bidirectional drug interactions - overlooking enzyme-inducing anticonvulsants or antiretrovirals that reduce contraceptive steroid levels, or overlooking that a contraceptive method changes levels of another drug the patient depends on.
Pharmacology is recalled as a list of interactions rather than as a property of the patient's actual medication list, so the interaction is only caught when the drug is named in the stem.
What to do instead
Read every medication list in the stem twice, once for inducers and once for narrow-therapeutic-index drugs, and default to a method whose efficacy does not depend on steroid metabolism (copper or levonorgestrel IUD, depot medroxyprogesterone) when an inducer is present.
Answering an ethics item with the legal minimum - citing a coverage restriction or state statute when the stem asks what the physician owes the patient - or applying an adult consent framework to a minor without checking minor consent and confidentiality rules.
Policy and ethics are studied as separate blocks, and the legal rule is the more memorable fact, so it displaces the professional-obligation reasoning the item is actually testing.
What to do instead
Before answering, label the question type in the stem as legal minimum, ethical obligation, or professional standard, then answer only that question; keep a separate short list of consent and confidentiality frameworks (minor consent, judicial bypass, Title X confidentiality, mandated reporting) with the specific trigger for each.
Misreading trial results - calling a noninferiority trial positive when the confidence interval crosses the prespecified margin, reporting 'no difference' from a superiority trial with a non-significant p-value, or mixing intention-to-treat with per-protocol conclusions.
Statistical interpretation is rehearsed as formula recall rather than as a reading habit, and under time pressure the candidate scans the p-value and skips the margin, the comparator, and the analysis population.
What to do instead
Force a fixed reading order for any research stem: design and comparator, primary outcome, effect size with confidence interval, prespecified margin, analysis population, then conclusion; say the margin out loud relative to the interval before choosing an option.