Afghanistan Midwifery Exit Exam common mistakes
Afghanistan Midwifery Exit Exam · Understand the traps and how to avoid them.
When asked to classify a woman's blood pressure or haemoglobin value, choosing the answer that matches the number to a remembered cutoff label (e.g., calling 145/95 'normal because it is close to 140/90') instead of applying the stated diagnostic threshold and then choosing management.
Candidates memorise cutoffs as isolated numbers and rehearse them by recognition rather than by applying them to a clinical vignette; small numeric distractors are placed deliberately close to the threshold.
What to do instead
For every vital-sign or lab question, restate the threshold aloud in the form 'value X against cutoff Y = category Z', then answer the management question separately. Practise 20 vignettes where the value sits 5 units either side of the cutoff.
On questions about the partograph or labour progress, answering with the action for 'poor progress' generally (e.g., 'augment with oxytocin') without first checking whether the finding is a cervical dilatation delay, a descent/fetal condition problem, or an obstruction sign such as moulding or a Bandl ring.
The partograph is learned as a chart to fill in rather than as a decision tool, so candidates jump to the most familiar intervention and skip the step of excluding obstruction before stimulation.
What to do instead
Use a fixed three-step routine for every labour-progress item: (1) which parameter is abnormal, (2) is there any sign of obstruction or fetal compromise, (3) only then choose augmentation, referral, or caesarean. Drill this on paper partographs with a single abnormal finding.
In immediate-postpartum and newborn items, giving the answer that describes the ideal sequence in the wrong order (e.g., drying before assessing breathing, or clamping the cord before starting resuscitation) or omitting the time-critical step such as uterine massage or immediate breastfeeding initiation.
Candidates learn the components of a bundle but not the priority ranking within it; exam items deliberately offer all correct-sounding actions in scrambled order.
What to do instead
Write out and memorise two ordered checklists: 'call-dry-warm-stimulate-assess-ventilate' for the newborn and 'call-help-massage-oxytocin-assess blood loss' for the mother. Answer ordering questions by matching to the checklist, not by plausibility.
When a vignette describes postpartum haemorrhage or eclampsia, selecting a single correct drug or manoeuvre and stopping there, rather than selecting the option that includes simultaneous resuscitation (airway, IV access, fluids, blood, monitoring) alongside the specific measure.
Emergency topics are revised drug-by-drug, so the candidate recognises the drug name and treats it as the complete answer; the 'best next action' format rewards the comprehensive step.
What to do instead
For every emergency item, ask 'what else is happening to this woman right now?' and prefer options that pair the specific intervention with stabilisation. Rehearse PPH and eclampsia as timed drills with a written sequence of at least five simultaneous actions.
In neonatal resuscitation questions, choosing a positive-pressure ventilation rate, initial FiO2, or compression-to-ventilation ratio from adult or paediatric memory, or continuing ventilation without reassessing heart rate at the recommended interval.
Newborn physiology is taught separately but revised late and under time pressure, so adult numbers intrude; candidates also forget that reassessment, not continuation, is the tested decision.
What to do instead
Build a single one-page newborn resuscitation card (initial steps, ventilation rate, compression ratio, reassessment timing, when to stop) and self-test it weekly. For each question, identify which step of the algorithm the stem is at before choosing.
On family planning and post-abortion items, recommending a method by efficacy alone while ignoring the client's stated medical condition, breastfeeding status, or preference (e.g., offering a combined hormonal method to a woman with migraine with aura or a smoker over 35).
Candidates study method effectiveness tables in isolation and treat eligibility criteria as a separate chapter, so they do not connect the two when the vignette supplies a contraindication.
What to do instead
For every contraception vignette, underline the client's condition first, then eliminate all methods contraindicated by it, then choose among survivors by efficacy and preference. Practise with a two-column sheet: condition vs methods to avoid.
In infection prevention items, answering with hand hygiene or gloves as the complete answer when the stem tests a specific sequence (e.g., doffing order, instrument decontamination steps, or waste segregation) or when the correct answer is a higher-level control such as sterilisation rather than disinfection.
Hand hygiene is over-rehearsed and becomes a default answer; candidates do not practise the procedural sequences, so they cannot distinguish disinfection from sterilisation under exam wording.
What to do instead
Learn the decontamination-to-sterilisation chain and the PPE doffing order as numbered sequences, and for each question decide which link in the chain the stem is asking about before answering.
In pharmacology items, choosing a dose, route, or drug that is plausible for an adult but wrong for pregnancy, lactation, or the newborn, or selecting a drug without checking the stated contraindication in the stem (e.g., giving a uterotonic to a woman with a stated cardiac condition).
Drug facts are memorised as lists without a safety-check habit, and stems bury the disqualifying detail in the history rather than in the question.
What to do instead
Before answering any medication item, extract four facts from the stem: who (pregnant, breastfeeding, newborn), what condition, what contraindication, what route is available. Eliminate any option that fails one of the four.
In ethics, law, and scope-of-practice items, answering with what is clinically best rather than what is lawful and within the midwife's authorised scope, or failing to identify the correct step of informed consent, confidentiality, or referral and escalation.
Candidates conflate clinical judgement with professional obligation and have not practised distinguishing 'should do' from 'may do' and 'must refer'.
What to do instead
For each ethics item, ask three questions in order: is this within my scope, does it require consent or confidentiality protection, and does it require referral or documentation? Choose the option that satisfies all three, then check it against the clinical preference.
In reproductive and sexual health items, giving a clinically correct answer that ignores the client's rights, autonomy, or the legal context of abortion care (e.g., disclosing to a partner, or requiring spousal consent where none is required), or misjudging gestational limits for a method.
These topics are revised as procedures rather than as rights-based care, so the candidate picks the medically efficient option and misses the consent, privacy, and legal-eligibility dimension the item is testing.
What to do instead
For each item, first state the client's stated wish and the legal gestational limit, eliminate any option that overrides her decision or breaches confidentiality, then choose the method appropriate to gestation. Review the national abortion and consent provisions together with method-by-gestation tables.