EFOG-EBCOG Part 1 common mistakes
EFOG-EBCOG Part 1 · Understand the traps and how to avoid them.
Reciting the definition of a condition (e.g. definition of pre-eclampsia or postpartum haemorrhage) instead of stating the current diagnostic thresholds and management steps the question actually asks for.
Candidates memorise textbook definitions from undergraduate revision and assume the examiner wants a definition, when EBCOG Part 1 items are usually framed around next-step management, diagnostic criteria, or a specific guideline threshold.
What to do instead
Before writing, underline the interrogative in the stem (diagnosis, next step, most likely cause, initial investigation). Practise answering only that verb. Build one-page summaries per topic listing diagnostic criteria and first-line management separately from the definition, and rehearse the criteria verbatim (blood pressure and proteinuria thresholds, PPH definitions by volume and drop in haemoglobin).
Applying a remembered numerical threshold from an outdated guideline, e.g. quoting an old haemoglobin cut-off for anaemia in pregnancy or an old gestational diabetes glucose value.
Guidelines change and candidates revise from notes made years earlier or from sources that predate the current NICE, RCOG, WHO, or FIGO updates. The exam is set against current guidance.
What to do instead
Anchor every numerical fact to a named source and year in your notes. Re-verify the small set of numbers that recur (anaemia thresholds by trimester, OGTT values, Bishop score components, partogram action lines, thromboprophylaxis scores). If you cannot recall the current figure confidently, reason from first principles and eliminate implausible options rather than guessing a stale number.
Confusing the timing and mechanism of the three PPH causes and choosing uterine atony management for a case that describes retained tissue or a genital tract tear.
Atony dominates teaching, so candidates pattern-match any bleeding after delivery to atony and skip the stem details (placenta completeness, perineal or cervical trauma, clotting history, uterine tone on examination).
What to do instead
Adopt a fixed sequence for any bleeding stem: assess tone, tissue, trauma, thrombin in that order, and let the stem's positive findings select the cause. Practise distinguishing examination findings (soft, poorly contracted uterus versus contracted uterus with ongoing bleeding) and match each to its first intervention.
Missing the obstetric emergency hidden in a stem that presents with non-specific symptoms, e.g. reading a case of shoulder-tip pain and collapse as gastroenteritis rather than an ectopic pregnancy.
Candidates focus on the named diagnosis in the stem and do not actively generate a differential, particularly in early pregnancy where symptoms are vague and the reproductive history is buried in the last line.
What to do instead
Make a habit of scanning every obstetrics stem for pregnancy status, gestation, and haemodynamic observations before reading the options. When a woman of reproductive age presents with abdominal pain, syncope, or gastrointestinal symptoms, always test ectopic pregnancy and other pregnancy-related emergencies first.
Choosing caesarean section or operative delivery as the answer for a condition where vaginal delivery or expectant management is recommended, without weighing the stem's severity markers.
Operative delivery feels like the definitive answer, and candidates over-weight the desire to 'solve' the problem rather than follow the graded management pathway (expectant, then medical, then surgical).
What to do instead
For each option, ask what would have to be true in the stem for it to be correct, then check whether those features are present. Learn the escalation ladders for placenta praevia, vasa praevia, breech, and preterm rupture of membranes, and note explicitly which severity features trigger delivery.
Mixing up ovarian tumour marker patterns and misassigning CA-125, inhibin, hCG, and AFP to the wrong tumour type in a case of a complex adnexal mass.
Tumour markers are learned as a list without the histological logic behind them, so candidates cannot reconstruct the answer when a marker they did not memorise appears.
What to do instead
Learn each marker with its cell of origin (epithelial, sex cord-stromal, germ cell, trophoblastic) and its typical age group. Then derive the answer from the stem's histology or age rather than recall. Test yourself by naming the marker for each of the four groups in both benign and malignant settings.
Applying a single abnormal cervical screening result to the wrong colposcopy pathway, e.g. referring immediately for treatment when the correct step is repeat testing or colposcopy.
Candidates collapse the screening algorithm into 'abnormal smear means colposcopy' and ignore the grade of abnormality, HPV status, age, and pregnancy status that determine the next step.
What to do instead
Draw the referral algorithm once, from primary HPV testing through cytology triage to colposcopy and treatment thresholds, and annotate it with age and pregnancy exceptions. Rehearse it by working backwards from the answer options to the grade of abnormality that would justify each.
Confusing the definitions of primary and secondary amenorrhoea, or of abnormal uterine bleeding, and therefore selecting the wrong first-line investigation.
Definitions are similar in wording and candidates revise them in isolation, so the precise duration and age criteria blur under exam pressure.
What to do instead
Write the definitions side by side with their exact duration and age cut-offs, then attach the first-line investigation to each (pregnancy test, gonadotrophins, prolactin, thyroid function, pelvic ultrasound). Practise short stems where the only discriminator is the duration of symptoms.
Answering a contraception or menopause question with the general rule while ignoring the contraindication named in the stem, such as migraine with aura, smoking over 35, or a history of venous thromboembolism.
Candidates recall the effectiveness or convenience of a method but not the UKMEC or equivalent category system, so they miss that the stem is testing a contraindication rather than efficacy.
What to do instead
Commit the UKMEC categories to memory for combined hormonal contraception and progestogen-only methods, organised by condition. For every contraception stem, list the patient's risk factors before looking at the options and eliminate any method that is UKMEC 3 or 4.
Spending disproportionate time on a few difficult items and leaving later, easier questions unanswered, or changing correct first answers on review without a clear reason.
Part 1 papers are long and time-pressured, and anxiety about a hard early question erodes pacing; second-guessing is driven by uncertainty rather than new information in the stem.
What to do instead
Do two passes: answer every item you know first, flag the rest, and return with remaining time. Only change an answer if you can name the specific stem word you missed. Rehearse this with timed mock papers under exam conditions and review your flag-and-return rate afterwards.