N&MC Ghana Exam common mistakes
N&MC Ghana Exam · Understand the traps and how to avoid them.
On ethics items, the candidate selects the option that defers to the doctor, the family, or the candidate's own moral view (e.g. choosing 'tell the patient what the doctor has decided' or 'withhold the diagnosis to protect her') instead of the option that protects informed consent, confidentiality and patient autonomy.
Ethics is often revised as a list of definitions to memorise, so under time pressure the candidate falls back on the deference-to-authority habit learned on the ward rather than applying a principle to the facts in the stem.
What to do instead
Use a fixed three-question drill on every ethics item before reading options: (1) which principle is in conflict (autonomy, beneficence, non-maleficence, justice, confidentiality)? (2) does this patient have capacity and full information? (3) which option keeps the decision with the informed patient? Drill 20 consent, confidentiality, refusal-of-treatment and whistleblowing scenarios until the drill is automatic.
Interpreting a vital-sign set by reacting to the single most abnormal number and ignoring the direction of change across the readings given in the stem - for example choosing 'reassure, the BP is normal' when the respiratory rate has climbed from 20 to 28 and SpO2 has fallen from 97% to 92%.
Vital signs are learned as isolated normal ranges for OSCE-style recall, so candidates check each value against its range and never construct a trajectory; deterioration is a trend phenomenon, not a single-value phenomenon.
What to do instead
Before looking at the options, write the last three values of the most abnormal parameter in a column on the question paper and mark the arrow (up/down). If any two parameters are moving in the wrong direction, the answer must be escalation of assessment or care, not reassurance.
Making arithmetic slips in dose and infusion items: placing the decimal point wrongly when converting mg to g or mL to L, adding a drop factor instead of multiplying by it, or computing drops per minute without converting the time to minutes.
Candidates memorise the formula as a shape rather than as unit-cancelling algebra, and they work mentally under time pressure without writing units down, so a factor-of-ten error survives to the answer options.
What to do instead
Use dimensional analysis with every unit written at each step: drops/min = (volume in mL x drop factor in drops/mL) / time in minutes, and mg/kg x weight in kg = mg. Finish with a plausibility check (an adult maintenance infusion is roughly 20-40 drops/min with a 20 drops/mL set) and reject any answer an order of magnitude away.
In a severe pre-eclampsia or eclampsia item, the candidate chooses 'give an antihypertensive first', quotes the wrong magnesium sulphate loading regimen, or cannot state the monitoring parameters and the antidote needed while the infusion runs.
Pre-eclampsia is revised as a list of signs rather than as a timed protocol, so the seizure-prophylaxis step and the toxicity-monitoring step get lost between the diagnosis and the delivery decision.
What to do instead
Write one protocol card and reproduce it from memory weekly: magnesium sulphate loading 4 g IV (20% solution) over about 20 minutes plus 10 g IM (5 g into each buttock), maintenance 5 g IM into alternate buttocks every 4 hours; monitor respiratory rate (at least 16/min), presence of the patellar reflex and urine output (at least 30 mL/hour); withhold the next dose and give calcium gluconate 1 g IV slowly as the antidote if toxicity appears. Control of severe hypertension and delivery are separate steps from seizure prophylaxis, not substitutes for it.
Judging postpartum blood loss by eye and documenting 'moderate lochia, observations stable' when the woman is tachycardic and the pads are saturating, instead of quantifying loss and activating the postpartum haemorrhage pathway.
Visual estimation of blood loss systematically underestimates volume, and candidates carry the habit from clinical areas where losses are described rather than measured; tachycardia in a young, fit woman is also a late and easily dismissed sign.
What to do instead
Always quantify: count and weigh saturated pads and swabs (1 g gained is approximately 1 mL of blood), note the time each pad was changed, and treat 500 mL or more after vaginal birth or 1000 mL or more after caesarean birth as postpartum haemorrhage requiring the full protocol (call for help, uterine massage, IV access, oxytocin, bladder emptying, monitor and escalate). Practise saying the number, not the adjective.
Applying adult physiological thresholds and adult dosing logic to a child - accepting a respiratory rate of 34/min as 'normal' in a 6-month-old, treating a heart rate of 150/min in an infant as tachycardia requiring immediate cardioversion, or endorsing a fixed adult tablet dose for a 12 kg child.
Adult placement dominates clinical exposure, and normal paediatric ranges are revised as a table once and then forgotten, so the adult template is applied by default.
What to do instead
Before answering any paediatric item, state the child's age band aloud and recall that band's respiratory and heart rate ranges; for any medicine item, compute the dose as mg/kg x weight in kg and check it against the stated maximum, rejecting options that are not weight-based unless the stem says a fixed formulation is prescribed.
Misclassifying a sick child in integrated management of childhood illness style items - recording 'cough or cold, no pneumonia' for a child with cough and fast breathing, or missing chest indrawing, inability to drink, convulsions or lethargy as general danger signs.
Candidates remember that 'fast breathing means pneumonia' but not the exact age-specific cut-offs or the rule that any general danger sign overrides the respiratory classification, so the classification is guessed.
What to do instead
Memorise three numbers and one rule: fast breathing is 50 breaths/min or more at 2-11 months and 40 breaths/min or more at 12-59 months (60 or more in a child under 2 months); any general danger sign means urgent referral and parenteral antibiotics regardless of other findings. Count breaths for a full minute using a timer, not by impression.
Answering Ghana health-system items from a foreign textbook template - placing the first point of contact at a district hospital, describing CHPS as a hospital service, or being unable to order the referral pathway from community to teaching hospital.
Most revision material is imported and community health is revised last, so the local service structure and the community-based programme names are the weakest, least rehearsed links in the candidate's knowledge.
What to do instead
Draw the pathway from memory until it is stable: community and household level (community health officer or volunteer) to CHPS compound to sub-district health centre to district hospital to regional hospital to teaching hospital, and write beside each level the services and the staff found there. Anchor each level with a real local example and with the programme names that appear in Ghanaian practice.
Choosing 'reassure the patient and review at the next appointment', 'distract the patient', or 'inform the family only' when a client expresses suicidal ideation, hopelessness or thoughts of harming the baby, rather than choosing direct risk assessment and immediate escalation with removal of means and one-to-one supervision.
Candidates fear that asking directly about suicide will 'plant the idea', and mental health content is often reduced to memorising diagnostic criteria rather than to rehearsing the escalation sequence.
What to do instead
Adopt a single hard rule: any expressed intent, plan or means converts the answer to immediate direct questioning, do not leave the patient alone, remove means, involve the multidisciplinary team and document. Rehearse this on postpartum psychosis, severe depression and deliberate self-harm vignettes, where the safe option is also the correct one.
Confusing the mandate and scope of the regulatory body with that of the service employer - attributing licensure, disciplinary hearings and scope-of-practice definition to the Ghana Health Service or the Ministry of Health, or agreeing that an unlicensed or junior cadre may independently perform an act outside their defined scope.
The roles of regulator, employer and policy-maker overlap in day-to-day talk on the ward, and candidates study professional foundations by reading the code once rather than by contrasting the institutions.
What to do instead
Build a two-column table for each body listing only what it does: regulator (registration, licensure, renewal, scope of practice, professional discipline, standards) versus employer and policy-maker (service delivery, employment, postings, national policy). Then apply one delegation test to every scenario: the licensed professional remains accountable, and a task may be delegated only if it falls within the delegate's defined scope and training and the patient is stable.