Cambodia Midwifery Exit Exam common mistakes
Cambodia Midwifery Exit Exam · Understand the traps and how to avoid them.
When a prolonged second stage is presented, the candidate immediately selects 'prepare for caesarean section' instead of first assessing descent, fetal heart rate, and contractions and starting an upright position, emptying the bladder, and oxytocin augmentation where appropriate.
Emergency-management drills dominate revision, so candidates pattern-match any abnormal labour scenario to the most dramatic intervention and skip the stepwise bedside assessment that Cambodian referral hospitals expect before theatre.
What to do instead
Practise a fixed decision ladder for prolonged second stage: confirm full dilatation and station, check fetal heart rate and moulding, assess contraction frequency and maternal effort, then list conservative measures (position, bladder, hydration, oxytocin) before assisted delivery or referral. Write the ladder out from memory weekly until the order is automatic.
On postpartum haemorrhage items, the candidate gives a single correct action (for example 'give oxytocin') and stops, rather than sequencing the full response: call for help, assess tone/trauma/tissue/thrombin, uterine massage, uterotonics in order, IV fluids, tranexamic acid, and referral.
Questions are read as single-best-answer recall when they are actually testing a protocol; candidates also confuse the order of uterotonics and forget non-drug steps such as bimanual compression and aortic pressure.
What to do instead
Memorise the PPH bundle as a numbered checklist with timings (within 30 minutes, 60 minutes, 90 minutes) and rehearse it aloud in simulation. For each practice item, write the full sequence before choosing the option, then identify which step the question is actually asking about.
In neonatal resuscitation items, the candidate spends time drying, suctioning, and stimulating a baby who is not breathing at birth, instead of starting positive pressure ventilation within the first minute when the baby is apnoeic or gasping.
Routine newborn care steps (dry, wipe, wrap, delayed cord clamping) are over-learned from normal-birth practice and get applied to the depressed newborn; candidates also overestimate the value of suctioning.
What to do instead
Drill the 'golden minute' rule: term baby not breathing after drying and stimulation means start ventilation now. Learn the 60-second decision points and the 3:1 compression-to-ventilation ratio, and practise bag-mask technique on a manikin with a timer so the sequence becomes physical memory.
The candidate answers hypertensive-disorder questions by treating all raised blood pressure the same, failing to distinguish severe features (severe headache, visual disturbance, epigastric pain, raised liver enzymes, low platelets) and failing to state that magnesium sulphate is for seizure prophylaxis and treatment, not blood pressure control.
Pre-eclampsia, eclampsia, and gestational hypertension overlap in memory, and candidates conflate antihypertensives with anticonvulsants because both appear in the same protocol.
What to do instead
Build a two-column table: 'blood pressure control' (labetalol, hydralazine, nifedipine) versus 'seizure prevention/treatment' (magnesium sulphate with loading and maintenance doses and monitoring for respiratory depression and oliguria). Add the severe-feature checklist and rehearse it on every hypertensive scenario.
When asked about prevention of mother-to-child transmission, the candidate gives a generic 'give antiretrovirals' answer and cannot state the timing of maternal ART, infant nevirapine prophylaxis duration, infant testing schedule, and feeding recommendation for a Cambodian setting.
PMTCT guidance has changed repeatedly, so candidates rely on outdated teaching from earlier training or from colleagues, and they mix up maternal treatment with infant prophylaxis.
What to do instead
Write a one-page PMTCT timeline from memory: maternal lifelong ART regardless of CD4, viral load monitoring, infant nevirapine prophylaxis duration by risk category, early infant diagnosis at 6 weeks and after breastfeeding cessation, and exclusive breastfeeding with maternal adherence. Verify each line against current national guidelines and correct the page until it is exact.
On family planning items, the candidate recommends a method without checking eligibility criteria, and cannot explain the difference between combined hormonal methods and progestogen-only methods for a woman with hypertension, smoking, migraine with aura, or during breastfeeding.
Contraceptive methods are memorised as a list of names and effectiveness figures rather than as a set of eligibility conditions, so contraindications and timing of initiation are weak.
What to do instead
Learn the Medical Eligibility Criteria categories (1 to 4) and apply them to five common profiles: smoker over 35, hypertension, breastfeeding under 6 weeks, migraine with aura, and postpartum. Practise explaining each method's mechanism, effectiveness, side effects, and return to fertility in plain Khmer as if counselling a client.
In infection prevention questions, the candidate describes hand hygiene or waste segregation in general terms but cannot state the specific sequence for donning and removing personal protective equipment, the correct use of chlorine concentrations for different purposes, or the difference between sterilization, high-level disinfection, and cleaning.
IPC is treated as common sense rather than as a set of exact procedures, and candidates have rarely seen the concentration tables or the decontamination-to-sterilization flow written out.
What to do instead
Learn the decontamination, cleaning, high-level disinfection, and sterilization pathway as a flow diagram with the correct chlorine concentration and contact time at each step. Memorise PPE doffing order and rehearse it with a partner, since removal order is where contamination occurs.
The candidate answers ethics and scope-of-practice items by choosing the option that seems most helpful or most senior, rather than identifying what is within the midwife's legal scope, when referral or supervision is required, and how consent and confidentiality apply to a minor or an unmarried client.
Clinical content is prioritised in study, and legal frameworks are skimmed, so candidates default to 'ask the doctor' or 'do what the family wants' instead of applying the actual scope and consent rules.
What to do instead
Study the national midwifery scope of practice and the code of ethics as documents, and for each scenario ask three questions: is this within my scope, does this client have capacity to consent, and what must be documented and referred. Build a short list of tasks that require referral and memorise it.
On health-system and community-health items, the candidate cannot describe the referral pathway from health centre to referral hospital, the role of the health centre midwife versus the hospital midwife, or the components of the minimum package of activities and complementary package of activities.
These topics feel administrative and are skipped, yet questions test concrete knowledge of levels of care, referral forms, and community structures such as village health support groups.
What to do instead
Draw the Cambodian health system pyramid from memory: health post, health centre, referral hospital, national hospitals, with the services at each level and the referral documentation required. Learn the roles of the village health support group and health centre management committee, and test yourself by explaining the pathway for a woman with obstructed labour.
In labour-assessment questions, the candidate records a cervical dilatation and calls it progress without plotting it against time, and cannot interpret a partograph that shows slow progress, a prolonged latent phase, or a fetal heart rate deceleration pattern.
The partograph is learned as a form to fill in rather than as a decision tool, and candidates rarely practise reading a completed chart to identify when action is needed.
What to do instead
Practise with ten completed partographs: mark the alert and action lines, classify the progress, and state the required action for each. Learn to distinguish early, variable, and late decelerations and what each implies, and always state dilatation together with hours elapsed and descent.