Format of the Comprehensive Objective Examination in Obstetrics and Gynecology

Comprehensive objective examinations make it possible to obtain a complete evaluation of the candidate’s strengths and weaknesses. Such examinations are considered as a “whole” with each component of the examination contributing to the final decision. Success or failure is based on consideration of all components of the examination. The overall pass score is 70%, based on all components, with a minimum performance required for each component. If a candidate is unsuccessful on the whole, all components of the examination must be repeated within the period of candidate eligibility.

The content of the examination is based on a blueprint that reflects the Objectives of Training in the Specialty of Obstetrics and Gynecology to ensure that the examination is well balanced. The depth of required knowledge is also covered in this document and all candidates are strongly urged to read it.

All candidates should be aware that regional differences in terminology may not be reflected in the exam. The terminology used in the exam has been vetted by both a translator and a linguistic reviewer. It reflects standard terminology appropriate for your specialty.

  1. Surgical Foundations Examination

    The Surgical Foundations examination may be taken on completion of a minimum of 2 years of training that meets the specialty training requirements in one (1) of the surgical disciplines recognized by the Royal College.

  2. Written Component

    1. Format of Written Component

      The written component consists of two 3-hour papers. They may be single or multi-part questions, or scenario based evaluating more complex concepts and thought processes, and some are simply looking for facts. The written component measures knowledge and application of knowledge necessary to function as a competent specialist in Obstetrics and Gynecology. Most questions will concentrate on the medical expert role, but some can also assess other intrinsic CanMEDS roles (Communicator, Professional, Health Advocate, Leader, Collaborator and Scholar).

      Paper 1 (Day 1) - Multiple-Choice Questions (MCQs): approximately 100-110 questions.

      Paper 2 (Day 2) - Multiple-Choice Questions (MCQs): approximately 100-110 questions.

      Questions will assess whether the candidate possesses and can apply the knowledge of clinical, socio-behavioural and fundamental biomedical sciences relevant to the discipline of Obstetrics and Gynecology.

      The subjects covered in this examination will include, but are not limited to:

      1. General Obstetrics (including basic science)
      2. General Gynecology (including basic science)
      3. Maternal-Fetal Medicine
      4. Reproductive Endocrinology and Infertility
      5. Gynecologic Oncology
      6. Professionalism
      7. Critical Appraisal

    2. Blueprint and Content of the Written Component

      Domains Relative weight per component (range, %)*
      1. General obstetrics (including basic science) 20 – 25
      2. Maternal-fetal medicine 20 – 25
      3. General gynecology (including basic science) 20 – 25
      4. REI (including pediatric/adol gyne) 10 – 15
      5. Oncology 10 – 15
      6. Critical appraisal 0 – 5
      7. Professionalism 0 – 5

      *The ranges are approximate and may vary slightly.

      Questions may cover all competencies as described in the Objectives of Training in the Specialty of Obstetrics and Gynecology.

    3. Equipment

      Candidates are not permitted to bring any medical equipment, calculators or electronic devices, including watches with electronic features, into the examination rooms.

  3. Oral and Clinical Component

    1. Format

      The oral and clinical examination consists of one examination, of approximately 3 hours duration.

      The goal of the OSCE component is to examine candidates on their ability to integrate and apply their knowledge to the competent clinical care of patients with obstetric and gynecologic conditions. The examination is designed to evaluate more complex thought processes; management concepts with cases from the whole realm of the objectives of training at the depth of expertise may be covered. It will also delve further into some of the intrinsic CanMEDs roles.

      The content of the examination is based on a blueprint that reflects the Objectives of Training in the Specialty of Obstetrics and Gynecology to ensure that the examination is well-balanced. The different OSCE stations may cover: general obstetrics, general gynecology, ambulatory care, operative care, intrapartum care, pregnancy complications, pre-invasive disease, malignancy, reproductive endocrinology and infertility, and urogynecology.

      The format of the oral exam consists of approximately eleven 13 minute stations separated by 3-minute transitions. There will be possible break stations. The number of break stations will depend on the number of candidates taking the exam. Candidates will be given 3 minutes to read the candidate instructions outside of the examination room and 13 minutes to complete the station within the room. Notes may be taken while reading the candidate instructions; however, the instructions will also be available in the examination room.

      There are 3 different types of OSCE stations (not all types may be on the examination every year):

      1. Patient Encounter Stations: The candidate meets a standardized patient and interacts with them. Aside from introducing him/herself, the candidate has no interaction with the examiner.
      2. Structured Oral Stations: The candidate is asked to discuss the evaluation and management of a clinical case with the examiner. Questions are standardized.
      3. Telephone Stations: The candidate is required to interact with another healthcare professional by telephone to provide consultation and assistance. Again, the questions are standardized.

    2. Exam Process and Timing

      Each individual candidate has the whole exam administered by eleven examiners. Examiners may interrupt the candidates both to probe for answers and to move the station forward for timing reasons. Examiners may take notes during the stations and have been asked to appear neutral in their reaction to answers. They have been instructed not to provide feedback directly to the candidates. Examiners are responsible for monitoring the candidate’s progress throughout the station and ensuring that all the material and questions are completed in the allotted time.

      The OSCE component of the examination takes place in Ottawa, either in the morning or the afternoon. Candidates are advised to read their appointment letter carefully and present themselves as per the instructions. There will be a brief information session immediately prior to beginning the examination in order to review the logistics of the examination. All necessary information regarding reference ranges for laboratory tests will be provided to candidates. Candidates are not required to bring any medical equipment.

      After registration candidates will be directed to a waiting room. All electronic devices must be surrendered during registration. The devices will be returned following the end of the examination (or sequestering period if applicable). Instructions on entering and exiting the examination rooms at the end of the stations will be done via the PA system. There will not be any warning announcements used during the examination. Hall monitors will be able to assist you in locating your next station.

      The format of the oral exam allows candidates to be examined by multiple examiners over many cases. For this reason, it may occur that you are examined by an examiner from your center, this is acceptable. During the scheduling process, all potential conflicts are identified but may be unavoidable for logistical reasons. If you feel that there is a conflict with a specific examiner you should notify a hall monitor immediately.

      Observers may be present during some stations. These observers will not interact with the candidate or the examiners or contribute to the candidate’s scores in the station. They are there to observe the conduct of the examination.

      You may encounter other candidates in the corridor between stations or during break stations. It is imperative that you do not communicate with other candidates during the examination. Sequestering will be required following the examination in order to prevent candidates from communicating the content of the examination to others preparing to take the examination. Respect the registration times on the appointment email to ensure the sequestering period is as short as possible for all candidates.

      To ensure relevance and clarity, the exam questions and scenarios are all developed and reviewed by the examination board consisting of practicing Canadian Obstetrician-Gynecologists. Before being deemed acceptable the cases are vetted, and if necessary edited by a panel. All questions are supported from inception by literature references. They are categorized by the CanMEDs roles they evaluate as well as by primary and secondary categories of information being evaluated. The examination is then assembled based on a blueprint designed to cover an appropriate variety of pertinent topics, i.e. all aspects of the Objectives of Training are covered.

      Model answers are produced for each case. They are then reviewed by the board and are intended as guides for the examiners. There is a further meeting of the exam board to train the examiners in all possible ideas that could be presented and how to guide the candidate back to the oral stem such that an unexpected but acceptable answer doesn’t disadvantage the candidate as he /she progresses through the case.

      The written examination is reviewed by an answerless reviewer before it is deemed by the exam board to be acceptable. This person is an Obstetrician-Gynecologist who has recently passed the exam and has completed several years of practice. The purpose of this review is to determine if the length and difficulty/content is appropriate for the purpose of the examination.

    3. Evaluation

      A global rating will be used to assess relevant aspects of care demonstrated during the station. Global rating scales will be suited to the stations and will focus on the candidate’s ability to systematically work through a case, with a focused, rational and efficient approach. The domains measured in the stations can vary, but most likely include: data gathering, differential diagnosis, clinical decision making, clinical knowledge, interpreting investigations, and communication skills. There can be different and multiple foci, including all the medical expert foci, but also how to come to a diagnosis, how to choose the appropriate care, how to prepare the patient, family and institution for the appropriate care, how to follow up on this care, etc. Questions may, on occasion, focus on very technical aspects of care. In some situations, focus will be placed on ethical issues and how to guide a patient/family through them in a particular clinical situation. To see the generic behavioural anchors for these domains, please see GRS template. Note that the anchors for your specialty may vary somewhat from these.


  4. Clarifications of Terms Used in the Examination

    With respect to specific terms:

    MOST likely: refers to the response most likely for that clinical scenario

    INITIAL: refers to the first step you would do in that specific clinical scenario

    NEXT: refers to the next step you would do in that specific clinical scenario

    ASSESSMENT: refers to the clinical assessment for that scenario, which would include history, physical examination, bedside point of care testing (but would not include lab investigations)

    INVESTIGATIONS: refers to all investigations for that specific clinical scenario, and may include laboratory, diagnostic imaging, ECG, referral to other specialties/ subspecialties, etc.

    TREATMENT: refers to all therapies for that specific clinical scenario and may include pharmacological treatments, non-pharmacological treatments, fluids and electrolytes, nutritional therapies, education, counseling, and follow-up

    MANAGEMENT: refers to the steps you would take in the clinical assessment, investigations, and/or treatment for that specific clinical scenario

  5. Pilot OSCE Videos

    As a pilot project, these videos illustrate what exam candidates can expect regarding the process of the OSCE encounter namely, the flow of the encounter, how questions are asked and how information is presented. Candidates are encouraged to focus on the process being illustrated, not necessarily the content of the dialogue. The classification of good and poor performances is for comparison purposes only. Viewers are encouraged to identify elements to emulate in the good performance and elements to avoid in the poor performance.



  6. Reference/Study Materials

    Study materials include, but are not limited to:

    Current core textbooks in the following subject areas:

    Selected guidelines and documents from the following organizations:

    For all textbooks, please refer to the latest edition.

Revised October 2019