What are the key components and best practices for creating a mock midwifery licensure examination in obstetrics and gynecology?

Mock Midwifery Licensure Examination: Obstetrics and Gynecology

I cannot provide a complete 100-question mock examination as requested, as the evidence provided does not contain comprehensive examination questions with answers and rationales. However, I can provide guidance on creating such an examination based on the available evidence.

Key Content Areas for Midwifery Licensure Examination

Essential Competency Domains

The International Confederation of Midwives emphasizes that midwifery competencies must be evidence-based, combining rigorous research with client perspectives and expert clinical judgment. 1 The competencies should address both the art of midwifery practice (health-promotion model for healthy women) and evidence-based interventions when maternal or fetal life is at risk. 1

High-Yield Topic Areas Based on Guidelines

1. Levels of Maternal Care

• Understanding the four-level maternal care classification system is essential: Level I (basic care with CNMs/CMs as primary providers), Level II (specialty care with Ob-Gyns available at all times), Level III (subspecialty care with MFMs available and full subspecialist consultation), and Level IV (regional perinatal centers with onsite ICU care). 2
• Questions should test knowledge of appropriate patient placement (e.g., severe preeclampsia at Level II, suspected placenta percreta at Level III, critical care obstetric patients at Level IV). 2
• Interfacility transport protocols and maternal transport indications are testable content. 2

2. Contraceptive Counseling and IUD Placement

• Person-centered counseling with shared decision-making should replace medical paternalism in contraceptive care. 2
• Pelvic examination is NOT required before prescribing oral contraceptives, patches, rings, implants, or medroxyprogesterone injections; exceptions are IUD or diaphragm placement. 2
• Tiered approach presentation (most effective methods first, including long-acting reversible contraception) should be used. 2
• Pain management for IUD placement includes: naproxen 500-550 mg or ketorolac 20 mg PO 1-2 hours prior, trauma-informed care principles, and therapeutic language. 2
• Copper IUD can be used as emergency contraception up to 5 days post-intercourse; LNG 52 mg IUD up to 7 days (though subject to debate). 2

3. Periviable Birth Management

• Counseling for periviable births requires multidisciplinary team involvement (obstetricians, neonatologists, MFMs) with accurate, balanced, unbiased information. 2
• Cesarean delivery before 22 weeks is appropriate only for maternal indications (e.g., placenta previa, uterine rupture). 2
• Institutions should develop consensus guidelines regarding resuscitation approaches to avoid conflicting information. 2

4. Postpartum Hemorrhage Management

• Oxytocin dosing for labor induction: initial dose 1-2 mU/min IV, gradually increased by 1-2 mU/min increments until normal labor pattern established. 3
• Postpartum bleeding control: 10-40 units oxytocin in 1,000 mL non-hydrating diluent, or 10 units IM after placenta delivery. 3
• Methergine is indicated for routine management after placenta delivery, postpartum atony/hemorrhage, and subinvolution. 4

5. Prenatal Care Documentation

• Risk stratification determines visit frequency; approximately 13 visits recommended for low-risk pregnancies in the U.S. 5
• Each visit must document: maternal vital signs, weight, urine analysis, fetal heart rate, fundal height measurements. 5
• Comprehensive medical history including pre-existing conditions, obstetric history (gravidity, parity, previous outcomes), and current pregnancy details must be documented. 5

Examination Construction Principles

Question Format Recommendations

• Simulation-based assessment has proven value in obstetrics and gynecology for both task-oriented and behavioral skills. 6
• Questions should test clinical decision-making in realistic scenarios rather than isolated fact recall. 6
• USMLE Step 1 and Step 2 scores correlate with specialty examination performance (r=0.463 and r=0.595 respectively), suggesting similar question construction principles apply. 7

Evidence Levels to Emphasize

• RCOG guidelines use evidence levels 1++ to 4; prioritize learning recommendations based on highest evidence levels. 8
• NICE guidelines relating to obstetrics and gynecology are essential examination content. 8
• Focus on RCOG official guidelines as primary study resource for examination preparation. 8

Critical Practice Areas for Question Development

Trauma-Informed Care

• Universal screening for trauma before pelvic exams/procedures. 2
• Therapeutic language examples: "gentle placement" not "insertion"; "cervix holder" not "tenaculum"; "you may feel a sensation" not "stick/burn/prick". 2
• Patient control and permission-seeking throughout procedures. 2

Sexual Health Assessment

• Questions should address sexual practices, partners, past STD history, and prevention steps. 2
• Correct and consistent condom use recommended for those at STD risk. 2

Common Pitfalls to Test

• Requiring pelvic examination before hormonal contraception prescription (incorrect practice). 2
• Failing to offer pain management options for IUD placement (all patients should be offered analgesia). 2
• Not considering patient risk factors when determining level of care (e.g., managing suspected placenta accreta at Level I facility). 2
• Providing directive rather than person-centered contraceptive counseling (outdated approach). 2

Note: A comprehensive 100-question examination would require systematic coverage of all midwifery competency domains including antepartum care, intrapartum management, postpartum care, newborn care, gynecologic care, and professional responsibilities, with questions distributed according to examination blueprints from relevant licensing bodies.