MRCGPApplied Knowledge Test

Format

• A 3-hour, 200-item multiple-choice test• No multiple true/false questions• No negative marking

• Delivered on a computer terminal at an invigilated test centre

• Offered three times a year:Jan/Feb, April/May, Oct/Nov.

Rules

• Only trainees in the ST2 and ST3 stages of training will be eligible to take the AKT

• A maximum number of four attempts will be permissible in the AKT

Jan 2013The pass mark for AKT 17 was set at 132 with pass rates as below:

Candidates (numbers) pass rate• All candidates (1248) 68.7%• ST2 first-time takers (755) 79.6%• ST3 first-time takers (115) 71.3%

Asthma guidelines, antibiotic guidelines, non-medical prescribers and diagnosis of DM were all done poorly

AKT content

80% of questions• Core clinical medicine and its application to problem

solving in a general practice context

10% of questions• Critical appraisal and evidence based clinical practice

10% of questions• Ethical and legal issues as well as the organisational

structures that support UK general practice

Clinical Medicine

• Common, low impact – e.g. sore throat, otitis media, impetigo

• Rare, high impact – e.g. child abuse, meningitis, phaeochromocytoma

• Topical – e.g. MRSA, Type 2 diabetes management

Ethical, Legal & Organisational

• NHS organisation• Legal aspects e.g. DVLA• Medical certification e.g. death certificates• Professional regulation, e.g. GMC• Business aspects e.g. GP contract• Prescribing e.g. controlled drugs• Appropriate use of resources e.g. drugs• Health & Safety e.g. needle stick injury• Social services e.g. safeguarding• Ethical e.g. mental capacity, consent

Question Formats

• Single Best Answer (SBA)• Extended Matching Questions (EMQ)• Table/Algorithm• Picture/Video Format• Drag and drop• Hotspot images• Data interpretation• Free text• Rank ordering

Single Best Answer (SBA)

• “According to national guidelines” means recommended by nationally accepted guidelines or the BNF, not local practice

• Often uses a clinical scenario• Only ONE answer is correct• Other options may be plausible but not “MOST LIKELY”

SBA example: Respiratory disease

A 17-year-old student suddenly develops chest pain and dyspnoea after a morning swim. There is hyper-resonance and decreased breath sounds on the right side.

Which is the SINGLE MOST likely diagnosis? Select ONE option only.A. AsthmaB. PneumothoraxC. Pulmonary embolusD. Left ventricular failureE. Pulmonary haemorrhage

Extended matching questions (EMQ)

• These questions have a list of possible options• There will usually be 2 or more scenarios• Choose the MOST appropriate option that BEST matches each

given scenario• Each option can be used once, more than once, or not at all.

A Berry aneurysm

B Cerebral glioma

C Drug induced

D Graves’ disease

E Ischaemic stroke

F Multiple sclerosis

G Myasthenia gravis

For the patient described, select the SINGLE MOST likely diagnosis from the list of options.

1. A 35-year-old man who is a non-smoker, suddenly develops a severe headache and double vision. His right pupil is fixed and dilated.

EMQ example: Double vision

A Berry aneurysm

B Cerebral glioma

C Drug induced

D Graves’ disease

E Ischaemic stroke

F Multiple sclerosis

G Myasthenia gravis

For the patient described, select the SINGLE MOST likely diagnosis from the list of options.

2. A 48-year-old woman has transitory double vision towards the end of most days. She smokes 10 cigarettes/day. She has vitiligo and hypothyroidism.

EMQ example: Double vision

Algorithm example:Medical management of menorrhagia

For each of the numbered gaps above, select ONE option from the list to complete the algorithm, based on current evidence.

Each option may be used once, more than once or not at all.A Cyclical norethisteroneB Copper-bearing intra-uterine deviceC Inert intra-uterine deviceD Levonorgestrel releasing intra-uterine systemE Medroxyprogesterone acetateF Mefenamic acidG Nonoxinol ‘9’H TiboloneI Tranexamic acid

Non-hormonal

Hormonal therapy

1 _______ 2 _______ Combined oral contraceptive pill

3 _______

Picture Format example:Skin disease

• A 32-year-old man has noticed painless non-itchy patches of hair loss on his beard area and scalp.

Picture Format example:Skin disease

Which is the SINGLE MOST likely diagnosis? Select ONE option only.

A Alopecia areata

B Eczema

C Lichen sclerosis

D Tinea infection

E Vitiligo

Ref: Dermnet.com

Data Interpretation

• Interpretation of data, e.g. for groups of patients with chronic conditions

• Interpretation of research and audit results• Understanding and application of common statistical terms, e.g. sensitivity and number needed to treat (NNT)

Data Interpretation example

• The summary findings of a systematic review which included six separate studies are shown opposite.

Ref: BMJ  2007;335:473 

Data Interpretation example

Which SINGLE study suggests the WEAKEST association between increased whole grain intake and a risk of type 2 diabetes?

Select ONE option only.

A Fung

B Meyer

C Montonen

D NHS1

E Van Dam

Free text questions

• Require the candidate to generate the correct answer without a list of options to choose from e.g:• dose calculation• name of first-line medication

• Eliminates guessing from a list of answers• All answers are screened manually to check for acceptable misspellings

Free text example

Which SINGLE vitamin is administered to reverse the anticoagulant effect of warfarin?

Give ONE answer only

Vitamin _____

Scoring

• All question formats have equal weighting• Each correctly answered question is awarded one mark

• Total score on the paper is the number of correct answers given

• No negative marking – it is important to answer all the questions

Feedback to candidates

• The following feedback will be provided to every candidate with their result

• Their overall score• The pass mark• Their performance in each of the 3 main subject areas

Further preparation

• Small revision groups to share the workload of reviewing national guidance, BNF chapters etc

• Learn from clinical experience – check the guidelines and references

• Exam website feedback (summary reports published for every AKT sitting)

• Exam website sample material• RCGP website – Essential Knowledge Updates and Challenges

Advice from successful trainees:

• Samples of AKT questions are provided every month, linked to the curriculum coverage, in the InnovAiT Journal provided free to AITs by the RCGP.

• PEP (RCGP) AKT style questions linked to curriculum statements and explanations

• PassMedicine Course http://www.passmedicine.com/akt/index.php Large question bank with feedback to place your mark in tests against others applying to AKT, plus teaching notes. Can set yourself practice exams and helps you get used to thinking quickly

• PasTest offer both online courses and revision books• NB GP Update Course http://www.nbmedical.co.uk/ One day course. Review

of recent developments. Useful course book provided.• NICE Guidelines- the exam is very up to date!• RCGP Essential Knowledge Updates• Dot medic• On Examination (BMA)

EBM & Stats & Critical Appraisal

T D. Sackett “Evidence Based Medicine” Churchill Livingstone

Greenhalgh articles or book “How to read a paper” 1997 BMJ Books

How to read a paper: A series in the British Medical Journal on database searching and article appraisal adapted from the book. BMJ 1997

Medical Statistics Made Easy- book

Slow readers/ some IMGs• www.irisreading.com

• If you think reading speed is slower than average this website can help to speed it up

Practice Management• Oxford Handbook of General Practice