MRCGP Applied Knowledge Test

Promoting Excellence in

Family Medicine

MRCGPMRCGPApplied Knowledge TestApplied Knowledge Test

Prepared by the AKT Core GroupPrepared by the AKT Core GroupDecember 2013December 2013


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Objectives

An overview of the content and structure

To give examples of current question formats

To describe how questions are constructed

To advise on how to prepare and pass the AKT

To explain practicalities of computer-based tests


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AKT Background

The AKT:Is a summative assessment of the knowledge base that underpins independent UK general practice.

Tests the application of this knowledge

Tests the critical interpretation of information

Is mapped to the 2012 Curriculum

Each question is intended to explore a topic of which an ordinary GP in the UK could be expected to have a working knowledge


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Format

A 3-hour, 200-item multiple-choice testNo multiple true/false questionsNo negative marking

Delivered on a computer terminal at an invigilated test centre

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


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Rules

For those starting specialty training from 1/8/10

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

AKT passes obtained after 1 August 2010 will no longer be subject to a three year validity limit


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Rules - exceptions

Those who commenced specialty training before 1/8/10 will be permitted to make an unlimited number of attempts at the AKT while they retain a national training number

Passes obtained between 1 August 2007 and 31 July 2010 by trainees in a specialty training programme will remain valid pending the award of a Certificate of Completion of Training (or Certificate of Eligibility for GP Registration)


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Vital Statistics – Oct 2013

Pass mark = 134/200 (67%)

Overall pass rate = 76.1%

ST3 first time takers pass rate = 83.4%

ST2 first time takers pass rate = 87.4%(This ratio varies in different diets of the AKT taken at

different times throughout the training year)

Cumulative pass rate after three attempts for all those who take AKT is approximately 98%


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Some areas that were not answered well(AKT October 2013)

Interactions between commonly used drugsDementia – managementPeripheral vascular diseaseWomen’s health – incontinenceVaccination regimes – pre-employmentDiabetes – managementDermatology – diagnosis and management of psoriasis

Remember that, as in real life, the “do nothing” and “normal” option may be correct


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Question writing

Scenarios are derived from clinical workPractice issuesTopical

All questions are referenced and the draft questions are then carefully scrutinised by a panel of experienced question writers.

Remember that all question writers are working GPs


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Common Reference Material

GP Curriculum 2012Content guide for the AKTBNFGMC Good Medical PracticeRCGP Essential Knowledge UpdatesNICE guidelinesSIGN guidelinesBMJ Review articles & original papersBJGPCochrane


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GP Curriculum & AKT Content Guide

Where to find themwww.rcgp.org.uk/gp-training-and-exams/gp-curriculum-overview.aspx

http://www.rcgp.org.uk/gp-training-and-exams/mrcgp-exam-overview/mrcgp-applied-knowledge-test-akt.aspx#howtoprep

How the AKT links to the curriculum

Questions in the AKT sample across the breadth of the curriculumThe AKT Content guide is a new learning resource which is designed to be used in conjunction with the curriculum


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AKT Content Guide

How to use the Content Guide

Don’t be put off by the lengthy list of topics!Do use the guide as a needs assessment toolIn particular, carefully review the sections:

Organisational –including administrative, statutory, ethical and regulatory frameworks

Evidence interpretation – including research, statistics and epidemiology


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Paper Construction ensures:

Reliability, validity and fairness

Adequate coverage of the topics that appear in the blueprint

The correct balance of question formats


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Principles of paper construction

Relevance: the AKT should be relevant to general practice

High prevalence: any topic covered can be one which occurs commonly

High impact: or one which is significant but less common


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AKT content

80% of questionsCore clinical medicine and its application to problem solving in a general practice context

10% of questionsCritical appraisal and evidence based clinical practice

10% of questionsEthical and legal issues as well as the organisational structures that support UK general practice


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Clinical Medicine (1)

The broad topic of clinical medicine is subdivided into groups of body systems, in approximately equal numbers

Each group will comprise questions on

disease factorssymptomsinvestigationmanagement


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CardiovascularDermatologyEndocrinologyENTGastroenterologyGeneticsHaematologyImmunologyInfectionMental health & learning disability

Musculo-skeletalNeurologyOphthalmologyPaediatricsRenalReproductive male/femaleRespiratoryTherapeutic indications and adverse reactions


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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


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Critical appraisal and evidence-based clinical practice

Understanding the principles of audit and its application in assessing the quality of careUnderstanding the application of critical appraisal skills which will be tested in a number of formats including:

the interpretation of research datathe understanding of terms used in both statistics and evidence based medicine Understanding epidemiology relevant to general practice


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Ethical, Legal & Organisational

NHS organisationLegal aspects e.g. DVLAMedical certification e.g. death certificatesProfessional regulation, e.g. GMCBusiness aspects e.g. GP contractPrescribing e.g. Controlled drugsAppropriate use of resources e.g. drugsHealth & Safety e.g. needlestick injurySocial services e.g. safeguardingEthical e.g. Mental capacity, consent


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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


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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”


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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.

SBA example: Respiratory disease

A. AsthmaB. PneumothoraxC. Pulmonary embolusD. Left ventricular failureE. Pulmonary haemorrhage


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• 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.

Extended matching questions (EMQ)


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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


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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


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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.

Non-hormonal

Hormonal therapy

1 _______ 2 _______ Combined oral contraceptive pill

3 _______


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Algorithm example:Medical management of menorrhagia

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


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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.

Ref: Dermnet.com


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Picture Format example:Skin disease

A. Alopecia areata

B. Eczema

C. Lichen sclerosis

D. Tinea infection

E. Vitiligo

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


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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)


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Data Interpretation example

Ref: BMJ 2007;335:473

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


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Data Interpretation example

A. Fung

B. Meyer

C. Montonen

D. NHS1

E. Van Dam

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

Select ONE option only.


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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


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Free text example

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

Give ONE answer only

Vitamin _____


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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


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Computer Based Testing

• Once candidates have registered with the RCGP to sit the AKT, they will be given instructions about booking their exam at a Pearson VUE test centre.

• There is a limited booking window with ‘first come, first serve’ choice of test session and venue.

• There are approximately 150 test centres covering all parts of the UK.


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Computer Based Testing Rules• Candidates MUST bring

identity documents WHICH MATCH their application details

• Candidates should arrive in good time

• Candidates who either arrive late or fail to provide matching ID, will NOT be admitted to sit the AKT


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Computer Based Testing• Security at each centre

will be robust: Identity checks Invigilated Video monitoring

• Separate morning and afternoon sittings with a ‘quarantine’ period at lunchtime.

• Morning candidates will not be allowed to leave before the end of the test


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• It is STRONGLY recommended that candidates familiarise themselves with the demonstration tutorial on the Pearson VUE website

http://www.pearsonvue.com/rcgp/

• Every AKT will begin with a short tutorial to remind candidates how to select answers and ‘mark’ questions – screen shots follow of the live tutorial


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• Responses will be uploaded to a central server and then passed to the RCGP for post-test analysis

• Following this, results and feedback will be sent individually to candidates


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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


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Feedback to Deaneries

• More general feedback on overall performance will continue to be forwarded to all UK deaneries and saved on the RCGP website

• It is helpful to look at this previous feedback to identify areas which commonly cause difficulty:

• http://www.rcgp.org.uk/gp-training-and-exams/mrcgp-examination-summary-reports-statistics/mrcgp-applied-knowledge-test-akt-summary-reports-and-statistics.aspx


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Online AKT Tutorial

http://www.rcgp.org.uk/gp-training-and-exams/mrcgp-exam-overview/mrcgp-applied-knowledge-test-akt.aspx#howtoprep

• Simulates format of AKT

• Requires Adobe Flash (not available on devices running iOS)


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Test Day Tutorial: Opening Screen


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Test Day Tutorial: Flagging questions for later review


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Test Day Tutorial: Using the review screen


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Test Day Tutorial: SBA question example


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Test Day Tutorial: EMQ question example


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Test Day Tutorial: MBA question example


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Test Day Tutorial: Free Text question example


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Test Day Tutorial: Drag and Drop question example


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Exam technique 1

• Time management – this is everything• Keep watching the countdown clock on the

computer• 200 questions in 3 hours = average of 54

seconds per question• You should skip difficult questions rather than

waste time (electronically highlight the ones you have left out) but don’t forget to leave time to go back before the end


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Exam technique 2• Cover test – can you answer the question with

the option list covered? If so, it’s probably the correct answer

• Go through unanswered questions 2nd time round using electronic review

• Do not leave any questions unanswered – educated guessing is worthwhile

• Check for silly mistakes if you still have time


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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


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And finally….

• Remember that most people pass this exam first time…..

• But you do need to prepare for it• So make use of the AKT Content Guide

Documents

MRCGP Applied Knowledge Test