1. MRCGP AKT - BASICS

2. AIMS What is the AKT? Why do I need to do it? When do I need to do it?
Where do I need to do it?
How do I need to do it?
How much does it cost?
How do I prepare for it?
?any other burning questions

3. What is the AKT? APPLIED KNOWLEDGE TEST
Summative Assessment
The AKT is designed to test the application of knowledge and interpretation of information.
Candidates who pass this assessment will have demonstrated their competence in applying knowledge at a level which is sufficiently high for independent practice.
Each question is intended to explore a topic of which an ordinary GP could be expected to have a working knowledge.
It is mapped to the latest RCGP Curriculum

4. 200 item Multiple Choice Test
The test takes the form of a 190 MINUTE machine-marked test – 57 seconds per question
Approximately 80% of question items will be on clinical medicine
10% on critical appraisal and evidence based clinical practice and
10% on ethical and legal as well as organisational structures that support UK General Practice
Delivered on a computer terminal at an invigilated test centre
Offered three times a year: Jan/Feb, April/May, Oct/Nov.
All questions will address important issues relating to UK general practice and will focus mainly on higher order problem solving rather than just the simple recall of basic facts.
All trainees will be expected to attempt this exam at least twice whilst in training.

5. Clinical
The broad topic of clinical medicine is subdivided into groups of body systems, in approximately equal numbers
Each group will comprise questions on
disease factors
symptoms
investigation
management

6. Clinical Cardiovascular Musculo-skeletal Dermatology Neurology
Endocrinology
Ophthalmology
ENT
Paediatrics
Gastroenterology
Renal
Genetics
Reproductive male/female
Haematology
Respiratory
Immunology
Therapeutic indications and adverse reactions
Infection
Mental health & learning disability

7. What is the AKT? Question writing…
Scenarios derived from clinical work
Practice issues
Topical
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. The writers do not write for any commercial organisations!

8. What is the AKT Question format….
Single Best Answer (SBA)
Extended Matching Questions (EMQ)
Table/Algorithm
Picture/Video Format
Data interpretation
Free text – eg typed one word answers

9. Exam Construction
Relevance: the AKT should be relevant to general practice
e.g. GMC guidance, management of type 2 diabetes
High prevalence: any topic covered can be one which occurs commonly
e.g. sore throat, otitis media, impetigo
High impact: or one which is significant but less common
e.g. child abuse, meningitis, pheochromocytoma

10. What is the AKT Research, epidemiology and stats!
Understanding the principles of audit and its application in assessing the quality of care.
Understanding the application of critical appraisal skills which will be tested in a number of formats including:
the interpretation of research data using results in published papers
the understanding of terms used in both statistics and evidence based medicine
understanding epidemiology relevant to general practice

11. What is the AKT Administrative and Management
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

12. What is the AKT Scoring All question formats have equal weighting
Each correct answer-1 mark
Total score is the number of correct answers given.
No negative marking - ‘Fear factor’
It is important to answer all the questions
If a question performs poorly across the whole exam it will be removed from the scores of ALL candidates.

13. Where? Pearson VUE Centers
CGP/641805
Pearson Professional Centres-UK Colchester
Pearson Professional Centres-UK Ipswich
Pearson Professional Centres-UK Chelmsford
Wellington House Butt Road Colchester CO3 3DA United Kingdom
Pearson Professional Centre Crown House Crown Street Ipswich IP1 3HS United Kingdom
Pearson Professional Centre 1st Floor Grosvenor House 51 New London Rd Chelmsford CM2 0ND United Kingdom

14. When do I take the AKT?
Offered three times a year- Oct/Nov, Jan/Feb, April/May
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
Nobody is recommending that you should take until you have done at last 6m in General Practice
Do not take it until you have had time to look at GP related medical knowledge as well as management and research
Do not take it after you have had a period away from work (e.g. pregnancy), as you need to have kept up to date on NICE and SIGN guidelines and how these are implemented in practice

15. When to take AKT ?later
College advice most appropriate point, and highest chance of success, will be whilst working as a GPStR in the final year of their specialty-training programme (ST3).
Taking once is cheaper than taking it twice
When everybody else on the scheme is taking it?? so it is easier to prepare together
Knowledge base for AKT helps with CSA so take together

16. How to take it? Time management – this is everything
Keep watching the countdown clock on the computer
Skip difficult questions rather than waste time (electronically highlight the ones you have left out)

17. How to take it? Exam tips
Cover test – can you answer the question with the option list covered? It’s probably the correct answer
Mark answer carefully
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

18. How to prepare?-resources used to devise AKT
GP Curriculum
Content Guide for the AKT (AKT website)
BNF
GMC Good Medical Practice
RCGP Essential Knowledge Updates
Cochrane
NICE
SIGN
BMJ Review articles & original papers
BJGP
Vaccine update ( / Green Book

19. How to prepare? Give yourself enough time
Familiarise yourself with GP curriculum-particularly 3 domains
Learn from your clinical experience – check the guidelines and references of cases you come across
Exam website feedback, sample material
Other resources to guide learning/practise questions
Prepare with peers

20. How to prepare Possible Resources
Oxford Handbook of General Practice by Chantal Simon and Hazel Everitt
(1st few chapters for primary care & admin)
Innovait magazine (matches to GP curriculum-also has sample questions)
Scheme has an account !!
Medical Statistics made easy. Michael Harris, Gordon Taylor.
How to Read a Paper: The Basics of Evidence-Based Medicine. Trisha Greenhalgh.
Other books
nMRCGP Practice Papers: Applied Knowledge Test. by Rob Daniels
NMRCGP Applied Knowledge Test Study Guide: Sample Questions and Explanatory Answers by Aalia Khan, Ramsey Jabbour, and Almas Rehman

21. How to prepare online resources
offers 1000s of MCQs at a cost (£30 for 4 months, £40 for 6 months )
On examination from the BMJ group practice/mrcgp#QuestionBrowser is more expensive (£82 for 3 months) but some have found that it reflected the type and standard of MCQ in the AKT better than above.
Past test-
(£59 for 3 months). Plus there is an app for the phone.

22. How to prepare? Courses GP update course, NB medical course,
Don’t feel it is needed-save your money for CSA!.
But if you really want to ,,
GP update course,
NB medical course,
Emedica course,
Local courses

23. Practicalities
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
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

24. MRCGP AKT EXAM WEBSITE Please look carefully at RCGP website
applied-knowledge-test-akt.aspx
The ‘How to prepare for the AKT’ section contains helpful resources, including:
InnovAiTAKT Podcast
‘Preparing to take the AKT’ pdf
50 AKT Sample questions with answers
The ‘AKT Summary Reports from October 2007 to April 2017’ section should help guide your revision plans

25. Statistics – AKT 30 (April 2017)
AKT 30 pass mark = 137/199 (68.8%)
Overall pass rate = 72.1%
After reviewing question performance, one question from the 200 in the exam was suppressed from the final scoring total.
Scores in AKT 30 ranged from 84 to 192 out of 199 questions with a mean overall score of 74.1%.
Cumulative pass rate after four attempts for all those who take AKT is approximately 95%

26. Statistics – April 2017
The mean scores by subject area were: ● ‘Clinical medicine’ 73.2% (160 questions) ● ‘Evidence interpretation’ 81.7% (20 questions) ● ‘Organisational’ 72.9% (19 questions) The pass mark for AKT 30 was set at 137 with pass rates as below: Candidates (numbers) Pass rate All candidates (1485) 72.1% ST2 first-time takers (1037) 77.3% ST3 first-time takers (112) 73.2%

27. Statistics – April 2017 SINGLE MOST likely
Candidates will note from the sample questions that the question stem frequently includes the phrase “Which is the SINGLE MOST likely ..?” referring to a list of options. When the question is about a single most likely diagnosis, candidates should consider the prevalence of a condition when identifying the correct answer. The most serious condition listed may not necessarily be the correct answer if this is less common as it will not be the MOST likely.
Option lists
All the AKT question formats, apart from the free text, require the candidate to identify the best answer(s) from a list of plausible alternatives, using all of the information in the question. There may be other answers which are not included in the option list, but the candidate should focus on the best available answer for the specific question asked; in other words, focus on the options given, and not what is absent.

28. Areas That Caused Difficulty in Last Sitting
3.01 Healthy people, promoting health and preventing disease
•National childhood and adult vaccination schedules, especially as childhood immunisation schedules are frequently changing.
3.06 Women’s Health
•Serious side effects of COC, management of common side effects of HRT, investigation of infertility, amenorrhoea.
3.17 Care of people with metabolic problems
•Diagnosis and management of diabetes
3.19 Care of people with respiratory problems
•Asthma management (see changes in 2016 BTS/SIGN guidance) and COPD management.
3.21 Care of people with skin problems
•Common problems associated with GP minor surgery

29. Areas That Caused Difficulty in Jan/Feb Sitting
The GP in the wider professional environment
End of Life Care, death reporting and certification
•Care of children and young people
Diagnosis and investigation of suspected cancer in children
•Women’s Health
‘Quick start’ and emergency contraception, HRT, urinary incontinence
•Care of people with eye problems
Eye emergencies
•Care of people with mental health problems
Medication for anxiety and depression: interactions, safety, monitoring
•Care of people with metabolic problems
Type 1 diabetes management during infection: sick day rules
•Care of people with skin problems
Fungal skin infections

30. Areas That Caused Difficulty 1 year ago
Care of acutely ill people Management including drug treatment of life-threatening conditions in adults and children •Care of children and young people Cancer recognition/investigation •Care of people with ENT problems Hearing loss, infections and conditions where no active treatment needed •Cardiovascular Erectile dysfunction, treatment of prostatic conditions •Patient safety and quality of care Monitoring requirements for commonly prescribed psychiatric drugs, antibiotic stewardship

31. Resources
applied-knowledge-test-akt.aspx
prep?gclid=EAIaIQobChMIsIvAlcS91gIVjcqyCh1K7A3fEAAYAiAAEgKiH_D_BwE
curriculum.aspx

32. Preparing to Take the AKT
Innovait AKT Podcast
_Finished_RCGP_AKT_podcast.mp3?c_id= &expiration= &h wt=794f68c5ab36c8a0aacc7ea725e64eea
Preparing to Take the AKT

33. Essential Knowledge Updates (RCGP)