1. nMRCGP Applied Knowledge Test November 2007 Prepared by the AKT Group

2. AKT aims The AKT is designed to test the application of knowledge and interpretation of information The AKT is designed to test the application of knowledge and interpretation of information Each question is intended to explore a topic of which an ordinary GP could be expected to have a working knowledge Each question is intended to explore a topic of which an ordinary GP could be expected to have a working knowledge

3. Background Replaces the previous Multiple Choice Paper (MCP) Replaces the previous Multiple Choice Paper (MCP) Summative assessment of the knowledge base that underpins independent general practice within the United Kingdom. Summative assessment of the knowledge base that underpins independent general practice within the United Kingdom. Mapped to the RCGP Curriculum Mapped to the RCGP CurriculumRCGP CurriculumRCGP Curriculum

4. Format: An “evolution” from the current MRCGP MCP An “evolution” from the current MRCGP MCP A three hour, 200 item multiple-choice test A three hour, 200 item multiple-choice test –No multiple true/false questions –No negative marking Delivered on a computer terminal at an invigilated test centre Delivered on a computer terminal at an invigilated test centre Offered initially three times a year Oct/Nov, Jan/Feb, April/May Offered initially three times a year Oct/Nov, Jan/Feb, April/May

5. Vital Statistics October 2007 results October 2007 results –Pass mark = 70.5% –ST3 pass rate = 87% –ST2 pass rate = 75% Results may vary from one session to another Results may vary from one session to another

6. Rules No limit to the number of attempts No limit to the number of attempts A pass will be valid for three years only A pass will be valid for three years only Can be attempted at any time during GP specialist training (GPST), but most appropriately during the GPR year (ST3) Can be attempted at any time during GP specialist training (GPST), but most appropriately during the GPR year (ST3)

7. Transitional Arrangements Will replace the Summative Assessment MCQ from August 2007 Will replace the Summative Assessment MCQ from August 2007 Is equivalent to the current MRCGP MCP for those completing the current exam during 2007-8 Is equivalent to the current MRCGP MCP for those completing the current exam during 2007-8

8. The MRCGP Curriculum Statements Where to find them RCGP website RCGP websitehttp://www.rcgp-curriculum.org.uk/ What are they? Series of papers, each covering different clinical and practice management areas, based on European Academy of Teachers in General Practice (EURACT) framework. Series of papers, each covering different clinical and practice management areas, based on European Academy of Teachers in General Practice (EURACT) framework. Written by a variety of GP experts and coordinated by RCGP Written by a variety of GP experts and coordinated by RCGP

9. The MRCGP Curriculum Statements continued How they are being used Curriculum statements have ‘Intended Learning Outcomes (ILO)’. Questions and CSA cases are linked to specified learning outcomes within specified curriculum statements. Curriculum statements have ‘Intended Learning Outcomes (ILO)’. Questions and CSA cases are linked to specified learning outcomes within specified curriculum statements. This enables sampling from across the curriculum, as cases can be mapped to the curriculum statements (or nMRCGP blueprint) This enables sampling from across the curriculum, as cases can be mapped to the curriculum statements (or nMRCGP blueprint)

10. Paper Construction ensures: Reliability, validity and fairness. Reliability, validity and fairness. Adequate coverage of the topics that appear in the blueprint. Adequate coverage of the topics that appear in the blueprint. The correct balance of question formats The correct balance of question formats

11. Principles of paper construction Relevance: Relevance: The AKT should be relevant to general practice; any topic covered can be one which occurs commonly or one which is significant but less common The AKT should be relevant to general practice; any topic covered can be one which occurs commonly or one which is significant but less common High prevalence: Low impact e.g. URTI High prevalence: Low impact e.g. URTI High impact: Low prevalence e.g meningitis High impact: Low prevalence e.g meningitis

12. Question writing Scenarios derived from clinical work Scenarios derived from clinical work Practice issues Practice issues Topical Topical All questions are referenced and the draft questions are then carefully scrutinised by a panel of other question writers. All questions are referenced and the draft questions are then carefully scrutinised by a panel of other question writers. All question writers are working GPs All question writers are working GPs

13. Common Reference Material Clinical Evidence Clinical Evidence Cochrane Cochrane BNF BNF GP Curriculum GP Curriculum NICE NICE SIGN SIGN BMJ Review articles & original papers BMJ Review articles & original papers BJGP BJGP DTB DTB GMP GMP

14. AKT subject content Core clinical medicine and its application to problem solving in a general practice context Core clinical medicine and its application to problem solving in a general practice context –80% of items Critical appraisal and evidence based clinical practice Critical appraisal and evidence based clinical practice –10% of items Ethical and legal issues as well as the organisational structures that support UK general practice Ethical and legal issues as well as the organisational structures that support UK general practice –10% of items

15. Clinical Medicine (1) The broad topic of clinical medicine is subdivided into groups of body systems, in approximately equal numbers The broad topic of clinical medicine is subdivided into groups of body systems, in approximately equal numbers Each group will comprise sections on Each group will comprise sections on –disease factors –symptoms –investigation –management

16. Clinical Medicine (2) –Cardiovascular –Dermatology –Endocrinology –ENT –Gastroenterology –Genetics –Haematology –Immunology –Infection –Mental health & learning disability –Musculo-skeletal –Neurology –Ophthalmology –Paediatrics –Renal –Reproductive male/female –Respiratory –Therapeutic indications and adverse reactions

17. Clinical Medicine (3) Common, low impact – e.g. sore throat Common, low impact – e.g. sore throat Rare, high impact – e.g. child abuse Rare, high impact – e.g. child abuse Topical – e.g. controlled drugs regulations Topical – e.g. controlled drugs regulations

18. Research, Epidemiology and Statistics (1) Understanding the principles of audit and its application in assessing the quality of care 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 e.g the interpretation of research data Understanding the application of critical appraisal skills which will be tested in a number of formats e.g the interpretation of research data

19. Research, Epidemiology and Statistics (2) Understanding and application of terms used in both inferential statistics and evidence based medicine. Understanding and application of terms used in both inferential statistics and evidence based medicine. E.g as described in the appendices of Clinical Evidence BMJ. www.clinicalevidence.org www.clinicalevidence.org

20. Administration and Management Regulatory frameworks, e.g. PCOs Regulatory frameworks, e.g. PCOs Legal aspects, e.g. DVLA Legal aspects, e.g. DVLA Social services, e.g. Certification Social services, e.g. Certification Professional regulation, e.g. GMC Professional regulation, e.g. GMC Business aspects, e.g. GP contract Business aspects, e.g. GP contract Prescribing, e.g. Controlled drugs Prescribing, e.g. Controlled drugs Appropriate use of resources, e.g. drugs Appropriate use of resources, e.g. drugs Health & Safety, e.g. needlestick injury Health & Safety, e.g. needlestick injury Ethical, e.g. Mental capacity, consent Ethical, e.g. Mental capacity, consent

21. Question Formats Single Best Answer (SBA) Single Best Answer (SBA) Extended Matching Questions (EMQ) Extended Matching Questions (EMQ) Table/Algorithm Table/Algorithm Picture Format Picture Format Data interpretation Data interpretation Seminal Trials Seminal Trials

22. New question formats Data interpretation Data interpretation Interpretation of complex sets of data for patients with chronic conditions. Relevant risk tables are included if appropriate. Interpretation of complex sets of data for patients with chronic conditions. Relevant risk tables are included if appropriate. Seminal trials Seminal trials Familiarity with significant new research Familiarity with significant new research e.g Knowledge of the ASCOT study which has changed clinical practice.

23. Single Best Answer (SBA) “According to national guidelines” means recommended by nationally accepted guidelines or the BNF, not local practice “According to national guidelines” means recommended by nationally accepted guidelines or the BNF, not local practice Often uses a clinical scenario Often uses a clinical scenario Only ONE answer is correct Only ONE answer is correct Other options may be plausible Other options may be plausible

24. 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. 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. Which is the SINGLE MOST likely diagnosis? Select ONE option only. A. Asthma A. Asthma B. Pneumothorax B. Pneumothorax C. Pulmonary embolus C. Pulmonary embolus D. Left ventricular failure D. Left ventricular failure E. Pulmonary haemorrhage. E. Pulmonary haemorrhage.

25. Extended matching questions (EMQ) These questions have a list of possible optionsThese questions have a list of possible options There will usually be 3 or more scenariosThere will usually be 3 or more scenarios Choose the most appropriate option that best matches each given scenarioChoose the most appropriate option that best matches each given scenario Each option can be used once, more than once, or not at all.Each option can be used once, more than once, or not at all.

26. AForm Med 3 BForm Med 4 CForm Med 5 DForm Med 6 EForm RM 7 FForm SC 1 GForm SC 2 HPrivate certificate For each patient described, select the SINGLE most appropriate certificate from the list of options above. Each option may be used once, more than once, or not at all. You see and examine a patient with back pain who has been off work for seven days. The following day he requests a certificate to cover his absence from work for the day he saw you and the following day. 1You see and examine a patient with back pain who has been off work for seven days. The following day he requests a certificate to cover his absence from work for the day he saw you and the following day. EMQ example: Certification

27. AForm Med 3 BForm Med 4 CForm Med 5 DForm Med 6 EForm RM 7 FForm SC 1 GForm SC 2 HPrivate certificate For each patient described, select the SINGLE MOST appropriate certificate from the list of options above. Each option may be used once, more than once, or not at all. 2. A patient has been on long-term sick leave for six months and has received a questionnaire prior to the ‘all work test’. He requests the appropriate certificate from you. EMQ example: Certification

28. Algorithm example: Medical management of menorrhagia For each of the numbered gaps above, select ONE option from the list below to complete the algorithm, based on current evidence. Each option may be used once, more than once or not at all. Not requiring contraception Requiring contraception 1 _______2 _______ Combined oral contraceptive pill 3 _______

29. Algorithm example: Medical management of menorrhagia ACyclical norethisterone BCopper-bearing intra-uterine device CInert intra-uterine device DLevonorgestrel releasing intra-uterine system EMedroxyprogesterone acetate FMefenamic acid GNonoxinol ‘9’ HTibolone ITranexamic acid

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

31. Picture Format example: Skin disease Which is the SINGLE MOST likely diagnosis? Select ONE option only. Which is the SINGLE MOST likely diagnosis? Select ONE option only. AAlopecia areata BEczema CLichen sclerosis DTinea infection EVitiligo Ref: Dermnet.com

32. Data Interpretation Interpretation of complex sets of data for patients with chronic conditions Interpretation of complex sets of data for patients with chronic conditions Interpretation of research and audit results Interpretation of research and audit results

33. Data Interpretation example The summary findings of a systematic review which included six separate studies are show opposite. The summary findings of a systematic review which included six separate studies are show opposite. Ref: BMJ 2007;335:473 Ref: BMJ 2007;335:473

34. Data Interpretation example Which SINGLE study suggests the WEAKEST association between increased whole grain intake and a lowered risk of diabetes? Select ONE option only. Which SINGLE study suggests the WEAKEST association between increased whole grain intake and a lowered risk of diabetes? Select ONE option only. A Fung B Meyer C Montonen D NHS1 E Van Dam

35. Scoring All question formats have equal weighting All question formats have equal weighting Each correct answer is awarded one mark Each correct answer is awarded one mark Total score on the paper is the number of correct answers given Total score on the paper is the number of correct answers given No negative marking - ‘Fear factor’ No negative marking - ‘Fear factor’

36. Feedback Feedback will be provided to every candidate with their result 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 More general feedback on overall performance will continue to be forwarded to all UK deaneries and placed on the RCGP website More general feedback on overall performance will continue to be forwarded to all UK deaneries and placed on the RCGP website

37. Computer Based Testing Once candidates have registered with the RCGP to sit the AKT, they will be given a phone number to book with the Pearson VUE test centre. Once candidates have registered with the RCGP to sit the AKT, they will be given a phone number to book with the Pearson VUE test centre. It is recommended that candidates familiarise themselves with the demonstration tutorial on the Pearson Vue website : It is recommended that candidates familiarise themselves with the demonstration tutorial on the Pearson Vue website :https://www.pearsonvue.com/rcgp/ The AKT also begins with a short tutorial to remind candidates how to mark the answers The AKT also begins with a short tutorial to remind candidates how to mark the answers

38. Computer Based Testing There are approximately 150 test centres covering all parts of the UK There are approximately 150 test centres covering all parts of the UK Candidates will be able to book the AKT at a local venue, on “a first come, first served” basis Candidates will be able to book the AKT at a local venue, on “a first come, first served” basis

39. Computer Based Testing Security at each centre will be robust Security at each centre will be robust –Identity checks –Invigilated –Video monitoring Test forms are downloaded to each centre on the test day Test forms are downloaded to each centre on the test day Separate morning and afternoon sittings with a quarantine period at lunchtime. 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 Morning candidates will not be allowed to leave before the end of the test

40. Computer Based Testing Responses will be uploaded to a central server and then passed to the RCGP for post test analysis 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 Following this, results and feedback will be sent individually to candidates

41. Computer Based Testing Rules Candidates must bring identity documents WHICH MATCH examination details Candidates must bring identity documents WHICH MATCH examination details Candidates should arrive in good time 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 Candidates who either arrive late or fail to provide matching ID, will NOT be admitted to sit the AKT