1. AKT – Going For Gold

2. It’s only an exam... The AKT is a licensing exam You have 200 questions to prove to me (RCGP) that you have the breadth and depth of knowledge required to be a safe UK GP That means enough to treat me and my family.... Take it seriously Requires more knowledge than medical finals How much cramming did you do for finals? The next sitting is only 56 days away....

3. AKT – The Exam The AKT is designed to test the application of knowledge and interpretation of information Three hour, 200 item multiple-choice test 80%clinical management 10%critical appraisal of EBM 10%administration & management 1.Do read the information on the RCGP website, including the presentations 2.Do look at the information on the VTS website 3.Do consider study groups.

4. AKT – The Basics Three sittings each year You are restricted to 4 sittings Are you ready to enter? – Use website scores as a guide Pass rate is about 72% ST282% of first-time takers passed ST373% of first-time takers passed 94% have passed by 3 rd attempt in ST3. Exam date:30/10/1329/01/1430/04/14 Bookings Close: 18/09/1304/12/1310/03/14

5. How Do Our ST2s Perform? Pre-2009Very few sitting in ST2 2010-11Disappointing ST2 pass-rate (40%) 2011-12Much better ST2 pass-rate (75%) 2012-13Very impressive (85%).

6. How Do Our ST2s Perform? Those who failed: Low scores across all 3 areas Clinical Management best “predictor” (80% of marks) –No-one who failed CM passed the overall exam Suggestion: Low CM scores (<60%) on test-papers then you are not ready.

7. Topics for Today 1.Exam Technique 2.General Preparation Tips 3.Tips for Administration & Management 4.Tips for EBM & statistics 5.Tips for Clinical Management - Organising learning sets.

8. Exam Technique Demonstration module - how the Pearson-VUE system works Use the cover test: - cover the answers. If your 1st thought is on the list, likely it is correct Mark answer spot carefully Time management is vital - watch the countdown clock on the computer - average of 54 seconds per question Skip difficult questions rather than waste time - electronically highlight the ones you have left out - use electronic review to return to unanswered questions 2 nd time - do not leave any questions unanswered – make an educated guess Check for silly mistakes if you still have time.

9. General Preparation Learning is always best cemented on experience Check the guidelines and reference material for patients that you see day by day You must create time for “book-work” –2 month run-in (1 month per year post foundation) –You should aim to do revision work most days –You can take up to 3-5 days of private study leave Websites, guidelines, study groups – more later –FPH Library: 3 month access to onexamination.

10. Administration & Management MRCGP is an licensing exam work in UK –Questions are based on working in UK –Detailed legal questions are unusual AKT: 10% of total = 20 marks Target score 70% = 14 marks –Score 20% reduces overall mark by about 5% –Score 60% reduces overall score by about 1% See “Suggested topics & web resources” –Work through these and you should score 70%.

11. EBM & Statistics Old MRCGP exam had one written question plus MCQs on stats & data interpretation AKT: 10% of total = 20 marks Target score 70% = 14 marks –Score 20% reduces overall mark by about 5% –Score 60% reduces overall score by about 1% Score 50% on stats & management? –Loses you about 5% –Means you now need 75% in clinical management.

12. EBM & Statistics The questions focus on definitions and interpreting results/ graphs 1.Mock question websites will drum a lot into you 2.“Basic statistics” guide on the VTS website - section on definitions & terms - learn the “screening test grid” by heart.

13. EBM & Statistics True Diagnosis Positive Negative True Result Positive a (TP True Positive) b (FP False Positive) Type 1 error Positive Predictive Value PPV = a/a+b Negative c (FN False Negative) Type 2 error d (TN True Negative) Negative Predictive Value NPV = d/c+d Sensitivity a/a+c Specificity d/b+d

14. Clinical Medicine 80% of the questions –SBA, EMQ, complete an algorithm, pictures Question writers are all GPs Questions “die” within 3-4 years –New material? NICE & SIGN guidelines, BNF, RCGP educational material (InnovAIT, EKU) Consider using Curriculum Map as a checklist.

15. Clinical Medicine Don’t rely just on on-line question banks Examiners give feedback after each AKT sitting Read the “Collated Feedback” on the website Not hard to spot the themes: Child developmentImmunisationsScreening Think what has been topical? Read guidelines – especially new ones EKU tells you what the RCGP thinks is important... Read Good Medical Practice There is an attempt to spread the exam questions evenly across the clinical areas of the GP Curriculum.

16. Clinical Medicine Common, low impact Sore throat, otitis media, impetigo Rare, high impact Child abuse, meningitis phaeochromocytoma TopicalMRSA, T2DM management.

17. Preparation Resources Knowledge & reference websites NICE - New Guidelines Within each curriculum area, you should actively look for appropriate NICE Guidelines SIGN - New Guidelines If a clinically important topic does not have NICE Guidelines, then check SIGN Patient.co.uk Patientplus section is directed towards Health Professionals. Personally I find it more in-depth and useful than GP Notebook GP Notebook Tried, tested, trusted Does now require (free) registration Lacks graphics... Knowledge modules & self-test sites RCGP Essential Knowledge Updates (EKU) Increasingly comprehensive resource - see Curriculum Map A lot of podcast material for those of you with car journeys InnovAIT “Courses” Available to AIT's. Log-in and select the InnovAIT journal 60-70 modules available - read the article from InnovAIT and then take a test Question-only websites Onexamination.com 1500 questions More realistic, more expensive “Management" questions are better Passtest Large question bank More medicine focus, less GP Works well as a phone app Passmedicine.com 2500 questions Harder questions, can set a 2hr exam Very good for O&G, Paeds, child development

18. How to Prepare a Topic If I was revising “Neurology”, then I would: 1.Read the Neurology curriculum statement 2.Check the summary on the curriculum map 3.Read any examiner’s feedback 4.For each topic/ line on the curriculum map: Revise knowledge –Read any NICE guidelines –Read up patient.co.uk –Focus on the obviously important (e.g. Respiratory – Occupational lung disease vs. Asthma) Take any knowledge tests on EKU/ InnovAIT 5.Run through questions on onexamination & passmedicine.

19. Learning Sets Small groups (6-8 best), trainee-led Meet weekly for about 2 hours GP post – after Wed pm teaching Now - AKT preparation Later - CSA preparation.

20. AKT Learning Sets Decide how many meetings between now & the exam For each learning-set week: - Timetable a core curriculum topic - Allocate a lead trainee Ahead of their allocated meeting, the lead trainee prepares that curriculum topic (see my suggestion) At the meeting, the lead trainee presents to the group an annotated curriculum map showing key guidelines, useful reading, useful online modules During the next few days, everyone else then works through this material and runs self-test questions Feedback by all at the start of the next meeting.

21. Summary - Any Questions? Pick your target slot Consider timing with a GP post if possible Remember run-in guide (1m per 1y post foundation) Remember access to onexamination via the library Do more than e-learning Look at the guides on the VTS website Consider study groups Exam date:30/10/1329/01/1430/04/14 Bookings Close:18/09/1304/12/1310/03/14