1. AKT Top Tips Sanju Joy & Gareth Smith

2. What’s so scary? Medical Statistics Is there enough time? Driving guidelines What questions will be asked on primary care admin? For me it was….. Are there any things in particular that worry you?

3. What will be cover today? -Structure of AKT -Applying for the exam -How to prepare -Where did other candidates struggle? -Example questions

4. Aims & Outcomes You should be able to… -Identify when would be best for you to sit the exam -Recognise the need to set aside some £££ -Understand the structure of the AKT exam & how to apply -Recall AKT revision resources

5. Structure of the AKT

6. The AKT test -Is a 3 hr 10 mins computer-based test -Consists of 200 question items -80% clinical medicine -10% critical appraisal & evidenced based clinical practice -10% health informatics & administrative issues Can anyone work out the math? (Works out at 57 seconds per question)

7. Clinical Medicine -Biggest part of the exam (160 questions) -Covers practically everything….. -low impact & common conditions (e.g. sore throat, URTI’s) -high impact & rarer (e.g. Child abuse, meningitis) Tip: -Look at topical things (read new NICE guidance, check BMJ/BJGP) -Refer to GP curriculum

8. Medical Statistics -Only 10% of exam (i.e. 20 questions) -Keep in perspective…. -YES…difficult to pass exam if do not get any of these marks -BUT…shouldn’t revise medical statistics to the detriment of clinical medicine -Make sure you know the basics -Mean/mode/median -PPV/NPV -Sensitivity/specificity -Standard deviations From Oct 2014 there is an on-screen calculator available Tip:

9. Health informatics & administrative issues -Another 10% (20 questions) -Includes…. -Legal aspects (e.g. DVLA) -Social services (e.g. Certification) -Professional regulation (e.g. GMC) -Business aspects (e.g. GP contracts) -Prescribing (e.g. Controlled drugs) -Health & safety (e.g Needle stick injuries) -Ethical (e.g. Mental capacity & consent)

10. How many pass? How difficult do you think the AKT is to pass? April 2015 (i.e. 65%)

11. Applying for the exam

12. When should I take it? You need to prepare for AKT so think about when would be best for you…

13. Applying -Can be taken during or after the GPST2 -A maximum number of 4 attempts will be permitted (On your e-portfolio)

14. Applying (2) -Apply through the RCGP website -AKT costs £530 (or £477 if you are an AiT member) Though as part of your AiT you ‘build a fund’ which you can put towards the cost of your exam

15. Where to take the test Tip: Apply early to avoid disappointment!!

16. How to prepare…

17. RCGP Content guide Available at: http://www.rcgp.org.uk/training-exams/mrcgp- exams- overview/~/media/D96EB4E0188E4355BCC92 21B55859B08.ashx (54 pages telling you what could be in the exam)

18. Demonstration tutorial The RCGP strongly recommends that candidates familiarise themselves with this on the Pearson VUE website… http://www.pearsonvue.com/rcgp/

19. Common reference materials -GP curriculum -BNF -GMC Good Medical Practice -RCGP Essential Knowledge Updates -NICE Guidelines -SIGN Guidelines -BMJ review articles & original papers -BJGP

20. Other revision tools Internet: -Pastest (£55 until Oct, £85 for Jan) -BMJ On examination (£50 - £120 for 1 – 6 months) -Pass medicine (£25 for 4 months, £35 for 6 months) -RCGP has sample Q’s with answers Books: -Succeeding in the MRCGP AKT, C Mehta, M Williams and M Mehta (£19.99) -Medical Statistics made easy, M. Harris & G. Taylor (£16)

21. What did I use? BMJ On examination Oxford Handbook GP Medical Statistics Made Easy Dermnet NZDVLA Guidance

22. When should you start revising? -Everyone’s different -BUT….remember there is a lot to cover -The earlier you start the more you get out of Pastest/On examination

23. On the day TIPS… -Don’t forget your identification documents! -Arrive early -Keep a close eye on the time! (Time is everything! – better to skip questions you struggle with rather than wasting time)

24. On the day TIPS… -Don’t leave any questions unanswered – there is NO negative marking -(If you have time) check through your answers to avoid silly mistakes

26. Question Types

27. The questions -All written by working GP’s -All reference to NATIONAL not local guidelines -Are not opinion – they can be supported with reference to facts & guidelines

28. Question types -Single Best Answer (SBA) -Extended Matching Questions (EMQ) -Multiple Best Answer (MBA) -Table/Algorithm -Picture format -Drag and drop -Data interpretation -Free text -Rank ordering

34. Picture Format THEME: Eye problems A 42-year-old woman who has previously had treatment For cervical CIN 2, has had a lump affecting her left upper lid for three months. It is asymptomatic. What is the single most likely diagnosis in this patient? Select one answer only A entropion B meibomian cyst C metastatic deposit D stye E xanthelasma

35. Data Interpretation A meta-analysis examines whether giving a new dietary supplement to patients who've recently had a myocardial infarction can help prevent a further attack. The meta-analysis consists of four randomised controlled trials and is summarised below: What is the most appropriate interpretation of the data? A. There is publication bias in studies looking into this question B. There is a non-significant trend that taking the supplement reduces the chance of a further myocardial infarctions C. There is a non-significant trend towards no benefit from taking the supplement in terms of reducing further myocardial infarctions D. Taking the supplement reduces the chance of a further myocardial infarctions E. Taking the supplement increases the chance of a further myocardial infarction

36. Data Interpretation (2) A rapid finger-prick blood test to help diagnosis deep vein thrombosis is developed. Comparing the test to current standard techniques a study is done on 1,000 patients: What is the specificity of the new test? A. 680/880B. 200/220 C. 680/780D. 680/700 E. 200/300 DVT presentDVT absent New test positive200100 New test negative20680

37. 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

38. Where did others go wrong?

39. Vital statistics – AKT January 2015 AKT 23 pass mark = 143/200 (71.5%) Overall pass rate = 75.8% ST2 first-time takers pass rate = 83.2% ST3 first-time takers pass rate = 67.3% Cumulative pass rate after four attempts for all those who take AKT is approximately 95%

40. Areas of difficulty in Jan 2015 -Promoting health and preventing disease National screening programmes, immunisations -Care of acutely ill people Acute but rare illness, anaphylaxis, CPR -Care of children and young people Serious but rare, asthma management -Women’s health Contraception e.g. ‘quick-start’ -Care of people with neurological problems Management of different types of headache

41. Types of question that caught me out…

42. Consultation Models Which one of the following consultation models advocates managing the presenting complaint, managing ongoing health problems and modifying health seeking behaviour? A. Neighbour B. Fraser C. Pendleton D. Stott and Davis E. Stewart

43. BNF Questions The following symbol appears in the British National Formulary: What does it mean? A.Newly licensed medicine B.Not prescribable on the NHS C.Denotes a preparation that is less suitable to prescribe D.Should only be prescribed by a specialist E.Controlled drug

44. Example Questions Over to Sanju…

45. Take home messages -Think about when would be best for you -Start revising early -Remember ‘Time management’ -Prepare and pass first time!

46. Thanks. Any questions?

47. And….GOOD LUCK