1. MRCGP Applied Knowledge Test

2. Format A 3-hour, 200-item multiple-choice test
No multiple true/false questions
No negative marking
Delivered on a computer terminal at an invigilated test centre
Offered three times a year:
Jan/Feb, April/May, Oct/Nov.

3. Rules
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

4. Jan 2013
The pass mark for AKT 17 was set at 132 with pass rates as below:
Candidates (numbers) pass rate
All candidates (1248) 68.7%
ST2 first-time takers (755) 79.6%
ST3 first-time takers (115) 71.3%
Asthma guidelines, antibiotic guidelines, non-medical prescribers and diagnosis of DM were all done poorly

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

6. Clinical Medicine
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 6

7. Ethical, Legal & Organisational
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
Content Guide Chapter +++

8. 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

9. 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”

10. 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.
Which is the SINGLE MOST likely diagnosis? Select ONE option only.
A. Asthma
B. Pneumothorax
C. Pulmonary embolus
D. Left ventricular failure
E. Pulmonary haemorrhage

11. Extended matching questions (EMQ)
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.

12. EMQ example: Double vision
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.
Berry aneurysm and stroke possible but age and non-smoker make aneurysm MOST likely

13. EMQ example: Double vision
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.
Myasthenia Gravis 13

14. Algorithm example: Medical management of menorrhagia
Non-hormonal
Hormonal therapy
1 _______
2 _______
Combined oral contraceptive pill
3 _______
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.
A Cyclical norethisterone
B Copper-bearing intra-uterine device
C Inert intra-uterine device
D Levonorgestrel releasing intra-uterine system
E Medroxyprogesterone acetate
F Mefenamic acid
G Nonoxinol ‘9’
H Tibolone
I Tranexamic acid
This would be a “drug and Drop” format on computer and candidates will have chance to practise on a tutorial

15. 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.
If a question was a ‘hotspot’ format, the candidate would be asked to mark the correct area on the picture

16. Picture Format example: Skin disease
Which is the SINGLE MOST likely diagnosis? Select ONE option only.
A Alopecia areata
B Eczema
C Lichen sclerosis
D Tinea infection
E Vitiligo
Ref: Dermnet.com

17. 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)

18. Data Interpretation example
The summary findings of a systematic review which included six separate studies are shown opposite.
Ref: BMJ  2007;335:473 
All the studies show reduced risk with increased intake of whole grain but Montenen reaches the line of no effect therefore has the weakest association

19. Data Interpretation example
Which SINGLE study suggests the WEAKEST association between increased whole grain intake and a risk of type 2 diabetes?
Select ONE option only.
A Fung
B Meyer
C Montonen
D NHS1
E Van Dam 19

20. 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 20

21. Free text example
Which SINGLE vitamin is administered to reverse the anticoagulant effect of warfarin?
Give ONE answer only
Vitamin _____ 21

22. 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 22

23. 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

24. 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

25. Advice from successful trainees:
Samples of AKT questions are provided every month, linked to the curriculum coverage, in the InnovAiT Journal provided free to AITs by the RCGP.
PEP (RCGP) AKT style questions linked to curriculum statements and explanations
PassMedicine Course Large question bank with feedback to place your mark in tests against others applying to AKT, plus teaching notes. Can set yourself practice exams and helps you get used to thinking quickly
PasTest offer both online courses and revision books
NB GP Update Course One day course. Review of recent developments. Useful course book provided.
NICE Guidelines- the exam is very up to date!
RCGP Essential Knowledge Updates
Dot medic
On Examination (BMA)

26. EBM & Stats & Critical Appraisal
T D. Sackett “Evidence Based Medicine” Churchill Livingstone
Greenhalgh articles or book “How to read a paper” 1997 BMJ Books
How to read a paper: A series in the British Medical Journal on database searching and article appraisal adapted from the book. BMJ 1997
Medical Statistics Made Easy- book

27. Slow readers/ some IMGs
If you think reading speed is slower than average this website can help to speed it up

28. Practice Management
Oxford Handbook of General Practice