Promoting Excellence in Family Medicine MRCGP Applied Knowledge Test Prepared by the AKT Core Group January 2013

Promoting Excellence in

Family Medicine

MRCGPMRCGPApplied Knowledge TestApplied Knowledge Test

Prepared by the AKT Core GroupPrepared by the AKT Core GroupJanuary 2013January 2013


Family Medicine

ObjectivesObjectives

An overview of the content and structure

To give examples of current question formats

To describe how questions are constructed

To advise on how to prepare and pass the AKT

To explain practicalities of computer-based tests


Family Medicine

AKT BackgroundAKT Background

The AKT:Is a summative assessment of the knowledge base that underpins independent UK general practice.

Tests the application of this knowledge

Tests the critical interpretation of information

Is mapped to the 2012 Curriculum

Each question is intended to explore a topic of which an ordinary GP in the UK could be expected to have a working knowledge


Family Medicine

FormatFormat

A 3-hour, 200-item multiple-choice testNo multiple true/false questionsNo negative marking

Delivered on a computer terminal at an invigilated test centre

Offered three times a year:Jan/Feb, April/May, Oct/Nov.


Family Medicine

RulesRules

For those starting specialty training from 1/8/10

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


Family Medicine

Rules - exceptionsRules - exceptions

Those who commenced specialty training before 1/8/10 will be permitted to make an unlimited number of attempts at the AKT while they retain a national training number

Passes obtained between 1 August 2007 and 31 July 2010 by trainees in a specialty training programme will remain valid pending the award of a Certificate of Completion of Training (or Certificate of Eligibility for GP Registration)


Family Medicine

Vital Statistics – Oct 2012Vital Statistics – Oct 2012

Pass mark = 139/199 (70%)

Overall pass rate = 71.6%

ST3 first time takers pass rate = 79.4%

ST2 first time takers pass rate = 79.3%(This ratio varies in different diets of the AKT taken at

different times throughout the training year)

Cumulative pass rate for all those who take AKT is approximately 98% after the maximum number of attempts


Family Medicine

Some areas that were not answered wellSome areas that were not answered well(AKT October 2012)(AKT October 2012)

Child health - normal range of developmental milestones, immunisation schedulesAntenatal screening programmesControlled drug regulationsOsteoporosis – diagnosisDiabetes – interpreting diagnostic test resultsDermatology – safe prescribing

Remember that, as in real life, the “do nothing” and “normal” option may be correct


Family Medicine

Question writingQuestion writing

Scenarios are derived from clinical workPractice issuesTopical

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


Family Medicine

Common Reference MaterialCommon Reference Material

GP Curriculum 2012Content guide for the AKTBNFGMC Good Medical PracticeRCGP Essential Knowledge UpdatesNICE guidelinesSIGN guidelinesBMJ Review articles & original papersBJGPCochrane


Family Medicine

GP Curriculum + AKT Content Guide GP Curriculum + AKT Content Guide

Where to find them

www.rcgp.org.uk/gp-training-and-exams/gp-curriculum-overview.aspx

www.rcgp.org.uk/gp-training-and-exams/mrcgp-exam-overview/mrcgp-applied-knowledge-test-akt.aspx#content

How the AKT links to the curriculum

Questions in the AKT sample across the breadth of the curriculumThe AKT Content guide is a new learning resource which is designed to be used in conjunction with the curriculum


Family Medicine

AKT Content GuideAKT Content Guide

How to use the Content Guide

Don’t be put off by the lengthy list of topics!Don’t be put off by the lengthy list of topics!Do use the guide as a needs assessment toolDo use the guide as a needs assessment toolIn particular, carefully review the sections:In particular, carefully review the sections:

Organisational –including administrative, statutory, Organisational –including administrative, statutory, ethical and regulatory frameworksethical and regulatory frameworksEvidence interpretation – including research, Evidence interpretation – including research, statistics and epidemiologystatistics and epidemiology


Family Medicine

Paper Construction ensures:Paper Construction ensures:

Reliability, validity and fairness

Adequate coverage of the topics that appear in the blueprint

The correct balance of question formats


Family Medicine

Principles of paper constructionPrinciples of paper construction

Relevance: the AKT should be relevant to general practice

High prevalence: any topic covered can be one which occurs commonly

High impact: or one which is significant but less common


Family Medicine

AKT contentAKT content

80% of questionsCore clinical medicine and its application to problem solving in a general practice context

10% of questionsCritical appraisal and evidence based clinical practice

10% of questionsEthical and legal issues as well as the organisational structures that support UK general practice


Family Medicine

Clinical Medicine (1)Clinical Medicine (1)

The broad topic of clinical medicine is subdivided into groups of body systems, in approximately equal numbers

Each group will comprise questions on

disease factorssymptomsinvestigationmanagement


Family Medicine


CardiovascularDermatologyEndocrinologyENTGastroenterologyGeneticsHaematologyImmunologyInfectionMental health & learning disability

Musculo-skeletalNeurologyOphthalmologyPaediatricsRenalReproductive male/femaleRespiratoryTherapeutic indications and adverse reactions


Family 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


Family Medicine

Critical appraisal and evidence-based clinical practice

Understanding the principles of audit and its application in assessing the quality of careUnderstanding the application of critical appraisal skills which will be tested in a number of formats including:

the interpretation of research datathe understanding of terms used in both statistics and evidence based medicine Understanding epidemiology relevant to general practice


Family Medicine

Ethical, Legal & OrganisationalEthical, Legal & Organisational

NHS organisationLegal aspects e.g. DVLAMedical certification e.g. death certificatesProfessional regulation, e.g. GMCBusiness aspects e.g. GP contractPrescribing e.g. Controlled drugsAppropriate use of resources e.g. drugsHealth & Safety e.g. needlestick injurySocial services e.g. safeguardingEthical e.g. Mental capacity, consent


Family Medicine

Question FormatsQuestion 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


Family Medicine

Single Best Answer (SBA)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”


Family Medicine

SBA example: SBA example: Respiratory diseaseRespiratory 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. AsthmaB. PneumothoraxC. Pulmonary embolusD. Left ventricular failureE. Pulmonary haemorrhage


Family Medicine

Extended matching questions (EMQ)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.


Family Medicine

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.

EMQ example: EMQ example: Double visionDouble vision


Family Medicine

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.

EMQ example: EMQ example: Double visionDouble vision


Family Medicine

Algorithm example:Algorithm example:Medical management of menorrhagiaMedical management of menorrhagia

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.

Non-hormonal

Hormonal therapy

1 _______ 2 _______ Combined oral contraceptive pill

3 _______


Family Medicine

Algorithm example:Algorithm example:Medical management of menorrhagiaMedical management of menorrhagia

A Cyclical norethisteroneB Copper-bearing intra-uterine deviceC Inert intra-uterine deviceD Levonorgestrel releasing intra-uterine systemE Medroxyprogesterone acetateF Mefenamic acidG Nonoxinol ‘9’H TiboloneI Tranexamic acid


Family Medicine

Picture Format example:Picture Format example:Skin diseaseSkin disease

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


Family Medicine

Picture Format example:Picture Format example:Skin diseaseSkin 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


Family Medicine

Data InterpretationData 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)


Family Medicine

Data Interpretation exampleData Interpretation example

The summary findings of a systematic review which included six separate studies are shown opposite. .

Ref: BMJRef: BMJ 2007;335:473 2007;335:473


Family Medicine

Data Interpretation exampleData 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


Family Medicine

Free text questionsFree 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


Family Medicine

Free text exampleFree text example

Which SINGLE vitamin is administered to reverse the anticoagulant effect of warfarin?

Give ONE answer only

Vitamin _____


Family Medicine

ScoringScoring

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


Family Medicine

Computer Based TestingComputer Based Testing

Once candidates have registered with the RCGP to sit the AKT, they will be given instructions about booking their exam at a Pearson VUE test centre.

There is a limited booking window with ‘first come, first serve’ choice of test session and venue.

There are approximately 150 test centres covering all parts of the UK.


Family Medicine

Computer Based Testing RulesComputer Based Testing Rules

Candidates MUST bring identity documents WHICH MATCH their application detailsCandidates should arrive in good timeCandidates who either arrive late or fail to provide matching ID, will NOT be admitted to sit the AKT


Family Medicine


Security at each centre will be robust:

Identity checks InvigilatedVideo 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


Family Medicine


It is STRONGLY recommended that candidates familiarise themselves with the demonstration tutorial on the Pearson Vue website

http://www.pearsonvue.com/rcgp/

Every AKT will begin with a short tutorial to remind candidates how to select answers and ‘mark’ questions – screen shots follow of the live tutorial


Family Medicine


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


Family Medicine

Feedback to candidatesFeedback to candidates

The following feedback will be provided to every candidate with their result

Their overall scoreThe pass markTheir performance in each of the 3 main subject areas


Family Medicine

Feedback to Deaneries Feedback to Deaneries

More general feedback on overall performance will continue to be forwarded to all UK deaneries and saved on the RCGP website

It is helpful to look at this previous feedback to identify areas which commonly cause difficulty:

http://www.rcgp.org.uk/gp-training-and-exams/mrcgp-exam-and-assessment-statistics/mrcgp-applied-knowledge-test-akt-summary-reports-and-statistics.aspx


Family Medicine

Example screenshot of tutorialExample screenshot of tutorial


Family Medicine

Example screenshot of marking Example screenshot of marking questions for later reviewquestions for later review


Family Medicine

Example screenshot of using the Example screenshot of using the review screenreview screen


Family Medicine

Example screenshot of a SBA Example screenshot of a SBA questionquestion


Family Medicine

Example screenshot of an extended Example screenshot of an extended matching questionmatching question


Family Medicine

Example screenshot of a rank Example screenshot of a rank ordering question ordering question


Family Medicine

Example screenshot of a free text Example screenshot of a free text questionquestion


Family Medicine

Example screenshot of a ‘drag and Example screenshot of a ‘drag and drop’ type questiondrop’ type question


Family Medicine

Exam technique 1Exam technique 1

Time management – this is everythingKeep watching the countdown clock on the computer200 questions in 3 hours = average of 54 seconds per questionYou should skip difficult questions rather than waste time (electronically highlight the ones you have left out) but don’t forget to leave time to go back before the end


Family Medicine

Exam technique 2Exam technique 2

Cover test – can you answer the question with the option list covered? If so, it’s probably the correct answerGo through unanswered questions 2nd time round using electronic reviewDo not leave any questions unanswered – educated guessing is worthwhileCheck for silly mistakes if you still have time


Family Medicine

Further preparationFurther 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


Family Medicine

And finally….And finally….

Remember that most people pass this exam first time…..

But you do need to prepare for it

So make use of the AKT Content Guide

Documents

Promoting Excellence in Family Medicine MRCGP Applied Knowledge Test Prepared by the AKT Core Group January 2013