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

Objectives An overview of the content and structure To give examples of current question Objectives 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 Promoting Excellence in Family Medicine

AKT Background The AKT: Is a summative assessment of the knowledge base that underpins AKT 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 Promoting Excellence in Family Medicine

Format A 3 -hour, 200 -item multiple-choice test No multiple true/false questions No negative 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. Promoting Excellence in Family Medicine

Rules For those starting specialty training from 1/8/10 Only trainees in the ST 2 Rules For those starting specialty training from 1/8/10 Only trainees in the ST 2 and ST 3 stages of training will be eligible to take the AKT A maximum number of four attempts will be permissible in the AKT passes obtained after 1 August 2010 will no longer be subject to a three year validity limit Promoting Excellence in Family Medicine

Rules - exceptions Those who commenced specialty training before 1/8/10 will be permitted to Rules - 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) Promoting Excellence in Family Medicine

Vital Statistics – Oct 2013 Pass mark = 134/200 (67%) Overall pass rate = Vital Statistics – Oct 2013 Pass mark = 134/200 (67%) Overall pass rate = 76. 1% ST 3 first time takers pass rate = 83. 4% ST 2 first time takers pass rate = 87. 4% (This ratio varies in different diets of the AKT taken at different times throughout the training year) Cumulative pass rate after three attempts for all those who take AKT is approximately 98% Promoting Excellence in Family Medicine

Some areas that were not answered well (AKT October 2013) Interactions between commonly used Some areas that were not answered well (AKT October 2013) Interactions between commonly used drugs Dementia – management Peripheral vascular disease Women’s health – incontinence Vaccination regimes – pre-employment Diabetes – management Dermatology – diagnosis and management of psoriasis Remember that, as in real life, the “do nothing” and “normal” option may be correct Promoting Excellence in Family Medicine

Question writing Scenarios are derived from clinical work Practice issues Topical All questions are Question writing Scenarios are derived from clinical work Practice issues Topical 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 Promoting Excellence in Family Medicine

Common Reference Material GP Curriculum 2012 Content guide for the AKT BNF GMC Good Common Reference Material GP Curriculum 2012 Content guide for the AKT BNF GMC Good Medical Practice RCGP Essential Knowledge Updates NICE guidelines SIGN guidelines BMJ Review articles & original papers BJGP Cochrane Promoting Excellence in Family Medicine

GP Curriculum & AKT Content Guide Where to find them www. rcgp. org. uk/gp-training-and-exams/gp-curriculum-overview. GP Curriculum & AKT Content Guide Where to find them www. rcgp. org. uk/gp-training-and-exams/gp-curriculum-overview. aspx http: //www. rcgp. org. uk/gp-training-and-exams/mrcgp-examoverview/mrcgp-applied-knowledge-test-akt. aspx#howtoprep How the AKT links to the curriculum Questions in the AKT sample across the breadth of the curriculum The AKT Content guide is a new learning resource which is designed to be used in conjunction with the curriculum Promoting Excellence in Family Medicine

AKT Content Guide How to use the Content Guide Don’t be put off by AKT Content Guide How to use the Content Guide Don’t be put off by the lengthy list of topics! Do use the guide as a needs assessment tool In particular, carefully review the sections: Organisational –including administrative, statutory, ethical and regulatory frameworks Evidence interpretation – including research, statistics and epidemiology Promoting Excellence in Family Medicine

Paper Construction ensures: Reliability, validity and fairness Adequate coverage of the topics that appear Paper Construction ensures: Reliability, validity and fairness Adequate coverage of the topics that appear in the blueprint The correct balance of question formats Promoting Excellence in Family Medicine

Principles of paper construction Relevance: the AKT should be relevant to general practice High Principles 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 Promoting Excellence in Family Medicine

AKT content 80% of questions Core clinical medicine and its application to problem solving AKT content 80% 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 10% of questions Ethical and legal issues as well as the organisational structures that support UK general practice Promoting Excellence in Family Medicine

Clinical Medicine (1) The broad topic of clinical medicine is subdivided into groups of 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 factors symptoms investigation management Promoting Excellence in Family Medicine

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

Clinical Medicine (3) Common, low impact – e. g. sore throat, otitis media, impetigo Clinical Medicine (3) 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 Promoting Excellence in Family Medicine

Critical appraisal and evidence-based clinical practice Understanding the principles of audit and its application Critical appraisal and evidence-based clinical practice 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 including: the interpretation of research data the understanding of terms used in both statistics and evidence based medicine Understanding epidemiology relevant to general practice Promoting Excellence in Family Medicine

Ethical, Legal & Organisational NHS organisation Legal aspects e. g. DVLA Medical certification e. 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. needlestick injury Social services e. g. safeguarding Ethical e. g. Mental capacity, consent Promoting Excellence in Family Medicine

Question Formats Single Best Answer (SBA) Extended Matching Questions (EMQ) Table/Algorithm Picture/Video Format Drag 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 Promoting Excellence in Family Medicine

Single Best Answer (SBA) “According to national guidelines” means recommended by nationally accepted guidelines 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” Promoting Excellence in Family Medicine

SBA example: Respiratory disease A 17 -year-old student suddenly develops chest pain and dyspnoea 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 Promoting Excellence in Family Medicine

Extended matching questions (EMQ) These questions have a list of possible options There will 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. Promoting Excellence in Family Medicine

EMQ example: Double vision A. Berry aneurysm E. Ischaemic stroke B. Cerebral glioma F. EMQ example: Double vision A. Berry aneurysm E. Ischaemic stroke B. Cerebral glioma F. Multiple sclerosis C. Drug induced G. Myasthenia gravis D. Graves’ disease 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. Promoting Excellence in Family Medicine

EMQ example: Double vision A. Berry aneurysm E. Ischaemic stroke B. Cerebral glioma F. EMQ example: Double vision A. Berry aneurysm E. Ischaemic stroke B. Cerebral glioma F. Multiple sclerosis C. Drug induced G. Myasthenia gravis D. Graves’ disease 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. Promoting Excellence in Family Medicine

Algorithm example: Medical management of menorrhagia Nonhormonal 1 _______ 2 _______ Hormonal therapy Combined Algorithm example: Medical management of menorrhagia Nonhormonal 1 _______ 2 _______ Hormonal therapy 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. Promoting Excellence in Family Medicine

Algorithm example: Medical management of menorrhagia A. B. C. D. E. F. G. H. Algorithm example: Medical management of menorrhagia A. B. C. D. E. F. G. H. I. Cyclical norethisterone Copper-bearing intra-uterine device Inert intra-uterine device Levonorgestrel releasing intra-uterine system Medroxyprogesterone acetate Mefenamic acid Nonoxinol ‘ 9’ Tibolone Tranexamic acid Promoting Excellence in Family Medicine

Picture Format example: Skin disease A 32 -year-old man has noticed painless nonitchy patches Picture Format example: Skin disease A 32 -year-old man has noticed painless nonitchy patches of hair loss on his beard area and scalp. Promoting Excellence in Family Medicine Ref: Dermnet. com

Picture Format example: Skin disease Which is the SINGLE MOST likely diagnosis? Select ONE Picture Format example: Skin disease Which is the SINGLE MOST likely diagnosis? Select ONE option only. A. B. C. D. E. Alopecia areata Eczema Lichen sclerosis Tinea infection Vitiligo Promoting Excellence in Family Medicine

Data Interpretation of data, e. g for groups of patients with chronic conditions Interpretation Data 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) Promoting Excellence in Family Medicine

Data Interpretation example The summary findings of a systematic review which included six separate Data Interpretation example The summary findings of a systematic review which included six separate studies are shown opposite. Ref: BMJ 2007; 335: 473 Promoting Excellence in Family Medicine

Data Interpretation example Which SINGLE study suggests the WEAKEST association between increased whole grain 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. B. C. D. E. Fung Meyer Montonen NHS 1 Van Dam Promoting Excellence in Family Medicine

Free text questions Require the candidate to generate the correct answer without a list 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 Promoting Excellence in Family Medicine

Free text example Which SINGLE vitamin is administered to reverse the anticoagulant effect of Free text example Which SINGLE vitamin is administered to reverse the anticoagulant effect of warfarin? Give ONE answer only Vitamin _____ Promoting Excellence in Family Medicine

Scoring All question formats have equal weighting Each correctly answered question is awarded one 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 Promoting Excellence in Family Medicine

Computer Based Testing Once candidates have registered with the RCGP to sit the AKT, Computer 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 approximately 150 test centres covering all parts of the UK. Promoting Excellence in Family Medicine

Computer Based Testing Rules Candidates MUST bring identity documents WHICH MATCH their application details Computer Based Testing Rules Candidates MUST bring identity documents WHICH MATCH their application details 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 Promoting Excellence in Family Medicine

Computer Based Testing Security at each centre will be robust: Identity checks Invigilated Video Computer Based Testing Security at each centre will be robust: Identity checks Invigilated Video 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 Promoting Excellence in Family Medicine

Computer Based Testing It is STRONGLY recommended that candidates familiarise themselves with the demonstration Computer Based Testing 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 Promoting Excellence in Family Medicine

Computer Based Testing Responses will be uploaded to a central server and then passed Computer Based Testing 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 Promoting Excellence in Family Medicine

Feedback to candidates The following feedback will be provided to every candidate with their 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 Promoting Excellence in Family Medicine

Feedback to Deaneries More general feedback on overall performance will continue to be forwarded 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-andexams/mrcgp-examination-summary-reportsstatistics/mrcgp-applied-knowledge-test-aktsummary-reports-and-statistics. aspx Promoting Excellence in Family Medicine

Online AKT Tutorial Simulates format of AKT Requires Adobe Flash (not available on devices Online AKT Tutorial Simulates format of AKT Requires Adobe Flash (not available on devices running i. OS) Promoting http: //www. rcgp. org. uk/gp-training-and-exams/mrcgp-exam-overview/mrcgp-applied. Excellence in knowledge-test-akt. aspx#howtoprep Family Medicine

Test Day Tutorial: Opening Screen Promoting Excellence in Family Medicine Test Day Tutorial: Opening Screen Promoting Excellence in Family Medicine

Test Day Tutorial: Flagging questions for later review Promoting Excellence in Family Medicine Test Day Tutorial: Flagging questions for later review Promoting Excellence in Family Medicine

Test Day Tutorial: Using the review screen Promoting Excellence in Family Medicine Test Day Tutorial: Using the review screen Promoting Excellence in Family Medicine

Test Day Tutorial: SBA question example Promoting Excellence in Family Medicine Test Day Tutorial: SBA question example Promoting Excellence in Family Medicine

Test Day Tutorial: EMQ question example Promoting Excellence in Family Medicine Test Day Tutorial: EMQ question example Promoting Excellence in Family Medicine

Test Day Tutorial: MBA question example Promoting Excellence in Family Medicine Test Day Tutorial: MBA question example Promoting Excellence in Family Medicine

Test Day Tutorial: Free Text question example Promoting Excellence in Family Medicine Test Day Tutorial: Free Text question example Promoting Excellence in Family Medicine

Test Day Tutorial: Drag and Drop question example Promoting Excellence in Family Medicine Test Day Tutorial: Drag and Drop question example Promoting Excellence in Family Medicine

Exam technique 1 Time management – this is everything Keep watching the countdown clock Exam technique 1 Time management – this is everything Keep watching the countdown clock on the computer 200 questions in 3 hours = average of 54 seconds per question You 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 Promoting Excellence in Family Medicine

Exam technique 2 Cover test – can you answer the question with the option Exam technique 2 Cover test – can you answer the question with the option list covered? If so, it’s probably the correct answer Go through unanswered questions 2 nd time round using electronic review Do not leave any questions unanswered – educated guessing is worthwhile Check for silly mistakes if you still have time Promoting Excellence in Family Medicine

Further preparation Small revision groups to share the workload of reviewing national guidance, BNF 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 Promoting Excellence in Family Medicine

And finally…. Remember that most people pass this exam first time…. . But you 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 Promoting Excellence in Family Medicine