You are on page 1of 48

nMRCGP Applied Knowledge Test

February 2010 Prepared by the AKT Group

Promoting Excellence in Family Medicine

Aims
To increase confidence To help you pass AKT element of nMRCGP

Promoting Excellence in Family Medicine

Objectives
To provide an overview of the content of the paper To describe, with examples, the current question formats To describe the principles of question construction in order to help candidates to answer them To advise on how best to prepare for and pass the paper - including feedback from recent papers
Promoting Excellence in Family Medicine

AKT aims
The AKT is designed to test the application of knowledge and interpretation of information Each question is intended to explore a topic of which an ordinary GP could be expected to have a working knowledge
Promoting Excellence in Family Medicine

Format:

A three hour, 200 item multiple-choice test Delivered on a computer terminal at an invigilated test centre Offered three times a year- Oct/Nov, Jan/Feb, April/May

Promoting Excellence in Family Medicine

Vital Statistics January 2010


Pass mark = 134/200 (67%) Overall pass rate;
ST3 first time takers pass rate = 83% ST2 first time takers pass rate = 80.6% This ratio varies in different diets of the AKT

Cumulative pass rate for all those in ST3 after 3 attempts is approximately 94%
Promoting Excellence in Family Medicine

Rules
No limit to the number of attempts A pass will be valid for three years only Can be attempted at any time during GP specialist training (GPST) However, most appropriate timing is at the end of ST2 or early ST3

Promoting Excellence in Family Medicine

How hard?
Examinations are formidable even to the best prepared, for the greatest fool may ask more than the wisest man can answer

Charles Colton (1780-1832), Lacon


Promoting Excellence in Family Medicine

Question writing
Scenarios 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


Cochrane BNF GP Curriculum NICE SIGN BMJ Review articles & original papers BJGP DTB GMC Good Medical Practice RCGP Essential Knowledge Updates
Promoting Excellence in Family Medicine

RCGP Curriculum Statements


Where to find them
RCGP website

http://www.rcgp-curriculum.org.uk/

What are they?


Series of papers, each covering different clinical and practice management areas, based on European Academy of Teachers in General Practice (EURACT) framework.
Written by a variety of GP experts and coordinated by RCGP
Promoting Excellence in Family Medicine

RCGP Curriculum Statements


How they are being used

continued

Curriculum statements have Intended Learning Outcomes (ILO). Questions are derived from specified learning outcomes within specified curriculum statements. This enables sampling from across the curriculum, as cases can be mapped to the curriculum statements (or nMRCGP blueprint)
Promoting Excellence in Family Medicine

AKT subject content


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

Promoting Excellence in Family Medicine

Clinical Medicine (1)


The broad topic of clinical medicine is subdivided into groups of body systems, in approximately equal numbers Each group will comprise sections 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 & learning disability Musculo-skeletal Neurology Ophthalmology Paediatrics Renal Reproductive male/female Respiratory Therapeutic indications and adverse reactions

Promoting Excellence in Family Medicine

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

Research, Epidemiology and Statistics (1)


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 e.g the interpretation of research data
Promoting Excellence in Family Medicine

Research, Epidemiology and Statistics (2)


Understanding and application of terms used in both inferential statistics and evidence based medicine. e.g. as described in BMJ Learning modules http://learning.bmj.com/learning/channelhome.html
Promoting Excellence in Family Medicine

Administration and Management


Regulatory frameworks, e.g. PCOs Legal aspects, e.g. DVLA Social services, e.g. Certification 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 Ethical, e.g. Mental capacity, consent
Promoting Excellence in Family Medicine

A few questions proved difficult Jan 2010


Several items related to alcohol Alcohol units, nutrition, treatment for alcohol dependence, complications of alcohol abuse other than liver disease Rare but significant findings at routine childhood examinations Over the counter medication side effects and contraindications Pregnancy care Legal role of the GP in patients lives Lifesaving emergency procedures
Promoting Excellence in Family Medicine

Question Formats
Single Best Answer (SBA) Extended Matching Questions (EMQ) Table/Algorithm Picture/Video Format Data interpretation Seminal Trials Other question formats such as free text will be piloted in the future
Promoting Excellence in Family Medicine

New question formats


Data interpretation Interpretation of complex sets of data for patients with chronic conditions. Relevant risk tables are included if appropriate. Seminal trials Familiarity with significant new research e.g knowledge of studies which significantly change clinical practice such as WHI, ALLHAT.
Promoting Excellence in Family Medicine

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

Promoting Excellence in Family Medicine

SBA example: Respiratory disease


A 17-year-old student suddenly develops chest pain and dyspnoea after a morning swim. There is hyperresonance 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 usually be 3 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 B Cerebral glioma C Drug induced D Graves disease For each patient described, select the SINGLE MOST likely diagnosis from the list of options above. 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

E Ischaemic stroke F Multiple sclerosis G Myasthenia gravis

EMQ example: Double vision


A Berry aneurysm B Cerebral glioma C Drug induced D Graves disease For each patient described, select the SINGLE MOST likely diagnosis from the list of options above. E Ischaemic stroke F Multiple sclerosis G Myasthenia gravis

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 Hormonal therapy

1 _______

2 _______

Combined oral contraceptive pill

3 _______

For each of the numbered gaps above, select ONE option from the list below 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 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 non-itchy patches of hair loss on his beard area and scalp.

Promoting Excellence in Family Medicine

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

Ref: Dermnet.com

Promoting Excellence in Family Medicine

Data Interpretation
Interpretation of complex sets of data for patients with chronic conditions Interpretation of research and audit results

Promoting Excellence in Family Medicine

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 intake and a risk of type 2 diabetes? Select ONE option only.
Promoting Excellence in Family Medicine

A Fung B Meyer C Montonen D NHS1 E Van Dam

Scoring
All question formats have equal weighting Each correct answer is awarded one mark Total score on the paper is the number of correct answers given No negative marking - Fear factor

Promoting Excellence in Family Medicine

Feedback
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

More general feedback on overall performance will continue to be forwarded to all UK deaneries and placed on the RCGP website
Promoting Excellence in Family Medicine

Computer Based Testing


Once candidates have registered with the RCGP to sit the AKT, they will be given information and MUST then ALSO ring Pearson VUE within a limited timeframe to book a test centre. It is recommended that candidates familiarise themselves with the demonstration tutorial on the Pearson Vue website : https://www.pearsonvue.com/rcgp/

The AKT also begins with a short tutorial to remind candidates how to mark the answers screen shots follow of the live tutorial
Promoting Excellence in Family Medicine

Promoting Excellence in Family Medicine

Promoting Excellence in Family Medicine

Promoting Excellence in Family Medicine

Promoting Excellence in Family Medicine

Computer Based Testing


There are approximately 150 test centres covering all parts of the UK Candidates will be able to book the AKT at a local venue, on a first come, first served basis
Promoting Excellence in Family Medicine

Computer Based Testing


Security at each centre will be robust Identity checks Invigilated Video monitoring
Test forms are downloaded to each centre on the test day 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


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

Computer Based Testing


Please bring identity documents which MATCH examination registration details Please arrive in good time Late arrival or failure to provide matching ID will result in you being unable to sit the AKT
Promoting Excellence in Family Medicine

POINTS TO REMEMBER AT ALL TIMES


Time management this is everything Cover test can you answer the question with the option list covered? Mark answer box carefully Skip difficult questions rather than waste time (you can electronically highlight the ones you have left out) Go through those not done 2nd time round Guess any at the end to ensure all answered Check for silly mistakes if you still have time Keep watching the clock (200 questions in 3 hours)
Promoting Excellence in Family Medicine

Further preparation
Small revision groups to share the workload Learn from your clinical experience check the guidelines and references Exam website feedback, sample material and syllabus
Promoting Excellence in Family Medicine

And finally..
Are you confident at tackling AKT statistics and critical reading questions? Can you see the achievable level of competence you need? Can you plan to efficiently prepare for this module?

Promoting Excellence in Family Medicine