AKT Top Tips
Gareth Smith
What’s so scary?
What were the main issues for me?
- Medical statistics!
- Time vs No of questions
- Driving guidelines
- Primary care admin
Aims
- Structure of AKT
- Applying for the exam
- Resources
- Where did other candidates struggle?
- Example questions
1) Structure of the AKT
The AKT test
- Is a 3 hr computer-based test
- Consists of 200 question items
- 80% clinical medicine
- 10% critical appraisal
- 10% health informatics & administrative issues
(Works out at 54 seconds per question)
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)
- Look at topical things (read new NICE guidance, check
BMJ/BJGP)
- Refer to GP curriculum
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
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)
How many pass?
2) Applying for the exam
Applying
- Can be taken during or after the GPST2
- A maximum number of 4 attempts will be
permitted
Applying (2)
- AKT costs £465
- ? Whether Associate in Training (AiT)
payments contribute
- We pay three annual instalments of £135
- £405 is available to put towards cost of exam
Where to take the test
3) Resources
Resources (1)
-
GP curriculum
BNF
GMC Good Medical Practice
RCGP Essential Knowledge Updates
NICE Guidelines
SIGN Guidelines
BMJ review articles & original papers
BJGP
Resources (2)
Internet:
- Pastest (£50 for Oct, £78 for Jan)
- BMJ On examination (£50 - £120 for 1 – 6 months)
- Pass medicine (£25 for 4 months, £35 for 6 months)
Books:
- Succeeding in the MRCGP AKT, C Mehta, M Williams
and M Mehta (£19.99)
- Medical Statistics made easy, M. Harris & G. Taylor
(£16)
What did I use?
- On examination
- Oxford Handbook GP
- Medical statistics made easy
- Dermnet NZ
- DVLA Guidance
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
4) Where did others go wrong?
Feedback from Jan 2014
Areas causing difficulty for candidates
2.02 Patient safety and quality of care – DRUG INTERACTIONS
“Candidates appeared unaware of hazards related to the use of over-the-counter
supplements or certain foodstuffs in combination with commonly prescribed
medication. We would encourage candidates to take a broad approach to the issue
of drug interactions and contraindications.”
3.04 Care of children and young people - DEVELOPMENTAL MILESTONES
“Candidates struggled to recognise when child development was deviating from
normal. Gaining relevant knowledge in this important area may be difficult for
candidates unless they are able to attend child health clinics and clinical
supervisors may be able to facilitate this.”
3.17 Care of people with metabolic problems – DIABETES DIAGNOSIS/MANAGEMENT
“Candidates had difficulty in answering questions related to management of type 2
diabetes, and in particular use of insulin. There also continued to be problems
around diagnosis of diabetes.”
Feedback from Jan 2014
3.16 Care of people with eye problems – OPHTHALMIC EMERGENCIES
“We expect candidates to be familiar with the diagnosis and management
of those which present most frequently. This will include conditions
related to trauma where urgent action may be required”
3.20 Care of people with musculoskeletal problems - OSTEOPOROSIS
“Questions on osteoporosis, in particular relating to DEXA scans, were not
well answered.”
2.03 The GP in the wider professional environment - CERTIFICATION
“Candidates often struggle with questions related to certification, such as
fitness to work certificates.”
(Look on RCGP website  Exams  Exam summary reports  AKT)
5) Question Types
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
Question types
- Single Best Answer (SBA)
- Extended Matching Questions (EMQ)
- Table/Algorithm
- Picture/Video Format
- Data interpretation
- Free text
Single Best Answer
Single Best Answer (SBA) questions
According to current evidence, in the management of croup in a 2year-old child, which is the single most effective treatment to
shorten the course of the condition? Select one option only.
A
B
C
D
E
F
Place the child in a steam filled bathroom
Administer inhaled budesonide
Prescribe amoxicillin 125 mg t.d.s. for five days
Administer inhaled salbutamol
Prescribe paediatric cough suppressant containing codeine
Administer inhaled tribavirin
Extended Matching Questions
THEME: Reduced Vision
Option list:
A
B
C
D
E
Basilar migraine
Cerebral tumour
Cranial arteritis
Macular degeneration
Occlusion of the central retinal artery
F
G
H
I
Occlusion of the central retinal vein
Optic neuritis
Retinal detachment
Tobacco optic neuropathy
Instruction:
For each patient with reduced vision, select the single most likely diagnosis.
Each option may be used once, more than once, or not at all.
Items:
1
A 75-year-old man, who is a heavy smoker, with blood pressure of 170/105, complains of floaters in the right eye for many
months and flashing lights in bright sunshine. He has now noticed a ‘curtain’ across the vision of his right eye.
2
A 70-year-old woman complains of shadows, which sometimes obscure her vision for a few minutes. She has felt unwell
recently with loss of weight and face pain when chewing food.
3
A 45-year-old woman, who is a heavy smoker, with blood pressure of 170/110, complains of impaired vision in the left eye.
She has difficulty discriminating colours and has noticed that her eye aches when looking to the side.
Picture Format
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
B
C
D
E
entropion
meibomian cyst
metastatic deposit
stye
xanthelasma
Algorithm completion
THEME: Medical management of menorrhagia
Not requiring
contraception
(14) -------
Requiring
contraception
(15) -------
Combined oral
contraceptive pill
(16) ---------
For each of the numbered gaps above, select ONE option from the list below to complete the algorithm, based
on current evidence. Select ONE option only
A
C
E
G
I
Copper intra-uterine device
Cyclical norethisterone
Levonorgestrel releasing intra-uterine system
Nonoxinol ‘9’
Tranexamic acid
B Cyclical medroxyprogesterone acetate
D Inert intra-uterine device
F Mefenamic acid
H Tibolone
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
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:
DVT present
DVT absent
New test positive
200
100
New test negative
20
680
What is the specificity of the new test?
A. 680/880
B. 200/220
C. 680/780
D. 680/700
E. 200/300
6) Types of question that
caught me out…
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
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
Thanks.
Any questions?
And….GOOD LUCK