MRCGP
Applied Knowledge Test
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.
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
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
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
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
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
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
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”
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
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.
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.
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.
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.
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
Picture Format example:
Skin disease
• A 32-year-old man has
noticed painless nonitchy patches of hair
loss on his beard area
and scalp.
Picture Format example:
Skin disease
Which is the SINGLE MOST likely diagnosis?
Select ONE option only.
A
B
C
D
E
Ref: Dermnet.com
Alopecia areata
Eczema
Lichen sclerosis
Tinea infection
Vitiligo
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)
Data Interpretation example
• The summary findings
of a systematic review
which included six
separate studies are
shown opposite.
Ref: BMJ 2007;335:473
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
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
Free text example
Which SINGLE vitamin is administered to reverse
the anticoagulant effect of warfarin?
Give ONE answer only
Vitamin _____
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
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
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
Advice from successful trainees:
• Samples of AKT questions are provided every month, linked to the curriculum
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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 http://www.passmedicine.com/akt/index.php 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 http://www.nbmedical.co.uk/ 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)
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
Slow readers/ some IMGs
• www.irisreading.com
• If you think reading speed is slower than average this
website can help to speed it up
Practice Management
• Oxford Handbook of General Practice