AKT
Guidance from trainees who’ve done it.
AIMS
What is the AKT?
 Why do I need to do it?
 When do I need to do it?
 Where do I need to do it?
 How do I need to do it?
 How much does it cost?
 How do I prepare for it?
?any other burning questions

Why do I need to do the AKT?
Essential requirement for completion of
MRCGP.
 NO OTHER CHOICE REALLY!

What is the AKT?

Summative Assessment
APPLIED KNOWLEDGE TEST
 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.
What is the AKT cont…
◦
200 item Multiple Choice Test.
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
What is the AKT? 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
What is the AKT
Question format….
Single Best Answer (SBA)
 Extended Matching Questions (EMQ)
 Table/Algorithm
 Picture/Video Format
 Data interpretation
 Free text
 New types of questions!! – AKT now
involves some written (typed one
word) answers – there was only 3 in
the AKT in OCT 2010.

Example questions








1. Management of chest pain
A 55-year-old man has a two hour history of severe central
chest pain radiating into his left arm. He has no previous
significant medical history. His BP is 150/85, his chest is clear
and his pulse is regular 90/min.
In addition to aspirin, which is the SINGLE MOST
appropriate NEXT drug for this patient? Select ONE
option only.
A Amiodarone
B Carvedilol
C Diamorphine
D Furosemide
E Ramipril
What is the AKT
Research, epidemiology and stats!

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
What is the AKT
















example questions
Risk of hip fracture
A cohort study is conducted to evaluate the relationship between dietary calcium supplementation and
the occurrence of hip fractures in post-menopausal women.
The study examines the hip fracture rate in 100 women taking calcium supplements and 100 women
taking placebo over three years.
Over the three year period, five women have hip fractures in the calcium group and ten women have
hip fractures in the placebo group. The 95% confidence interval is 0.18 to 1.4.
8. In calculating the RISK of a hip fracture in the TREATED group, which is the SINGLE
CORRECT answer? Select ONE option only.
A 0.01
B 0.05
C 0.1
D 0.5
E 1.0
9. In calculating the RISK RATIO for this study, which is the SINGLE CORRECT answer?
Select ONE option only.
A 0.01
B 0.05
C 0.1
D 0.5
E 1.0
Administrative 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
What is the AKT
example question
25. Medical standards of fitness to drive
A 65-year-old retired man had a routine coronary artery
angioplasty and stent insertion one week ago. He is now
Well and asymptomatic. He asks you for advice about
driving.
According to DVLA guidance, which is the SINGLE
MOST appropriate advice with regard to driving?
Select ONE option only.
 A He may resume drive immediately
 B He may resume driving after a further week
 C He may resume driving one month after the angioplasty
 D He may resume driving six months after the angioplasty
 E He must inform the DVLA and await their decision before
resuming driving
What is the AKT
Scoring
All question formats have equal weighting
 Each correct answer-1 mark
 Total score is the number of correct answers
given.
 No negative marking - ‘Fear factor’
 If a question performs poorly across the
whole exam it will be removed from the
scores of ALL candidates.

When do I take the AKT?
Number of attempts
From 1 August 2010, a maximum of 4
attempts!
 Those who commenced specialist training
before this date will be permitted to
unlimited number of attempts at the AKT
while they retain a national training
number
When do I take the AKT?
Time limit of AKT validity:
 AKT passes obtained after 1 August 2010 no longer three year validity limit.

Passes obtained between 1 August 2007 and
31 July 2010 by trainees in a specialist
training programme will remain valid pending
the award of a Certificate of Completion of
Training (or Certificate of Eligibility for GP
Registration)
When do I take the AKT?

Offered three times a year- Oct/Nov, Jan/Feb, April/May
Rams website tips;
 Do not consider doing in your first year on a 3 year
scheme (even though you are allowed to by the regulations)
 Nobody is recommending that you should take until you
have done at last 6m in General Practice.
 Do not take it until you have had time to look at GP related
medical knowledge as well as management and research.
 Do not take it after you have had a period away from work
(e.g. pregnancy), as you need to have kept up to date on
NICE and SIGN guidelines and how these are implemented
in practice
 Revising with others helps
When to take AKT ?earlier

Preparing for the exam helps keep a focus on learning
knowledge when in hospital posts.

More opportunities for retakes

Will help you work out your weak areas if you do not pass
and prepare for a second attempt.
Lots to do in ST3 without adding AKT prep to the list/Getting
it out of the way
 Taking it when others are taking it-helps with preparation.


Leaving it late and failing is a high risk strategy
When to take AKT ?later

College advice most appropriate point, and highest chance of
success, will be whilst working as a GPStR in the final year of
their specialty-training programme (ST3).

Taking once is cheaper than taking it twice

Everybody else on my scheme is taking at the very start of ST3
so it is easier to prepare together

Knowledge base for AKT helps with CSA so take together
Success rates-Jan 2011
Pass mark = 136/200 (68.0%)
Overall pass rate = 74.9%
ST3 first time takers pass rate = 81.0%
ST2 first time takers pass rate = 79.2%
(This ratio varies in different diets of the AKT taken at
different times throughout the training year)
Cumulative pass rate for all those in ST3
after 3 attempts is approximately 94%
How do I take it?
Book test via RCGP website-instructions
to follow.
 Morning/afternoon sessions at local
Pearson Vue Centre.
 Done on computer work station (like
driving theory test)-with tutorial (CBT)
 Dates available on rcgp website\results via
eportfolio-1st come/1st served.

How/Where do I take it?
Familarise yourself with 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.



Security at each centre will be robust!!!!!
◦ Identity checks -2 forms of ID-one photograph ID
◦ 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.
How to take it?

Time management – this is everything

Keep watching the countdown clock on the computer

200 questions in 3 hours = average of 54 seconds per
question

Skip difficult questions rather than waste time
(electronically highlight the ones you have left out)
How to take it?
Exam tips

Cover test – can you answer the question with the option list covered?
It’s probably the correct answer

Mark answer spot carefully

Go through unanswered questions 2nd time round using electronic
review

Do not leave any questions unanswered – educated guessing is
worthwhile

Check for silly mistakes if you still have time
How to prepare?-resources used to devise AKT









GP Curriculum (IOLs)
BNF
GMC Good Medical Practice
RCGP Essential Knowledge Updates
Cochrane
NICE
SIGN
BMJ Review articles & original papers
BJGP
How to prepare?






Give yourself enough time.
Familarise yourself with GP curriculum-particularly 3
domains.
Learn from your clinical experience – check the
guidelines and references of cases you come across
Exam website feedback, sample material.
Other resources to guide learning/practise questions
?prepare with peers.
How to prepare
Resources
Oxford Handbook of General Practice by Chantal Simon and Hazel Everitt
(1st few chapters for primary care & admin)

Innovait magazine (matches to GP curriculum-also has sample questions)
Can register and set up account if AIT member who receives Innovait magazine.
Need unique mailing subscriber ID on Innovait magazine.
https://access.oxfordjournals.org/oup/registration/customerDetail.do?commandview.

Medical Statistics made easy. Michael Harris, Gordon Taylor.
 How to Read a Paper: The Basics of Evidence-Based Medicine by Trisha
Greenhalgh.

Other books

nMRCGP Practice Papers: Applied Knowledge Test. by Rob Daniels

NMRCGP Applied Knowledge Test Study Guide: Sample Questions and
Explanatory Answers by Aalia Khan, Ramsey Jabbour, and Almas Rehman
How to prepare
online resources

www.passmedicine.com offers 1000s of MCQs at little
cost (£20 for 4 months)

On examination from the BMJ group
www.onexamination.com/Exam-Revision/MRCGP.aspx
is more expensive (£60 for 3 months) but some have
found that it reflected the type and standard of MCQ in
the AKT better than above.
Past test- http://www.pastest.co.uk
(~£39 for 2 months £59 for 3 months). Plus there is an
app for the phone.

How to prepare? Courses
Don’t feel it is needed-save your money
for CSA!.
But if you really want to ,,





GP update course,
NB medical course,
Emedica course,
Local courses- Nick Price may know about!
Feedback-difficulties 2011

Diagnosis and management of acutely unwell
patients – common injuries, acute abdominal pain

Eye problems – identifying patients who require
urgent specialist assessment

Personal and professional responsibilities –
patient/practice interface, GMC guidance, certification

Remember that, as in real life, the “do nothing” option
may be correct