rcgp akt

1. RCGP AKT What your Registrar needs to know!

3. Format Designed to test knowledge and interpretation of data Three hours 200 item multiple choice test No multiple true false questions No negative marking Delivered on computer terminal at invigilated test centre � runs Oct, Jan, May.

4. Rules No limit on number of attempts Pass only valid for three years Can attempt any time during VTS training but best sat during year three.

5. Scoring Pass mark approx 68% 85.5% pass first time. 95.2% after second attempt.For Registrar yr 3 Overall pass rate 75% This includes multiple sitters. Pass rate clinical medicine 73.9%, evidence interpretation 73.2%, organisational 67.9% NB

6. Construction Relevance � covers high prevalence low impact e.g. UTI and low prevalence high impact e.g. meningitis Scenarios from clinical work, practice issues and topical issues. E.g. CD regs All question writers are working GPs

7. Reference material Clinical evidence Cochrane BNF GP curriculum NICE SIGN BMJ review articles and original papers BJGP Drugs and therapeutics bulletin

8. Subject content Core clinical medicine and its application to problem solving in GP context 80% of items Critical appraisal and evidence based clinical practice 10% of items Ethical and legal issues organisational structures supporting G Practice 10%

9. Clinical medicine Subdivided into groups of body systems in approx equal numbers Each group will have sections on disease factors, symptoms, investigation, and management Covers CVS, Dermatology, Endocrinology, ENT, Gastroenterology, Genetics, Haematology, Immunology, Infection, Mental health and learning disabilities, Musculo-skeletal, Opthalmology, Neurology, Paediatrics, Renal, Reproductive medicine, Respiratory,Therapeutic indications and adverse reactions.

10. Research Epidemiology and Statistics Principles and application of audit Application of critical appraisal skills and interpretation of research data Application of terms used in both interferential statistics and EBM e.g. as in appendices of clinical evidence BMJ www.clinicalevidence.org

11. Administration and management Regulatory frameworks e.g. DVLA Legal aspects � e.g. DVLA Social services e.g. certification Profession regulation e.g. GMC Business aspects e.g. GP Contract Prescribing e.g. CDs Appropriate use of resources e.g. drugs Health and safety e.g. needlestick injury Ethical e.g. mental capacity consent etc

12. So what are the learning needs? State benefits, sickness certification, incapacity, disability benefits and fitness to drive. Dermatology � esp acne, eczema, psoriasis Eye problems e.g. visual loss, approp management Prophylaxis against pandemics e.g. flu Meningococcal disease Evidence based management of high prevalence conditions Contraception.

13. And yet more learning needs�. Loss of consciousness Diagnosis and management of serious neonatal problems Clinical risk management about working in a safe clinical environment Children �prescribing, development, chronic disease. Access to medical records Travel medicine

14. Question formats Single best answer Extended matching questions Tables and algorithms e.g. BTS algorithm Picture format � e.g. alopecia areata Data interpretation � complex data, risk tables Seminal trials � ASCOT etc All scored equally 1 mark each correct answer No negative marking

15. Single best answer According to national guidelines �not local practice Often using clinical scenario Only one answer is correct Other options may be plausible.

16. Example cardiac anatomy The way to a mans heart is�. single most likely answer�. Through his aorta Down the M6 and off at Junction 4 Through his pulmonary arteries Though his pulmonary veins Though his stomach

17. Example resp disease 17 year old develops chest pain and SOB after swim. Hyper reonance an decreased breath sounds on the right side Single most likely diagnosis is�. Asthma Pneumothorax Pulmonary embolus LVF Pulmonary haemorrhage

18. Example extended matching question List of possible options 3 or more scenarios Most appropriate option should be chosen Options can be used several times or not at all.

19. EMQ food and drinkfor each food listed select the single most appropriate drink Asti spumante Shiraz Barolo Ceylon tea Chablis Chianti Chilled vodka Mexican beer Sherry Sauternes Coq au vin Cr�me brulee Kipper Nuts Oysters Snapper Wild duck Cucumber sandwiches

20. EMQ e.g. certificationFor each patient described pick the single most applicable certificate Med 3 Med 4 Med 5 Med 6 RM 7 SC 1 SC 2 Private cert See pt with back pain off work 7 days needs cert from the day he sees you Pt on long term sick for 6/12 and has a questionnaire prior to all work test Wants a cert�

21. Regarding data� Quantitative, qualitative, meta-analyses and systematic reviews Hierarchy of evidence � as in NICE Essential stats � mean, median, mode, normal distribution, confidence intervals, p values, ARR and RRR, NNT and NNH, sensitivity and specificity, positive and negative predictive values!!! Oh and forest plots, funnel plots, scattergrams and homogeneity and heterogeneity!

22. Feedback to candidates. Their result � overall score, the pass mark, their performance in each of the three areas. Pass is overall and not for each of the three areas General feedback to Deaneries also placed on RCGP web site.

23. The practicalities.. 150 test centres -first come first served. Register and phone to book in Demonstration tutorial � www.pearsonvue.com/rcgp/ AKT does start with short tutorial Security identity checks, invigilated, once in cannot leave, no phones, notepads. Confidentiality document signed. No late entries. Test forms downloaded on day of test. Never the same on consecutive days.

24. Revision strategies.. Small revision groups- share workload Practice timed MCQs Exam website has samples syllabus and feedback How to read a paper Trish Greenhalgh, RCGP website material Time management � is everything Skip difficult ones Guess at the end Cover test � answer before reading options.

25. Trainers can help by.. Broad an experience as possible Target areas of need e.g. medicolegal Question clinical decisions and look for evidence Use clinical evidence Cover Stats and critical reading Familiarise with algorithms.

26. CSA Format of exam What candidates must know Venue, examiners, cases Candidate experience Exam preparation and timing

27. Format 3 parallel circuits trice daily 13 simulated patient stations Cases last 10 minutes Candidates stay in own room as a real surgery Role player accompanied by an assessor throughout Prescription pads, certificates, test forms provided.

28. Timing and security Circuit lasts 3.5 hours. 15 minute break Case 10 mins 2 min break and so on Monitored during break �no talking!! Separate am and pm candidates Confidentiality agreement signed

29. Candidates must�. Not be late!! Remember ID Bring Drs bag and BNF � clean!! No mobiles = disqualification Read patient record thoroughly Own food and drink � no canteen.

30. Examiners 260 many are GP trainers Hands on Drs, team player, not prejudiced. Selection and training in place Idea is good representation form Primary Care QA of assessors and role players to ensure fairness. Remote cameras in place.

31. Cases 600 written Change daily Reflect spectrum of General Practice Designed to fill 10 minute slot Costs a lot of money to run.

32. Scope Wide clinical scope Differing contexts all from GP Range of ages including children by proxy Ethnicity and disability Breaking bad news Emotional problems, depression. May have a body part to examine Consultations with health professionals No manikins or models - almost

33. Trainers should cover� Telephone consulting Home visits Different ethnicities Disabled patients Difficult patients Uncertainty

34. Pitfalls� Jumping to conclusions too soon. Mechanistic consulting � irrelevant stock phrases Forgetting examination skills 33% need hands on examining- remove clothing!! Looking for non-existent hidden agenda Rigid, Dr centred consulting.

35. Standard expected.. That of GPR at end of 3 years. Safe for independent practice. Feedback form candidates � fair, centre fit for purpose, actors realistic, reflects real life experience, stressful,CSA exam fees are high!! Feedback to candidates � pass � excellent or fail, number of cases passed, which cases failed, formative feedback statements. Fed into E Portfolio.

36. Key messages for registrars Revise from curriculum statements No assumptions based on previous candidates experience. Read the case paperwork Manage time Structure consultations

37. Trainers can help by.. Allow Reg to experience wide variety of cases. Short practice swaps Use the COT as a way of assessing 10 minute consulting in practice a must. Use info on web site � dummy cases Wessex DVD RCGP book coming

38. Marking schedule for CSA Each vase is marked in three domains Data gathering examination and assessment skills Clinical management skills Interpersonal skills Overall grade only counts. 8 passes to get through � no compensation. One bad mistake does not fail, cover all domains in all cases, watch the timing.

39. Data technical and assessment Positives Clarifies problem Accept uncertainty Use of time good Systematic approach to information gathering Selective choice of enquiries, examination and investigations Identifies abnormal findings Uses instruments well Appropriate interpretation of information Negatives Immediate assumptions made Interventional Data gathering not related to probablilty of disease Fails to identify abnormal data or interpret it. Unsure re instruments Disorganised unsystematic

40. Clinical management skills Positives Recognises presentations of common problems Plans reflect natural history of common problems Feasible appropriate management options Appropriate assessment of risk Refers appropriately co-ordinates care with team members Manages risk, safety netting Manages multiple problems Encourages improvement rehab recovery Encourage patient participation Negatives Does not consider common conditions Patient not made aware of risks or different possible approaches Inappropriate decisions Referral inappropriate Follow up not planned Co-morbidity not considered No problem list No prioritisation No enhancement of patients coping strategies.

41. Interpersonal skills Positives Explore patients agenda Alert to verbal and nonverbal cues Explores impact of illness on patients life Works in partnership Psych and social info elicited Responds to pt preferences feeling and expectations Shared management plan Respect. Inclusive.Open Non-judgemental Sensitive to pts feelings Consent consent confidentiality Negatives Misses patient perspective Misses verbals and non verbals Misses psychosocial context No empowerment Inappropriate language Little understanding No compassion Own views paramount Prejudiced Patronising. Paternalistic. Embarrasses patient.

42. Candidates comments Cases favoured chronic conditions Real interesting enjoyable!!! So lets try some cases and see if we agree!!

43. Group rules Idea is to get a feel for the cases Not to judge colleagues performance Need one patient one registrar and one observer. Timing- 10 minutes to do, 10 to chat then change over cases if time! Use generic indicators sheet to assist. Confidentiality please.

44. 2 cases to try� Mrs Smith Cleaner mid 50s married C/o fluid retention bloating In reality just getting fatter FH NIDM brother and CCF Father Wants water tabs and tests Bloods 2 weeks ago normal Mrs Jones mid 50s smoker C.Of increased sob at rest and on exertion No chest pain or ankle oedema BP controlled with ACE Father had lung cancer Worried she may have something serious Wants a CXR