MRCGP Applied Knowledge Test

1. MRCGPApplied Knowledge Test October 2011 Prepared by the AKT Group

2. Aims To inform you about the structure and content of the AKT To inform you about computer-based testing with Pearson VUE centres

3. 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

4. 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

5. Format: A three hour, 200 item multiple-choice test No multiple true/false questions No negative marking Delivered on a computer terminal at an invigilated test centre (Pearson VUE) Offered three times a year- Oct/Nov, Jan/Feb, April/May

6. Rules Eligibility For those starting specialty training from 1 August 2010, only trainees in the ST2 and ST3 stages of training will be eligible to take the AKT

7. Rules continued Number of attempts For those starting specialty training from 1 August 2010, a maximum number of four attempts will be permissible in the AKT Those who commenced specialty training before this date will be permitted to make an unlimited number of attempts at the AKT while they retain a national training number

8. Rules continued Time limit of AKT validity: AKT passes obtained after 1 August 2010 will no longer be subject to a three year validity limit Passes obtained between 1 August 2007 and 31 July 2010 by trainees in a specialty training programme will remain valid pending the award of a Certificate of Completion of Training (or Certificate of Eligibility for GP Registration)

9. Vital Statistics � October 2011 Pass mark = 134 (67%) Overall pass rate = 70.6% ST3 first time takers pass rate = 76.4% ST2 first time takers pass rate = 77% (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 95%

10. A few questions proved difficult�(AKT October 2011) Accuracy of prescribing including dose calculations Management of clinical areas which may be delegated e.g antenatal care, child development and immunisations Personal and professional responsibilities � NHS organisation, patient/practice interface, GMC guidance, statutory certification Critical appraisal including interpretation of data Remember that, as in real life, the �do nothing� and �normal� option may be correct

11. Question writing Scenarios derived from clinical work Practice issues Topical and emerging knowledge and guidelines 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

12. Common Reference Material GP Curriculum BNF GMC Good Medical Practice RCGP Essential Knowledge Updates NICE guidelines SIGN guidelines BMJ Review articles & original papers BJGP Cochrane Emphasise the BNF � beginning chapters, current edition and updatesEmphasise the BNF � beginning chapters, current edition and updates

13. RCGP Curriculum Statements Where to find them RCGP website http://www.rcgp-curriculum.org.uk/ What are they? Series of documents, 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

14. RCGP Curriculum Statements continued How the AKT links to the curriculum The AKT questions sample across the breadth of the curriculum

15. 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

16. Clinical Medicine (1) The broad topic of clinical medicine is subdivided into groups of body systems, in approximately equal numbers Each group will comprise questions on disease factors symptoms investigation management

17. 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

18. 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

19. Critical appraisal and evidence based clinical practice (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

20. Critical appraisal and evidence based clinical practice (2) Understanding and application of terms used in both statistics and evidence based medicine Understanding the role of epidemiology and public health medicine in general practice

21. 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. needlestick injury Social services, e.g safeguarding Ethical, e.g. Mental capacity, consent

22. Question Formats Single Best Answer (SBA) Extended Matching Questions (EMQ) Table/Algorithm Picture/Video Format Data interpretation Free text

23. 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�

24. 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

25. 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.