NMRCGP Applied Knowledge Test

1. nMRCGPApplied Knowledge Test July 2009 Prepared by the AKT Group

2. 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

3. Background Replaces the previous Multiple Choice Paper (MCP) Summative assessment of the knowledge base that underpins independent general practice within the United Kingdom. Mapped to the RCGP Curriculum

4. Format: An “evolution” from the previous MRCGP Multiple Choice Paper 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 Offered three times a year- Oct/Nov, Jan/Feb, April/May

5. Vital Statistics April 2009 results Pass mark = 126/199 (63.3%) Overall pass rate ST3 first time takers pass rate = 83.8% ST2 first time takers pass rate = 86.3% (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%

6. Rules No limit to the number of attempts A pass will be valid for three years only Can be attempted at any time during GP specialist training (GPST), but most appropriately during the ST2-ST3 years

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

8. The MRCGP Curriculum Statements continued How they are being used Curriculum statements have ‘Intended Learning Outcomes (ILO)’. Questions are derived from specified learning outcomes within specified curriculum statements. This enables sampling from across the curriculum, as cases can be mapped to the curriculum statements (or nMRCGP blueprint)

9. Paper Construction ensures: Reliability, validity and fairness. Adequate coverage of the topics that appear in the blueprint. The correct balance of question formats

10. Principles of paper construction Relevance: the AKT should be relevant to general practice High prevalence: any topic covered can be one which occurs commonly High impact: or one which is significant but less common

11. 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 other question writers. All question writers are working GPs

12. Common Reference Material Cochrane BNF GP Curriculum NICE SIGN BMJ Review articles & original papers BJGP DTB GMC Good Medical Practice

13. AKT subject content 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

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

15. 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

16. 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

17. Research, Epidemiology and Statistics (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

18. Research, Epidemiology and Statistics (2) Understanding and application of terms used in both inferential statistics and evidence based medicine. e.g. as described in BMJ Learning modules http://learning.bmj.com/learning/channel-home.html

19. Administration 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

20. A few questions proved difficult…(AKT January 2009) Prescribing for children Child development Clinical governance: medicines management Infectious diseases, especially use of antimicrobials Contraceptive problems

21. A few questions proved difficult…(AKT April 2009) Prescribing for children Chronic disease management in children Clinical governance: medicines management Acute and emergency medicine in primary care Certification and fitness to drive legislation

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

23. New question formats Data interpretation Interpretation of complex sets of data for patients with chronic conditions. Relevant risk tables are included if appropriate. Seminal trials Familiarity with significant new research e.g Knowledge of studies which significantly change clinical practice such as WHI, ALLHAT.

24. 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

25. 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.

26. Extended matching questions (EMQ) These questions have a list of possible options There will usually be 3 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.