MRCGP Applied Knowledge Test

1. MRCGPApplied Knowledge Test May 2012 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. 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. Background Summative assessment of the knowledge base that underpins independent general practice within the United Kingdom. Mapped to the RCGP Curriculum

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 Offered three times a year- Jan/Feb, April/May, Oct/Nov.

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 specialist 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 specialist 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 – April 2012 Pass mark = 137/199 (68.8%) Overall pass rate = 67.6% ST3 first time takers pass rate = 69.6% ST2 first time takers pass rate = 76% (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 April 2012) Prescribing in children Identifying normal findings in children Management of anaphylaxis in children Critical appraisal including interpretation of data Confidentiality and disclosure in insurance reports NICE guidelines on diagnosis and treatment of hypertension Interpretation of spirometry results 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 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 GMCGood Medical Practice RCGPEssential Knowledge Updates NICE guidelines SIGN guidelines BMJ Review articles & original papers BJGP Cochrane

13. RCGP Curriculum Statements Where to find them RCGP websitehttp://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

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

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Question Formats Single Best Answer (SBA) Extended Matching Questions (EMQ) Table/Algorithm or ‘Drag and drop’ Picture/Video Format Data interpretation Free text

25. 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”

26. 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

27. 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.

28. EMQ example: Double vision A Berry aneurysm B Cerebral glioma C Drug induced D Graves’ disease E Ischaemic stroke F Multiple sclerosis G Myasthenia gravis 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.

29. EMQ example: Double vision A Berry aneurysm B Cerebral glioma C Drug induced D Graves’ disease E Ischaemic stroke F Multiple sclerosis G Myasthenia gravis 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.

30. Algorithm example:Medical management of menorrhagia Non-hormonal Hormonal therapy 3 _______ 1 _______ 2 _______ Combined oral contraceptive pill For each of the numbered gaps above, select ONE option from the list below to complete the algorithm, based on current evidence. Each option may be used once, more than once or not at all.

31. Algorithm example:Medical management of menorrhagia 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 GNonoxinol ‘9’ HTibolone I Tranexamic acid

32. Picture Format example:Skin disease A 32-year-old man has noticed painless non-itchy patches of hair loss on his beard area and scalp.

33. Picture Format example:Skin disease Which is the SINGLE MOST likely diagnosis? Select ONE option only. A Alopecia areata B Eczema C Lichen sclerosis D Tinea infection E Vitiligo • Ref: Dermnet.com

34. 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)

35. Data Interpretation example The summary findings of a systematic review which included six separate studies are shown opposite. Ref: BMJ  2007;335:473

36. 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

37. Free text questions Require the candidate to generate the correct answer without a list of options to choose from e.g. calculation, name of drug Eliminates guessing from a list of answers All answers are screened manually to check for acceptable misspellings

38. Free text example Which SINGLE vitamin is administered to reverse the anticoagulant effect of warfarin? Give ONE answer only Vitamin _____

39. 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

40. Feedback 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 More general feedback on overall performance will continue to be forwarded to all UK deaneries and placed on the RCGP website

41. Computer Based Testing Once candidates have registered with the RCGP to sit the AKT, they will be given instructions about booking their exam at a Pearson VUE test centre. There is a limited booking window with ‘first come, first serve’ choice of test session and venue.

42. Computer Based Testing It is STRONGLY recommended that candidates familiarise themselves with the 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 select answers and ‘mark’ questions – screen shots follow of the live tutorial

47. POINTS TO REMEMBER -Advice to candidates Time management – this is everything Keep watching the countdown clock on the computer 200 questions in 3 hours = average of 54 seconds per question You can skip difficult questions rather than waste time (electronically highlight the ones you have left out) but don’t forget to go back before the end

48. POINTS TO REMEMBER Advice to candidates Cover test – can you answer the question with the option list covered? It’s probably the correct answer 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

49. Further preparation Small revision groups to share the workload Learn from clinical experience – check the guidelines and references Exam website feedback, sample material RCGP website – Essential Knowledge Updates and Challenges

50. Computer Based Testing There are approximately 150 test centres covering all parts of the UK Candidates will be able to book the AKT at a local venue, on “a first come, first served” basis