AKT

1. Guidance from trainees who’ve done it. AKT

2. 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

3. Why do I need to do the AKT? • Essential requirement for completion of MRCGP. • NO OTHER CHOICE REALLY!

4. 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.

5. 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

6. 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

7. 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.

8. 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

9. What is the AKTResearch, 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

10. 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

11. 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

12. 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

13. 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.

14. 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

15. 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)

16. 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

17. 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 ?earlier

18. 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

19. 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%

20. 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.

21. 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.

22. 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.

23. 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)

24. 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

25. 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

26. 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.

27. 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

28. 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.

29. 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!

30. 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