NMRCGP The Applied Knowledge Test

1. nMRCGPThe Applied Knowledge Test June 2008 Prepared by the AKT Group

2. Aims To increase confidence To help you pass nMRCGP

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: An �evolution� from the previous MRCGP MCP A three hour, 200 item multiple-choice test Delivered on a computer terminal at an invigilated test centre Offered initially three times a year Oct/Nov, Jan/Feb, April/May

6. Vital Statistics May 2008 results Pass mark = 67.7% Overall pass rate 74.9% ST3 first time takers pass rate = 86% (cumulative pass rate for all those now in ST3 = 94%) Results may vary from one session to another

7. 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 GPR year (ST3)

8. Transitional Arrangements Has replaced the Summative Assessment MCQ from August 2007 Is equivalent to the �old� MRCGP MCP for those completing the current exam during 2007-8

9. How hard? �Examinations are formidable even to the best prepared, for the greatest fool may ask more than the wisest man can answer� Charles Colton (1780-1832), Lacon

10. A few questions proved difficult�(AKT May 2008) Prescribing for skin conditions (again!) Diagnosis/management of eye problems Scientific aspects of childhood infections Travel health (again!) Clinical governance: performance indicators/regulatory standards

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. Remember that all question writers are working GPs

12. Common Reference Material Clinical Evidence Cochrane BNF GP Curriculum NICE SIGN BMJ Review articles & original papers BJGP DTB GMP

13. 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

14. The MRCGP Curriculum Statements continued How they are being used Curriculum statements have �Intended Learning Outcomes (ILO)�. Questions and CSA cases are linked to 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)

15. 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

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 sections 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 Rare, high impact � e.g. child abuse Topical � e.g. controlled drugs regulations

19. 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

20. Research, Epidemiology and Statistics (2) Understanding and application of terms used in both inferential statistics and evidence based medicine. E.g as described in the appendices of Clinical Evidence BMJ. www.clinicalevidence.org

21. 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

22. Question Formats Single Best Answer (SBA) Extended Matching questions (EMQ) Tables and Algorithms (for completion) 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 the ASCOT study which has changed clinical practice.

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.