AKT Candidate Presentation Feb 2010 Final

Promoting Excellence in

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nMRCGPnMRCGPApplied Knowledge TestApplied Knowledge Test

February 2010February 2010

Prepared by the AKT GroupPrepared by the AKT Group


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AimsAims

To increase confidence To increase confidence

To help you pass AKT element of To help you pass AKT element of nMRCGPnMRCGP


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ObjectivesObjectives

To provide an overview of the content of the To provide an overview of the content of the paperpaper

To describe, with examples, the current question To describe, with examples, the current question formatsformats

To describe the principles of question To describe the principles of question construction in order to help candidates to construction in order to help candidates to answer themanswer them

To advise on how best to prepare for and pass To advise on how best to prepare for and pass the paper - including feedback from recent the paper - including feedback from recent paperspapers


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AKT aimsAKT aims

The AKT is designed to test the The AKT is designed to test the application of knowledge and application of knowledge and interpretation of informationinterpretation of information

Each question is intended to explore a Each question is intended to explore a topic of which an ordinary GP could be topic of which an ordinary GP could be expected to have a working knowledge expected to have a working knowledge


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Format:Format:

A three hour, 200 item multiple-choice A three hour, 200 item multiple-choice testtest

Delivered on a computer terminal at an Delivered on a computer terminal at an invigilated test centreinvigilated test centre

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


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Vital Statistics – January 2010Vital Statistics – January 2010

Pass mark = 134/200 (67%)Pass mark = 134/200 (67%)

Overall pass rate;Overall pass rate;ST3 first time takers pass rate = 83%ST3 first time takers pass rate = 83%ST2 first time takers pass rate = 80.6%ST2 first time takers pass rate = 80.6%

This ratio varies in different diets of the AKTThis ratio varies in different diets of the AKT

Cumulative pass rate for all those in ST3 after 3 Cumulative pass rate for all those in ST3 after 3 attempts is approximately 94%attempts is approximately 94%


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RulesRules

No limit to the number of attemptsNo limit to the number of attempts

A pass will be valid for three years onlyA pass will be valid for three years only

Can be attempted at any time during GP Can be attempted at any time during GP specialist training (GPST)specialist training (GPST)

However, most appropriate timing is at the However, most appropriate timing is at the end of ST2 or early ST3end of ST2 or early ST3


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How hard?How hard?

“ “Examinations are formidable even to the Examinations are formidable even to the best prepared, for the greatest fool may best prepared, for the greatest fool may

ask more than the wisest man can ask more than the wisest man can answer”answer”

Charles Colton (1780-1832), Charles Colton (1780-1832), LaconLacon


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Question writingQuestion writing

Scenarios derived from clinical workScenarios derived from clinical workPractice issuesPractice issuesTopicalTopical

All questions are referenced and the draft questions are All questions are referenced and the draft questions are then carefully scrutinised by a panel of experienced then carefully scrutinised by a panel of experienced question writers.question writers.

Remember that all question writers are working GPsRemember that all question writers are working GPs


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Common Reference MaterialCommon Reference Material

CochraneCochraneBNFBNFGP CurriculumGP CurriculumNICENICESIGNSIGNBMJ Review articles & original papersBMJ Review articles & original papersBJGPBJGPDTBDTBGMC GMC Good Medical PracticeRCGP RCGP Essential Knowledge UpdatesEssential Knowledge Updates


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RCGP Curriculum StatementsRCGP Curriculum Statements

Where to find themWhere to find them

RCGP websiteRCGP website

http://www.rcgp-curriculum.org.uk/

What are they?What are they?

Series of papers, each covering different Series of papers, each covering different clinical and practice management areas, clinical and practice management areas, based on European Academy of Teachers in based on European Academy of Teachers in General Practice (EURACT) framework. General Practice (EURACT) framework.

Written by a variety of GP experts and Written by a variety of GP experts and coordinated by RCGPcoordinated by RCGP


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RCGP Curriculum StatementsRCGP Curriculum Statements continuedcontinued

How they are being usedHow they are being used

Curriculum statements have ‘Intended Learning Curriculum statements have ‘Intended Learning Outcomes (ILO)’. Questions are derived from Outcomes (ILO)’. Questions are derived from specified learning outcomes within specified specified learning outcomes within specified curriculum statements.curriculum statements.

This enables sampling from across the This enables sampling from across the curriculum, as cases can be mapped to the curriculum, as cases can be mapped to the curriculum statements (or nMRCGP blueprint)curriculum statements (or nMRCGP blueprint)


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AKT subjectAKT subject contentcontentCore clinical medicine and its application to problem Core clinical medicine and its application to problem solving in a general practice context solving in a general practice context

80% of items80% of items

Critical appraisal and evidence based clinical practiceCritical appraisal and evidence based clinical practice10% of items10% of items

Ethical and legal issues as well as the organisational Ethical and legal issues as well as the organisational structures that support UK general practicestructures that support UK general practice

10% of items10% of items


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Clinical Medicine (1)Clinical Medicine (1)

The broad topic of clinical medicine The broad topic of clinical medicine is subdivided into groups of body is subdivided into groups of body systems, in approximately equal systems, in approximately equal numbersnumbers

Each group will comprise sections on Each group will comprise sections on disease factorsdisease factorssymptomssymptomsinvestigationinvestigationmanagementmanagement


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CardiovascularCardiovascularDermatologyDermatologyEndocrinologyEndocrinologyENTENTGastroenterologyGastroenterologyGeneticsGeneticsHaematologyHaematologyImmunologyImmunologyInfectionInfectionMental health & learning Mental health & learning disabilitydisability

Musculo-skeletalMusculo-skeletalNeurologyNeurologyOphthalmologyOphthalmologyPaediatricsPaediatricsRenalRenalReproductive Reproductive male/femalemale/femaleRespiratoryRespiratoryTherapeutic indications Therapeutic indications and adverse reactionsand adverse reactions


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Common, low impact – e.g. sore throat, Common, low impact – e.g. sore throat, otitis media, impetigootitis media, impetigo

Rare, high impact – e.g. child abuse, Rare, high impact – e.g. child abuse, meningitis, phaeochromocytomameningitis, phaeochromocytoma

Topical – e.g. MRSA, Type 2 diabetes Topical – e.g. MRSA, Type 2 diabetes managementmanagement


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Research, Epidemiology and Research, Epidemiology and Statistics (1)Statistics (1)

Understanding the principles of audit and Understanding the principles of audit and its application in assessing the quality of its application in assessing the quality of carecare

Understanding the application of critical Understanding the application of critical appraisal skills which will be tested in a appraisal skills which will be tested in a number of formats e.g the interpretation of number of formats e.g the interpretation of research dataresearch data


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Research, Epidemiology and Research, Epidemiology and Statistics (2)Statistics (2)

Understanding and application of terms Understanding and application of terms used in both inferential statistics and used in both inferential statistics and evidence based medicine.evidence based medicine.

e.g. as described in BMJ Learning e.g. as described in BMJ Learning modules modules http://learning.bmj.com/learning/channel-http://learning.bmj.com/learning/channel-home.htmlhome.html


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Administration and Administration and ManagementManagement

Regulatory frameworks, e.g. PCOsRegulatory frameworks, e.g. PCOsLegal aspects, e.g. DVLALegal aspects, e.g. DVLASocial services, e.g. CertificationSocial services, e.g. CertificationProfessional regulation, e.g. GMCProfessional regulation, e.g. GMCBusiness aspects, e.g. GP contractBusiness aspects, e.g. GP contractPrescribing, e.g. Controlled drugsPrescribing, e.g. Controlled drugsAppropriate use of resources, e.g. drugsAppropriate use of resources, e.g. drugsHealth & Safety, e.g. needlestick injuryHealth & Safety, e.g. needlestick injuryEthical, e.g. Mental capacity, consentEthical, e.g. Mental capacity, consent


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A few questions proved difficult – Jan 2010A few questions proved difficult – Jan 2010

Several items related to alcoholSeveral items related to alcohol

Alcohol units, nutrition, treatment for alcohol Alcohol units, nutrition, treatment for alcohol dependence, complications of alcohol abuse other than dependence, complications of alcohol abuse other than liver diseaseliver disease

Rare but significant findings at routine childhood Rare but significant findings at routine childhood examinationsexaminations

Over the counter medication – side effects and Over the counter medication – side effects and contraindicationscontraindications

Pregnancy carePregnancy care

Legal role of the GP in patients’ livesLegal role of the GP in patients’ lives

Lifesaving emergency proceduresLifesaving emergency procedures


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Question FormatsQuestion Formats

Single Best Answer (SBA)Single Best Answer (SBA)

Extended Matching Questions (EMQ)Extended Matching Questions (EMQ)

Table/AlgorithmTable/Algorithm

Picture/Video FormatPicture/Video Format

Data interpretationData interpretation

Seminal TrialsSeminal Trials

Other question formats such as “free text” Other question formats such as “free text” will be piloted in the futurewill be piloted in the future


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New question formatsNew question formats

Data interpretationData interpretation Interpretation of complex sets of data for Interpretation of complex sets of data for

patients with chronic conditions. Relevant risk patients with chronic conditions. Relevant risk tables are included if appropriate.tables are included if appropriate.

Seminal trialsSeminal trials Familiarity with significant new researchFamiliarity with significant new research

e.g knowledge of studies which significantly e.g knowledge of studies which significantly change clinical practice such as WHI, ALLHAT. change clinical practice such as WHI, ALLHAT.


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Single Best Answer (SBA)Single Best Answer (SBA)

““According to national guidelines” means According to national guidelines” means recommended by nationally accepted recommended by nationally accepted guidelines or the BNF, not local practiceguidelines or the BNF, not local practice

Often uses a clinical scenarioOften uses a clinical scenario

Only ONE answer is correctOnly ONE answer is correct

Other options may be Other options may be plausibleplausible


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SBA example:SBA example:Respiratory diseaseRespiratory disease

A 17-year-old student suddenly develops chest pain and A 17-year-old student suddenly develops chest pain and dyspnoea after a morning swim. There is hyper-dyspnoea after a morning swim. There is hyper-resonance and decreased breath sounds on the right resonance and decreased breath sounds on the right side.side.

Which is the SINGLE MOST likely diagnosis? Select Which is the SINGLE MOST likely diagnosis? Select ONE option only.ONE option only.

A. AsthmaA. AsthmaB. PneumothoraxB. PneumothoraxC. Pulmonary embolusC. Pulmonary embolusD. Left ventricular failureD. Left ventricular failureE. Pulmonary haemorrhage.E. Pulmonary haemorrhage.


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Extended matching questions (EMQ)Extended matching questions (EMQ)

• These questions have a list of possible These questions have a list of possible optionsoptions

• There will usually be 3 or more scenariosThere will usually be 3 or more scenarios• Choose the most appropriate option that Choose the most appropriate option that

best matches each given scenariobest matches each given scenario• Each option can be used once, more than Each option can be used once, more than

once, or not at all.once, or not at all.


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A Berry aneurysm

B Cerebral glioma

C Drug induced

D Graves’ disease

E Ischaemic stroke

F Multiple sclerosis

G Myasthenia gravisFor each patient described, select the SINGLE

MOST likely diagnosis from the list of options above.

1. A 35-year-old man who is a non-smoker, suddenly A 35-year-old man who is a non-smoker, suddenly develops a severe headache and double vision. develops a severe headache and double vision. His right pupil is fixed and dilated.His right pupil is fixed and dilated.

EMQ example: EMQ example: Double visionDouble vision


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A Berry aneurysm

B Cerebral glioma

C Drug induced

D Graves’ disease

E Ischaemic stroke

F Multiple sclerosis

G Myasthenia gravisFor each patient described, select the SINGLE

MOST likely diagnosis from the list of options above.

2. A 48-year-old woman has transitory double vision A 48-year-old woman has transitory double vision towards the end of most days. She smokes 10 towards the end of most days. She smokes 10 cigarettes/day. She has vitiligo and cigarettes/day. She has vitiligo and hypothyroidism.hypothyroidism.

EMQ example: EMQ example: Double visionDouble vision


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Algorithm example:Algorithm example:Medical management of menorrhagiaMedical management of menorrhagia

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.

Non-hormonal

Hormonal therapy

1 _______ 2 _______ Combined oral contraceptive pill

3 _______


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Algorithm example:Algorithm example:Medical management of menorrhagiaMedical management of menorrhagia

AA Cyclical norethisteroneCyclical norethisteroneBB Copper-bearing intra-uterine deviceCopper-bearing intra-uterine deviceCC Inert intra-uterine deviceInert intra-uterine deviceDD Levonorgestrel releasing intra-uterine systemLevonorgestrel releasing intra-uterine systemEE Medroxyprogesterone acetateMedroxyprogesterone acetateFF Mefenamic acidMefenamic acidGG Nonoxinol ‘9’Nonoxinol ‘9’HH TiboloneTiboloneII Tranexamic acidTranexamic acid


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Picture Format example:Picture Format example:Skin diseaseSkin disease

A 32-year-old man A 32-year-old man has noticed painless has noticed painless non-itchy patches of non-itchy patches of hair loss on his beard hair loss on his beard area and scalp. area and scalp.


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Picture Format example:Picture Format example:Skin diseaseSkin disease

Which is the SINGLE Which is the SINGLE MOST likely MOST likely diagnosis? Select diagnosis? Select ONE option only.ONE option only.

AA Alopecia areataAlopecia areata

BB EczemaEczema

CC Lichen sclerosisLichen sclerosis

DD Tinea infectionTinea infection

EE VitiligoVitiligo

Ref: Dermnet.com


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Data InterpretationData Interpretation

Interpretation of complex sets of data for Interpretation of complex sets of data for patients with chronic conditionspatients with chronic conditions

Interpretation of research and audit resultsInterpretation of research and audit results


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Data Interpretation exampleData Interpretation example

The summary The summary findings of a findings of a systematic review systematic review which included six which included six separate studies are separate studies are shown opposite. shown opposite.

Ref: BMJRef: BMJ 2007;335:473 2007;335:473


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Data Interpretation exampleData Interpretation example

Which SINGLE study Which SINGLE study suggests the suggests the WEAKEST WEAKEST association between association between increased whole increased whole grain intake and a grain intake and a risk of type 2 risk of type 2 diabetes? Select diabetes? Select ONE option only.ONE option only.

A FungA Fung

B MeyerB Meyer

C MontonenC Montonen

D NHS1D NHS1

E Van DamE Van Dam


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ScoringScoring

All question formats have equal weightingAll question formats have equal weighting

Each correct answer is awarded one markEach correct answer is awarded one mark

Total score on the paper is the number of Total score on the paper is the number of correct answers givencorrect answers given

No negative marking - ‘Fear factor’No negative marking - ‘Fear factor’


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FeedbackFeedback

Feedback will be provided to every candidate Feedback will be provided to every candidate with their resultwith their result

Their overall scoreTheir overall scoreThe pass markThe pass markTheir performance in each of the 3 main subject Their performance in each of the 3 main subject areasareas

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


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Computer Based TestingComputer Based Testing

Once candidates have registered with the RCGP to sit Once candidates have registered with the RCGP to sit the AKT, they will be given information and MUST then the AKT, they will be given information and MUST then ALSO ring Pearson VUE within a limited timeframe to ALSO ring Pearson VUE within a limited timeframe to book a test centre.book a test centre.

It is recommended that candidates familiarise It is recommended that candidates familiarise themselves with the demonstration tutorial on the themselves with the demonstration tutorial on the Pearson Vue website :Pearson Vue website :https://www.pearsonvue.com/rcgp/https://www.pearsonvue.com/rcgp/

The AKT also begins with a short tutorial to remind The AKT also begins with a short tutorial to remind candidates how to mark the answers – screen shots candidates how to mark the answers – screen shots follow of the live tutorialfollow of the live tutorial


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There are There are approximately 150 approximately 150 test centres covering test centres covering all parts of the UKall parts of the UK

Candidates will be Candidates will be able to book the AKT able to book the AKT at a local venue, on at a local venue, on “a first come, first “a first come, first served” basisserved” basis


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Computer Based TestingComputer Based TestingSecurity at each centre will be Security at each centre will be robustrobust

Identity checks Identity checks InvigilatedInvigilatedVideo monitoringVideo monitoring

Test forms are downloaded to Test forms are downloaded to each centre on the test dayeach centre on the test day

Separate morning and Separate morning and afternoon sittings with a afternoon sittings with a quarantine period at lunchtime. quarantine period at lunchtime.

Morning candidates will not be Morning candidates will not be allowed to leave before the allowed to leave before the end of the testend of the test


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Responses will be Responses will be uploaded to a central uploaded to a central server and then server and then passed to the RCGP passed to the RCGP for post test analysisfor post test analysis

Following this, Following this, results and feedback results and feedback will be sent will be sent individually toindividually to candidatescandidates


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Please bring identity Please bring identity documents which documents which MATCH examination MATCH examination registration detailsregistration details

Please arrive in good Please arrive in good timetime

Late arrival or failure to Late arrival or failure to provide matching ID will provide matching ID will result in you being result in you being unableunable to sit the AKT to sit the AKT


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POINTS TO REMEMBER POINTS TO REMEMBER AT ALL TIMESAT ALL TIMES

Time management – this is everythingTime management – this is everythingCover test – can you answer the question with the Cover test – can you answer the question with the option list covered?option list covered?Mark answer box Mark answer box carefullycarefullySkip difficult questions rather than waste time (you can Skip difficult questions rather than waste time (you can electronically highlight the ones you have left out)electronically highlight the ones you have left out)Go through those not done 2Go through those not done 2ndnd time round time roundGuess any at the end to ensure all answeredGuess any at the end to ensure all answeredCheck for silly mistakes if you still have timeCheck for silly mistakes if you still have timeKeep watching the clock (200 questions in 3 hours)Keep watching the clock (200 questions in 3 hours)


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Further preparationFurther preparation

Small revision groups to share Small revision groups to share the workloadthe workload

Learn from your clinical Learn from your clinical experience – check the experience – check the guidelines and referencesguidelines and references

Exam website feedback, sample Exam website feedback, sample material and syllabus material and syllabus


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And finally..And finally..

Are you confident at tackling AKT Are you confident at tackling AKT statistics and critical reading questions?statistics and critical reading questions?

Can you see the achievable level of Can you see the achievable level of competence you need?competence you need?Can you plan to efficiently prepare for this Can you plan to efficiently prepare for this module?module?

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AKT Candidate Presentation Feb 2010 Final

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