11 tips to help you boost your Foundation SJT exam scores

Dr Mahibur Rahman

The Situational Judgement Test (SJT) for final year medical students plays an important part in your ranking for the applications for Foundation training (FPAS). Whether you have a great Educational Performance Measure (EPM) score or not, the SJT will influence which placement you get.

In this article, Dr Mahibur Rahman discusses some key tips to help you improve your score so you can get the placement that you want.

1. Understand the basics
The exam lasts 2 hours and 20 minutes and has 70 questions, although only 60 of the questions are marked – the other 10 are pilot questions. Pilot questions are mixed in with the examined ones, so you need to treat them all as live questions.

There are two types of question – ranking and selection. In a ranking question, candidates will be presented with a scenario and 5 options – the options need to be ranked from best (1) to worst (5). This format makes up two thirds of the exam, with each question being marked out of 20.

Selection questions have 8 options, and candidates should select the 3 options that taken together make the best response to the scenario. This format is a third of the exam, with each question marked out of 12.

Sample questions for each type are given below:

Sample SJT ranking question
While working on the medical wards as an FY1 you are asked by a nurse to complete the discharge paperwork for a patient you are not familiar with. This includes a summary of the admission as well as drugs to be taken home when discharged. You are in a hurry and on the post-take ward round. The rest of the team is about to start discussing the next patient that was admitted overnight.
Rank in order the following actions in response to this situation (1= Most appropriate; 5= Least appropriate)
A – Ask the nurse what drugs the patient needs and the diagnosis, so you can quickly note this on the discharge paperwork and keep up with the ward round
B – Explain that you are busy at the moment but that you will come back and do it as soon as the ward round is complete
C – Sign the paperwork and ask the nurse to complete the summary and medication while you join the rest of the team
D – Check the patient’s notes and complete the paperwork with a summary of the admission and all required medication – you can catch up with the ward round later
E – Ignore the request. The nurse knows you are on the post-take round and can ask you later

Sample SJT selection question
You are an FY1 working in obstetrics and gynaecology. You see a lady on the labour ward who is having a massive postpartum haemorrhage. In the last few minutes she has become very unwell and is now unresponsive and continuing to bleed. From reading her notes you know she is a Jehovah’s Witness and has signed a form in antenatal clinic stating she declines all blood products even if her life is threatened. The midwife looking after her states that she asked the lady a few minutes before she became unresponsive if she would accept blood products if her life was threatened and again she said no. Her husband is holding his new born daughter and states you must do everything you can to save her even if that means giving her blood.
Choose the THREE most appropriate actions to take in this situation

A. Give blood products as this is an emergency and they may be life saving
B. Do not give blood products even if it means she comes to harm
C. Put aside the patient’s wishes as her decision suggests a lack of capacity
D. Explain to the husband that you have to respect the patient’s decision
E. Ask the husband to give formal consent on behalf of his wife to give blood products
F. Do everything else you can to save the patient’s life
G. Do nothing else as she will inevitably die without blood products
H. Contact your consultant and ask them for permission to give blood products in the best interests of the patient

Read the answer and details explanations on the main Emedica site.

2. Learn the domains being tested
The SJT questions are written to test whether you have the attributes deemed important to be a good Foundation doctor. These are divided into 5 domain areas. A good first step in your preparation would be to understand the key attributes and behaviours being tested. Learning what is being assessed will help you pick between options based on how well they demonstrate these attributes. The domains and some of the key attributes are:
Commitment to professionalism – punctuality, honesty, taking responsibility for own actions, challenging unacceptable behaviour, ethical practice, respecting confidentiality.
Coping with pressure – remaining calm and in control when dealing with difficult situations, good judgement, seeking support when required, dealing with confrontation appropriately.
Effective communication – sensitive use of language, adapting communication according to the needs of patients and relatives, using clear and understandable language, good written communication.
Patient focus – empathetic towards patients, showing respect to patients, putting the patient at the centre of care, providing reassurance appropriately, willing to spend time with patients and relatives, considering patient safety at all times.
Effective team working – understanding the roles of team members, willing to take direction, showing respect to colleagues, delegating and sharing tasks effectively, sharing knowledge and expertise with colleagues.
The full list is available in the official SJT monograph

3. Revise the core knowledge being tested
While the SJT does not test clinical knowledge, there are questions that assess knowledge of what is deemed to be good practice based on core guidance from the General Medical Council (GMC). Most of this comes from Good Medical Practice and some of the explanatory guidance published by the GMC. This includes areas such as confidentiality, maintaining boundaries, care of children and younger people, raising concerns, end of life care and advanced directives, and even the use of social media. The SJT asks you to answer what you “should do” rather than what you “would do” – i.e. what does the guidance say a good doctor should do in the ideal situation. This is much easier to do with a good working knowledge of the key guidance.

4. Spend time on the ward
A useful technique to deal with scenarios in the SJT is to try to picture the situation in your mind. This is much easier if you have spent lots of time on the wards. Try to observe how the doctors communicate with patients and relatives, how the team interact with each other, and the roles of different members of the multidisciplinary team. If there are areas from the GMC guidance that you are unclear about, it can be really helpful to talk through potential issues with a junior doctor – they may have encountered similar situations in real life and can talk you through approaches they used to deal with it.

Test Quiz

5. Work through the official practice paper
The official Foundation Programme SJT practice paper is a complete 70 question SJT paper. There is an interactive version that you can do on a computer, and also a paper version. Doing the paper version, and getting used to completing the paper marking sheet will help familiarise you with the format and improve speed on the day. There is a marking key with detailed explanations so you understand the rationale behind why some questions are ranked the way they are.

6. Read the scenario carefully
Sometimes keywords have a big impact on the best response in both ranking and selection questions. Try underlining important words as you read. For example, your approach may differ in a situation where you suspect inappropriate behaviour compared to when you are certain of inappropriate behaviour. This small difference might change where you ranked waiting to gather more information, compared to raising an issue with a senior colleague for example. For ranking questions, there are different types of question – most ask you to rank from most to least appropriate, but some ask you to rank according to the order in which you would do things, how important considerations are to the situation or how much you agree with different statements.

7. Use only the information provided in the question
In some scenarios there will be limited information. In real life, it might be possible to get clarification or gather more information from the patient or a colleague. In the exam, your answers should be based only on what you are told in the scenario and the options. Do not make any assumptions – an incorrect assumption may lead you to a poor response.

8. Look at all the options before assigning any rankings (ranking questions)
For ranking questions, it is important to go through and consider all the options before you start deciding on the order. If you read the first option and decide it is a “bad” option, you may mentally place it last. This may then impact your thinking when reading other options – you may not remain objective and could end up fitting other options around the preconception that option A is the worst. The ranking questions are comparative not absolute – so rather than “good” or “bad”, it is about comparing one option to the other possibilities – “better” or “worse”.

9. Make sure your choices make sense when taken together (selection questions). In the selection questions, all 3 options that you select should be looked at together as a combined response to the scenario. In some cases you can eliminate options if they would contradict each other or would not make sense when taken together. If you are confident that an option that suggests seeing a patient when a chaperone is available is correct, then you could eliminate another option that suggested seeing the patient immediately without a chaperone. A good way to check if your answer is likely to be correct is to read all 3 options back together and see if they make sense together. If they don’t you should consider changing at least one of the options.

10. Double check you have marked the correct options.
The SJT paper is machine marked so check that you have marked the answer sheet correctly – transcription errors are a silly way to lose marks. In ranking questions, if you accidentally marked option A and option E as the best options (rank 1), you will be awarded zero marks for BOTH these options. In the selection questions, if more than 3 options are marked, the total score for the entire question will be zero. If you transcribed the answers to question 1 to the box on the answer sheet for question 2, it would be possible to accidentally mark all the later questions in the wrong box and have a serious impact on your overall score.

11. Keep to time
To complete the entire paper, you have just 2 minutes per question. Try to be disciplined – if you are not entirely sure of the best answer, it is better to put down your best guess and move on. You will still get marks for answers that are not perfect but close to the best answer. For ranking questions, you get 8 marks for the worst possible ranking. If you are fairly close, but not quite perfect, you can still get 16 or 18 marks. Spending an extra 2 minutes to get the perfect answer may only increase your score for that question from 18 to 20 (2 extra marks) – whereas using that 2 minutes to answer another question will get you at least 8-20 extra marks. Even worse – the question you spent a long time on could turn out to be one of the pilot questions, and so carry no marks.

Summary
The Foundation SJT plays an important part in determining where you will be placed for your first two years after qualifying. Understanding the attributes that are being tested, and learning the core GMC guidance will give you the basic tools to help you prepare. Practising sample questions and getting used to the format and time pressures will help you to get the best possible score on the day.

Dr Mahibur Rahman is a portfolio GP and a consultant in medical education. He is also the medical director of Emedica. Emedica has been offering courses to help medical students prepare for the Foundation SJT since 2012. We have helped students from every UK medical school prepare, with 94% getting one of their top 3 rotations in 2016.

Foundation SJT Course

Foundation SJT tips from a high scorer – how I got my 1st choice Foundation programme

The Foundation SJT is an important part of the application process for entering the Foundation Programme (FPAS). In this article, Niamh Rogers explains how she managed to score amongst the top 2% of over 8,000 candidates that took the SJT for Foundation Programme entry in her year. She scored 45.42 and got a place in her 1st choice Foundation Programme, Northern Ireland.

Foundation SJT

The Foundation SJT

The Situational Judgement Test (SJT) is an exam that is now faced by all final year medical students hoping to gain a Foundation Programme training place in the United Kingdom. As the exam itself has only recently been brought in as a method of selecting candidates to training posts, a lot of speculation and anxiety surrounds the test. The fact that the SJT accounts for 50% of all marks available means that for most students this exam is the single most determining factor in allocation of foundation schools and house officer jobs. I was lucky enough to achieve a high score, placing me in my first choice deanery with my choice of jobs. Here is my experience of preparing for the situational judgement test and hints and tips for performing well on the day.

Emedica Foundation SJT Course

I booked one SJT preparation course, Emedica, to tackle the SJT. I choose Emedica because although the SJT is new for medical students, it has been used for doctors in GP training since 2007, and Emedica has been running courses for it since it began. As my SJT assessment date was in December I made sure to book the earliest course in October to give myself sufficient time to practice.

The course itself was excellent and gave me both the confidence and knowledge to know how to prepare for the exam. Emedica explained the different types of question styles, how to go about structuring your time (in what was an extremely time pressured exam) and to rank each option for the question at face value.

The mock test at the end of the day was a good insight into the process of the exam and the mark obtained was translated into points like in the real SJT.

Preparing for the Exam

The SJT isn’t an exam you can cram for! Speaking from the biggest crammer of every exam going, I soon realised that the SJT was more a “way of thinking ” than something you could learn with intense days of revision before the test. As I was revising for medical finals and doing A&E placements I knew that I would have to schedule some time to practice questions. I found that by doing around 30/45 minutes of questions 3/4 evenings a week, after I had finished revision for the evening, very manageable.

This is where going to the Emedica SJT course came into its own. There are vast numbers of SJT books with hugely varying quality between them. The Emedica course provided you with a question bank that was split into smaller sections- perfect for completing small stints of practice. The questions accurately reflected the content, length and difficulty of questions in the exam.

Initially I didn’t practice timed- I wanted to thoroughly understand why each option was in the order stated. I felt that by understanding why exactly the options ranked in a certain order , it would give me a better insight into what the exam was testing. With about two weeks to go I started timing myself and always tried to use blank answer sheets so that it would become second nature on the day.

I printed out the sample paper online along with a blank mark sheet, and over the course of my revision I did this exam x3 times. I felt that repeating questions helpful as often I was getting the same questions wrong .

Two other SJT books I found useful were Situational Judgement Test for the Foundation Years Programme by Dr Omar Taha and Dr Mizanul Hoque and Get Ahead ! The Situational Judgement Test. These were handy to have in your bag whilst travelling or having a spare few minutes when you could look at question or two.

Exam Day

In order to focus for the exam I had an early night’s sleep, went for a run that morning and made sure to have a good breakfast before the exam. The exam is long and timing is a big factor. I made a mental note of what question I should be on at 30 min intervals and wrote this down on the front of the exam paper when I sat down. Make sure you use the bathroom before you start as the exam is 2 hours 20 minutes long!

I highlighted key words in each question (each word is used specifically as the exam is developed by subject experts and psychologists) . I numbered my order on the exam paper and once happy with my answer, transferred it to the answer sheet. I found using a ruler helped focus my eye and made sure I wrote my answer in the correct box. I went through the paper systematically. I circled some questions that I felt I could spend more time on and returned to them at the end.

In summary, the SJT is a high stakes exam that can be prepared for. Practice little and often can boost your score and give you confidence on the day of the exam. Being extremely familiar with the format of the paper and the answer sheet and preparing mentally to focus for an intense 140 minutes are key factors to succeeding in the SJT.

Best of luck!

Niamh Rogers

Final Year Medical Student Norwich Medical School

Niamh  scored 45.42 (within the top 2% in the country) and got a place in her 1st choice Foundation Programme, Northern Ireland.

Foundation SJT Course

10 tips to help you pass the MRCGP AKT exam

Dr Mahibur Rahman MRCGP AKT exam tips

The MRCGP AKT exam is a challenging exam, testing applied knowledge relevant to UK general practice. In this article, Dr Mahibur Rahman discusses some key tips to help you prepare for and pass the exam.

  1. Understand the basics

The exam lasts 3 hours and 10 minutes, and consists of 200 questions. 80% of the questions relate to clinical medicine, 10% to evidence based practice, and 10% the organisational domain. The exam is computerised, and there is now access to a basic on-screen calculator if needed. The majority of questions are single best answer and extended matching questions. Other formats include algorithm questions, short answer (you type the correct answer into a box), video questions, and picture based questions.

  1. Fail to prepare, prepare to fail

Allow enough time to revise all material in the exam – most candidates need 3 or 4 months to be able to cover everything sufficiently well to pass the exam. We help a lot of candidates prepare when they are resitting the exam – a common finding amongst candidates that failed the exam is that they had not realised how long it would take to prepare, and did not have enough time to complete their revision. The curriculum is large and covers a broad range of topics – try to have a systematic approach to allow you to cover all the important topics adequately. The RCGP has produced an AKT topic review which details the key areas and subjects covered in the exam.  The MPS has produced a more concise checklist of key topics that frequently feature in the exam as part of their free MRCGP Study Guide.

  1. Focus on the clinical domain

Aim to spend the majority of your revision focusing on the clinical domain – this makes up 80% of the marks and questions (160 questions). Someone who scored very poorly in this area (under 60%) would usually fail the exam – even with 100% in the other domains. Overall, a poor score in this domain is the most common cause of failure in the AKT exam. This domain also takes the longest amount of time to cover as the bulk of the curriculum is focused on clinical topics. Questions from the clinical domain can include those relating to making a diagnosis, ordering and interpreting tests, disease factors and risks, and management. It is important to have a good knowledge of key guidelines – NICE, SIGN, BTS etc. for common and important disease areas as they are frequently tested.

  1. Revise core statistics and evidence based practice

10% of the exam is evidence based medicine, including basic statistics, graphs and charts and types of study. These offer easy marks if you make sure you have a good grasp of the basic concepts and can interpret common charts and graphs. Make sure you can calculate averages (mean, mode, median), numbers needed to treat, sensitivity and specificity as well as understanding absolute and relative risk, odds ratios, p values, 95% confidence intervals and standard deviation. You should be able to interpret scatter plots, L’Abbe plots, Forest plots, funnel plots as well as Cates plots. Finally, you should be able to understand the usage of common study types including cross sectional surveys, case control studies, cohort studies and randomised controlled trials.

  1. Don’t forget the organisational domain

This makes up another 10% of the exam, and is the area that candidates tend to do worst on. These areas can be dull to read, but learning about practice management, QOF, certification, DVLA guidelines and legal duties of doctors will not only get you easy marks, it will be useful when you qualify.

  1. Learn from other people’s mistakes

Read through the examiners’ feedback reports to see which topics caused trainees problems, as they are usually retested in the next few exams. Having analysed every feedback report published so far, it is interesting to note that the same subjects get featured repeatedly! In the last feedback report, there was not a single topic that had not already featured as an area of poor performance in a previous report.

  1. Make the most of your revision time

Effective revision should combine reading with practising questions. Try to practise questions to time, as time pressure is a big issue with this exam – you have about 57 seconds for each question! If you get a question wrong, try to read more broadly about the subject to gain a deeper understanding. By relating it to a question you have just answered, you are more likely to retain the information. Concentration drops dramatically after an hour, so try to revise in chunks of no more than an hour at a time. Take a short break – even 10 minutes to make a hot drink, or get some fresh air is often enough to refresh you and improve concentration for the next burst of revision.

  1. Learn the subject, not the question

Some candidates approach AKT revision by picking an online revision service and then go through all the questions multiple times. This can lead to a false sense of security and ultimately failure in the exam. Repeating the SAME questions multiple times provides very little additional benefit. Often complex questions such as data interpretation are answered the second time by remembering the pattern rather than understanding the subject. In the exam, you will not get the same question, but a different one testing knowledge of the subject. While your mark will improve with each repeated attempt at the same questions, your knowledge may have only improved marginally (having seen the correct answers the first time, it is not surprising that you get most of them correct the next time). A better approach is to read up on the subjects and explanations after doing a set of questions, and then once you complete all the questions, move on to a different set of questions from a different service or book. This will give you a better idea of how well you have understood the topic and retained the knowledge.

  1. Read the question carefully

Many candidates that have a good knowledge base still fail the AKT by a few marks. This can be owing to poor exam technique. It is really important to read the question carefully to prevent losing marks for silly mistakes. This can relate to the instructions – some questions ask you to drag the right answer into a certain part of the screen. Clicking the right answer instead of dragging it will gain no marks. It is important to watch out for and to understand certain keywords – if the question asks for a characteristic feature, it means it is there in almost every case (90% or more) – whereas if it asks for a feature that is commonly seen in a condition, it only needs to be there in around 60% or more of cases. Some questions are negatively framed – “which of the following is not part of the Rome III criteria for diagnosing irritable bowel syndrome?” – candidates that fail to spot the “not” in this question could easily select the wrong answer despite knowing the Rome III criteria.

  1. Keep to time

To complete the entire paper, you have just 57 seconds per question. Try to be disciplined – if you are not entirely sure of the best answer, it is better to put down your best guess after about 55 seconds and move on. You can flag questions for review, so you could try to come back if you finish a little early to look at those are unsure of. By being strict with your time, you will at least pick up all the easy marks for topics that you have covered in your revision. Candidates that spend 2-3 minutes struggling with a few really challenging questions often end up unable to complete the paper. They may have missed easy marks from questions at the end of the paper that they did not see. It is useful to have some pace checkpoints – try to finish 33 questions every 30 minutes. At this pace, you will have completed 66 questions after 1 hour, 99 at 1.5 hours, and complete the whole paper with just under 10 minutes left to go over any questions flagged earlier.

Summary

The MRCGP AKT is a challenging exam with a significant failure rate – over 1 in 4 candidates fail each exam, with the long term mean pass rate around 73%. It covers a large curriculum, so it is important to allow enough time and to have a plan to enable you to prepare in a systematic way. A lot of the knowledge gained from preparing will help you not only in everyday practice, but also for the MRCGP CSA examination. By mixing reading with practice questions, you should have both the knowledge and the exam technique to allow you to pass well.

Dr Mahibur Rahman is a portfolio GP and a consultant in medical education. He has been the medical director of Emedica since 2005 and has taught over 20,000 delegates preparing for GP entry exams, MRCGP and on GP careers. He teaches an intensive 1 day MRCGP AKT preparation course in London, Birmingham and Manchester that covers all 3 domains and includes key theory and high yield topics, exam technique as well as mock exams in timed conditions. Details of the course are available at http://courses.emedica.co.uk/acatalog/nMRCGP_AKT_Preparation.html

akt_course

Foundation SJT course review – preparing for the FPAS SJT exam

The Foundation SJT exam plays a large part in determining which Foundation rotation you get placed in. In this post, a final year medical student from Glasgow shares his thoughts on the Emedica SJT preparation course.100281534

So recently I sat the situational judgement test (SJT), a test that every final year medical student who wants to work in the UK has to sit. The score in this test is given 50% of the total score used to rank medical graduates in the process through which they’re allocated to foundation schools across the country. Everything else one has done in medical school and before including grades, extra degrees, publications, prizes, merits and distinctions all account for the other 50% (aka EPM score). In fact the lowest EPM score one can get is 34 out of 50 while with the SJT one can get anywhere between 0 and 50 which makes the SJT all the more important. In other words this 140-minute test pretty much determines where in the country I’ll work for the first two years as a doctor, and which hospitals and rotations I get. This could potentially have a knock-on effect on where I’ll end up in the long-term and which specialty I will get into.

Needless to say I was getting anxious in the run up to the exam. This year was only the 3rd year this test has been used so the available information about it was still relatively scarce, with only 1 official practice paper released by the UK foundation programme office (UKFPO).  There are several preparation books and online question banks but they were getting varying reviews and most of their questions were not similar in difficulty level to the official ones.

There were also at least 2 revision courses that I was aware of that were being advertised. One of them was in its first year, and the other one, by Emedica, had been going on for three years. A quick search on Google revealed that Emedica has also been running GP SJTs for several years. The search also led me to a blog by a King’s College med student in which she reviewed the course. Her favourable review and the fact that she got 45.6 in her test encouraged me to book this course.

A big myth which has been repeatedly regurgitated at us is that the SJT is not an exam one can prepare for. Having taken the test, I can now say that this couldn’t be further from the truth. While it’s true that the SJT doesn’t assess medical knowledge and that answering  questions comes down to good judgement, one still needs to have a good knowledge of the ethico-legal framework that doctors are expected to operate within. One also needs to be aware of the natural hierarchy of the medical team, the role of other healthcare professionals, and the dynamics of interaction between all these people.

This became very clear when I attended the Emedica SJT course. I quickly realized that there is a lot more to the exam than just “using common sense” and taking the questions at face value. When I left the course I felt that while I was still not 100% confident of my preparation for the exam, I felt that there were less unknown unknowns, and that at least I had learnt a structured approach to answer the questions. The course lasted from 10 till 5.30 and apart from a small lunch break and 2 tiny tea breaks, it was a full day. It started with an introductory talk about the SJT, its significance, and how the score is calculated. I found this part was very interesting as it contained a lot of insider info not available anywhere else. The second part was a run-through of the ethical and legal issues one needs to be aware of as well as outlining the resources one can use to prepare. The third part, which I found the most useful, was about how to approach the questions. This part opened my eyes to things I was not aware of such as the big difference in the approaches required for the two types of questions (ranking and choose the best 3 out of 8). After the course I was a lot more comfortable with answering practice questions, and found myself able to answer question quicker and in a more confident manner while still sensibly considering all the choices and their potential risk/benefit/urgency. The last part of the course touched on general exam strategy and time management issues which was also very helpful. The course was well attended and the people I chatted with afterwards all gave good reviews. And although none of them said they were completely worry-free after the course, most said that it helped them adopt a structured approach to the different types of question and gave them good tips when it came to general exam strategy.

A few days after the course I was pleasantly surprised by an email from Emedica giving me extra revision material, in the form of practice questions as well GMC and other official material covering the important ethical and legal topics. They also offered to answer any questions I had in the last week before the test. Their practice questions were similar in length and difficulty level to the official practice questions, but I still didn’t take them as dogma, which is what I did with the official UKFPO answers to the practice questions.

The test went well overall. At the moment, I cannot predict my score since for most questions there were no clear right and wrong answers. And compared to the practice paper I would say there were more questions which weren’t very clear in terms of the most appropriate answers. Nevertheless I’m overall happy with how it went. I managed to finish all the questions about 6 minutes before the end of the exam which gave me enough time to go over the answer sheet again to make sure that I didn’t forget to fill in my answer for any questions.  This was also reassuring for me as it meant I was able to consider all the questions without having to guess or rush though any of them, meaning I gave each and every single one of them a fair shot. My understanding is that most people who have done poorly in the SJT in previous years were those who didn’t finish all the questions in time or who made major mistake such as not transcribing the answers to the answer sheet in time. Hopefully this will mean that I won’t get a score less than 2 standard deviations from the average (i.e not less than mid-30s) which would guarantee me at least my second choice foundation school. And if all goes well and I haven’t messed up my rankings for a big chunk of the questions, I should be looking at a 40+ which would – based on previous yearly figures – be enough to get me into my first choice foundation school. Update – this student actually scored 41.5 SJT points, and accepted an academic rotation – however this score would have got him a spot in his 1st choice rotation!

The Emedica Foundation SJT preparation course has been running since the first year the SJT was used for Foundation programme entry / FPAS. It has been updated to take account of the new format questions added for 2015 entry onwards.

Foundation SJT tips from a resitter, Part 2

Foundation SJT tips from a resitter, Part 2100281534

With FPAS applications open now, the day is getting closer- the SJT, which will rank you with the rest of the UK medical students for jobs. It seems daunting, but remember that to get this far you are a sensible, intelligent person- it’s simply a matter of showing this as best you can, with my help!

As the exam comes up, I can’t stress enough that it is different- not about knowledge but about applying the right principles to make sensible decisions. It’s really not about cramming practice questions- after finding many of the books problematic I did very few. It’s about knowing the key guidance. It’s about showing that you know the GMC Duties of a Doctor and can apply them in scenarios of day-to-day hospital life.

You will need to reduce these massive documents to frameworks that are easily memorable for you. Have an idea of the kind of situations you will need to seek help in- when will you talk to an F1 colleague? When will you escalate a problem, and to who? We found it useful to have a framework “hierarchy” of who you would go to next with an unsolved problem.

It’s also worth reading over things such as DVLA guidance and ethical guidance on issues such as confidentiality and consent, so you are prepared for any of those issues that may come up.

Last year as part of my preparation for the SJT I took a course with Emedica– part of what was so helpful about it was their clear summaries of ethical principles, conscientious objections, confidentiality and other guidance that can almost be applied as “rules” to certain questions.

Remember that the test reflects “real-life” behaviour: Are you remembering to take care of yourself in your decisions, as well as projecting the image of the perfect caring Doctor?

On the flip-side, remember that the exam tests what you should do ideally: so even if you’d be too scared to phone your Registrar in real life, so you can put the ideal option.

FPAS provides a practice paper, which is the only “official” one so you might want to consider when you use it- early on to get an idea of real questions, or closer to the exam as a “mock”.

Consider how you’ll answer the questions. With 70 questions in 140 minutes, you have just 2 minutes in which to read a question, weigh up the scenario, and mark your answer down. Usually with MCQ’s I like to go through the question paper at least twice- you won’t have time here. Also if you’re one of those people who likes to write down your answers and transfer them at the end, consider if you want to risk running out of time for that! Bring several sharp HB pencils (so you don’t waste time sharpening, or worse, waiting for an invigilator to sidle along to you to bring you a new pencil), and please, a decent rubber, so we can avoid the marksheet fiasco of 2012!

I wouldn’t recommend cramming for this exam at all. You can’t learn answers as a slight variation in a question would change it completely. (None of the past paper questions came up last year, either!) Even if it’s not your usual pre-exam style, I’d recommend a good night’s sleep and a good breakfast before the exam, so you’re awake and ready to reason out situations, and apply some well-needed common sense!

This article was written by a final year medical student at Kings College London medical school. She has since passed finals, got a great SJT score again, and is now a foundation doctor at her 1st choice Foundation rotation in London.
The Emedica Foundation SJT preparation course has been running since the first year the SJT was used for Foundation programme entry / FPAS. It has been updated to take account of the new format questions added for 2015 entry onwards.

Foundation SJT tips from a resitter, Part 1

Foundation SJT tips from a resitter, Part 1stockxpertcom_id563921_size2

I did fairly well in the SJT last year; ending up with a total score of 91.6, and landing myself my top-choice job in the hospitals I wanted.

Unfortunately for me I’m retaking the year due to OSCE difficulties, which includes everything that comes with it- including all logbook signups and, of course, the FPAS application system. So whilst digging out my SJT notes from last year, I realised that having gone through the whole experience (including it’s ups and downs!) I had some experience and advice that may prove useful to share.

As you probably know by now, it’s a bit of an odd exam, focusing not on knowledge but on appropriate reactions to scenarios, such as your senior Doctor being drunk (there were at least three questions on that last year, bizarrely) or handling a complaint from a patient. You answer each question by ranking five possible scenarios, from most to least appropriate. The tricky part comes when you realise you can’t justify your answers, or gain extra information, and have to go exactly with what’s in front of you!

So what’s the best way to learn for this new test?

It’s very tempting to try and learn the “correct” answers to a variety of questions, such as from working through the variety of SJT practice question books available. Personally, I didn’t rate any of these, as I found they each had their own biases. The Oxford Handbook version was clearly written by older Consultants with the idea of “don’t bother your seniors”- NOT the SJT ethos! Another book I found had questions on clinical scenarios- the test actually requires very little medical knowledge. We even found such bizarre options in question banks as “try to stab the patient with your pen”- unfortunately nothing in the exam was so clear-cut wrong or right!

I daresay the books/question banks will have improved this year (look out for anything on its second edition, I see on Amazon that the Oxford Handbook one is), but if you use them, use them with an open mind. Be willing to rethink answers that don’t seem right, and discuss with your peers. Remember that a slight change in the options could completely affect your answer in the exam.
(Also: order the books as soon as possible- they sell out fast, and last year one didn’t arrive for me until the week before the exam!)

My main strategy for revision was to try and get into the right “mind-set” of the test. The test isn’t about knowledge- it’s about thinking like a Doctor, and so I did my best to learn what the test was looking for, and familiarise myself with the principles I should be applying/would be tested on. To start with, you can do background reading about how the test was developed and what it is looking for. I went to www.isfp.org.uk for this, and specifically read through the SJT monograph which is a really good explanation of what the test is looking to measure, and how.
The UK Foundation Programme Website also provides a person specification for the SJT on their documents page.

Then I spent a lot of time reading the various GMC guidance such as Good Medical Practice (I went so far as to have a summary of this on my bedroom wall!) and Tomorrow’s Doctors. We should of course know these backwards by now, but they are very clear and thorough documents laying out everything expected of us. There are even interactive scenarios you can work through to break up the book-work: http://www.gmc-uk.org/static/media/Medical_Students/index.html and http://www.gmc-uk.org/gmpinaction/ which will help you practice all the guidance to aid recall.

Finally, I would definitely recommend going on a revision course. While my University tried to advise us on this exam, they aren’t familiar with it- but GP trainees are, having been doing SJT’s for years now. Emedica ran an intensive day course where they provided key background information, including the ethical principles, GMC guidance and day-to-day problems you may face as a junior doctor (and so on the test). They provided and confidently went through example questions; explaining the correct answers in a really sensible way that made sense. This was supplemented by a set of practice questions to go through online afterwards; which I found very useful, as I knew I could trust the examples!
The course also included a timed practice test that forced you to answer each question in a set amount of time- this is really important thing as the timing is close and indeed I know of some people whose mark dropped simply due to running out of time.

In summary:

  • Learn the background knowledge;
  • Get advice from the experts;
  • Practise putting the guidance into practice;
  • And use common sense… you’ll be fine!
This article was written by a final year medical student at Kings College London medical school. She has since passed finals, got a great SJT score again, and is now a foundation doctor at her 1st choice Foundation rotation in London.
The Emedica Foundation SJT preparation course has been running since the first year the SJT was used for Foundation programme entry / FPAS. It has been updated to take account of the new format questions added for 2015 entry onwards.

MRCGP AKT exam 2014 – key changes

MRCGP AKT Mock ExamDr Mahibur Rahman

The MRCGP AKT exam was introduced in 2007 as part of the new MRCGP examination. Since then it has been through a few minor changes relating to question formats and the passing standard. From October 2014, some important changes are being implemented. This article looks at the exam format, including the new changes.

Exam basics

The Applied Knowledge Test (AKT) is one part of the MRCGP examination. It can be taken in the ST2 year of training or later. It is a computerised test consisting of 200 questions, and can be attempted a maximum of 4 times. The major change being implemented in 2014 is that the time allowed for the exam is being increased by 10 minutes – candidates will now have 3 hours and 10 minutes to complete the exam. The other change is a minor one – an on screen calculator will be available if needed.

Exam content

The exam is based around UK general practice, with all questions being drawn from areas within the RCGP GP curriculum. The breakdown of the questions are as follows:

  • 80% (160 questions) – clinical medicine relevant to general practice
  • 10% (20 questions) – organisational – this includes administrative issues, medicolegal, practice management, GP contract, certification etc.
  • 10% (20 questions) – evidence based practice – statistics, types of study, graphs and charts etc.

Question formats

The majority of questions (about 90%) are of two formats – extended matching questions (EMQs) and single best answer questions (SBA). Candidates sitting the AKT will be familiar with this type of question from the GP Stage 2 assessments used as part of GP recruitment. The remaining question formats include:

  • Algorithm question – testing knowledge of specific guidelines or protocols – sometimes you will be required to drag the correct answer into the relevant box.
  • Picture question – this will have a scenario with a related image – ranging from an investigation, blood result, audiogram, skin lesion, otoscopy or a photo of a clinical sign.
  • Video question – this will involve a short clip (20 – 30 seconds) with a relevant question. This could show an abnormal gait, a test for a sign, a physical abnormality etc.
  • Seminal trial – this will test knowledge of a specific trial that has had a significant impact on general practice.
  • Rank ordering question – this is a relatively new format, and will ask you to order options from best to worst e.g. most secure password to least secure password
  • Short answer question – this will provide a question and then a blank space into which you have to type the correct answer. Typically the answer will be one or two words.
  • Calculation – this may involve calculating a paediatric drug dosage, converting one opioid to a different formulation, or working out the sensitivity or specificity of a test. The maths is usually limited to basic arithmetic, although an no screen calculator is now available.

Preparation

The AKT is a challenging exam, and most candidates will need at least 3 months revision to be able to cover the entire curriculum thoroughly. Combining reading with practising exam level questions to time will help make your revision more effective. The Emedica AKT preparation course offers comprehensive coverage of the curriculum, with a focus on the challenging areas highlighted by examiners from previous sittings. This includes statistics and evidence based practise made simple, the organisational domain, and over 100 core clinical topics including high yield topics from previous examinations. You can get a £20 discount by using the code alumnimrcgp

Useful links:

RCGP AKT Content Guide

MRCGP AKT tips for effective preparation – from a registrar with the highest score in the country

MRCGP AKT Exam Revision – High Yield Topics from the April 2014 AKT Exam

MRCGP AKT Exam – High Yield Topics from the April 2014 AKT Exam

Dr Mahibur RahmanDrug dosage

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently examined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.

As some of you may be starting to think about the October 2014 MRCGP AKT Exam at the moment, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.

Key facts from the April 2014 MRCGP AKT exam:

The top score was 95%
The mean score was 72.2%
The lowest score was 43%
The pass mark was 67% (this is one of the lowest it has ever been so far)
The pass rate was 72.5%

Scores by domain:

Clinical medicine – 72.5%
Evidence interpretation – 73.8%
Organisational – 67.9%

High Yield Topics

The examiners’ report from this diet of the MRCGP AKT exam highlighted the following key topics:

  • Drug dosage calculations
  • Drugs administered by other health professionals
  • Good Medical Practice – 2013 GMC guidance
  • Contraception – including LARC and drug interactions
  • Acute infections – antibiotics and prophylaxis
  • Mental health – diagnosis and management of anxiety
  • Digestive health – irritable bowel and coeliac disease
  • Death and cremation certification
  • Substance misuse – including treatment of withdrawal symptoms
  • Poisoning – symptoms and management
  • Psoriasis – diagnosis and management

The MRCGP AKT is a comprehensive examination, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Our AKT course offers comprehensive coverage of all 3 domains, and is updated after every exam to take account of high yield topics from the examiners’ feedback reports.

Further reading:
Complete Examiners’ report – April 2014 MRCGP AKT Exam

MRCGP AKT Exam Revision – High Yield Topics from the January 2014 AKT Exam

MRCGP AKT Exam – High Yield Topics from the January 2014 AKT Exam

Dr Mahibur RahmanHuman eye

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently examined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.

As some of you may be revising for the April 2014 MRCGP AKT Exam at the moment, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.

Key facts from the January 2014 MRCGP AKT exam:

The top score was 95%
The mean score was 75.8%
The lowest score was 39.5%
The pass mark was 70.5% (this is the highest it has ever been so far)
The pass rate was 74.7%

Scores by domain:

Clinical medicine – 76.3%
Evidence interpretation – 74.3%
Organisational – 73.3%

High Yield Topics

The examiners’ report from this diet of the MRCGP AKT exam highlighted the following key topics:

  • Hypertension – NICE guidelines on management
  • Good Medical Practice – 2013 GMC guidance
  • Freedom of Information
  • OTC supplements and interactions with drugs
  • Normal childhood development
  • Eye disease – acute eye problems
  • Certification – fitness to work / Med3
  • Osteoporosis – DEXA scan interpretation
  • Diabetes – diagnosis, management (including insulin therapy)

The MRCGP AKT is a comprehensive examination, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Our AKT course offers comprehensive coverage of all 3 domains, and is updated after every exam to take account of high yield topics from the examiners’ feedback reports.

Further reading:
Complete Examiners’ report – January 2014 MRCGP AKT Exam

MRCGP AKT Exam Revision – High Yield Topics from the October 2013 AKT Exam

MRCGP AKT Exam – High Yield Topics from the October 2013 AKT Exam

Dr Mahibur Rahman

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently examined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.

As some of you may be revising for the January 2014 MRCGP AKT Exam at the moment, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.156204109

Key facts from the October 2013 MRCGP AKT exam:

The top score was 94%
The mean score was 73.2%
The lowest score was 43.5%
The pass mark was 67%
The pass rate was 76.1% (this is one of the highest pass rates in recent years)

Scores by domain:

Clinical medicine – 72.9%
Evidence interpretation – 69.4%
Organisational – 79.3%

High Yield Topics

The examiners’ report from this diet of the MRCGP AKT exam highlighted the following key topics:

  • Drug interactions for common drugs – statins, macrolides, oral anticoagulants
  • Management of type 2 diabetes
  • Psoriasis – diagnosis and management
  • Oral contraception and LARC
  • Pre-employment vaccinations
  • Incontinence
  • Peripheral vascular disease
  • Dementia – management and diagnosis
  • Diabetes – diagnosis, management, interpreting diabetic blood results

The MRCGP AKT is a comprehensive examination, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Our AKT course offers comprehensive coverage of all 3 domains, and is updated after every exam to take account of high yield topics from the examiners’ feedback reports.

Further reading:
Complete Examiners’ report – October 2013 exam