10 tips to help you pass the MRCGP AKT exam

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. 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

shutterstock_247056754Effective 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 29,000 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. The course includes key theory and high yield topics, exam technique as well as mock exams in timed conditions. You can get a £25 discount by using the code passmrcgp

Details of the course are available at http://courses.emedica.co.uk/acatalog/nMRCGP_AKT_Preparation.html

MRCGP AKT Course

10 tips to help you pass the MRCGP CSA

The MRCGP CSA is a challenging exam, acting as an exit exam for GP training in the UK. 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 is based on a simulated surgery consisting of 13 cases played by simulated patients. The cases will include a range of disease areas and case types, with at least 1 child health case, and at least 2 cases that will significantly test prescribing knowledge. You will have 2 minutes to read the case notes before each consultation, and exactly 10 minutes for the consultation itself. There will be a different examiner with each simulated patient, assessing the same 3 domains in every case: data gathering (history and examination), clinical management (including diagnosis, management, follow up and safety netting), and interpersonal skills (clear explanations, empathy and sensitivity and having a patient-centred approach).

Each domain is graded as either clear pass (3 marks), pass (2 marks), fail (1 mark) or clear fail (0 marks). The total score from all 13 cases determines whether you pass or fail the exam. The pass mark is adjusted each day to take account for the level of difficulty of the cases, but usually ranges from 72-78 out of 117. The total score is the only thing that determines if you pass or fail – there is no minimum score in each case. A candidate that scored 9 in several cases could get 0 in some cases and still pass i.e. you pass or fail the exam as a whole, rather than individual cases.

  1. Join a study group

Forming a study group early on in your preparation for CSA – 6-9 months prior to your exam – can help in many ways. A good number to meet for a study session is 3 – one to be the doctor, one the patient, and one to observe and provide feedback. Some candidates find that being observed makes them nervous and affects their performance – having a colleague observe and be the “examiner” can simulate some of that pressure and over time, help to overcome it. It is also easier for someone observing and making notes to give useful feedback. Agree in advance the importance of being honest and constructive when giving feedback – some registrars feel shy to say anything critical and just focus on the positives when observing others. While this might make you feel good, it won’t help you improve.

Putting yourself in the role of the examiner with a clearly defined mark scheme can also help give an insight into the importance of clearly demonstrating the criteria in the different domains.

  1. Seek feedback regularly

Try to get feedback on your consulting whenever possible. This can be through consultation observation tool (COT) assessments, joint surgeries, during out of hours (OOH) sessions and also during tutorials. Video can be a useful tool – you can watch a few recorded consultations with your trainer, but it can also be helpful to watch some of these back later yourself to pick up on things like body language and non-verbal cues from the patient. It can be helpful to get different perspectives, so ask for other doctors at your practice to observe you and give feedback.

  1. Observe how others consult

shutterstock_98521166Try to do some “reverse” joint surgeries – where you sit in and observe your trainer and other team members consult. This can be a good way to pick up useful tips and good habits from experienced colleagues. You may have a doctor in the team that has a lot of women’s health experience, and may be able to tweak how you explain certain conditions based on their approach. Sitting in with the practice nurse during an asthma clinic might give you some ideas on things like demonstrating inhaler technique or discussing spirometry. Don’t feel that you have to do everything the same way your colleagues do – it is important that you consult in a way that is comfortable and natural to you. You may find that you can adapt your own style and add in what works from others.

  1. Prepare for challenging cases

It is important identify areas you find challenging and actively prepare for them. If you find it difficult to take sexual health history because you get embarrassed when asking sensitive but important questions relating to risk factors for sexually transmitted infections, you should practise this until you can do it confidently. If you do not see many women with gynaecological issues, you could go through important areas of the history and examination in a tutorial or with your study group. Equally, if you have not treated many patients with testicular problems, or erectile dysfunction, you should revise the key parts of the history, examination and management. Try going through the CSA case checklist in the MPS MRCGP Study Guide and go over any areas that you are not confident in. Practise telephone consultations as it can be challenging taking a history when you do not have some of the non-verbal cues that we rely on in clinic.

  1. Learn to manage your time effectively

You have 2 minutes to read the case notes, and exactly 10 minutes to get through each case. Candidates that regularly struggle to complete cases will often get a low score for the management domain, as they may not have had time to discuss treatment options, or to talk about follow up and safety netting. Try to get comfortable with getting through your consultation in 10-12 minutes the month before sitting the exam. You may still be on 15 minute slots, but try to use the last few minutes to type up your notes. It is very difficult for a candidate who regularly needs 16-17 minutes per case in surgery to suddenly shave several minutes from their consulting time in the exam.

  1. Remember all 3 domains are marked in every case

A common myth about the CSA is that it is all about communication skills. While good communication is an essential part of being a good GP, this is only a third of the marks in each case – the other two thirds relate to clinical areas.

Data gathering is about history and examination – it is important to be able to take a focused, systematic history. If you spend too long on the history by asking vague or irrelevant general questions you may find that you get a poor mark for data gathering, and also run out of time and get a poor score for the clinical management domain. Candidates often lose marks in this domain by failing to ask about relevant red flag symptoms to exclude rarer but serious conditions, or forgetting to request an essential examination.

There is a lot to cover in the management domain to get a clear pass – you need to allow enough time to go through the diagnosis, discuss management options, cover other important risks, and to discuss follow up and safety netting. This will usually take 3-4 minutes to cover well. You can also lose marks if your proposed management plan is not in line with current evidence – a good knowledge of current guidelines is very important.

In the interpersonal domain, you may lose marks if you do not build a good rapport, or take on board the patient’s agenda. Work on being able to explain investigations, diagnoses and results in clear, concise language without using technical jargon. Pay attention to both verbal and non-verbal cues – it is important to explore them as there may be an important symptom or issue that will only come out when the cue is explored.

  1. It’s not enough to know it, to get marks you have to show it

Examiners can only mark observed behaviours, so it is important to demonstrate your knowledge and skills clearly in each domain. For example, in the clinical management domain for a case of newly diagnosed Stage 2 hypertension in a 50 year old, a candidate that informed the patient that they would be “starting a once daily tablet for your blood pressure” would not get the marks for correct management. A candidate that made it clear that they would be starting the patient on a suitable dose of an ACE inhibitor would. Similarly, a patient with a transient ischaemic attack (TIA) with high risk of stroke needs to be seen within 24 hours by a specialist according to the current guidelines. A candidate that did not make the timeframe clear may not get the marks. For example, saying “I will arrange for the specialists to see you urgently” is unclear in this situation – as a 2 week referral is urgent, but not appropriate for a patient at high risk of stroke. Making it clear that you would arrange for the specialists to see the patient “within the next 24 hours” would be much better.

  1. Treat the exam like a regular clinic

Treat the CSA as a regular 13 patient clinic, with the benefit of a break halfway through, and without having to write up any notes on the computer. Do not do any acting – the only person doing any role play should be the simulated patient. You should be doing the same things you would do with a similar case in real life. Some candidates make up false options that they would never offer in real life or pretend to write a prescription rather than using the sample prescription on the table. This looks awkward and unnatural, and can be embarrassing when the patient points out that there is nothing there! Imagine the examiner is not there – do not look at them, talk to them, or try to engage them in any way – they are there to mark the case, not to influence the outcome. You should focus on the patient, and give them your full attention – just as you would in surgery. If you think there is a relevant examination, you should ask the patient if you can examine, rather than asking the examiner. If you would offer a chaperone for an examination in real life, offer one in the exam. Getting regular practice in your study group or in a joint surgery can help you get used to consulting with an observer in a way that does not affect your focus on the patient.

  1. Focus only on the case at hand

In an exam with 13 cases, it is quite normal to have 1 or 2 cases that either don’t go as well as you would have liked, or that include a rare or high challenge presentation. Remember that a bad performance in any case can be compensated by doing well in others. Just do your best to listen carefully to the patient, try to be safe, and to communicate clearly. At the end of the case, take a deep breath, clear your mind and go into the next case with a positive attitude – otherwise 1 poor case can go on to affect how you score on the next few and have a much bigger impact on your overall score.

Summary

The MRCGP CSA is a challenging exam with a significant failure rate. To pass, you need to demonstrate that you have the skills and knowledge to practise safely without supervision – from taking a structured history and focused examination to being up-to-date with your management. You need to show that you can communicate clearly and effectively with the patient, and engage them appropriately. Finally, you need to be able to manage your time well to get through everything in 10 minutes. Like any skill, consulting well improves with practise – you can get this by seeing patients in clinic, with your trainer in a tutorial and in a study group with your colleagues. Best wishes with your exam!

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 29,500 delegates including those preparing for GP entry exams, MRCGP and on GP careers. He teaches an intensive 1 day MRCGP CSA preparation course in London and Birmingham that includes key theory and high yield topics, exam technique as well as plenty of practise with professional role players in CSA exam conditions. 

Useful links and further reading:

MRCGP Exam Preparation: A revision guide for the AKT and CSA – MPS (includes CSA topic checklist)

Emedica MRCGP CSA Preparation course

Emedica MRCGP CSA Online package – video lectures, high scoring consultations + 52 CSA cases to practise (4 full CSA exam circuits):

MRCGP AKT Examination – an overview

The AKT (Applied Knowledge Test) is one of the assessments required to gain Membership of the Royal College of General Practitioners (MRCGP) and can be taken in ST2 or ST3 years of GP training. It is available 3 times each year, in October, January and April. Most candidates sit the exam for the first time at some point in ST2.

The examination questions are all drawn from the GP Curriculum, and the test is completed on computer at a Pearson Vue professional testing centre (there are centres all over the UK).

The exam lasts for 3 hours and 10 minutes and consists of around 200 questions. You can mark questions for review later to go back over those that you are unsure of.

The pass rate is variable and based on a set pass standard for each exam, with a variable pass mark that has ranged from as low as 67% to as high as 71.5% (average is around 68%). The pass rate has a long term mean of just over 73%.

Question formats

studying girlThe majority of questions are Extended matching questions (EMQs) and Single Best Answer questions (SBAs). Other question formats include Multiple Best Answer (MBA), Algorithm questions, seminal trial questions (focusing on important research relevant to primary care), picture questions, video questions and short answer questions.

The makeup of the exam is:

  • 80% – Clinical medicine relevant to GP
  • 10% – Critical appraisal / evidence based practice
  • 10% – Health informatics and administrative issues

The RCGP has produced a set of sample questions you can view the answers alongside the questions here.

Examiner’s reports

The panel of examiners produce a report after each sitting outlining key areas that canidates performed poorly at, and this is very helpful in highlighting important topics to include in your revision. You can access the reports from the RCGP website.

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

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

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

MRCGP AKT Exam – High Yield Topics from the May 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 135018281examined 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 your revision for the October 2013 MRCGP AKT Exam, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.

Key facts from the May 2013 MRCGP AKT exam:

The top score was 97%
The mean score was 72.74%
The lowest score was 38%
The pass mark was 68%
The pass rate was 71.4%

Scores by domain:

Clinical medicine – 72.6%
Evidence interpretation – 76.0%
Organisational – 70.4%

High Yield Topics

The AKT summary report after each AKT exam usually highlights topics that were either not answered well by many candidates, or that although were tackled well, were important enough to be mentioned by the examiners. This is usually a clue that these topics will be retested in the next few sittings of the exam.

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

  • Management of hypertension
  • Fitness to work certification (sick notes)
  • Drug interactions
  • Skin lesions – recognising common and serious conditions
  • Screening programmes
  • Drug monitoring – blood tests
  • Enteral feeding – including complications
  • Emergency contraception
  • 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

Further reading:
Complete May 2013 AKT Summary report

Improving feedback from the MRCGP CSA examination

Improving feedback from the MRCGP CSA examination

Dr Mahibur Rahman

We are often contacted by GP registrars or GP trainers requesting support with understanding the feedback from the MRCGP CSA. Many doctors have commented that they find the feedback difficult to interpret. This has been recognised as an important issue and recently a motion was passed at the LMCs conference calling for immediate improvement in the feedback from the CSA. In this article Dr Mahibur Rahman looks at the current feedback, the areas that could be improved and suggestions on ways to make the feedback clearer and more helpful for both trainers and registrars.

Understanding the current CSA feedback

Currently there are 2 main sections to the feedback from the CSA. The top part gives the candidate’s total score from all 13 cases (out of 117), with the pass mark for the date they sat the exam. This total score is based on the summative part of the assessment, which is based on 3 domains for every case: data gathering, clinical management, and interpersonal skills.

For each domain, a candidate is graded with a score attached to each grade as follows: Clear pass: 3 marks, Pass: 2 marks, Fail: 1 mark, Clear fail: 0 marks. This gives a total score for each case of between 0 and 9.

To gain a pass, a candidate must get an overall score equal to or above the pass mark for a given day. This is adjusted each day using the borderline group method to ensure the standard of the exam remains the same each day. The actual pass mark is variable with a usual range between 72 and 77 out of 117.

The second part of the feedback is formative – it relates to the 16 feedback statements provided by the RCGP in a grid. This grid can provide information on consulting areas that a candidate could improve on. It is important to understand that this part does NOT determine the score or whether a candidate has passed or failed – it is formative, and aimed at helping doctors identify areas of their consulting that they could improve. The current feedback looks like this:

CSA feedback current

What are the problems with the current feedback?

There is no breakdown of the marks awarded from each case (out of 9), and no way for a candidate or trainer to see clearly if marks were dropped in data gathering, clinical management or interpersonal skills for each case, or as a general trend over the course of the whole exam.

In some cases, the formative feedback can help identify areas to work on, but in some cases it can lead to confusion. A common source of confusion relates to the fact that candidates with the same number of crosses can have very different scores. Finally, where a candidate has no crosses relating to a specific case, many candidates think that it means they must have scored very well, or at least gained 6 or more marks out of 9. However it is impossible to tell how well or poorly they have performed in that case from the lack of crosses– they could have scored anywhere from 0 to 9. This is because:

  • The formative feedback does NOT determine the score for a case – this is determined by the performance in the 3 domains being assessed. Scores for these are not provided in the current feedback as standard – candidates that want to access these scores can request their mark sheets under the Data Protection Act.
  • Only feedback statements that were flagged in 2 different cases show up in the feedback provided to candidates – there are hidden crosses where a statement was only flagged in a single case. A candidate with no crosses could actually have had several crosses relating to feedback statements that did not occur again in other cases. This could have led them to score very poorly in that case, but they would not know it from looking at the feedback.

This candidate failed the CSA by a few marks – look at the formative feedback for their first 3 cases:

CSA formative feedback - current

This candidate scored 7/9 for the first case (joint problems), and 2/9 for the second case (acute illness), but there would be no way to know that they had performed really poorly in the second case from the current feedback. There were actually 3 feedback statements that were flagged in this case, but they don’t show up because those statements did not apply to any other case (and currently these statements are hidden).

How could the feedback be improved?

The GPC motion called for “the feedback from the MRCGP exams to be improved immediately”. Here are 3 simple ways that the feedback could be made clearer and more effective in helping identify areas to work on to improve performance. They can all be introduced using data that is already collected in the exam, and so could be implemented quickly with little additional cost.

1. Provide a breakdown of total marks for each domain as well as the total score. In the AKT, candidates get a breakdown of their scores in the 3 domains (clinical medicine, organisational, and evidence interpretation). This will give a clearer indication of any weaker areas overall:

New CSA feedback - summative

This candidate and their trainer can immediately see that they could make improvements in all parts of the consultation, but that the clinical management domain was their weakest overall. This may allow more targeted work on this part of the consultation. Without this information, this candidate (and their trainer) may focus more on the interpersonal domain, without realising that although this could be improved further, this is actually their strongest domain overall.

2. Provide the domain scores for every case as well as the formative feedback. Taking both the summative and formative feedback together provides more meaningful information and will allow easier identification of both consulting skills and curriculum areas that need improving. This could be provided by adding a separate table for the domain scores:

CSA domain feedback for individual cases

Looking at this, it is clear that this candidate had 2 cases where they performed very poorly – the young adult female with an acute illness, and the middle aged female with a women’s health issue. These may be areas that they struggle with, and indetifying them will allow focused improvement in knowledge.

3. Provide details in the formative feedback section of ALL statements that were flagged, even when this only applied to a single case. This will allow candidates to identify all areas that examiners felt they could work on – even candidates that have done well can benefit from knowing areas that they could improve. Combined with the summative feedback above, this would also make it easier to separate a candidate that is below the pass standard in multiple areas of multiple cases from one that had a couple of really poor cases due to poor knowledge of a specific curriculum area, or because they missed something key in that case. Here is the formative feedback from those first 3 cases that we looked at earlier; the second image shows all crosses (those that were previously hidden are shown in red for clarity):

Current feedback:

CSA formative feedback - current

Proposed feedback:

Proposed feedback showing all crosses

You can see that taking this with the domain scores, it is immediately clear why this candidate got such a low score in the acute illness case, and that had they performed better in this case, they may have passed. This would also help candidates understand their performance better. From the current feedback they may think that this was one of their better cases when actually it is their worst. Providing this extra information does not give any information that will jeopardize case security, but it does provide more meaningful information for someone trying to improve.

How it would look together

All the feedback would fit onto 1 A4 page, allowing quick cross referencing between the different sections. This is how the new feedback could look in the e-portfolio.

New CSA feedback - summative

CSA domain feedback for individual cases

New CSA feedback

Summary

It is clear that further research needs to be carried out to investigate the possible reasons behind the differential pass rates in different groups – however this will take time. By improving feedback immediately, we can ensure that candidates and trainers have clearer, more effective feedback. All these changes can me made using data that is already being collected, so this could be implemented quickly and with little additional cost. Hopefully this will enable more focused work on the key consultation skills that an individual doctor may need to work on to help them improve and pass the exam.

Are you a GP trainer or a GP registrar? What do you think about these ideas for improving the feedback from the CSA? Please share your thoughts!

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