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.

Salaried GP Posts – Advantages and Disadvantages

Dr Mahibur Rahman

Many doctors spend a large part of their careers working in a salaried capacity. For some doctors, it is the first step on the path to a partnership, for others, working as a salaried GP bring the benefits of working in general practice without the extra responsibility, time and uncertainty of partnership. Here is a comprehensive guide to some of the advantages and disadvantages of working as a salaried GP:

Advantages

Stability

As a salaried GP, you will have a stable work environment, being able to develop a working relationship with members of the team. You will be able to plan your finances as you will have a fixed monthly income. You should have a structured working week, making it easier to plan social engagements, childcare etc. Having a regular workplace also makes it easier to access CPD, to take part in audit and significant event analysis – all of which are important as part the appraisal and revalidation process.

Employment rights

As an employee, you have significant rights. First, you have entitlement to sick pay, a minimum amount of paid annual leave, paternity / maternity pay and leave and unpaid time off for compassionate leave. After working for 2 years in the same employment, you also gain full employment rights including the right to redundancy pay. Usually your past NHS service would be recognised towards this as long as you have not had a break in service. Employment rights are one of the biggest advantages of being an employee.

Fixed commitment

As a salaried GP you should have a job plan outlining your duties, and your work time commitment should be fixed. If the practice suddenly needs extra cover, while your employer can request that you do an extra shift, you do not have to accept, and they cannot demand that you provide the extra cover. Your main commitment will be to clinical work, and many doctors prefer this – managing other employees, dealing with the upkeep of the building, keeping an eye on the accounts will not be your responsibility.

Disadvantages

Pay

Salaried GP pay is very variable throughout the UK, and even between practices within the same region. The review body recommended range for salaried GP pay for full time doctors (working 9 sessions) is currently £55,965 and £84,453 (2016 figures). These figures apply to doctors working for GMS practices or for PCOs directly. PMS and APMS practices are free to offer any salary they wish. Average pay for salaried GPs in the UK working in either GMS or PMS practices in 2013-2014 (last available actual figures) was £54,600. This figure includes those GPs working less than full time (i.e. less than 9 sessions), which make up a large proportion of salaried GPs.

In some cases, if there is a shortage of applicants, or if you are taking a salaried role with additional responsibilities, pay can be much higher, or include a “Golden Hello” – an incentive to take a post in a specific area. In the current climate of GP shortages though, you may be able to negotiate a good overall package, especially if you have additional skills that can bring the practice extra income (such as fitting coils and implants, offering joint injections etc.). In many cases, actual take home pay for a full time salaried GP may be similar to a full time partner in a practice with below average profits once you take into account deductions for NHS pensions and indemnity.

Lack of Control

As a salaried GP, you will have less control on the direction of the practice or the services offered. You may also have less flexibility in terms of how much leave you have or when you take it, compared to working as a locum or a partner. Over time, some doctors find that the workload expected of them can creep up, with additional time and responsibilities expected that are not always reflected in additional income.

Summary

shutterstock_98508338Like any job, there are both advantages and disadvantages to working as a salaried GP. Hopefully this article is a good starting point to thinking about how whether working as a salaried GP is for you.  Please feel free to contact us with any queries you may have about your career – we will always do our best to offer advice and support.

Please post a comment and share your tips and advice for newly qualified GPs.

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

Developing a career as a Portfolio GP

Dr Mahibur Rahman

You may have heard the term “portfolio GP” more frequently over the last few years. This is an umbrella term used to describe any GP that has multiple jobs or that does multiple types of work within their working week. Most portfolio GPs have a primary job – this could be a partnership, a part time salaried position or being a locum GP, with one or more additional jobs in their portfolio.

Many GPs develop a portfolio over time almost by accident – what starts as a one off extra session working in a prison for example can become an interesting part of the regular working week.

The range of additional jobs that you might develop an interest in as part of your portfolio is huge – from developing a specialist interest, to taking on a management role as part of the CCG. Some of the more flexible additions to a portfolio can include:

  • Medical Education
  • Forensic Medical Examiner
  • Prison Doctor
  • GP with Specialist Interest (GPSI)

In this article I will discuss some of these options in a bit more detail.

Medical Education

There are various ways to become involved in medical education, from the occasional teaching and supervision of medical students on placement at the practice to becoming a GP trainer or Training Programme Director. Teaching can be very rewarding, as well as acting as a stimulus to refresh your own knowledge and to keep up to date.

Teaching Medical Students and Foundation Trainees

Most medical schools require doctors that will be teaching students on placement to attend a short training course (often over 1 or 2 days), and then to attend annual training days. Beyond this, you will not need to have any formal medical education qualifications. For teaching Foundation trainees, most deaneries require a similar amount of training.

Clinical Tutor

Many medical schools recruit qualified GPs to become clinical tutors to facilitate small group teaching, or teach clinical and communication skills for undergraduates at the medical school. Having experience in teaching will make you a more attractive candidate, and medical schools often offer further in house training as well as support to complete a postgraduate certificate or diploma in medical education. Time requirements are usually 1-2 sessions a week.

GP Trainer

The requirements to become a GP trainer vary by deanery, although there are some requirements that are fairly common throughout:

  • MRCGP – either by examination or via portfolio
  • Training in teaching – either a trainers’ course or a postgraduate certificate or diploma in medical education.
  • Experience – the minimum post CCT experience varies from 2 years to 5 years.

There are also requirements that need to be met in relation to the training practice. A trainer would usually need to put aside the equivalent of 2 sessions a week to allow time for supervision, tutorials and ongoing workshops for trainers.

Training Programme Director

Programme Directors (formerly known as VTS Course Organisers) have responsibility for organising the regular teaching for Speciality Training schemes, as well as supporting trainers. Programme Directors are usually appointed via deaneries, and again requirements vary across the county, although most require experience of teaching and a formal postgraduate qualification in medical education at diploma or Masters level. Many Programme Directors are experienced trainers. The time commitment required is usually equivalent to 2 sessions a week or more. In many areas with larger training schemes, there are multiple Programme Directors for the same area.

Prison GP

Working as a GP in secure environments may seem daunting, however it can have many benefits. There is currently a huge shortage of GPs in the prison service, so the rates paid are usually very good. The work includes GP style clinics and ward rounds for inmates – you will usually be well supported with an experienced nursing team, and guards are nearby (they can be in the room on request in some cases). As well as acute illness and ongoing management of chronic disease, there is a high proportion of patients with mental health issues and drug misuse problems. Undertaking the RCGP Drug Misuse certificate can be useful to give you more confidence in dealing with this aspect of the work. If you are not sure if this is for you, contact your local prison and talk to the lead clinician – in most cases they will be happy to show you around the unit and offer some induction and training. There is also usually some need for on call cover, although this varies at different units.

Portfolio GP

Forensic Medical Examiner

Forensic Medical Examiners (formerly Police Surgeons) work with police forces to provide assessment and treatment to victims of crime and persons in custody. Many FMEs are GPs that work with the police as an additional role. The work can be interesting and varied, and will include assessment and treatment of injuries, minor illness, sudden illness in custody, and assessment of victims of sexual assault. Most FMEs work as part of a group of doctors that provide cover for one or more police stations day and night. A lot of the time you may be able to be on call from home, with extra fees payable for each visit to the station. Another aspect of the work of the FME involves giving evidence in court.

GP with Specialist Interest (GPSI or GPwSI)

A GPSI is a GP that has gained additional skills allowing them to offer services that have tradionally been offerd in secondary care. They can range from ENT or minor surgery to dermatology, sexual health or musculoskeletal medicine. Usually, there is a process of accreditaion that will require relevant additional qualifications and experience and then getting signed off by a consultant to state that the practitioner is capable of independent practice. Once accredited, a practice may be able to bid for work from a CCG that will allow them to accept referrals from other practices within the area. Having a special interest can make you more attractive to a practice, and a practice offering a successful GPSI service can bring in valuable extra income. There are dozens of possible special interests, and so we will look at this in more detail in a separate article.

Variety is the spice of life

These are just a few examples of some of the options you might build into your career as a portfolio GP. I know GPs that work as civilian medical practitioners on military bases, work as team doctors for sporting clubs, are involved with the air ambulance or emergency services One of the great things about being a portfolio GP is that working in different roles can help keep you stimulated and reduce the chances of burnout. I find that for me, it really is true that “a change is as good as a rest”!

Dr Mahibur Rahman is a portfolio GP and the author of “GP Jobs – A Guide to Career Options in General Practice”. 

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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