AKT – Going For Gold. It’s only an exam... The AKT is a licensing exam You have 200 questions to prove to me (RCGP) that you have the breadth and depth.

AKT – Going For Gold

It’s only an exam...

• The AKT is a licensing exam• You have 200 questions to prove to me (RCGP)

that you have the breadth and depth of knowledge required to be a safe UK GP

• That means enough to treat me and my family....• Take it seriously• Requires more knowledge than medical finals• How much cramming did you do for finals?• The next sitting is only 56 days away....

AKT – The Exam

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

Three hour, 200 item multiple-choice test80% clinical management10% critical appraisal of EBM10% administration & management

1. Do read the information on the RCGP website, including the presentations

2. Do look at the information on the VTS website3. Do consider study groups.

AKT – The Basics

Three sittings each year

You are restricted to 4 sittings

Are you ready to enter? – Use website scores as a guide

Pass rate is about 72%

ST2 82% of first-time takers passed

ST3 73% of first-time takers passed

94% have passed by 3rd attempt in ST3.

Exam date: 30/10/13 29/01/14 30/04/14

Bookings Close:

18/09/13 04/12/13 10/03/14

How Do Our ST2s Perform?

Pre-2009 Very few sitting in ST2

2010-11 Disappointing ST2 pass-rate (40%)

2011-12 Much better ST2 pass-rate (75%)

2012-13 Very impressive (85%).

How Do Our ST2s Perform?

Those who failed:

Low scores across all 3 areas

Clinical Management best “predictor”

(80% of marks)– No-one who failed CM passed the overall exam

Suggestion:

Low CM scores (<60%) on test-papers then you are not ready.

Topics for Today

1. Exam Technique

2. General Preparation Tips

3. Tips for Administration & Management

4. Tips for EBM & statistics

5. Tips for Clinical Management

- Organising learning sets.

Exam TechniqueDemonstration module - how the Pearson-VUE system works

Use the cover test:- cover the answers. If your 1st thought is on the list, likely it is correct

Mark answer spot carefully

Time management is vital- watch the countdown clock on the computer- average of 54 seconds per question

Skip difficult questions rather than waste time - electronically highlight the ones you have left out- use electronic review to return to unanswered questions 2nd time- do not leave any questions unanswered – make an educated guess

Check for silly mistakes if you still have time.

General Preparation• Learning is always best cemented on experience

Check the guidelines and reference material forpatients that you see day by day

• You must create time for “book-work”– 2 month run-in (1 month per year post foundation)– You should aim to do revision work most days– You can take up to 3-5 days of private study leave

• Websites, guidelines, study groups – more later– FPH Library: 3 month access to onexamination.

Administration & Management

• MRCGP is an licensing exam work in UK– Questions are based on working in UK

– Detailed legal questions are unusual

• AKT: 10% of total = 20 marks

• Target score 70% = 14 marks– Score 20% reduces overall mark by about 5%

– Score 60% reduces overall score by about 1%

• See “Suggested topics & web resources”

– Work through these and you should score 70%.

EBM & Statistics

• Old MRCGP exam had one written question plus MCQs on stats & data interpretation

• AKT: 10% of total = 20 marks

• Target score 70% = 14 marks– Score 20% reduces overall mark by about 5%

– Score 60% reduces overall score by about 1%

• Score 50% on stats & management?

– Loses you about 5%

– Means you now need 75% in clinical management.

EBM & Statistics

The questions focus on definitions and interpreting results/ graphs

1. Mock question websites will drum a lot into you

2. “Basic statistics” guide on the VTS website

- section on definitions & terms

- learn the “screening test grid” by heart.

EBM & Statistics

True Diagnosis

Positive Negative

True Result

Positivea

(TP True Positive)

b(FP False Positive)

Type 1 error

Positive Predictive

ValuePPV = a/a+b

Negativec

(FN False Negative)

Type 2 error

d(TN True Negative)

Negative Predictive

ValueNPV = d/c+d

Sensitivitya/a+c

Specificityd/b+d

Clinical Medicine

• 80% of the questions– SBA, EMQ, complete an algorithm, pictures

• Question writers are all GPs• Questions “die” within 3-4 years

– New material?• NICE & SIGN guidelines, BNF, • RCGP educational material (InnovAIT, EKU)

• Consider using Curriculum Map as a checklist.

Clinical MedicineDon’t rely just on on-line question banks

Examiners give feedback after each AKT sitting

Read the “Collated Feedback” on the website

Not hard to spot the themes:

Child development Immunisations Screening

Think what has been topical?

Read guidelines – especially new ones

EKU tells you what the RCGP thinks is important...

Read Good Medical Practice

There is an attempt to spread the exam questions evenly across the clinical areas of the GP Curriculum.

Clinical Medicine

Common, low impact Sore throat, otitis media, impetigo

Rare, high impact Child abuse, meningitis phaeochromocytoma

Topical MRSA, T2DM management.

Preparation ResourcesKnowledge & reference websites 

NICE - New Guidelines Within each curriculum area, you should actively look for appropriate NICE Guidelines

SIGN - New Guidelines If a clinically important topic does not have NICE Guidelines, then check SIGN

Patient.co.uk Patientplus section is directed towards Health Professionals. Personally I find it more in-depth and useful than GP Notebook

GP Notebook Tried, tested, trustedDoes now require (free) registrationLacks graphics...

Knowledge modules & self-test sites

RCGP Essential Knowledge Updates (EKU)

Increasingly comprehensive resource - see Curriculum MapA lot of podcast material for those of you with car journeys

InnovAIT “Courses” Available to AIT's. Log-in and select the InnovAIT journal 60-70 modules available - read the article from InnovAIT and then take a test

Question-only websites Onexamination.com 1500 questionsMore realistic, more expensive“Management" questions are better 

Passtest Large question bankMore medicine focus, less GPWorks well as a phone app

Passmedicine.com 2500 questionsHarder questions, can set a 2hr examVery good for O&G, Paeds, child development

How to Prepare a TopicIf I was revising “Neurology”, then I would:

1. Read the Neurology curriculum statement

2. Check the summary on the curriculum map

3. Read any examiner’s feedback

4. For each topic/ line on the curriculum map:• Revise knowledge

– Read any NICE guidelines– Read up patient.co.uk– Focus on the obviously important

(e.g. Respiratory – Occupational lung disease vs. Asthma)

• Take any knowledge tests on EKU/ InnovAIT

5. Run through questions on onexamination & passmedicine.

Learning Sets

Small groups (6-8 best), trainee-led

Meet weekly for about 2 hours

GP post – after Wed pm teaching

Now - AKT preparation

Later - CSA preparation.

AKT Learning SetsDecide how many meetings between now & the exam

For each learning-set week:

- Timetable a core curriculum topic

- Allocate a lead trainee

Ahead of their allocated meeting, the lead trainee prepares that curriculum topic (see my suggestion)

At the meeting, the lead trainee presents to the group an annotated curriculum map showing key guidelines, useful reading, useful online modules

During the next few days, everyone else then works through this material and runs self-test questions

Feedback by all at the start of the next meeting.

Summary - Any Questions?

• Pick your target slot• Consider timing with a GP post if possible• Remember run-in guide (1m per 1y post foundation)• Remember access to onexamination via the library• Do more than e-learning• Look at the guides on the VTS website• Consider study groups

Exam date: 30/10/13 29/01/14 30/04/14

Bookings Close: 18/09/13 04/12/13 10/03/14