Dr Mark Feldman
Dec 13, 2015
Relevance: The AKT should be relevant to general
practice; any topic covered can be one which occurs commonly or one which is significant but less common
High prevalence: Low impact e.g. URTI High impact: Low prevalence e.g.
meningitis Topical: e.g. Controlled drugs
Clinical Evidence
Cochrane Database
BNF
GP Curriculum
NICE
SIGN
BMJ Review articles & original papers
BJGP
DTB
Core clinical medicine and its application to problem solving in a general practice context ◦ 80% of items
Critical appraisal and evidence based clinical practice◦ 10% of items
Ethical and legal issues as well as the organisational structures that support UK general practice◦ 10% of items
Regulatory frameworks
Legal aspects, e.g. DVLA
Social services, e.g. Certification
Professional regulation, e.g. GMC
Business aspects, e.g. GP contract
Prescribing, e.g. Controlled drugs
Appropriate use of resources, e.g. drugs
Health & Safety, e.g. needlestick injury
Ethical, e.g. Mental capacity, consent
Know latest guidelines
Know the BNF
Know basic stats
Your core medical knowledge is probably already sufficient.
1102 candidates Mean score 71% Top Score 92% Pass mark 63.3% Pass rate 83.8%Pass rate ST2 86.3%Pass rate ST3 83.8%
Asthma – in childhood
Breast and skin disorders
Certification
Fitness to work and drive
Emergency medicine
You must bring:
BNF, Stethoscope, Ophthalmoscope, Auroscope, Thermometer, Patella hammer, Sphygmomanometer (aneroid or electronic), Tape measure, Peak flow meter and disposable mouthpieces
There are no spares at the exam centre
Anything else you need is provided
You have your own room.
You have a list of patients – your ‘surgery’ for the morning.
The list contains brief info about the patient.
It may or may not include PMH, drugs etc.
You probably wont know why they are coming.
You have never seen the patient before – but colleagues might have.
Buzzer will sound and patient and examiner come in.
You have 10mins after which buzzer will sound again. Anything said or done after this will not count. The patient and examiner then leave.
There is no ‘1min/2min’ warning buzzer.
There is a 2 minute break between patients.
There is a 15min break after 7 patients seen.
The examiner sits out of your line of site.
Examiner does not participate in the consultation. Ignore them.
All patients are played by actors who have been well briefed beforehand
They will almost certainly not have any physical signs to elicit on examination
If you want to examine the patient say so and say what you are going to examine.
If they are testing this exam technique they will let you go ahead.
They will then give you the exam findings.
If they are not testing this exam they will just give you the findings and tell you not to examine.
They will only give you results of exams you say you will do.
Examination is what you would normally do as a GP.
This means a lot of it can be done with the patient sitting in the chair.
It does not have to be exhaustive.
Eg. Chest exam – percussion and auscultation is fine.
Any investigation results will be on the table in front of you or, more likely, will be brought in by the patient.
It will list normal levels so you don’t have to remember them.
Abnormal findings will be common GP tests.
Eg. Hb, HbA1c, urinalysis etc.
It will not be anything obscure.
If you want to prescribe a drug you don’t have to write a prescription
All you need do is say
Eg. I will give you omeprazole 20mg once a day.
This is as good as having written it.
There are prescription pads on the table. Do not let these distract you.
DON’T WRITE ANYTHING DOWN
There is no time
The prescription will be marked
There is no penalty for just saying it
You have to say what you are giving anyway
The same applies for blood tests and sick notes and any other forms you might write.
Just say what you will do.
If you want to make a referral, ask the patient to wait in the waiting room and you will bring the letter/form out to them.
Leaflets can be ‘collected from reception’
You have 10 minutes per case.
‘Shows poor time management’ is a reason they can fail you at the station.
And they will.
You MUST be consulting at 10 minutes.
Each case is marked in 3 domains :
◦ Data gathering, examination and clinical assessment skills
◦ Clinical management skills◦ Interpersonal skills
All domains have equal weighting
Do not spend 8 minutes on history and examination – you will fail the station.
DATA-GATHERING, TECHNICAL & ASSESSMENT SKILLS
Gathering & using data for clinical judgement
Choice of examination
Investigations & their interpretation
Demonstrating proficiency in performing physical examinations & using diagnostic and therapeutic instruments
CLINICAL MANAGEMENT SKILLS
Recognition & management of common medical conditions in primary care
Demonstrating a structured & flexible approach to decision-making.
Demonstrating the ability to deal with multiple complaints and co-morbidity.
Demonstrating the ability to promote a positive approach to health
INTERPERSONAL SKILLS
Demonstrating the use of recognised communication techniques to gain understanding of the patient's illness experience and develop a shared approach to managing problems.
Practising ethically with respect for equality & diversity issues, in line with the accepted codes of professional conduct.
The grades will be on a four point scale:
Clear Pass Marginal Pass Marginal Fail Clear Fail
There are no merits or ‘grades’ at the end for the exam as a whole.
You pass or fail.
Disorganised and unsystematic in gathering information from history taking, examination and investigation
Does not identify abnormal findings or results or fails to recognise their implications
Data gathering does not appear to be guided by the probabilities of disease
Does not undertake physical examination competently, or use instruments proficiently
Does not make appropriate diagnosis
Does not develop a management plan (including prescribing and referral) that is appropriate and in line with current best practice.
Follow-up arrangements and safety netting are inadequate
Does not demonstrate an awareness of management of risk, and health promotion
Does not identify patient’s agenda, health beliefs & preferences / does not make use of verbal & non-verbal cues
Does not develop a shared management plan or clarify the roles of doctor and patient
Does not use explanations that are relevant and understandable to the patient
Does not show sensitivity for the patient’s feelings in all aspects of the consultation including physical examination
Disorganised / unstructured consultation
Does not recognise the challenge (e.g. the patient’s problem, ethical dilemma etc.)
Shows poor time management
Shows inappropriate doctor - centeredness