NMRCGP
AKT
APPLIED
KNOWLEDGE TEST
(Adapted from RCGP AKT GROUP)
AKT aims
The AKT is designed to test the
application of knowledge and
interpretation of information
Each question is intended to explore a
topic of which an ordinary GP could be
expected to have a working knowledge
Background
Replaces the previous Multiple
Choice Paper (MCP)
Summative assessment of the
knowledge base that underpins
independent general practice
within the United Kingdom.
Mapped to the RCGP Curriculum
Format:
An evolution from the previous
MRCGP Multiple Choice Paper
A three hour, 200 item multiple-choice
test
No multiple true/false questions
No negative marking
Delivered on a computer terminal at an
invigilated test centre
Offered three times a year- Oct/Nov,
Jan/Feb, April/May
Vital Statistics
Jan 2010 results
Pass mark = 134/200 (67%)
Overall pass rate
ST3 first time takers pass rate = 83%
ST2 first time takers pass rate = 80%
(This ratio varies in different times of the AKT taken at
different times throughout the training year)
Cumulative pass rate for all those in ST3 after 3
attempts is approximately 94%
Rules
i. NO COPYING !
ii. NO limit to the number of attempts
iii. A pass will be valid for three years
only
iv. Can be attempted at any time during
GP specialist training (GPST), but
most appropriately during the ST2-
ST3
The MRCGP Curriculum Statements
Where to find them
RCGP website
http://www.rcgp-curriculum.org.uk/
What are they?
Series of papers, each covering different clinical and
practice management areas, based on European
Academy of Teachers in General Practice (EURACT)
framework.
Written by a variety of GP experts and coordinated by
RCGP
The MRCGP Curriculum Statements
How they are being used
Curriculum statements have Intended
Learning Outcomes (ILO). Questions are
derived from specified learning outcomes
within specified curriculum statements.
This enables sampling from across the
curriculum, as cases can be mapped to the
curriculum statements (or nMRCGP
blueprint)
Paper Construction ensures:
Reliability, validity and fairness.
Adequate coverage of the topics that
appear in the blueprint.
The correct balance of question
formats
Principles of paper construction
Relevance: the AKT should be
relevant to general practice
High prevalence: any topic
covered can be one which occurs
commonly
High impact: or one which is
significant but less common
Question writing
Scenarios derived from clinical work
Practice issues
Topical
All questions are referenced and the
draft questions are then carefully
scrutinised by a panel of other
question writers.
All question writers are working GPs
YOUR MISSION
IF YOU CHOOSE TO ACCEPT IT
In your CLUSTER:-
Be a RCGP Examiner
Research a topic
Choose what is important
Write 30 questions based on this
Of which 20 will be submitted by each
cluster for a VTS AKT Exam on
27/5/2010, invigilated by???????
AKT subject content
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
Common Reference
Material
Cochrane
BNF
GP Curriculum
NICE
SIGN
BMJ Review articles & original papers
BJGP
DTB
GMC Good Medical Practice
Clinical Medicine
The broad topic of clinical
medicine is subdivided into
groups of body systems, in
approximately equal numbers
Each group will comprise
sections on
disease factors
symptoms
investigation
management
Clinical Medicine
Dermatology
Cardiovascular
Endocrinology
ENT
Gastroenterology
Genetics
Haematology
Immunology
Infection
Mental health &
learning
disability
Musculo-skeletal
Neurology
Ophthalmology
Paediatrics
Renal
Reproductive
male/female
Respiratory
Therapeutic
indications and
adverse reactions
Clinical Medicine
Common, low impact e.g. sore
throat, otitis media, impetigo
Rare, high impact e.g. child
abuse, meningitis,
phaeochromocytoma
Topical e.g. MRSA, Type 2
diabetes management
Research, Epidemiology & Statistics
Understanding the principles
of audit and its application in
assessing the quality of care
Understanding the application
of critical appraisal skills
which will be tested in a
number of formats e.g the
interpretation of research data
Research, Epidemiology and
Statistics
Understanding and application
of terms used in both inferential
statistics and evidence based
medicine.
e.g. as described in BMJ
Learning modules
http://learning.bmj.com/learnin
g/channel-home.html
Administration / Management
Regulatory frameworks,e.g.PBC
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. needle stick
injury
Ethical, e.g. Mental capacity,
consent
Feedback on the January 2010
MRCGP Applied Knowledge Test
(AKT)
The mean scores by subject area were:
'Clinical medicine' 73.7 %
Evidence interpretation 69.1 %
Organisational questions 65.1%
Areas causing difficulty for
candidates Jan 2010
Drug and alcohol problems
Care of Children and Young
Care of Older Adults
Women`s health
Care of Acutely Ill People
Personal and Professional Responsibilities
Performance in organisational questions
is often fairly poor
Question Formats
Single Best Answer (SBA)
Table/Algorithm
Picture Format
Data interpretation
Seminal Trials
Extended Matching Questions (EMQ)
Single Best Answer (SBA)
According to national
guidelines means recommended
by nationally accepted
guidelines or the BNF, not local
practice
Often uses a clinical scenario
Only ONE answer is correct
Other options may be plausible
SBA example:
Respiratory disease
A 17-year-old student suddenly develops
chest pain and dyspnoea after a morning
swim. There is hyper-resonance and
decreased breath sounds on the right side.
Which is the SINGLE MOST likely
diagnosis? Select ONE option only.
A. .Asthma
B. Pneumothorax
C. Pulmonary embolus
D. Left ventricular failure
E. Pulmonary hemorrhage.
SBA example:
Respiratory disease
A 17-year-old student suddenly develops
chest pain and dyspnoea after a morning
swim. There is hyper-resonance and
decreased breath sounds on the right side.
Which is the SINGLE MOST likely
diagnosis? Select ONE option only.
A. .Asthma
B. Pneumothorax
C. Pulmonary embolus
D. Left ventricular failure
E. Pulmonary hemorrhage.
New question formats
Data interpretation
Interpretation of complex sets of
data for patients with chronic
conditions. Relevant risk tables
are included if appropriate.
Seminal trials
Familiarity with significant new
research
e.g. Knowledge of studies which
significantly change clinical
practice such as ALLHAT.
Extended matching questions
(EMQ)
These questions have a list of
possible options
There will usually be 3 or more
scenarios
Choose the most appropriate option
that best matches each given
scenario
Each option can be used once, more
than once, or not at all.
A Berry
aneurysm
B Cerebral glioma
C Drug induced
D Graves disease
E Ischaemic stroke
F Multiple sclerosis
G Myasthenia gravis
For each patient described, select the SINGLE MOST
likely diagnosis from the list of options above.
1. A 35-year-old man who is a non-smoker,
suddenly develops a severe headache and
double vision. His right pupil is fixed and
dilated.
EMQ example: Double vision
A Berry
aneurysm
B Cerebral glioma
C Drug induced
D Graves disease
E Ischaemic stroke
F Multiple sclerosis
G Myasthenia gravis
For each patient described, select the SINGLE MOST
likely diagnosis from the list of options above.
1. A 35-year-old man who is a non-smoker,
suddenly develops a severe headache and
double vision. His right pupil is fixed and
dilated.
EMQ example: Double vision
A Berry
aneurysm
B Cerebral glioma
C Drug induced
D Graves disease
E Ischaemic stroke
F Multiple sclerosis
G Myasthenia gravis
For each patient described, select the SINGLE MOST
likely diagnosis from the list of options above.
2) A 48-year-old woman has transitory
double vision towards the end of most days.
She smokes 10 cigarettes/day. She has
vitiligo and hypothyroidism.
EMQ example: Double vision
A Berry
aneurysm
B Cerebral glioma
C Drug induced
D Graves disease
E Ischaemic stroke
F Multiple sclerosis
G Myasthenia gravis
For each patient described, select the SINGLE MOST
likely diagnosis from the list of options above.
2 ) A 48-year-old woman has transitory
double vision towards the end of most days.
She smokes 10 cigarettes/day. She has
vitiligo and hypothyroidism.
EMQ example: Double vision
Algorithm example:
Medical management of menorrhagia
For each of the numbered gaps above, select ONE option
from the list below to complete the algorithm, based on
current evidence. Each option may be used once, more
than once or not at all.
Non-
hormonal
Hormonal
therapy
1
_______
2
_______
Combined oral
contraceptive
pill
3
_______
Algorithm example:
Medical management of menorrhagia
A Cyclical norethisterone
B Copper-bearing intra-uterine device
C Inert intra-uterine device
D Levonorgestrel releasing intra-
uterine system
E Medroxyprogesterone acetate
F Mefenamic acid
G Nonoxinol 9
H Tibolone
I Tranexamic acid
Algorithm example:
Medical management of menorrhagia
For each of the numbered gaps above, select ONE option
from the list below to complete the algorithm, based on
current evidence. Each option may be used once, more
than once or not at all.
Non-
hormonal
Hormonal
therapy
F i
Tranexamic
acid
Combined oral
contraceptive
pill
D
Levonorgestrel
releasing intra-
uterine system
Mefenamic
acid
Picture Format example:
Skin disease
A 32-year-old man has noticed painless non-itchy
patches of hair loss on his beard area and scalp.
Picture Format example:
Skin disease
Which is the SINGLE MOST likely
diagnosis? Select ONE option only.
A Alopecia areata
B Eczema
C Lichen sclerosis
D Tinea infection
E Vitiligo
Ref: Dermnet.com
Picture Format example:
Skin disease
Which is the SINGLE MOST likely
diagnosis? Select ONE option only.
A Alopecia areata
B Eczema
C Lichen sclerosis
D Tinea infection
E Vitiligo
Ref: Dermnet.com
Data Interpretation
Interpretation of complex sets of
data for patients with chronic
conditions
Interpretation of research and
audit results
Data Interpretation example
The summary findings of a systematic review which
included six separate studies are shown.
Data Interpretation
example
Which SINGLE
study suggests the
WEAKEST
association between
increased whole
grain intake and a
risk of type 2
diabetes? Select
ONE option only.
A Fung
B Meyer
C Montonen
D NHS1
E Van Dam
Data Interpretation
example
Which SINGLE
study suggests the
WEAKEST
association between
increased whole
grain intake and a
risk of type 2
diabetes? Select
ONE option only.
A Fung
B Meyer
C Montonen
D NHS1
E Van Dam
Scoring
All question formats have
equal weighting
Each correct answer is
awarded one mark
Total score on the paper is the
number of correct answers
given
No negative marking - Fear
factor
Computer Based Testing
Once candidates have registered with the
RCGP to sit the AKT, they will be given a
phone number to book with the Pearson VUE
test centre.
It is recommended that candidates
familiarise themselves with the
demonstration tutorial on the Pearson Vue
website :
https://www.pearsonvue.com/rcgp/
The AKT also begins with a short tutorial to
remind candidates how to mark the answers
screen shots follow of the live tutorial
Test Centre Information
Sutton Coldfield, Test Centre: Pearson
Professional Centres-UK Sutton
Coldfield Address:
Four Oaks House
160 Lichfield Road
Sutton Coldfield, B74 2TZ
United Kingdom
Computer Based Testing
Security at each centre will be robust
Identity checks
Invigilated
Video monitoring
Test forms are downloaded to each centre on
the test day
Separate morning and afternoon sittings with a
quarantine period at lunchtime.
Morning candidates will not be allowed to leave before the end of
the test
Computer Based Testing Rules
Candidates must bring
identity documents
WHICH MATCH
examination details
Candidates should arrive in
good time
Candidates who either arrive
late or fail to provide
matching ID, will NOT be
admitted to sit the AKT
