AKT

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WHAT IS THE AKT?

It’s a multiple choice type paper testing the application of knowledge.

You wont find any true-false type questions that you might be use to because these only test the recall of facts.

Instead, the AKT has MCQs like “extended matching questions” and “single best response” because they test the application of knowledge rather than parrot fashion recall.

Pearson Vue centres are currently where the driving theory test is held.

INCREASING YOUR CHANCES OF PASSING THE AKT

Basically, to pass the AKT you need to be able to do two things:

  1. aquire knowledge and
  2. know how to apply that knowledge (using it in context)

A way of doing this might be:

The applied knowledge test can test from the whole of the GP curriculum and as you know, that is one heck of a document. So, how can you study effectively to ensure a better chance of passing the exam? There are several things that come to mind:

  • Practise, practise and practise!   No GP training scheme can give you experience in every branch of medicine. Therefore, practise as many MCQs as you can even if they are not in the MRCGP format.
  • Read the questions carefully. Look for clues in the wording. Keep checking that you are filling in the lozenges in the right place on the answer sheet.
  • When practising, identify which areas you are weak on and then read around those subject areas.
  • Go to the Royal College’s website and read the feedback from the AKT examiners.   They often give you clues about what trainees struggled with.  Questions from these areas of difficulty are often repeatedly tested.
  • This is Important: 80% of the questions are clinical, 10% on critical appraisal and EBM and another 10% on health informatics and organisational aspects. The clinical domain is limitless but critical appraisal, EBM, health informatics and organisational stuff are more contained. Therefore, don’t neglect these areas as the questions relating to them are pretty easy to pick up.
  • Quite a lot of questions will be based on recent literature. So get to grips with the evidence for common conditions.  Images such as algorithms, ECG traces and photographs may also be shown.

READING FOR THE AKT

Examiners are always playing around with the format so read the latest RCGP guidance which you will usually find on their web site www.rcgp.org.uk  .   Also, you need to develop a schedule on how you are going to cover all the areas (clinical, organisational etc.) from now until the exam.  And stick to that schedule.

The AKT Content Guide

The first thing to look at is the AKT Content Guide which is downloadable from the resources link above.  The AKT Core Group has developed this learning resource to complement the curriculum which essentially lists the topics that could be tested in the AKT.  It is not an exhaustive list and inevitably it will need to be updated but we hope that it will be helpful in defining the topics that candidates should be aware of, particularly in the areas of Evidence interpretation including research, statistics and epidemiology, and Organisational questions which include administrative, statutory, ethical and regulatory frameworks.  It is designed to be used in conjunction with the curriculum and is not a substitute for it.  It may look daunting but we would encourage trainees to read the Introduction to understand its use, and there are examples to show how topics relate to the curriculum. The curriculum link is  www.rcgp.org.uk/gp-training-and-exams/gp-curriculum-overview.aspx

Review Articles & Journals

Some questions for the multiple-choice paper are derived from review articles and journals. Therefore in preparing for this component of the examination you should also cast your eye over several of these publications regularly.

  • NICE guidelines (and all the NSFs)
  • InnovAIT
  • BJGP
  • Drugs & Therapeutics Bulletin
  • MeReC Bulletins
  • CMO updates
Occasionally flicking through some GP magazines (like Pulse, Doctor, GP) can be helpful too.  They have a knack of summarising clinical topics very well, often through colourful pictures and flow diagrams.
E-learning
Books
  • Oxford Handbook of General Practice
  • Medical Statistics Made Easy

Both of these can be bought from our Amazon-linked bookstore.  For a full range of books on AKT, click here.   Please consider buying from Bradford VTS’s link through Amazon – they give us around 4% of sales which helps keep this website free. 

NATIONAL COURSES FOR THE AKT

There are two GP update types of courses (both are as good as each other) which kind of aim to give you a crash course in the latest clinical knowledge and evidence. But remember, AKT is also about managment and organisation in general practice too.

The two national courses in the UK are…

LOCAL COURSES FOR THE AKT (YORKSHIRE & THE HUMBER)

There are two courses in the Y&H region.  The RCGP Faculty course and AKT Remedial course.  The first is for any trainee.  The second is only for trainees who have taken it and failed.

RCGP Faculty course

This well established course is very well evaluated by GP trainees. It has a very strong focus on developing an understanding of and abilities in using Evidence Based Practice. The course aims to cover particular areas like :

  • Understand the practical logistics of sitting the exam
  • Understand and apply relevant principles, methods and tools of Clinical Epidemiology
  • Learn important equations and principles of statistics
  • To practice questions on statistics (and screening tests) with feedback from tutors
  • To sit a RCGP approved mock AKT Paper and reflect on the experience of taking an RCGP AKT paper with feedback on your performance.
  • To understand the major sources that AKT examiners use to derive their questions. To identify learning needs and tips on how to address them.
  • Learn how to focus your learning and save time.

It is a one day course.  Applications for Study leave for the course should be made through the local scheme  along with an application for study leave. Details are available through:  http://www.rcgp.org.uk/courses-and-events/yorkshire/white-rose/

School of GP remedial course

This course is available only to those who have failed AKT and who are GP trainees in Yorkshire and the Humber.  Its focus is much less technical than the RCGP course and it will not attempt to teach skills in Evidence-based medicine, or statistics nor does it include a mock exam paper. The emphasis of the School Half Day Remedial course is to help those who prepared once already to look at how they prepared  the first time and so look at the changes they need to make to enable a successful later attempt at the AKT.

The course will therefore look at :

  • Share experience of preparation strategies both short, medium and long term
  • Explore learning styles and how to identify learning needs
  • Discuss resources for learning and issues around practice questions and mock examinations
  • Discuss personal and professional organisation and how this can impact on AKT preparation
  • Examine how life, family and other pressures as well as personal health and well being effect ability to prepare           for AKT
  • Explore how best to use available resources (written, online, ES/CS etc.)

Those who have failed will be contacted and notified of the application process. The scheme and practice /employer will need to be informed and leave applied for.

Is it appropriate to go on both courses?

This is something to discuss with your ES /TPD  but the courses are significantly different and feedback from those who have been to both has been that they gained very different knowledge and skills from attending each course.

ADVICE FROM A TRAINEE

There were a number of things I did which taken in totality completely altered my revision.  Please remember, some of these things will work for some people and for others they won’t make that much of a difference.  You decide.

  1. I got a new computer that worked more effectively, in particular better screen and resolution resulting in less flicker and less concentration issues through less issues re ease of use;
  2. Changing my revision location from the couch to a desk. In part changing to a desktop computer forced me to do this. Using a desk rather than a couch improved focus and concentration. It also meant I had a place of ‘study’ and a place of ‘rest';
  3. Changing to paper for revision questions. After attending an AKT preparation course I had a Eureka moment – where I found I could do the questions at least on paper and much faster than on a computer.   I suspected that for me I was burning concentration doing revision questions off a computer rather than burning the concentration focusing on reading the question. I changed to paper-based books which somehow felt more appropriate;
  4. I continued to do some EMQ questions to keep myself in tune with answering such questions but I focused on topics that I had struggled with. For example dermatology and ophthalmology questions, especially the picture questions;
  5. I looked at how my brain likes to retain information. My brain is one that likes to question why and is poor at rope learning- it does not have enough things to hang the information on. Rather than just read the Prodigy topics I also looked at the Evidence and Background (epidemiology) sections. The additional information in these sections gave me the context and arguments to allow my brain to comprehend and therefore retain the information as to the evidence and guidelines. It also allowed me to understand why certain investigations/tests are appropriate or not for the different topics- this allowed me to answer the questions where you have to answer which is the single best or most appropriate test/option from a given list of possible answers (typically all plausible to varying degrees). In this respect I identified that the revision needed to give me context, something which only going through revision questions and their answers per se gives you limited info on and is where perhaps revision for undergraduate finals and professional exams differs;
  6. I adapted the ePortfolio to my learning needs, using the PDP to highlight topics I was revising and when done signing off the PDP and then linking from the given PDP to a reflection of learning where I summarised the key points learnt. This kept my ePortfolio relatively up-to-date in a time of considerable stress and time pressure, and also by doing the reflective account 2-3 days after the initial learning allowed me to use the ePortfolio to reinforce my revision in a timely and efficient manner;
  7. I used the AKT Preparation course material to highlight topics and tools for further revision. This was especially useful for topics that were perhaps obscure and are little highlighted in VTS teaching, for example Organisational and Business aspects of GP life;
  8. I rope-learnt key topics which consistently come-up and which can only be rope learnt. To do this I used the 72 hours lead-up to the exam to rope learn flight + driving rules, vaccination schedules and the like. I had not done this before namely because I had not had sufficient time to prepare (mainly my own fault). using spare study days/holidays is probably sensible and is what I did. I also suspect that many people try to rope learn such topics in the day before the exam. For me (and I suspect many others) this is not possible to do successfully, and I am glad I took 2-3 days to learn it all. I definitely picked-up easy marks doing this;
  9. I spoke frankly with my clinical trainers and asked them where they thought my weakness were and what they felt I needed to do. I did not take all of their advice but I used them to help focus me especially during review of my clinical sessions;
  10. And finally, I made sure that I got a good nights sleep beforehand.

SPECIFIC RESOURCES

  • Prodigy websiteI looked at Prodigy and focused on ‘current’ topics. I appreciated that the CKS website is no longer updated but given that this was written essentially by Prodigy I merely moved my focus to the Prodigy website; the Prodigy website continues to be updated and the data is presented in similar manner to the CKS website, therefore likely to be applicable to AKT revision. I hammered the last 3-4 months of Prodigy topics- many of these were relevant to the upcoming AKT as they highlighted relatively recent topics and changes, and therefore are likely to be reflected by topics of interest to the AKT;
  • eGuidelines: I used eGuidelines to go over recent guidelines in topics where I was more familiar and needed specific, comprehensive summaries of information, for example in topics which I felt I knew a little more in-depth than those I used Prodigy for. Topics where I struggled to retain/understand the eGuideline info from I then returned to Prodigy or used other texts (including google) to drill down further;
  • I read through the BNF sections on prescribing, poisoning, prescribing in the elderly, palliative care prescribing and the like;
  • I bought the Oxford Handbook of General Practice and read through the first 6 chapters which included information on the GMC contract etc;
  • I used the RCGP website extensively. I went through at least the past 2 AKT paper summaries to identify topics which people had scored poorly on and were likely to come-up. Doing this helped me identify a number of topics I had not thought of and thus would not have revised.  I used the free e-learning modules on the RCGP website. These were concise and gave you free questions of relevance to the AKT exam. For me they were especially useful as they also provided context to the topic and allowed me to understand ‘why’ and so retain the information better;  
  • I did the same thing with a number of free websites such as that run by HAYS Publishing, publisher of MIMS and (I believe) Pulse. These were not as good as the RCGP website but often highlighted new changes in topics, for example new contraceptives; these changes were often acknowledged in the AKT exam questions and so an awareness was relevant and often made you do further study in these areas in Prodigy, etc.;
  • I used the RCGP Essential Knowledge Updates and their questions. I went through a number of these. The questions are very similar to those of the AKT exam (unsurprisingly) and the update info was also concise and useful;
  • I used the National Prescribing Centre evidence-based medicine website - pages that were highlighted in the preparation material for the AKT preparation course. Whilst I had already done them, revising them again allowed me to hone my thoughts and avoid simple errors. I then did some practice questions to remind myself of the formulae and hopefully retain them in my head along with the definitions of things like sensitivity and specificity.There seemed to be a lot of calculations in this exam (more so than in previous) and I believe doing some practice in the day or so before the exam helped;
  • Other resources worth mentioning at this point: the book called ‘Medical Statistics Made Easy’ by Harris.  
  • And of course, don’t forget the NICE guidance for the common stuff like COPD, Heart stuff and so on.
  • I went through the AKT online video from the Pearson Vue website. Despite having done the exam before I discovered information on the video that was useful and helped me in the exam.
  • For practice questions use passmedicine.com or onexamination.com. I also used the Scottish nPEP website for free questions; I had already done this previously but I went back over 1 or 2 key topics. They are free for everyone if you phone the Scottish RCGP and explain who you are.

CLOSING SUMMARY

Put simply I had enough time before the exam for adequate revision. I didn’t go stupid on revision and probably did a lot less than some people.  I had an idea of the Examiners’ thought processes through the AKT Preparation course and from this I was able to devise a strategy that worked for me.   For example, Examiners love the BNF and NICE guidance for common stuff like COPD, heart failure and hypertension. Targeted study is much more efficient than a scatter gun approach – using previous RCGP AKT reports as mentioned.  Stats for example is an easy place to pick up easy marks.    The ‘Medical Statistics Made Easy’ book has loads of worked examples – keep doing them until you are slick.   There are quite a few calculations in the exam.  I spent 1-2 days solid on it total and got 100%, and I don’t like stats.   I also looked at myself and my weakness and challenged myself to adapt, either focusing on those weaknesses that could be improved relatively easily (like organisational and statistics).   Set aside some study or annual leave.

ADVICE FROM AN EXAMINER

How to revise for the AKT – by James Heathcote, GP Trainer and Examiner, Bromley, Kent

In planning how best to help you, I have tried to guess your ideas, concerns and expectations for this article and I hope I’ve got it wrong, because my guess is that you probably think that revision is the best way to pass an exam and that what you really need now is a short reading list. This idea is based on the assumption that the best way to pass an exam is to go on the right course, read the right books and practice lots of MCQ questions. But that’s not going to be my advice to you, because that’s not how I see the exam and not how I would recommend you should study.

So, if the very idea of applying ideas, concerns and expectations to the AKT is already making you uncomfortable – Why is that?

Well, firstly, don’t worry – I’m not going to completely overturn your expectations. I would however strongly advise you to reflect on an alternative view of this exam, which is based on the idea that the AKT is an exam designed to test the working knowledge of a competent GP, the concern that what you cram today stays in your brain for a couple of weeks at most and the expectation that if I can persuade you to consider lifelong learning, it really will set you up for life!

Although I have only the accounts of others to tell me how today’s GP trainees study, I do have 13 years of experience of examining for the old MRCGP and was briefly involved in writing AKT questions. I therefore know a lot about how examiners think and have witnessed the process whereby questions are chosen and refined for inclusion in the AKT question bank. I also sat the first ever AKT, when examiners were invited to try out the paper in advance of the candidates, and passed it with a score of 82.5% having done no revision whatsoever. So my advice on studying for the exam is not just a collection of random thoughts.

So – what does lifelong learning look like? Well, there are two ways of looking at what you need to know to be a GP. The current favourite is to define a ‘curriculum’ and then structure an exam around that curriculum using a ‘blueprint’ (see: www.rcgp.org.uk/gp-training-and-exams/gp-curriculum-overview.aspx ).

This feels reasonably scientific and the exam is very carefully planned to sample different areas of the curriculum in due proportion. But there is another view of what you need to know for real life general practice, which I suggest provides a much better way of preparing both for the exam and for your future career – i.e. consider that common things are common and, as you already know, after just a few weeks you have seen all of the most common conditions (URTIs, headache, back pain, UTIs, feverish children, hypertension etc.), after three or four months, you will have seen the majority of important GP problems and after a year you will have seen almost everything you need to know.

You may not have seen a case of Churg Strauss syndrome or pseudo-hyperparathyroidism, but that doesn’t matter. You will have seen all the common and reasonably common conditions and refined your ability to recognise what you don’t know and how to find the information you need to manage uncertainty. That is what GPs do and if throughout your trainee year you keep your eyes open and research your gaps and your learning needs (your PUNs and DENs) you will easily cover all that you need to pass the exam.

But because you may think it better to take the exam early in the year (which I understand, but don’t really recommend) you should also get reading now!

Buy a good general practice textbook (eg Khot and Polmear) and use on line resources such as GPnotebook, Patient UK and the NHS Library for Health both during and after your consultations, so that you link your learning to live cases. Make revision notes if you are a note taker and include the patient ID number, so that you can refresh your memory later.

Then read what your trainer and the examiners read: read the BMJ because it is a reliable source of information and follows the mood of the day, but concentrate on the bits that are relevant to general practice – clinical reviews, the Ten Minute Consultation articles and papers written by ‘ordinary’ GPs.

Read also the assorted bits of paper that come to the practice on a daily basis from various sources. In the past few days, I have seen some useful information on HIV and the Chief Medical Officer’s newsletter which included updates on HPV vaccination, carbon monoxide poisoning and changes to the law on cremation – the sort of information that the AKT question setters are reading but that you won’t find elsewhere!

And when you go to meetings in the practice or elsewhere, keep your ears and eyes open for essential information that might make a good AKT question – i.e. information that is relevant to general practice, clear cut and not so detailed or obscure that you would expect to have to look it up. Then read GP magazine (or an equivalent on-line), subscribe to Update and the Practitioner (see links below) because they focus on subjects of relevance to ordinary GPs and their production values are very high and read InnovAiT, because it is written for you and comes as part of your AiT package.

“But what about the cramming?” you ask. Well before you hit the NICE guidelines, first make yourself really familiar with the bible of general practice therapeutics (the BNF) and study the chapter headings for all common conditions. Then register for eGuidelines, which is a good web resource and only then (if you must) order some NICE guidelines – but be selective. The AKT is not a test of NICE guidance – just ask your trainer when s/he last referred to a NICE guideline during a consultation! By all means know about the guidelines that exist, but focus on when and how to apply them in real life situations.

General practice is a very broad subject and quite different to the hospital medicine that you are used to. It does have clear cut content, but there is no definitive study guide, the MCQ books on the market are not written by AKT question setters and the real examiners approach general practice and the AKT from many different angles.

Read widely and learn from the patients you see and you will have no problem passing the AKT.

(with thanks to Kate Neden, member of the AKT development group of examiners, who commented on this article in draft form)

I AM REPEATEDLY FAILING THE AKT. WHAT CAN I DO?

If this is something like your third or fourth attempt, consider getting a dyslexia assessment. Dyslexia is a common but unrecognised condition and if you have it, you may be given an extra 45 minutes in the AKT exam. Look at these two websites for more information.

Talk to your TPD, ES and/or Trainer if you think you might have it. Please don’t feel embarassed. More information here: at the www.bdadyslexia.org.uk site.