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’ (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 years 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’s 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 Practical General Practice by Khot and Polmear) 
• Use online resources such as GPnotebook, Patient UK and CKS 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.
• 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.
• And read  a  GP magazine (online if you wish to) like Pulse or GP or InnovAIT.  InnovAIT is written for you and comes as part of your AiT package.
•  Practitioner (see links below) because they focus on subjects of relevance to ordinary GPs and their production values are very high and 

“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 has a mobile app 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.