Akt Notes Vts

NMRCGPAKT

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 StatisticsJan 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 MISSIONIF 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

CochraneBNFGP CurriculumNICESIGNBMJ Review articles & original papersBJGPDTBGMC 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 factorssymptomsinvestigationmanagement

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/learning/channel-home.html

Administration / Management

Regulatory frameworks,e.g.PBCLegal aspects, e.g. DVLASocial services, e.g. CertificationProfessional regulation, e.g. GMCBusiness aspects, e.g. GP contractPrescribing, e.g. Controlled drugsAppropriate use of resources, e.g.

drugsHealth & Safety, e.g. needle stick

injuryEthical, 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 diseaseA 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. .AsthmaB. PneumothoraxC. Pulmonary embolusD. Left ventricular failureE. Pulmonary hemorrhage.

New question formatsData 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


G Myasthenia gravis


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.


A Berry aneurysm

B Cerebral glioma

C Drug induced

D Graves disease

E Ischaemic stroke


G Myasthenia gravis


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.


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

_______


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


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 iTranexamic acid

Combined oral contraceptive pill

DLevonorgestrel 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

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

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 RoadSutton 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

Documents

Akt Notes Vts