NMRCGP Applied Knowledge Test

1. nMRCGPApplied Knowledge Test July 2009 Prepared by the AKT Group

2. Aims To increase confidence To help you pass AKT element of nMRCGP

3. Objectives To provide an overview of the content of the paper To describe, with examples, the current question formats To describe the principles of question construction in order to help candidates to answer them To advise on how best to prepare for and pass the paper - including feedback from recent papers

4. 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

5. Format: An “evolution” from the previous MRCGP Multiple Choice Paper A three hour, 200 item multiple-choice test Delivered on a computer terminal at an invigilated test centre Offered three times a year- Oct/Nov, Jan/Feb, April/May

6. Vital Statistics April 2009 results Pass mark = 126/199 (63.3%) Overall pass rate ST3 first time takers pass rate = 83.8% ST2 first time takers pass rate = 86.3% (This ratio varies in different diets 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%

7. Rules No limit to the number of attempts A pass will be valid for three years only Can be attempted at any time during GP specialist training (GPST), but most appropriately during the ST2 -ST3 years

8. How hard? “Examinations are formidable even to the best prepared, for the greatest fool may ask more than the wisest man can answer” Charles Colton (1780-1832), Lacon

9. 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. Remember that all question writers are working GPs

10. Common Reference Material Cochrane BNF GP Curriculum NICE SIGN BMJ Review articles & original papers BJGP DTB GMC Good Medical Practice

11. 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

12. The MRCGP Curriculum Statements continued How they are being used Curriculum statements have ‘Intended Learning Outcomes (ILO)’. Questions are derived to 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)

13. 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

14. Clinical Medicine (1) 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

15. Clinical Medicine (2) Cardiovascular Dermatology 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

16. Clinical Medicine (3) 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

17. Research, Epidemiology and Statistics (1) 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

18. Research, Epidemiology and Statistics (2) 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

19. Administration and Management Regulatory frameworks, e.g. PCOs 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

20. A few questions proved difficult…(AKT January 2009) Prescribing for children Child development Clinical governance: medicines management Infectious diseases, especially use of antimicrobials Contraceptive problems

21. A few questions proved difficult…(AKT April 2009) Prescribing for children Chronic disease management in children Clinical governance: medicines management Acute and emergency medicine in primary care Certification and fitness to drive legislation

22. Question Formats Single Best Answer (SBA) Extended Matching questions (EMQ) Tables and Algorithms (for completion) Picture format Data interpretation Seminal trials

23. 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 WHI, ALLHAT.

24. 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

25. 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 haemorrhage.

26. 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.

27. EMQ example: Double vision

28. EMQ example: Double vision

29. Algorithm example:Medical management of menorrhagia

30. 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

31. 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.

32. 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

33. Data Interpretation Interpretation of complex sets of data for patients with chronic conditions Interpretation of research and audit results

34. Data Interpretation example The summary findings of a systematic review which included six separate studies are show opposite. Ref: BMJ  2007;335:473 

35. 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

36. 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’

37. Feedback Feedback will be provided to every candidate with their result Their overall score The pass mark Their performance in each of the 3 main subject areas More general feedback on overall performance will continue to be forwarded to all UK deaneries and placed on the RCGP website

38. 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

42. Computer Based Testing There are approximately 150 test centres covering all parts of the UK Candidates will be able to book the AKT at a local venue, on “a first come, first served” basis

43. 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

44. Computer Based Testing Responses will be uploaded to a central server and then passed to the RCGP for post test analysis Following this, results and feedback will be sent individually to candidates

45. Computer Based Testing Please bring identity documents which MATCH examination registration details Please arrive in good time Late arrival or failure to provide matching ID will result in you being unable to sit the AKT

46. POINTS TO REMEMBER AT ALL TIMES Time management – this is everything Cover test – can you answer the question with the option list covered? Mark answer box carefully Skip difficult questions rather than waste time (you can electronically highlight the ones you have left out) Go through those not done 2nd time round Guess any at the end to ensure all answered Check for silly mistakes if you still have time Keep watching the clock (200 questions in 3 hours)

47. Further preparation Small revision groups to share the workload Learn from your clinical experience – check the guidelines and references Exam website feedback, sample material and syllabus

48. And finally.. Are you confident at tackling AKT statistics and critical reading questions? Can you see the achievable level of competence you need? Can you plan to efficiently prepare for this module?