MRCGP Applied Knowledge Test

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An overview of the content and structure
To give examples of current question formats
To describe how questions are constructed
To advise on how to prepare and pass the AKT
To explain practicalities of computer-based tests
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The AKT:
Is a summative assessment 
of the knowledge base
underpinning independent UK general practice
Tests the application of this knowledge
Tests the critical interpretation of information
Is mapped to the latest RCGP Curriculum updates
Each question is intended to explore a topic
which an ordinary GP in the UK could be
expected to have a working knowledge
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200-item multiple-choice test lasting 190 minutes
(3 hours 10 minutes)*
No multiple true/false questions
No negative marking
Delivered on a computer terminal* at an
invigilated test centre
Offered four times a year:
 
Jan/Feb, April/May, July, Oct/Nov
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Only trainees in the ST2 and ST3 stages of training are
eligible to take the AKT.
In accordance with GMC guidance* an AKT pass is valid
for seven years.
AiTs in training 
(includes TGPT, LTFT, on Maternity
Leave)
 in ST2/3 between 18 March 2020 and 3 August
2021 
whose ability to study for and take the exam was
affected by COVID-19 have the currency of their AKT
extended to 7 years and 6 months.
* https://www.gmc-uk.org/education/postgraduate/9813.asp#Currency
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For further information:
https://www.rcgp.org.uk/mrcgp-exams
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Side-effects of long-term medications for chronic disease
Pathology results: look for borderline and abnormal parameters
Controlled drugs’ prescriptions
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Faltering growth in children (‘failure to thrive’)
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ECG changes (and normal ECGs)
Acute neurological presentation
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Monitoring DMARDs
Quality improvement tools and methodologies
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Management of asthma exacerbations and peak flow readings
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Management of acne in line with national guidance
Medically unexplained symptoms
Urgent and unscheduled care and potential admission e.g. breathlessness
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Some of these topics have been highlighted several times over recent years:
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Communication of risk and use of risk tools
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Basic understanding of concepts and terms in research (e.g. absolute and relative risk)
Data interpretation (both research and other data sources)
Research methodology
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Antibiotic indications, guidance, and resistance
Drugs: monitoring; adverse reactions; interactions; (dose calculations)*; end-of-life care
Safe prescribing and medicines management (including MHRA alerts)
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Confidentiality* and privacy (including social media and digital technologies)
Death certification and notifications to Coroner/ Procurator fiscal
Staff health, and health and safety in the workplace
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Recently improved (AKT 45-50)
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Children and Young People including consent and capacity; developmental
assessment and screening; safeguarding and non-accidental injury
People at the End-of-Life including ethics, pain management, and mental capacity
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Asthma, COPD and rarer respiratory diagnoses; interpreting lung function tests
Cardiovascular health including: diagnosis, ECG interpretation; reducing risk
Common gynaecological problems incl. investigations, timely pregnancy testing
Contraception (incl. use with teratogenic drugs) and HRT
Diagnosis of common oral conditions
Different presentations of multi-system disease
Eye and eyelid problems
Mental health – presentations with physical symptoms; substance abuse
Neurological diagnosis, red flags, and interpretation of examination findings 
Normal findings, minor illness, and infections in childhood
Suspected cancer: diagnosis* & investigation (including less common presentations)
Timely but appropriate referral (including emergencies and when to do nothing)
Prescribing in diabetes, including insulin
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 is also available on the AKT website
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All questions are referenced and the draft
questions are then carefully scrutinised by a
panel of experienced question writers
Care is taken to consider any conflict between
national guidance and regulations across the
four devolved nations
Remember that all question writers are working
GPs
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NICE guidelines
SIGN guidelines
CKS (NICE clinical knowledge summaries)
BMJ Review articles & original papers
BJGP
Cochrane
Vaccine update (www.gov.uk) / Green Book
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print version
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For example, although items might appear to be
about a respiratory, cardiovascular or endocrine
issue, the management will often involve
recommending the correct medication – also
requiring an awareness of the potential for
interactions and monitoring requirements
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https://www.rcgp.org.uk/training-exams/training/gp-curriculum-
overview.aspx
Curriculum summaries (to help identify learning needs):
https://www.rcgp.org.uk/mrcgp-exams/gp-curriculum/super-condensed-
guides
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Questions in the AKT sample across the breadth of the
curriculum
The previous ‘AKT Content Guide’ has been subsumed
within the GP Curriculum and details can be found in the
Knowledge and Skills subsections of each Topic Guide
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Don’t be put off by the lengthy list of topics!
Use the topic guides as needs assessment tools
Carefully review the sections relevant to:
Organisation and management – including
administrative, statutory, ethical and regulatory
frameworks
Evidence-based practice – including research,
statistics and epidemiology
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https://www.rcgp.org.uk/mrcgp-exams
The ‘How to prepare for the AKT’ section contains
helpful resources, including:
‘Preparing to take the AKT’ pdf
50 AKT Sample questions with answers
How trainers can help with AKT preparation
Evidence and data interpretation in the AKT
AKT FAQs
Re-sitting the AKT 
The section ‘AKT Feedback Reports’ contains
specific feedback on previous exams and
should help guide your revision plans
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:
Reliability, validity, and fairness
Adequate coverage of the topics that appear
in the blueprint
The correct balance of question formats
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8
0
%
 
o
f
 
q
u
e
s
t
i
o
n
s
 
Core clinical medicine and its application to problem solving
in a general practice context
1
0
%
 
o
f
 
q
u
e
s
t
i
o
n
s
 
Data interpretation, critical appraisal, and evidence based
clinical practice
1
0
%
 
o
f
 
q
u
e
s
t
i
o
n
s
 
Ethical and legal issues as well as the organisational
structures that support UK general practice
C
l
i
n
i
c
a
l
 
M
e
d
i
c
i
n
e
 
(
1
)
The broad topic of clinical medicine is subdivided
into groups of body systems, in approximately
equal numbers
Each group will comprise questions on:
disease factors
symptoms
investigation
management
C
l
i
n
i
c
a
l
 
M
e
d
i
c
i
n
e
 
(
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
C
l
i
n
i
c
a
l
 
M
e
d
i
c
i
n
e
 
(
3
)
Common, (mostly) low impact – e.g. sore
throat,  contraception, irritable bowel syndrome
Rare, high impact – e.g. child abuse,
meningitis, phaeochromocytoma
Topical – e.g. guidance, COVID-19, optimum
use of antibiotics
C
r
i
t
i
c
a
l
 
a
p
p
r
a
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a
l
 
a
n
d
 
e
v
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b
a
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e
d
 
c
l
i
n
i
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a
l
 
p
r
a
c
t
i
c
e
Understanding the application of critical
appraisal skills which will be tested in several
formats including:
interpretation of data commonly seen by GPs,
including methods and results from published
research
understanding of common terms used in both
evidence-based medicine and statistics
understanding epidemiology relevant to general
practice
Understanding the principles of audit and its
application in assessing the quality of care
C
r
i
t
i
c
a
l
 
a
p
p
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s
a
l
 
a
n
d
 
e
v
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b
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d
 
c
l
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a
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p
r
a
c
t
i
c
e
We use a range of resources to test data
interpretation, including the types of graphs and
tables regularly sent to practices from local
health service organisations and health boards.
We would encourage you to use the following
AKT Group tutorial worksheet:
 
https://www.rcgp.org.uk/getmedia/e2ba263c-385f-4e3c-9fc4-
7bd13beeca40/Evidence-and-data-interpretation-in-the-AKT.pdf
There
is a new video tutorial by prof Mike Harris:
 
How to interpret the results of a randomised controlled trial
E
t
h
i
c
a
l
,
 
L
e
g
a
l
 
&
 
O
r
g
a
n
i
s
a
t
i
o
n
a
l
These questions are written to be applicable UK-wide
 NHS organisation
 Legal aspects e.g. DVLA
 Medical certification e.g. death certificates
 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
 Social services e.g. safeguarding
 Ethical e.g. Mental capacity, consent
Q
u
e
s
t
i
o
n
 
F
o
r
m
a
t
s
Single Best Answer (SBA)
Multiple Best Answer (MBA)
Extended Matching Questions (EMQ)
Photographic image
Data interpretation
Free text
Drug calculation
S
i
n
g
l
e
 
B
e
s
t
 
A
n
s
w
e
r
 
(
S
B
A
)
“According to national guidelines” means
recommended by nationally accepted guidelines
or the BNF, not local practice
Often use a clinical scenario
O
n
l
y
 
o
n
e
 
a
n
s
w
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i
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c
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m
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p
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y
/
m
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t
 
a
p
p
r
o
p
r
i
a
t
e
A 41-year-old man has a chronic cough and expectorates
green sputum daily. He has a history of recurrent chest
infections in childhood.
W
h
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c
h
 
i
s
 
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s
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m
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o
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.
S
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e
x
a
m
p
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:
 
R
e
s
p
i
r
a
t
o
r
y
 
d
i
s
e
a
s
e
 
A. 
 
Asthma
 
B. 
 
Bronchiectasis
 
C.
 
Chronic obstructive pulmonary disease
 
D. 
 
Gastro-oesophageal reflux
 
E. 
 
Lung cancer
M
u
l
t
i
p
l
e
 
B
e
s
t
 
A
n
s
w
e
r
 
(
M
B
A
)
Often uses a clinical scenario
T
w
o
 
a
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a
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c
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m
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m
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b
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b
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t
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m
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a
p
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p
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a
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e
A 35-year-old man has persistent dyspepsia.  A stool
test for 
Helicobacter pylori 
is positive. He has not yet
received any antibiotic treatment and is allergic to
penicillin.
A
c
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t
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c
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n
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g
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,
 
w
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a
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t
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m
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a
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.
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m
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c
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o
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e
m
a
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k
.
(See next slide)
M
B
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e
x
a
m
p
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e
:
 
H
e
l
i
c
o
b
a
c
t
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p
y
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B
A
 
e
x
a
m
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:
 
H
e
l
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c
o
b
a
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t
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r
 
p
y
l
o
r
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A.
Amoxicillin
B.
Cefalexin
C.
Clarithromycin
D.
Co-amoxiclav
E.
Doxycycline
F.
Erythromycin
G.
Lymecycline
H.
Metronidazole
These questions have a list of possible options
There will usually be two or more scenarios
C
h
o
o
s
e
 
t
h
e
 
m
o
s
t
 
l
i
k
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g
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s
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Each option can be used once, more than once,
or not at all
E
x
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d
 
m
a
t
c
h
i
n
g
 
q
u
e
s
t
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o
n
s
 
(
E
M
Q
)
 
A.
Elemental diet
B.
FODMAP
C.
Food elimination
D.
Gluten-free
E.
High fibre
F.
Lactose-free
G.
Low purine
H.
Mediterranean
 
F
o
r
 
t
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p
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t
 
d
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s
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l
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o
f
 
o
p
t
i
o
n
s
.
1.
 
A 23-year-old woman has had mild diarrhoea, abdominal
pain and bloating for several years. Her bloods are
normal, including IgA anti-tTG antibodies test.
E
M
Q
 
e
x
a
m
p
l
e
:
 
 
D
i
e
t
a
r
y
 
a
d
v
i
c
e
 
A.
Elemental diet
B.
FODMAP
C.
Food elimination
D.
Gluten-free
E.
High fibre
F.
Lactose-free
G.
Low purine
H.
Mediterranean
 
F
o
r
 
t
h
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p
a
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t
 
d
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s
.
2.
 
A 62-year-old man has recurrent swelling of his great toe
which responds to naproxen. He drinks 18 units of
alcohol a week and his urate level is 540 μmol/L (Normal
< 450 μmol/L).
E
M
Q
 
e
x
a
m
p
l
e
:
 
 
D
i
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t
a
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y
 
a
d
v
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P
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t
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F
o
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e
x
a
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p
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:
S
k
i
n
 
d
i
s
e
a
s
e
A 32-year-old man has
a rash affecting both
elbows
.
He is using a topical
emollient regularly.
pcds.org.uk
P
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c
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r
e
 
F
o
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a
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e
x
a
m
p
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:
S
k
i
n
 
d
i
s
e
a
s
e
A.
Calcipotriol + betamethasone
B.
Calcitriol
C.
 
Fusidic acid + hydrocortisone
D.
Mometasone furoate
E.
 
Tacrolimus
A
c
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t
o
 
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g
u
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i
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a
d
d
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t
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m
o
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l
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,
 
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i
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t
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s
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m
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o
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y
.
D
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I
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e
r
p
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t
a
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i
o
n
Interpretation of data, e.g for groups of patients
with chronic conditions
Interpretation of research and audit results
Understanding and application of common
statistical terms, e.g number needed to treat
(NNT) and absolute or relative risk
The figure shows a meta-analysis of safety and efficacy outcomes for
statins in the primary prevention of cardiovascular disease (CVD).
D
a
t
a
 
I
n
t
e
r
p
r
e
t
a
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i
o
n
 
e
x
a
m
p
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S
t
a
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i
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s
BMJ 2021;374:n1537 Fig 3
D
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e
x
a
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p
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t
a
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i
n
s
A. Increased risk of diabetes
B. Increased risk of muscle disorders
C. Increased risk of stroke
D. Reduced risk of death from CVD
E. Reduced risk of liver dysfunction
A
c
c
o
r
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g
 
t
o
 
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d
a
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a
 
s
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o
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n
,
 
w
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s
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m
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s
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d
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o
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o
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y
.
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t
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x
t
 
q
u
e
s
t
i
o
n
s
Require the candidate to generate the correct
answer without a list of options to choose from
For example:
dose calculation
name of first-line medication
Eliminates guessing from a list of answers
All answers are screened manually to check for
minor typographical errors which may be counted as
correct.
Candidates will be expected to spell drug names
correctly
F
r
e
e
 
t
e
x
t
 
e
x
a
m
p
l
e
A
 
6
7
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y
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d
 
m
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a
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2
 
d
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a
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a
 
B
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3
3
 
k
g
/
m
2
.
 
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b
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2
 
m
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m
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a
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h
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f
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n
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.
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a
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d
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G
i
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o
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e
 
a
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s
w
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r
 
o
n
l
y
.
F
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t
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x
t
 
q
u
e
s
t
i
o
n
s
 
-
 
n
u
m
e
r
i
c
a
l
An on-screen calculator is available
Any arithmetic required in an AKT question (e.g.
drug dose calculations) is basic and simple and
most candidates do not need to use it
Remember to check that your given answer is
credible!
A 3-year-old boy is to start prophylactic trimethoprim 2 mg/kg
once every night. He weighs 12.5 kg and trimethoprim oral
suspension is available as 50 mg/ 5ml.
W
h
a
t
 
v
o
l
u
m
e
 
o
f
 
l
i
q
u
i
d
 
i
s
 
r
e
q
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d
 
f
o
r
 
t
h
i
r
t
y
 
d
a
y
s
 
u
s
e
?
Type your answer in the following text box. Use figures
not words. Percentages and fractions are not acceptable.
m
l
s
C
a
l
c
u
l
a
t
i
o
n
 
e
x
a
m
p
l
e
S
c
o
r
i
n
g
All question formats have equal weighting
Each correctly answered question is awarded
one mark
Total score on the paper is the number of
correct answers given
No negative marking – it is important to answer
all the questions
C
o
m
p
u
t
e
r
 
B
a
s
e
d
 
T
e
s
t
i
n
g
Once candidates have applied via the RCGP
website to sit the AKT, they are then directed to the
Pearson VUE website to make their test centre
booking.
There is a limited booking window with ‘first come,
first serve’ choice of test session and venue.
There are approximately 150 test
centres covering all parts of the UK.
C
o
m
p
u
t
e
r
 
B
a
s
e
d
 
T
e
s
t
i
n
g
 
R
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e
s
C
a
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d
i
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s
 
m
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The RCGP has a duty to ensure equality and fairness to candidates
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If you have a disability or specific need which requires an adjustment to
your exam, please consult the 
MRCGP RA page
 of the RCGP website
for further information in the first instance
All requests for adjustments should be submitted by the deadline
defined on the RA page of the RCGP website
To aid the RCGP in providing your approved reasonable adjustment,
early booking is recommended (separate individual test rooms are
limited)
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Identity checks
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Every AKT will begin with a short tutorial to remind
candidates how to select answers and ‘mark’
questions – screen shots follow of the live tutorial
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then passed to the RCGP for post-test analysis
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The following feedback will be provided to every
candidate with their result
Their overall score
The pass mark
Their performance in each of the three main subject
areas
The mean performance of the cohort overall and in
each of the three main subject areas
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It is helpful to look at these individual feedback
reports and the Five-year summary report to
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https://www.rcgp.org.uk/mrcgp-exams/applied-
knowledge-test/further-help-support
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from a link on the AKT exam webpages
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Keep watching the countdown clock on the
computer
200 questions in 3 hours 10 minutes = an
average of 57 seconds per question
You should skip questions you find difficult
rather than waste time.  Electronically ‘flag for
review’ the ones you have left out but don’t
forget to leave time to go back before the end
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Cover test – can you answer the question with
the option list covered? If so, it’s probably the
correct answer
Go through unanswered questions 2
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round using the review facilty
Do not leave any questions unanswered –
educated guessing is worthwhile
Check for silly mistakes if you still have time
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All the AKT question formats, apart from the
free text, require the candidate to identify the
best answer(s) from a given list of plausible
alternatives, using all of the information in the
question
There may be other answers which are not
included in the option list, but you have to
focus on the best available answer listed for
the specific question asked
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Small (online?) revision groups share the workload: review
national guidance, BNF etc.
Learn from clinical experience – check the guidelines and
references.
AKT Exam website feedback (feedback reports published
for every AKT sitting and the 5-year summary)
AKT Exam website podcast, preparation guide and sample
material
RCGP eLearning website – Essential Knowledge Updates
and Challenges, as well as GP Self Test to help identify
educational needs for more specific revision planning
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Remember that most people can pass this
exam…..
But you do need to be organised, plan
ahead and prepare well for it
Do make effective use of the RCGP
Curriculum Knowledge and Skills guides
and don’t overlook the 
super condensed
guides
Slide Note
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The MRCGP Applied Knowledge Test (AKT) is a crucial assessment for UK general practice trainees in ST2 and ST3 stages. Conducted four times a year, this computer-based test evaluates knowledge, interpretation skills, and application ability. The test format consists of 200 multiple-choice questions to be completed within 190 minutes. Candidates must adhere to rules regarding eligibility, attempt limits, and validity duration. For detailed insights into the AKT, its objectives, background, format, and rules, this essential guide offers valuable information to aid successful preparation for passing the exam.


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  1. MRCGP Applied Knowledge Test Prepared by the AKT Core Group Feb 2024 Promoting Excellence in Family Medicine

  2. Objectives An overview of the content and structure To give examples of current question formats To describe how questions are constructed To advise on how to prepare and pass the AKT To explain practicalities of computer-based tests Promoting Excellence in Family Medicine

  3. AKT Background The AKT: Is a summative assessment of the knowledge base underpinning independent UK general practice Tests the application of this knowledge Tests the critical interpretation of information Is mapped to the latest RCGP Curriculum updates Each question is intended to explore a topic which an ordinary GP in the UK could be expected to have a working knowledge Promoting Excellence in Family Medicine

  4. Format 200-item multiple-choice test lasting 190 minutes (3 hours 10 minutes)* No multiple true/false questions No negative marking Delivered on a computer terminal* at an invigilated test centre Offered four times a year: Jan/Feb, April/May, July, Oct/Nov * Please see slide 53 and the RCGP website for information on reasonable adjustments Promoting Excellence in Family Medicine

  5. Rules Only trainees in the ST2 and ST3 stages of training are eligible to take the AKT. In accordance with GMC guidance* an AKT pass is valid for seven years. AiTs in training (includes TGPT, LTFT, on Maternity Leave) in ST2/3 between 18 March 2020 and 3 August 2021 whose ability to study for and take the exam was affected by COVID-19 have the currency of their AKT extended to 7 years and 6 months. * https://www.gmc-uk.org/education/postgraduate/9813.asp#Currency Promoting Excellence in Family Medicine

  6. Rules: numbers of attempts For trainees who are already in training on 1 August 2023: Four attempts are allowed in the AKT but: due to COVID-19, a single unsuccessful attempt at either the July or August 2020 AKT did not count towards the total number of permitted attempts. trainees who have support of their deanery and additional educational attainment can apply for an exceptional fifth attempt at the AKT. They must have passed the CSA, SCA, or RCA. For trainees who enter GP Speciality training for the first time on or after 2 August 2023: A maximum of six attempts are allowed Promoting Excellence in Family Medicine https://www.rcgp.org.uk/mrcgp-exams For further information:

  7. Vital Statistics Jan 2024 AKT 50 pass mark = 141/199 (70.9%) Overall pass rate = 68.4% UK graduates first-time takers pass rate = 87.7% (Pass rates vary in different diets of the AKT taken at different times throughout the training year) The cumulative pass rate for all those who take the AKT is stable at 95% Promoting Excellence in Family Medicine

  8. Vital Statistics Jan 2024 Overall mean score = 148.2 (74.5%) Mean scores by subject area: Subject area Mean score (%) No. of questions Clinical knowledge 75.3 159 Evidence-based practice 72.8 20 Organisation and management 69.9 20 Promoting Excellence in Family Medicine

  9. Topics causing most difficulty for candidates in AKT 50 Professional topics: Improving Quality, Safety and Prescribing Side-effects of long-term medications for chronic disease Pathology results: look for borderline and abnormal parameters Controlled drugs prescriptions Leadership and management: Practice administration Life stages topics: Children and Young People Faltering growth in children ( failure to thrive ) Maternity and reproductive health Investigation of gynaecological problems (and pre-referral tests) Clinical topics: ECG changes (and normal ECGs) Acute neurological presentation Promoting Excellence in Family Medicine

  10. Topics causing most difficulty for candidates in AKT 49 Professional topics: Improving Quality, Safety and Prescribing Monitoring DMARDs Quality improvement tools and methodologies Population and planetary health Vaccinations: contraindications Life stages topics: Children and Young People Eating disorders Clinical topics: National guidance on lower and upper urinary tract infection Management of asthma exacerbations and peak flow readings Promoting Excellence in Family Medicine

  11. Topics causing most difficulty for candidates in AKT 48 Professional topics: Improving Quality, Safety and Prescribing Prescribing antibiotics in line with national guidance Monitoring of drugs prescribed for mental health conditions Leadership and management: Death administration and involving the coroner/ procurator fiscal Application of rules on data protection and confidentiality to use of social media Clinical topics: Management of acne in line with national guidance Medically unexplained symptoms Urgent and unscheduled care and potential admission e.g. breathlessness Promoting Excellence in Family Medicine

  12. Summary of professional topics causing most difficulty in recent AKT exams Some of these topics have been highlighted several times over recent years: Consulting in General Practice: Communication of risk and use of risk tools Evidence-based practice, Research and Sharing Knowledge: Basic understanding of concepts and terms in research (e.g. absolute and relative risk) Data interpretation (both research and other data sources) Research methodology Improving Quality, Safety and Prescribing: Antibiotic indications, guidance, and resistance Drugs: monitoring; adverse reactions; interactions; (dose calculations)*; end-of-life care Safe prescribing and medicines management (including MHRA alerts) Leadership and management: Confidentiality* and privacy (including social media and digital technologies) Death certification and notifications to Coroner/ Procurator fiscal Staff health, and health and safety in the workplace * Recently improved (AKT 45-50) Promoting Excellence in Family Medicine

  13. Summary of other topics causing most difficulty in recent AKT exams Life stages topics: Children and Young People including consent and capacity; developmental assessment and screening; safeguarding and non-accidental injury People at the End-of-Life including ethics, pain management, and mental capacity Clinical topics: Asthma, COPD and rarer respiratory diagnoses; interpreting lung function tests Cardiovascular health including: diagnosis, ECG interpretation; reducing risk Common gynaecological problems incl. investigations, timely pregnancy testing Contraception (incl. use with teratogenic drugs) and HRT Diagnosis of common oral conditions Different presentations of multi-system disease Eye and eyelid problems Mental health presentations with physical symptoms; substance abuse Neurological diagnosis, red flags, and interpretation of examination findings Normal findings, minor illness, and infections in childhood Suspected cancer: diagnosis* & investigation (including less common presentations) Timely but appropriate referral (including emergencies and when to do nothing) Prescribing in diabetes, including insulin Promoting Excellence in Family Medicine A Five-year summary is also available on the AKT website

  14. Question writing (1) Topical Practice issues Scenarios derived from clinical work Promoting Excellence in Family Medicine

  15. Question writing (2) All questions are referenced and the draft questions are then carefully scrutinised by a panel of experienced question writers Care is taken to consider any conflict between national guidance and regulations across the four devolved nations Remember that all question writers are working GPs Promoting Excellence in Family Medicine

  16. Common Reference Material (1) GMCGood Medical Practice NICE guidelines SIGN guidelines CKS (NICE clinical knowledge summaries) BMJ Review articles & original papers BJGP Cochrane Vaccine update (www.gov.uk) / Green Book The AKT does not test on local guidance Promoting Excellence in Family Medicine

  17. Common Reference Material (2) BNF including the initial generic chapters in the print version A review has highlighted that up to 27% of AKT questions require a knowledge of therapeutics For example, although items might appear to be about a respiratory, cardiovascular or endocrine issue, the management will often involve recommending the correct medication also requiring an awareness of the potential for interactions and monitoring requirements Promoting Excellence in Family Medicine

  18. GP Curriculum Where to find https://www.rcgp.org.uk/training-exams/training/gp-curriculum- overview.aspx Curriculum summaries (to help identify learning needs): https://www.rcgp.org.uk/mrcgp-exams/gp-curriculum/super-condensed- guides How the AKT links to the curriculum Questions in the AKT sample across the breadth of the curriculum The previous AKT Content Guide has been subsumed within the GP Curriculum and details can be found in the Knowledge and Skills subsections of each Topic Guide Promoting Excellence in Family Medicine

  19. GP Curriculum How to use the GP Curriculum Don t be put off by the lengthy list of topics! Use the topic guides as needs assessment tools Carefully review the sections relevant to: Organisation and management including administrative, statutory, ethical and regulatory frameworks Evidence-based practice including research, statistics and epidemiology Promoting Excellence in Family Medicine

  20. MRCGP AKT Exam website Please look carefully at our website https://www.rcgp.org.uk/mrcgp-exams The How to prepare for the AKT section contains helpful resources, including: Preparing to take the AKT pdf 50 AKT Sample questions with answers How trainers can help with AKT preparation Evidence and data interpretation in the AKT AKT FAQs Re-sitting the AKT The section AKT Feedback Reports contains specific feedback on previous exams and should help guide your revision plans Promoting Excellence in Family Medicine

  21. Exam Construction ensures: Reliability, validity, and fairness Adequate coverage of the topics that appear in the blueprint The correct balance of question formats Promoting Excellence in Family Medicine

  22. Principles of exam construction Relevance: the AKT should be relevant to general practice High prevalence: any topic covered can be one which occurs commonly High impact: any topic covered can be one that is significant but less common Promoting Excellence in Family Medicine

  23. AKT content 80% of questions Core clinical medicine and its application to problem solving in a general practice context 10% of questions Data interpretation, critical appraisal, and evidence based clinical practice 10% of questions Ethical and legal issues as well as the organisational structures that support UK general practice Promoting Excellence in Family Medicine

  24. Clinical Medicine (1) The broad topic of clinical medicine is subdivided into groups of body systems, in approximately equal numbers Each group will comprise questions on: disease factors symptoms investigation management Promoting Excellence in Family Medicine

  25. 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 Promoting Excellence in Family Medicine

  26. Clinical Medicine (3) Common, (mostly) low impact e.g. sore throat, contraception, irritable bowel syndrome Rare, high impact e.g. child abuse, meningitis, phaeochromocytoma Topical e.g. guidance, COVID-19, optimum use of antibiotics Promoting Excellence in Family Medicine

  27. Critical appraisal and evidence- based clinical practice Understanding the application of critical appraisal skills which will be tested in several formats including: interpretation of data commonly seen by GPs, including methods and results from published research understanding of common terms used in both evidence-based medicine and statistics understanding epidemiology relevant to general practice Understanding the principles of audit and its application in assessing the quality of care Promoting Excellence in Family Medicine

  28. Critical appraisal and evidence- based clinical practice We use a range of resources to test data interpretation, including the types of graphs and tables regularly sent to practices from local health service organisations and health boards. We would encourage you to use the following AKT Group tutorial worksheet: https://www.rcgp.org.uk/getmedia/e2ba263c-385f-4e3c-9fc4- 7bd13beeca40/Evidence-and-data-interpretation-in-the-AKT.pdfThere is a new video tutorial by prof Mike Harris: How to interpret the results of a randomised controlled trial Promoting Excellence in Family Medicine

  29. Ethical, Legal & Organisational These questions are written to be applicable UK-wide NHS organisation Legal aspects e.g. DVLA Medical certification e.g. death certificates 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 Social services e.g. safeguarding Ethical e.g. Mental capacity, consent Promoting Excellence in Family Medicine

  30. Question Formats Single Best Answer (SBA) Multiple Best Answer (MBA) Extended Matching Questions (EMQ) Photographic image Data interpretation Free text Drug calculation Promoting Excellence in Family Medicine

  31. Single Best Answer (SBA) According to national guidelines means recommended by nationally accepted guidelines or the BNF, not local practice Often use a clinical scenario Only one answer is correct Other incorrect options may be plausible but not most likely/most appropriate Promoting Excellence in Family Medicine

  32. SBA example: Respiratory disease A 41-year-old man has a chronic cough and expectorates green sputum daily. He has a history of recurrent chest infections in childhood. Which is the single most likely diagnosis? Select one option only. A. Asthma B. Bronchiectasis C. Chronic obstructive pulmonary disease D. Gastro-oesophageal reflux E. Lung cancer Promoting Excellence in Family Medicine

  33. Multiple Best Answer (MBA) Often uses a clinical scenario Two answers are correct Both answers must be chosen to score one mark Other options may be plausible but not the most likely/most appropriate Promoting Excellence in Family Medicine

  34. MBA example: Helicobacter pylori A 35-year-old man has persistent dyspepsia. A stool test for Helicobacter pylori is positive. He has not yet received any antibiotic treatment and is allergic to penicillin. According to current national guidance, which are the two most appropriate first-line antibiotics to combine with omeprazole to eradicate H.pylori? Select two options only and both must be correct to score one mark. Promoting Excellence in Family Medicine (See next slide)

  35. MBA example: Helicobacter pylori A. Amoxicillin B. Cefalexin C. Clarithromycin D. Co-amoxiclav E. Doxycycline F. Erythromycin G. Lymecycline H. Metronidazole Promoting Excellence in Family Medicine

  36. Extended matching questions (EMQ) These questions have a list of possible options There will usually be two or more scenarios Choose the most likely/most appropriate option that best matches each given scenario Each option can be used once, more than once, or not at all Promoting Excellence in Family Medicine

  37. EMQ example: Dietary advice A. Elemental diet E. High fibre B. FODMAP F. Lactose-free C. Food elimination G. Low purine D. Gluten-free H. Mediterranean For the patient described, select the most appropriate diet from the list of options. 1. A 23-year-old woman has had mild diarrhoea, abdominal pain and bloating for several years. Her bloods are normal, including IgA anti-tTG antibodies test. Promoting Excellence in Family Medicine

  38. EMQ example: Dietary advice A. Elemental diet E. High fibre B. FODMAP F. Lactose-free C. Food elimination G. Low purine D. Gluten-free H. Mediterranean For the patient described, select the most appropriate diet from the list of options. 2. A 62-year-old man has recurrent swelling of his great toe which responds to naproxen. He drinks 18 units of alcohol a week and his urate level is 540 mol/L (Normal < 450 mol/L). Promoting Excellence in Family Medicine

  39. Picture Format example: Skin disease A 32-year-old man has a rash affecting both elbows. He is using a topical emollient regularly. pcds.org.uk Promoting Excellence in Family Medicine

  40. Picture Format example: Skin disease According to current guidance, in addition to emollients, which is the single most appropriate initial topical treatment? Select one option only. A. Calcipotriol + betamethasone B. Calcitriol C. Fusidic acid + hydrocortisone D. Mometasone furoate E. Tacrolimus Promoting Excellence in Family Medicine

  41. Data Interpretation Interpretation of data, e.g for groups of patients with chronic conditions Interpretation of research and audit results Understanding and application of common statistical terms, e.g number needed to treat (NNT) and absolute or relative risk Promoting Excellence in Family Medicine

  42. Data Interpretation example Statins The figure shows a meta-analysis of safety and efficacy outcomes for statins in the primary prevention of cardiovascular disease (CVD). BMJ 2021;374:n1537 Fig 3 Promoting Excellence in Family Medicine

  43. Data Interpretation example Statins According to the data shown, which is the single most accurate statistical description of the effects of statins? Select one option only. A. Increased risk of diabetes B. Increased risk of muscle disorders C. Increased risk of stroke D. Reduced risk of death from CVD E. Reduced risk of liver dysfunction Promoting Excellence in Family Medicine

  44. Free text questions Require the candidate to generate the correct answer without a list of options to choose from For example: dose calculation name of first-line medication Eliminates guessing from a list of answers All answers are screened manually to check for minor typographical errors which may be counted as correct. Candidates will be expected to spell drug names correctly Promoting Excellence in Family Medicine

  45. Free text example A 67-year-old man has type 2 diabetes and a BMI of 33 kg/m2. His HbA1c is 62 mmol/mol on diet alone and his renal function is normal. Which is the single most appropriate initial drug treatment? Give one answer only. Promoting Excellence in Family Medicine

  46. Free text questions - numerical An on-screen calculator is available Any arithmetic required in an AKT question (e.g. drug dose calculations) is basic and simple and most candidates do not need to use it Remember to check that your given answer is credible! Promoting Excellence in Family Medicine

  47. Calculation example A 3-year-old boy is to start prophylactic trimethoprim 2 mg/kg once every night. He weighs 12.5 kg and trimethoprim oral suspension is available as 50 mg/ 5ml. What volume of liquid is required for thirty days use? Type your answer in the following text box. Use figures not words. Percentages and fractions are not acceptable. mls Promoting Excellence in Family Medicine

  48. Scoring All question formats have equal weighting Each correctly answered question is awarded one mark Total score on the paper is the number of correct answers given No negative marking it is important to answer all the questions Promoting Excellence in Family Medicine

  49. Computer Based Testing Once candidates have applied via the RCGP website to sit the AKT, they are then directed to the Pearson VUE website to make their test centre booking. There is a limited booking window with first come, first serve choice of test session and venue. There are approximately 150 test centres covering all parts of the UK. Promoting Excellence in Family Medicine

  50. Computer Based Testing Rules Candidates must bring identity documents which match exactly their application details (see next slide) 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 Promoting Excellence in Family Medicine

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