MRCGP AKT Exam Revision – High Yield Topics from the April 2014 AKT Exam

MRCGP AKT Exam – High Yield Topics from the April 2014 AKT Exam

Dr Mahibur RahmanDrug dosage

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently examined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.

As some of you may be starting to think about the October 2014 MRCGP AKT Exam at the moment, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.

Key facts from the April 2014 MRCGP AKT exam:

The top score was 95%
The mean score was 72.2%
The lowest score was 43%
The pass mark was 67% (this is one of the lowest it has ever been so far)
The pass rate was 72.5%

Scores by domain:

Clinical medicine – 72.5%
Evidence interpretation – 73.8%
Organisational – 67.9%

High Yield Topics

The examiners’ report from this diet of the MRCGP AKT exam highlighted the following key topics:

  • Drug dosage calculations
  • Drugs administered by other health professionals
  • Good Medical Practice – 2013 GMC guidance
  • Contraception – including LARC and drug interactions
  • Acute infections – antibiotics and prophylaxis
  • Mental health – diagnosis and management of anxiety
  • Digestive health – irritable bowel and coeliac disease
  • Death and cremation certification
  • Substance misuse – including treatment of withdrawal symptoms
  • Poisoning – symptoms and management
  • Psoriasis – diagnosis and management

The MRCGP AKT is a comprehensive examination, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Our AKT course offers comprehensive coverage of all 3 domains, and is updated after every exam to take account of high yield topics from the examiners’ feedback reports.

Further reading:
Complete Examiners’ report – April 2014 MRCGP AKT Exam

MRCGP AKT Exam Revision – High Yield Topics from the January 2014 AKT Exam

MRCGP AKT Exam – High Yield Topics from the January 2014 AKT Exam

Dr Mahibur RahmanHuman eye

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently examined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.

As some of you may be revising for the April 2014 MRCGP AKT Exam at the moment, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.

Key facts from the January 2014 MRCGP AKT exam:

The top score was 95%
The mean score was 75.8%
The lowest score was 39.5%
The pass mark was 70.5% (this is the highest it has ever been so far)
The pass rate was 74.7%

Scores by domain:

Clinical medicine – 76.3%
Evidence interpretation – 74.3%
Organisational – 73.3%

High Yield Topics

The examiners’ report from this diet of the MRCGP AKT exam highlighted the following key topics:

  • Hypertension – NICE guidelines on management
  • Good Medical Practice – 2013 GMC guidance
  • Freedom of Information
  • OTC supplements and interactions with drugs
  • Normal childhood development
  • Eye disease – acute eye problems
  • Certification – fitness to work / Med3
  • Osteoporosis – DEXA scan interpretation
  • Diabetes – diagnosis, management (including insulin therapy)

The MRCGP AKT is a comprehensive examination, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Our AKT course offers comprehensive coverage of all 3 domains, and is updated after every exam to take account of high yield topics from the examiners’ feedback reports.

Further reading:
Complete Examiners’ report – January 2014 MRCGP AKT Exam

MRCGP AKT Exam Revision – High Yield Topics from the October 2013 AKT Exam

MRCGP AKT Exam – High Yield Topics from the October 2013 AKT Exam

Dr Mahibur Rahman

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently examined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.

As some of you may be revising for the January 2014 MRCGP AKT Exam at the moment, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.156204109

Key facts from the October 2013 MRCGP AKT exam:

The top score was 94%
The mean score was 73.2%
The lowest score was 43.5%
The pass mark was 67%
The pass rate was 76.1% (this is one of the highest pass rates in recent years)

Scores by domain:

Clinical medicine – 72.9%
Evidence interpretation – 69.4%
Organisational – 79.3%

High Yield Topics

The examiners’ report from this diet of the MRCGP AKT exam highlighted the following key topics:

  • Drug interactions for common drugs – statins, macrolides, oral anticoagulants
  • Management of type 2 diabetes
  • Psoriasis – diagnosis and management
  • Oral contraception and LARC
  • Pre-employment vaccinations
  • Incontinence
  • Peripheral vascular disease
  • Dementia – management and diagnosis
  • Diabetes – diagnosis, management, interpreting diabetic blood results

The MRCGP AKT is a comprehensive examination, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Our AKT course offers comprehensive coverage of all 3 domains, and is updated after every exam to take account of high yield topics from the examiners’ feedback reports.

Further reading:
Complete Examiners’ report – October 2013 exam

MRCGP AKT Exam Revision – High Yield Topics from the May 2013 AKT Exam

MRCGP AKT Exam – High Yield Topics from the May 2013 AKT Exam

Dr Mahibur Rahman

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently 135018281examined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.

As some of you may be starting your revision for the October 2013 MRCGP AKT Exam, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.

Key facts from the May 2013 MRCGP AKT exam:

The top score was 97%
The mean score was 72.74%
The lowest score was 38%
The pass mark was 68%
The pass rate was 71.4%

Scores by domain:

Clinical medicine – 72.6%
Evidence interpretation – 76.0%
Organisational – 70.4%

High Yield Topics

The AKT summary report after each AKT exam usually highlights topics that were either not answered well by many candidates, or that although were tackled well, were important enough to be mentioned by the examiners. This is usually a clue that these topics will be retested in the next few sittings of the exam.

The examiners’ report from this diet of the MRCGP AKT exam highlighted the following key topics:

  • Management of hypertension
  • Fitness to work certification (sick notes)
  • Drug interactions
  • Skin lesions – recognising common and serious conditions
  • Screening programmes
  • Drug monitoring – blood tests
  • Enteral feeding – including complications
  • Emergency contraception
  • Diabetes – diagnosis, management, interpreting diabetic blood results

The MRCGP AKT is a comprehensive examination, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Further reading:
Complete May 2013 AKT Summary report

Improving feedback from the MRCGP CSA examination

Improving feedback from the MRCGP CSA examination

Dr Mahibur Rahman

We are often contacted by GP registrars or GP trainers requesting support with understanding the feedback from the MRCGP CSA. Many doctors have commented that they find the feedback difficult to interpret. This has been recognised as an important issue and recently a motion was passed at the LMCs conference calling for immediate improvement in the feedback from the CSA. In this article Dr Mahibur Rahman looks at the current feedback, the areas that could be improved and suggestions on ways to make the feedback clearer and more helpful for both trainers and registrars.

Understanding the current CSA feedback

Currently there are 2 main sections to the feedback from the CSA. The top part gives the candidate’s total score from all 13 cases (out of 117), with the pass mark for the date they sat the exam. This total score is based on the summative part of the assessment, which is based on 3 domains for every case: data gathering, clinical management, and interpersonal skills.

For each domain, a candidate is graded with a score attached to each grade as follows: Clear pass: 3 marks, Pass: 2 marks, Fail: 1 mark, Clear fail: 0 marks. This gives a total score for each case of between 0 and 9.

To gain a pass, a candidate must get an overall score equal to or above the pass mark for a given day. This is adjusted each day using the borderline group method to ensure the standard of the exam remains the same each day. The actual pass mark is variable with a usual range between 72 and 77 out of 117.

The second part of the feedback is formative – it relates to the 16 feedback statements provided by the RCGP in a grid. This grid can provide information on consulting areas that a candidate could improve on. It is important to understand that this part does NOT determine the score or whether a candidate has passed or failed – it is formative, and aimed at helping doctors identify areas of their consulting that they could improve. The current feedback looks like this:

CSA feedback current

What are the problems with the current feedback?

There is no breakdown of the marks awarded from each case (out of 9), and no way for a candidate or trainer to see clearly if marks were dropped in data gathering, clinical management or interpersonal skills for each case, or as a general trend over the course of the whole exam.

In some cases, the formative feedback can help identify areas to work on, but in some cases it can lead to confusion. A common source of confusion relates to the fact that candidates with the same number of crosses can have very different scores. Finally, where a candidate has no crosses relating to a specific case, many candidates think that it means they must have scored very well, or at least gained 6 or more marks out of 9. However it is impossible to tell how well or poorly they have performed in that case from the lack of crosses– they could have scored anywhere from 0 to 9. This is because:

  • The formative feedback does NOT determine the score for a case – this is determined by the performance in the 3 domains being assessed. Scores for these are not provided in the current feedback as standard – candidates that want to access these scores can request their mark sheets under the Data Protection Act.
  • Only feedback statements that were flagged in 2 different cases show up in the feedback provided to candidates – there are hidden crosses where a statement was only flagged in a single case. A candidate with no crosses could actually have had several crosses relating to feedback statements that did not occur again in other cases. This could have led them to score very poorly in that case, but they would not know it from looking at the feedback.

This candidate failed the CSA by a few marks – look at the formative feedback for their first 3 cases:

CSA formative feedback - current

This candidate scored 7/9 for the first case (joint problems), and 2/9 for the second case (acute illness), but there would be no way to know that they had performed really poorly in the second case from the current feedback. There were actually 3 feedback statements that were flagged in this case, but they don’t show up because those statements did not apply to any other case (and currently these statements are hidden).

How could the feedback be improved?

The GPC motion called for “the feedback from the MRCGP exams to be improved immediately”. Here are 3 simple ways that the feedback could be made clearer and more effective in helping identify areas to work on to improve performance. They can all be introduced using data that is already collected in the exam, and so could be implemented quickly with little additional cost.

1. Provide a breakdown of total marks for each domain as well as the total score. In the AKT, candidates get a breakdown of their scores in the 3 domains (clinical medicine, organisational, and evidence interpretation). This will give a clearer indication of any weaker areas overall:

New CSA feedback - summative

This candidate and their trainer can immediately see that they could make improvements in all parts of the consultation, but that the clinical management domain was their weakest overall. This may allow more targeted work on this part of the consultation. Without this information, this candidate (and their trainer) may focus more on the interpersonal domain, without realising that although this could be improved further, this is actually their strongest domain overall.

2. Provide the domain scores for every case as well as the formative feedback. Taking both the summative and formative feedback together provides more meaningful information and will allow easier identification of both consulting skills and curriculum areas that need improving. This could be provided by adding a separate table for the domain scores:

CSA domain feedback for individual cases

Looking at this, it is clear that this candidate had 2 cases where they performed very poorly – the young adult female with an acute illness, and the middle aged female with a women’s health issue. These may be areas that they struggle with, and indetifying them will allow focused improvement in knowledge.

3. Provide details in the formative feedback section of ALL statements that were flagged, even when this only applied to a single case. This will allow candidates to identify all areas that examiners felt they could work on – even candidates that have done well can benefit from knowing areas that they could improve. Combined with the summative feedback above, this would also make it easier to separate a candidate that is below the pass standard in multiple areas of multiple cases from one that had a couple of really poor cases due to poor knowledge of a specific curriculum area, or because they missed something key in that case. Here is the formative feedback from those first 3 cases that we looked at earlier; the second image shows all crosses (those that were previously hidden are shown in red for clarity):

Current feedback:

CSA formative feedback - current

Proposed feedback:

Proposed feedback showing all crosses

You can see that taking this with the domain scores, it is immediately clear why this candidate got such a low score in the acute illness case, and that had they performed better in this case, they may have passed. This would also help candidates understand their performance better. From the current feedback they may think that this was one of their better cases when actually it is their worst. Providing this extra information does not give any information that will jeopardize case security, but it does provide more meaningful information for someone trying to improve.

How it would look together

All the feedback would fit onto 1 A4 page, allowing quick cross referencing between the different sections. This is how the new feedback could look in the e-portfolio.

New CSA feedback - summative

CSA domain feedback for individual cases

New CSA feedback

Summary

It is clear that further research needs to be carried out to investigate the possible reasons behind the differential pass rates in different groups – however this will take time. By improving feedback immediately, we can ensure that candidates and trainers have clearer, more effective feedback. All these changes can me made using data that is already being collected, so this could be implemented quickly and with little additional cost. Hopefully this will enable more focused work on the key consultation skills that an individual doctor may need to work on to help them improve and pass the exam.

Are you a GP trainer or a GP registrar? What do you think about these ideas for improving the feedback from the CSA? Please share your thoughts!

MRCGP AKT Exam Revision – High Yield Topics from the January 2013 AKT Exam

MRCGP AKT Exam – High Yield Topics from the January 2013 AKT Exam

Dr Mahibur Rahman

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently 867805_inhalerexamined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.

As some of you may be starting your revision for the May 2013 MRCGP AKT Exam, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.

Key facts from the January 2013 MRCGP AKT exam:

The top score was 93.5%
The mean score was 70.7%
The lowest score was 33.5%
The pass mark was 66%
The pass rate was 68.7%

Scores by domain:

Clinical medicine – 70.6%
Evidence interpretation – 66.9%
Organisational – 75.2%

High Yield Topics

The examiners’ report from this diet of the MRCGP AKT exam highlighted the following key topics:

  • Adverse effects for common drugs
  • Administration of drugs by non-prescribers
  • Drug dosage calculations
  • Oral contraception and LARC
  • Paediatrics – recognising normal findings
  • Asthma management in children
  • Colorectal cancer – screening and diagnosis
  • Breast cancer – screening, diagnosis and referral
  • Diabetes – diagnosis, management, interpreting diabetic blood results

The MRCGP AKT is a comprehensive examination, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Further reading:
Complete January 2013 AKT Summary report

MRCGP AKT Exam – High Yield Topics from the October 2012 Exam

MRCGP AKT Exam – High Yield Topics from the October 2012 Exam

Dr Mahibur Rahman

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently exaChild Healthmined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.

As some of you may be finalising your revision for the January 2013 MRCGP AKT Exam, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.

Key facts from the October 2012 MRCGP AKT exam:

The top score was 93%
The mean score was 74.3%
The lowest score was 40.7%
The pass mark was 69.8%
The pass rate was 71.6%

Scores by domain:

Clinical medicine – 76.1%
Evidence interpretation – 69.8%
Organisational – 64.1%

High Yield Topics

The examiners’ report from the October 2012 diet of the MRCGP AKT exam highlighted the following key topics:

  • DMARDs and inflammatory arthritides
  • Drug calculations
  • Oral contraception and LARC
  • Childhood development
  • Childhood immunisation schedule
  • Childhood screening programmes
  • Antenatal screening / antenatal care
  • Controlled drugs – prescribing, regulations, storage
  • Osteoporosis
  • Diabetes – diagnosis, management, interpreting diabetic blood results
  • Topical steroids for skin conditions

The MRCGP AKT is a comprehensive examination, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

The highest scorer in the April AKT examination was Dr Razwan Ali. He attended the Emedica AKT course about a month before his exam. You can read his AKT Preparation Tips on our blog.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Further reading:
Complete October 2012 AKT Summary report

Elumnus blog: 2012 in review

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 10,000 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 17 years to get that many views.

Click here to see the complete report.

MRCGP CSA Exam Feedback and Summary – February 2012 exams

MRCGP CSA Exam Feedback and Summary – February 2012 exams

Dr Mahibur Rahman

After each MRCGP CSA examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates for the sitting, along with the number of candidates sitting the exam. Since the February 2012 exam they also started releasing a feedback report highlighting key areas that candidates found challenging.

These topics are likely to continue to feature in future CSA sittings, as there is a common case bank, so it is worth ensuring that you have a good understanding of how to tackle them.

If you are thinking of sitting the MRCGP CSA in November 2012 or January / February 2013, then you have probably started preparing. As the January / February sitting is the most popular each year, we thought it would be helpful to look at the feedback and challenging areas from this sitting in 2012. The sumary report for the May 2012 CSA exam is not yet available.

Key facts from the February 2012 MRCGP CSA exam:

Number of candidates: 2074

Proportion sitting the CSA for the first time: 92.5%

Overall pass rate: 71.8% (1490 candidates passed, 584 candidates failed)

The top score was 111 out of 117
The mean score was 81 out of 117
The lowest score was 37 out of 117
97 candidates (4.7%) scored 100 or more out of 117
67 candidates (3.2%) scored 20 or more marks below the pass mark.

Challenging areas

The examiners’ report from the February 2012 diet of the MRCGP CSA exam was released in April, and highlighted the following areas that caused candidates difficulty:

Genetics in primary care

Cases involving genetics regularly cause CSA candidates problems in the exam. Examples of cases you should be prepared to handle include:

Prenatal counselling for risk of single gene disorders – e.g. sickle cell disease, Huntington’s, neurofibromatosis, cystic fibrosis etc.

An asymptomatic patient requesting a colonoscopy with a family history of colon cancer.

While you do not need to have an in depth knowledge of specific genetic disorders, you should be able to take a good history and draw a family tree. You should also be able to explain the difference in risk for autosomal dominant and autosomal recessive disorders, and know when it is appropriate to refer to a genetics counselling service.

Examinations

In some cases in the CSA you will actually perform a physical examination. In some cases, candidates lost marks for being unable to be focused in their choice of examination, or not being able to perform the examination proficiently. Examples of a lack of focus would include requesting a full physical examination in someone with hearing loss – it would be more appropriate to examine the ears, and to perform a Rinne and Weber test. Examples of an inadequate examination highlighted by the examiners included listening to a patient’s chest with through their shirt! Most examinations in the CSA are fairly straightforward – you should try to practice all the common examinations with a study group until you are fluent. Ask your trainer to observe you and to provide feedback.

The MRCGP CSA is a challenging, comprehensive examination, so it is important that you start preparing for it early. Try to get as many observed consultations as possible with your trainer, and form a study group early on.

Further reading:
Complete February 2012 CSA Summary report

The Emedica MRCGP CSA Course includes teaching on the new CSA mark scheme including the new 2012 CSA feedback statements. Each course only takes 6 GP registrars, with a strong emphasis on practice with individual feedback. Practice sessions are donw in groups of 3, allowing each candidate to have 4 mock CSA practice cases. There is detailed, constructive 1 to 1 feedback after each case using the new marking criteria. Our mock CSA cases are done in a realistic setting with professional simulated patients and timed in the same way as the real exam. Alumni members can get a £20 discount by using the code alumnimrcgp

 

MRCGP AKT Exam – High Yield Topics from the April 2012 Exam

MRCGP AKT Exam – High Yield Topics from the April 2012 Exam

Dr Mahibur Rahman

After each MRCGP AKT examination, the examiners release a report highlighting key information from the last exam. This includes pass marks and rates, and also key topics – both those that were answered well, and those that GP trainees performed poorly on. These topics are frequently examined again in the next few sittings of the AKT exam, so it is worth ensuring that you have a good understanding of them.

As some of you may be starting your revision for the October 2012 MRCGP AKT Exam, we thought it would be helpful to look at the high yield topics from the latest examiners’ report.

Key facts from the April 2012 MRCGP AKT exam:

The top score was 93.5%
The mean score was 73.2%
The lowest score was 41%
The pass mark was 68.8%
The pass rate was 67.6%

Scores by domain:

Clinical medicine – 74.2%
Evidence interpretation – 70.2%
Organisational – 68.1%

High Yield Topics

The examiners’ report from the April 2012 diet of the MRCGP AKT exam highlighted the following key topics:

  • Prescribing for children – asthma, migraine
  • Normal childhood development
  • Data interpretation / statistics
  • Confidentiality – insurance reports / ABI / BMA guidance
  • Nice Hypertension guidelines 2011 – diagnosis and treatment
  • Spirometry – interpreting results
  • Cancer – 2 week referral guidelines

The MRCGP AKT is a comprehensive examinations, so it is important that you cover the entire curriculum. Remember that 80% of the marks are related to applying knowledge relating to clinical medicine in general practice, 10% to evidence interpretation and 10% to the organisational domain.

The highest scorer in the April AKT examination was Dr Razwan Ali. He attended the Emedica AKT course about a month before his exam. You can read his AKT Preparation Tips on our blog.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumnimrcgp

Further reading:
Complete April 2012 AKT Summary report