10 tips to help you pass the MRCGP AKT exam

Dr Mahibur RahmanMRCGP AKT Courses The MRCGP AKT exam is a challenging exam, testing applied knowledge relevant to UK general practice. In this article, Dr Mahibur Rahman discusses some key tips to help you prepare for and pass the exam.

  1. Understand the basics

The exam lasts 3 hours and 10 minutes, and consists of 200 questions. 80% of the questions relate to clinical medicine, 10% to evidence based practice, and 10% the organisational domain. The exam is computerised, and there is now access to a basic on-screen calculator if needed. The majority of questions are single best answer and extended matching questions. Other formats include algorithm questions, short answer (you type the correct answer into a box), video questions, and picture based questions.

  1. Fail to prepare, prepare to fail

Allow enough time to revise all material in the exam – most candidates need 3 or 4 months to be able to cover everything sufficiently well to pass the exam. We help a lot of candidates prepare when they are resitting the exam – a common finding amongst candidates that failed the exam is that they had not realised how long it would take to prepare, and did not have enough time to complete their revision. The curriculum is large and covers a broad range of topics – try to have a systematic approach to allow you to cover all the important topics adequately. The RCGP has produced an AKT topic review which details the key areas and subjects covered in the exam.  The MPS has produced a more concise checklist of key topics that frequently feature in the exam as part of their free MRCGP Study Guide.

  1. Focus on the clinical domain

Aim to spend the majority of your revision focusing on the clinical domain – this makes up 80% of the marks and questions (160 questions). Someone who scored very poorly in this area (under 60%) would usually fail the exam – even with 100% in the other domains. Overall, a poor score in this domain is the most common cause of failure in the AKT exam. This domain also takes the longest amount of time to cover as the bulk of the curriculum is focused on clinical topics. Questions from the clinical domain can include those relating to making a diagnosis, ordering and interpreting tests, disease factors and risks, and management. It is important to have a good knowledge of key guidelines – NICE, SIGN, BTS etc. for common and important disease areas as they are frequently tested.

  1. Revise core statistics and evidence based practice

10% of the exam is evidence based medicine, including basic statistics, graphs and charts and types of study. These offer easy marks if you make sure you have a good grasp of the basic concepts and can interpret common charts and graphs. Make sure you can calculate averages (mean, mode, median), numbers needed to treat, sensitivity and specificity as well as understanding absolute and relative risk, odds ratios, p values, 95% confidence intervals and standard deviation. You should be able to interpret scatter plots, L’Abbe plots, Forest plots, funnel plots as well as Cates plots. Finally, you should be able to understand the usage of common study types including cross sectional surveys, case control studies, cohort studies and randomised controlled trials.

  1. Don’t forget the organisational domain

This makes up another 10% of the exam, and is the area that candidates tend to do worst on. These areas can be dull to read, but learning about practice management, QOF, certification, DVLA guidelines and legal duties of doctors will not only get you easy marks, it will be useful when you qualify.

  1. Learn from other people’s mistakes

Read through the examiners’ feedback reports to see which topics caused trainees problems, as they are usually retested in the next few exams. Having analysed every feedback report published so far, it is interesting to note that the same subjects get featured repeatedly! In the last feedback report, there was not a single topic that had not already featured as an area of poor performance in a previous report.

  1. Make the most of your revision time

Effective revision should combine reading with practising questions. Try to practise questions to time, as time pressure is a big issue with this exam – you have about 57 seconds for each question! If you get a question wrong, try to read more broadly about the subject to gain a deeper understanding. By relating it to a question you have just answered, you are more likely to retain the information. Concentration drops dramatically after an hour, so try to revise in chunks of no more than an hour at a time. Take a short break – even 10 minutes to make a hot drink, or get some fresh air is often enough to refresh you and improve concentration for the next burst of revision.

  1. Learn the subject, not the question

Some candidates approach AKT revision by picking an online revision service and then go through all the questions multiple times. This can lead to a false sense of security and ultimately failure in the exam. Repeating the SAME questions multiple times provides very little additional benefit. Often complex questions such as data interpretation are answered the second time by remembering the pattern rather than understanding the subject. In the exam, you will not get the same question, but a different one testing knowledge of the subject. While your mark will improve with each repeated attempt at the same questions, your knowledge may have only improved marginally (having seen the correct answers the first time, it is not surprising that you get most of them correct the next time). A better approach is to read up on the subjects and explanations after doing a set of questions, and then once you complete all the questions, move on to a different set of questions from a different service or book. This will give you a better idea of how well you have understood the topic and retained the knowledge.

  1. Read the question carefully

Many candidates that have a good knowledge base still fail the AKT by a few marks. This can be owing to poor exam technique. It is really important to read the question carefully to prevent losing marks for silly mistakes. This can relate to the instructions – some questions ask you to drag the right answer into a certain part of the screen. Clicking the right answer instead of dragging it will gain no marks. It is important to watch out for and to understand certain keywords – if the question asks for a characteristic feature, it means it is there in almost every case (90% or more) – whereas if it asks for a feature that is commonly seen in a condition, it only needs to be there in around 60% or more of cases. Some questions are negatively framed – “which of the following is not part of the Rome III criteria for diagnosing irritable bowel syndrome?” – candidates that fail to spot the “not” in this question could easily select the wrong answer despite knowing the Rome III criteria.

  1. Keep to time

To complete the entire paper, you have just 57 seconds per question. Try to be disciplined – if you are not entirely sure of the best answer, it is better to put down your best guess after about 55 seconds and move on. You can flag questions for review, so you could try to come back if you finish a little early to look at those are unsure of. By being strict with your time, you will at least pick up all the easy marks for topics that you have covered in your revision. Candidates that spend 2-3 minutes struggling with a few really challenging questions often end up unable to complete the paper. They may have missed easy marks from questions at the end of the paper that they did not see. It is useful to have some pace checkpoints – try to finish 33 questions every 30 minutes. At this pace, you will have completed 66 questions after 1 hour, 99 at 1.5 hours, and complete the whole paper with just under 10 minutes left to go over any questions flagged earlier.

Summary The MRCGP AKT is a challenging exam with a significant failure rate – over 1 in 4 candidates fail each exam, with the long term mean pass rate around 73%. It covers a large curriculum, so it is important to allow enough time and to have a plan to enable you to prepare in a systematic way. A lot of the knowledge gained from preparing will help you not only in everyday practice, but also for the MRCGP CSA examination. By mixing reading with practice questions, you should have both the knowledge and the exam technique to allow you to pass well.

Dr Mahibur Rahman is a portfolio GP and a consultant in medical education. He has been the medical director of Emedica since 2005 and has taught over 20,000 delegates preparing for GP entry exams, MRCGP and on GP careers. He teaches an intensive 1 day MRCGP AKT preparation course in London, Birmingham and Manchester that covers all 3 domains. The course includes key theory and high yield topics, exam technique as well as mock exams in timed conditions. You can get a £25 discount by using the code passmrcgp

Details of the course are available at http://courses.emedica.co.uk/acatalog/nMRCGP_AKT_Preparation.html

MRCGP AKT Course

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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

MRCGP AKT Mock Exam launched – 25% discount for alumni

We are pleased to announce that our complete AKT Mock Exam has been tested and is now available.  The online service has a complete AKT mock exam consisting of 200 AKT questions compiled in a realistic mock AKT exam.  Questions are laid out with a similar screen layout to the real exam, to help increase your speed in dealing with the layout in the real AKT exam.

The mock exam has been developed over the past few years, and is a realistic reflection of the real AKT exam – we have modified some of the questions based on feedback from doctors that have sat and passed the real exam. We have also included high yield AKT questions based on examiners’ feedback reports from recent past AKT exams.

The mock exam is timed just like the real exam – 200 AKT questions in exactly 3 hours.  The AKT questions have been written to reflect the same level of challenge as the real exam, and includes the same proportion of questions from each domain as the real exam:

80% clinical medicine – including wide coverage of the RCGP curriculum areas.

10% organisational – practice management, medicolegal issues, statutory duteis of a doctor, DVLA guidelines, sickness certification etc.

10% evidence interpretation – statistics, types of study, interpreting graphs and charts.

The AKT Mock Exam usually costs £20, but we are pleased to offer Alumni a 25% discount – you can save £5 and pay just £15 by using the code aktmock in the coupon code box when registering. Get full details of the complete AKT Mock Exam and see how ready you are for the real AKT exam today!

Doctors that attend the Emedica AKT Preparation Course get free access to this mock exam after attending the course.

Alumni discounts 2012 – MRCGP courses / CCT courses

We are happy to offer the following discounts for Alumni.  These discounts are valid for bookings made until 31 December 2012.

MRCGP for Trainees: Understanding the AKT and CSA coursesSave £50 off the full price on any of our MRCGP for Trainees courses (available in Birmingham and London) – enter the code elumnus – These courses are aimed at doctors in ST1 and ST2 that want a better understanding of the MRCGP exams.

MRCGP AKT Preparation coursesSave £20 off the full price on any of our MRCGP AKT preparation courses (available in Birmingham and London) – enter the code alumnimrcgp – These courses are aimed at doctors already preparing for the MRCGP AKT exams – the best time to attend is about a month BEFORE your AKT exam date.

MRCGP CSA Preparation coursesSave £20 off the full price on any of our MRCGP CSA preparation courses (available in Birmingham and London) – enter the code alumnimrcgp – These courses are aimed at doctors starting their preparation for the MRCGP CSA exams – the best time to attend is about 2-3 months BEFORE your CSA exam date.

Life after CCT course coursesSave £95 off the full price on any of our Life after CCT courses courses (available in Birmingham and London) – enter the code alumnicct – These courses are aimed at doctors finishing their GP training this year or in the first few years post qualification.


MRCGP AKT Exam – High Yield Topics from the January 2011 Exam

MRCGP AKT Exam – High Yield Topics from the January 2011 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.

Key facts from the January 2011 exam:

The top score was 93.5%
The mean score was 72.7%
The lowest score was 42.5%
The pass mark was 68%.
The pass rate was 74.9%.

Scores by domain:

Clinical medicine – 73.9%
Evidence interpretation – 72.1%
Organisational – 64.0%

High Yield Topics

The examiners report from the January 2011 diet of the MRCGP AKT exam highlighted the following key topics:

• Common eye problems, especially those needing urgent referral or admission
• Normal findings in childhood – including development
• Childhood immunisation schedules
• Contraception
• Drugs that require monitoring
• Prescribing in pregnancy – infectious diseases
• Common injuries
• Acute abdominal pain – including in children
• Good Medical Practice
• Patient – practice interface – e.g. handling complaints

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.

Emedica Alumni can get a £20 discount off the Emedica MRCGP AKT course by entering this code when booking: alumniakt2011

Further reading:
Complete January 2011 MRCGP AKT examiners report

Alumni Discounts and Special Offers 2011

We are happy to offer the following discounts for Alumni.  These discounts are valid for bookings made between 4 January 2011 and 31 December 2011.

MRCGP for Trainees: Understanding the AKT and CSA coursesSave £50 off the full price on any of our MRCGP for Trainees courses (available in Birmingham and London) – enter the code mrcgp2011 – These courses are aimed at doctors in ST1 and ST2 that want a better understanding of the MRCGP exams.

MRCGP AKT Preparation coursesSave £20 off the full price on any of our MRCGP AKT preparation courses (available in Birmingham and London) – enter the code alumniakt2011 – These courses are aimed at doctors already preparing for the MRCGP AKT exams – the best time to attend is about a month BEFORE your AKT exam date.

MRCGP CSA Preparation coursesSave £20 off the full price on any of our MRCGP CSA preparation courses (available in Birmingham and London) – enter the code alumnicsa2011 – These courses are aimed at doctors starting their preparation for the MRCGP CSA exams – the best time to attend is about 2-3 months BEFORE your CSA exam date.

Life after CCT course coursesSave £95 off the full price on any of our Life after CCT courses courses (available in Birmingham and London) – enter the code gpcareers2011 – These courses are aimed at doctors finishing their GP training this year or in the first few years post qualification.