Abstract
The Applied Knowledge Test (AKT) is the main test of knowledge within the MRCGP examination. This article aims to give you ideas about how to revise for it. Hopefully, since the first day of your ST1 year, you have religiously read the British Journal of General Practice, British Medical Journal, National Institute for Health and Clinical Excellence (NICE) guidelines and updates and this very magazine from cover to cover! Even the most driven registrar may find this difficult, so we hope to provide you with some useful pointers geared specifically towards the examination.
You should be cautious about attempting the AKT too early in your training, because with time you automatically tend to pick up the knowledge and experience you will need to improve your chances in the examination. If the AKT is taken nearer to the time of the CSA, the clinical knowledge will be fresh in your mind leaving you concentrate on your consultation skills. However, the temptation to get it out of the way at a much earlier stage in ST2 is understandable, and this is a personal choice. Do not underestimate the challenge of the AKT, which on first attempt has a similar failure rate to that of those taking the CSA for the first time.
When and where to start?
When to start preparing in relation to the examination depends largely on where you are in training and your degree of confidence. Your educational supervisor should be involved in helping you to make the right decisions in terms of timing and helping you to devise a revision plan. Many registrars find 3–4 month preparation time is ample. However you have to consider the job you will be doing during that time; a busy hospital post may leave you exhausted and not very receptive to learning at the end of the day.
The Condensed Curriculum Guide is very useful for pointing out which of those more peripheral areas and conditions you need to consider or more usually what you can reasonably ignore if pressed for time. There are also detailed guides in the ‘Curriculum Documents’ subheading on the RCGP e-portfolio, so look at these if you're not sure whether it's worth revising a certain topic or rare condition. The RCGP website also contains 50 practice questions (unfortunately without all the answers) and InnovAiT and its online back catalogue of AKT questions is a rich source of questions of a similar high standard.
Revision aids
There is a wealth of choice when it comes to resources for this purpose. There are multiple highly developed commercial websites with banks of questions, usually with a registration fee. They can provide a lot of information backed up by evidence and guidelines, which is linked to each question. This enables you to update your knowledge when you get it wrong without having to drag out all the old textbooks. Areas in which you are struggling can be identified by looking at the breakdown of your performance on these websites. However, do be aware that these questions may not be representative of the level of difficulty you may face in the examination.
There are also many books which have a selection of questions or ‘mock examinations’, but you must be careful that they are up to date as new guidance may have been released since publication.
Linking your learning to experience usually makes it more effective. So when encountering problems during your surgery, make a note of these and read up on it as soon as possible. Even when you are working in hospital try to think from a primary care perspective as to what might be relevant.
Looking at NICE guidance for common chronic conditions is helpful, but be selective with the others as they may not be that relevant to primary care and can be time consuming to wade through. The British National Formulary is an invaluable source of information which we all use daily, and therapeutics can be a common tricky area of questioning. Side effects and drug monitoring are worth looking at.
GP ‘update’ or ‘hot topics’ courses have been running for many years and can be a good way of getting to grips with the important changes to guidelines and are popular with registrars and established GPs and Trainers. Journals and selected magazines can provide a good source of revision material but try to source most of your references from UK-based guidance.
InnovAiT articles cover common problem areas from a GP perspective which are very likely to come up in the examination and link directly to curriculum statements, which is helpful.
The RCGP ‘Essential Knowledge Updates’ are available to all AiTs via the RCGP website. They are released every 6 months and summarize the latest information and changes and are accompanied by 50 AKT style questions.
Nonclinical areas
The examination also tests your ability to apply your knowledge of critical appraisal and evidence-based practice. The temptation is simply to learn the formulas without really understanding the principles. This can cause problems if data are presented in an unfamiliar way either in terms of wording or perhaps as a graph.
Practice administration and health informatics is difficult to understand without several months grounding in general practice. The early chapters of the Oxford Handbook of General Practice provide useful summaries of some of these areas including the commonly asked questions around certification.
The examination
Time management is critical during the examination, with just under 1 minute per question. There is no negative marking so it is probably better to take your best guess rather than getting stuck on an individual question. You can flag problem questions for review and then return to these if time allows, but try to keep these to a minimum.
Revision methods are very personal, and you are likely to know by now what works for you, but hopefully this will give you some ideas of where to start. Good luck!