nMRCGP The Applied Knowledge Test

1. nMRCGPThe Applied Knowledge Test November 2007 Prepared by the AKT Group

2. Aims • To increase confidence • To help you pass nMRCGP

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

4. AKT aims • The AKT is designed to test the application of knowledge and interpretation of information • Each question is intended to explore a topic of which an ordinary GP could be expected to have a working knowledge

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

6. Vital Statistics • October 2007 results • Pass mark = 70.5% • ST3 pass rate = 87% • ST2 pass rate = 75% • Results may vary from one session to another

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

8. Transitional Arrangements • Will replace the Summative Assessment MCQ from August 2007 • Is equivalent to the current MRCGP MCP for those completing the current exam during 2007-8

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

10. A few questions proved difficult…(MRCGP) • Barrier contraception • Glycaemic index • Diagnosis & management of serious neonatal problems • Visual loss - differential diagnosis, appropriate management • Prophylaxis against influenza during the initial phase of a pandemic and Rx. • Meningococcal disease • Evidence-based management of high prevalence conditions

11. A few more questions proved difficult… • State benefits – SSP, IB, AA • Dermatology – management of acne, eczema, psoriasis • Clinical risk management - a basic understanding of the legislation and practical aspects of working in a safe clinical environment

12. Question writing • Scenarios derived from clinical work • Practice issues • Topical • All questions are referenced and the draft questions are then carefully scrutinised by a panel of other question writers. • Remember that all question writers are working GPs

13. Common Reference Material • Clinical Evidence • Cochrane • BNF • GP Curriculum • NICE • SIGN • BMJ Review articles & original papers • BJGP • DTB • GMP

14. The MRCGP Curriculum Statements Where to find them • RCGP website http://www.rcgp-curriculum.org.uk/ What are they? • Series of papers, each covering different clinical and practice management areas, based on European Academy of Teachers in General Practice (EURACT) framework. • Written by a variety of GP experts and coordinated by RCGP

15. The MRCGP Curriculum Statementscontinued How they are being used • Curriculum statements have ‘Intended Learning Outcomes (ILO)’. Questions and CSA cases are linked to specified learning outcomes within specified curriculum statements. • This enables sampling from across the curriculum, as cases can be mapped to the curriculum statements (or nMRCGP blueprint)

16. AKT subjectcontent • Core clinical medicine and its application to problem solving in a general practice context • 80% of items • Critical appraisal and evidence based clinical practice • 10% of items • Ethical and legal issues as well as the organisational structures that support UK general practice • 10% of items

17. Clinical Medicine (1) • The broad topic of clinical medicine is subdivided into groups of body systems, in approximately equal numbers • Each group will comprise sections on • disease factors • symptoms • investigation • management

18. 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 Clinical Medicine (2)

19. Clinical Medicine (3) • Common, low impact – e.g. sore throat • Rare, high impact – e.g. child abuse • Topical – e.g. controlled drugs regulations

20. Research, Epidemiology and Statistics (1) • Understanding the principles of audit and its application in assessing the quality of care • Understanding the application of critical appraisal skills which will be tested in a number of formats e.g the interpretation of research data

21. Research, Epidemiology and Statistics (2) • Understanding and application of terms used in both inferential statistics and evidence based medicine. E.g as described in the appendices of Clinical Evidence BMJ. www.clinicalevidence.org

22. Administration and Management • Regulatory frameworks, e.g. PCOs • Legal aspects, e.g. DVLA • Social services, e.g. Certification • Professional regulation, e.g. GMC • Business aspects, e.g. GP contract • Prescribing, e.g. Controlled drugs • Appropriate use of resources, e.g. drugs • Health & Safety, e.g. needlestick injury • Ethical, e.g. Mental capacity, consent

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

24. New question formats • Data interpretation Interpretation of complex sets of data for patients with chronic conditions. Relevant risk tables are included if appropriate. • Seminal trials Familiarity with significant new research e.g Knowledge of the ASCOT study which has changed clinical practice.

25. Single Best Answer (SBA) • “According to national guidelines” means recommended by nationally accepted guidelines or the BNF, not local practice • Often uses a clinical scenario • Only ONE answer is correct • Other options may be plausible

26. SBA example:Respiratory disease • A 17-year-old student suddenly develops chest pain and dyspnoea after a morning swim. There is hyper-resonance and decreased breath sounds on the right side. • Which is the SINGLE MOST likely diagnosis? Select ONE option only. • A. Asthma • B. Pneumothorax • C. Pulmonary embolus • D. Left ventricular failure • E. Pulmonary haemorrhage.

27. Extended matching questions (EMQ) • These questions have a list of possible options • There will usually be 3 or more scenarios • Choose the most appropriate option that best matches each given scenario • Each option can be used once, more than once, or not at all.

28. EMQ example: Certification A Form Med 3 B Form Med 4 C Form Med 5 D Form Med 6 E Form RM 7 F Form SC 1 G Form SC 2 H Private certificate For each patient described, select the SINGLE most appropriate certificate from the list of options above. Each option may be used once, more than once, or not at all. 1 You see and examine a patient with back pain who has been off work for seven days. The following day he requests a certificate to cover his absence from work for the day he saw you and the following day.

29. EMQ example: Certification A Form Med 3 B Form Med 4 C Form Med 5 D Form Med 6 E Form RM 7 F Form SC 1 G Form SC 2 H Private certificate For each patient described, select the SINGLE MOST appropriate certificate from the list of options above. Each option may be used once, more than once, or not at all. 2. A patient has been on long-term sick leave for six months and has received a questionnaire prior to the ‘all work test’. He requests the appropriate certificate from you.

30. Not requiring contraception Requiring contraception 3 _______ 1 _______ 2 _______ Combined oral contraceptive pill Algorithm example:Medical management of menorrhagia For each of the numbered gaps above, select ONE option from the list below to complete the algorithm, based on current evidence. Each option may be used once, more than once or not at all.

31. Algorithm example:Medical management of menorrhagia A Cyclical norethisterone B Copper-bearing intra-uterine device C Inert intra-uterine device D Levonorgestrel releasing intra-uterine system E Medroxyprogesterone acetate F Mefenamic acid G Nonoxinol ‘9’ H Tibolone I Tranexamic acid

32. Picture Format example:Skin disease • A 32-year-old man has noticed painless non-itchy patches of hair loss on his beard area and scalp.

33. Which is the SINGLE MOST likely diagnosis? Select ONE option only. A Alopecia areata B Eczema C Lichen sclerosis D Tinea infection E Vitiligo Picture Format example:Skin disease Ref: Dermnet.com

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

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

36. Which SINGLE study suggests the WEAKEST association between increased whole grain intake and a lowered risk of diabetes? Select ONE option only. A Fung B Meyer C Montonen D NHS1 E Van Dam Data Interpretation example

37. Scoring • All question formats have equal weighting • Each correct answer is awarded one mark • Total score on the paper is the number of correct answers given • No negative marking - ‘Fear factor’

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

39. Computer Based Testing • Once candidates have registered with the RCGP to sit the AKT, they will be given a phone number to book with the Pearson VUE test centre. • It is recommended that candidates familiarise themselves with the demonstration tutorial on the Pearson Vue website : https://www.pearsonvue.com/rcgp/ • The AKT also begins with a short tutorial to remind candidates how to mark the answers

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

41. Computer Based Testing • Security at each centre will be robust • Identity checks • Invigilated • Video monitoring • Test forms are downloaded to each centre on the test day • Separate morning and afternoon sittings with a quarantine period at lunchtime. • Morning candidates will not be allowed to leave before the end of the test

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

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

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

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

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