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everything you ever wanted to know
by Drs. Anish Kotecha & Ramesh Mehay
path: AKT RESOURCES
You need to have good medical knowledge to pass the AKT – this should be obvious and not need spelling out. But the problem is that the field of General Practice covers ALL the clinical specialties – so, to know everything in great detail would take years! And by the time you have updated your knowledge on say Respiratory Medicine, the knowledge update you did on say Diabetes 2 years ago, will now be out of date!
So, here is a set of super-condensed “at-a-glance” curriculum guides which tell you the bare minimum you should know for the AKT. It’s still a lot to cover, but at least you now have a list you can tick off.
The ‘Applied Knowledge Test’ is a summative examination that assesses the knowledge required for independent general practice in the United Kingdom. Along with the CSA and WPBA, it forms part of the MRCGP. It uses multiple choice questions because it focuses on application of knowledge rather than just basic recall of facts. 80% of the questions are based on clinical medicine, 10% on health informatics and administrative issues and 10% on evidence-based medicine and critical appraisal.
Click on the link below to see what a Pearson Vue Centre is like and how the exam is set up. By getting to know what it is like in advance should lessen your anxieties.
For starters, you are not allowed to take it in ST1.Therefore you can only take it in ST2 or ST3. I personally think it is better taken at the end of ST2 or the beginning of ST3 – after you have had at least 4-6 months of GP experience. Do not leave it until the second post of ST3 – you have CSA to do and 101 other things and life will become heavily pressurised. Trust me!
This is a difficult exam and the amount needed to cover is vast so giving plenty of time to revise is crucial (probably 4- 6 months is recommended). Whether you need 4 or 6 months depends on you and your circumstances. For instance, a full-time working mum probably needs 6 months because you will have a lot on your plate.
We have complied the following advice from a number of sources. Of course, we have talked to trainers, TPDs and AKT examiners. But we have also conversed with a number of trainees how have passed the AKT with very high scores. In talking to all these different ‘experts’, we have picked out common pieces of advice agreed by all. Whilst you are reading through this page, if you come across anything which is at variance with what you are doing, please take a moment to pause, breathe, reflect and decide whether you need to make a change or not. Remember, there is always your Trainer, TPD and Educational Supervisor you can talk to (as well as your GP trainee colleagues. Please do talk to a lot of those who have passed the exam, and take their feedback onboard.
The first thing to look at is the AKT Content Guide which is downloadable from the resources link above . The RCGP’s AKT Core Group has developed this learning resource to complement the curriculum which essentially lists the topics that could be tested in the AKT. It is not an exhaustive list and inevitably it will need to be updated but we hope that it will be helpful in defining the topics that candidates should be aware of.
It is particularly good for defining the areas of
Remember, together these are worth 20% of the marks and if you know some of your basic stuff in this area, those questions will be a breeze!
It is designed to be used in conjunction with the curriculum and is not a substitute for it. It may look overwhelming but we would encourage you to read the introduction to understand its use, and there are examples to show how topics relate to the curriculum. The curriculum link is www.rcgp.org.uk/gp-training-and-exams/gp-curriculum-overview.aspx
That brings us nicely onto the Curriculum Self-Assessment tool available in the downloads section about. Use that to score yourself and identify areas you need to focus on. Remember to be honest with yourself!
Some questions for the multiple-choice paper are derived from review articles and journals. Therefore, you should also cast your eye over several of these publications regularly:
Occasionally flicking through some online GP magazines (like Pulse and GP Online) can be helpful too. They have a knack of summarising clinical topics very well, often through colourful pictures and flow diagrams.
Please consider buying these books from our Bradford VTS’s bookstore. Amazon give us 4%, although not huge, it helps keep this website free.
If you are into your podcasts, there are several out there to help with your AKT exam…
It is probably worth using a few different question banks to allow sight of different writing styles.
For the books, please consider buying these books from our Bradford VTS’s bookstore. Amazon give us around 4% of sales, although not a huge amount, helps keep this website free.
Timing is really important in the AKT. A lot of trainees run out of time because they were thinking too long and too hard about several other questions. The problem with this is that in spending that extra time on these difficult questions, you will run out of time and wont finish the exam. And the remaining questions that you missed might have been lots easier than the ones you were spending extra time struggling on. Hence you lose easy marks, and then you risk failing!
In planning how best to help you, I have tried to guess your ideas, concerns and expectations for this article and I hope I’ve got it wrong, because my guess is that you probably think that revision is the best way to pass an exam and that what you really need now is a short reading list. This idea is based on the assumption that the best way to pass an exam is to go on the right course, read the right books and practice lots of MCQ questions. But that’s not going to be my advice to you, because that’s not how I see the exam and not how I would recommend you should study.
So, if the very idea of applying ideas, concerns and expectations to the AKT is already making you uncomfortable – why is that?
Well, firstly, don’t worry – I’m not going to completely overturn your expectations. I would however strongly advise you to reflect on an alternative view of this exam, which is based on the idea that the AKT is an exam designed to test the working knowledge of a competent GP, the concern that what you cram today stays in your brain for a couple of weeks at most and the expectation that if I can persuade you to consider lifelong learning, it really will set you up for life!
Although I have only the accounts of others to tell me how today’s GP trainees study, I do have 13 years of experience of examining for the old MRCGP and was briefly involved in writing AKT questions. I therefore know a lot about how examiners think and have witnessed the process whereby questions are chosen and refined for inclusion in the AKT question bank. I also sat the first ever AKT, when examiners were invited to try out the paper in advance of the candidates, and passed it with a score of 82.5% having done no revision whatsoever. So my advice on studying for the exam is not just a collection of random thoughts.
So – what does lifelong learning look like? Well, there are two ways of looking at what you need to know to be a GP. The current favourite is to define a ‘curriculum’ and then structure an exam around that curriculum using a ‘blueprint’ (www.rcgp.org.uk/gp-training-and-exams/gp-curriculum-overview.aspx ).
This feels reasonably scientific and the exam is very carefully planned to sample different areas of the curriculum in due proportion. But there is another view of what you need to know for real life general practice, which I suggest provides a much better way of preparing both for the exam and for your future career – i.e. consider that common things are common and, as you already know, after just a few weeks you have seen all of the most common conditions (URTIs, headache, back pain, UTIs, feverish children, hypertension etc.), after three or four months, you will have seen the majority of important GP problems and after a year you will have seen almost everything you need to know.
You may not have seen a case of Churg Strauss syndrome or pseudo-hyperparathyroidism, but that doesn’t matter. You will have seen all the common and reasonably common conditions and refined your ability to recognise what you don’t know and how to find the information you need to manage uncertainty. That is what GPs do and if throughout your trainee years you keep your eyes open and research your gaps and your learning needs (your PUNs and DENs) you will easily cover all that you need to pass the exam.
But because you may think it’s better to take the exam early in the year (which I understand, but don’t really recommend), you should also get reading now!
“But what about the cramming?” you ask. Well before you hit the NICE guidelines, first make yourself really familiar with the bible of general practice therapeutics (the BNF) and study the chapter headings for all common conditions. Then register for eGuidelines, which is a good web resource and has a mobile app and only then (if you must) order some NICE guidelines – but be selective. The AKT is not a test of NICE guidance – just ask your trainer when s/he last referred to a NICE guideline during a consultation! By all means know about the guidelines that exist, but focus on when and how to apply them in real life situations.
General practice is a very broad subject and quite different to the hospital medicine that you are used to. It does have clear cut content, but there is no definitive study guide, the MCQ books on the market are not written by AKT question setters and the real examiners approach general practice and the AKT from many different angles.
First of all, make contact with someone (like your Trainer or TPD) and tell them how you feel. Most trainees who fail feel like they are a complete failure and often feel embarassed at their result.
But there is not need to be. Remember, you managed to complete medical school. Therefore you are in the top 1% of this country’s intelligent and educated people. So, don’t feel like a failure. Instead try and see this as part of your journey. Okay, so you failed – let’s learn from that and become a better you. And there is no reason to feel embarassed. We all know that the AKT is a hard exam – and lots of us would fail.
Failing the AKT does not mean you are stupid. It simply means that you’re probably not learning in an effective way. Note: I did not say you are not studying hard. Nearly everyone I have come across who has failed always studies very very very hard. But what they don’t do is study in a way that is most effective for them. Instead, they stick to old learning methods like reading a book from cover to cover (and the latest research shows that this method does not make learning stick).
Therefore, I suggest you talk with your TPD and trainer and Educational Supervisor. Tell them how you study and ask them if they have any advice on a better and more effective strategy.
If this is something like your third or fourth attempt, consider getting a dyslexia assessment. Dyslexia is a common but unrecognised condition and if you have it, you may be given an extra 45 minutes in the AKT exam. Look at these two websites for more information.
Talk to your program director, educational supervisor and/or trainer if you think you might have it. Please don’t feel embarrassed.
