Taking the applied knowledge test

The topics covered by the AKT and advice on how to prepare for the exam. By Dr Prashini Naidoo.

What is the AKT?

The RCGP defines the AKT as:

‘a summative assessment of the knowledge base that underpins independent general practice in the United Kingdom within the context of the National Health Service. Candidates who pass this assessment will have demonstrated their competence in applying knowledge at a level which is sufficiently high for independent practice.’

The knowledge base

The knowledge base for general practice is huge. Of the 200 questions in the examination, 80% of question items will be on clinical medicine, 10% on critical appraisal and evidence-based clinical practice, and 10% on health informatics and administrative issues. 

The exam lasts for 190 minutes, so you have 57 seconds to answer each question.

Clinical medicine

Clinical medicine (80%) includes an equal proportion of:

  • Cardiovascular
  • Dermatology/ENT/ophthalmology
  • Endocrinology/metabolic
  • Gastroenterology/nutrition
  • Infectious diseases/haematology/immunology/allergies/genetics
  • Musculoskeletal
  • Paediatrics
  • Pharmacotherapeutics
  • Psychiatry/neurology
  • Reproductive/renal
  • Respiratory

    Make a list of revision topics, starting with areas of greatest weakness. To identify your areas of greatest weakness, do a few sample AKTs, either online or from revision texts. The RCGP has two useful online resources here and here.

    Look at areas in which you score the lowest, for example, contraception. Read around this topic using a variety of sources, such as review journals, textbooks and online articles.

    Slowly work your way down your list of weak topics. After three to five topics, go back and do a few more sample papers and see if your knowledge has improved.

    Critical appraisal and evidence-based clinical practice

    Critical appraisal and evidence-based clinical practice (10%) includes:

    • Critical appraisal skills – how to read, interpret and apply the results of qualitative and quantitative research.
    • Evidence-based medicine – including statistics, such as relative risk and numbers needed to treat (NNT).
    • Audit – the principles of audit and how to use audit to assess the quality of patient care.

      Start with some background reading, such as 'How to read a paper' by Trisha Greenhalgh (see Resources, below).

      This can be a dry subject, so after initial revision, get together in a group and try to answer some test questions. Examiners will not be asking for definitions of terminology because these are straightforward recall questions. Instead, they focus on testing your ability to interpret and evaluate data, so be prepared to do some simple calculations, such as the NNT, sensitivity and specificity.

      You will need to understand absolute and relative risk, odds ratios, p values, 95% confidence intervals and standard deviation and interpret scatter, L’Abbe, Forest, funnel and Cates plots.

      Health informatics and administrative issues

      Health informatics and administrative issues (10%) includes:

      • Certification, allowances and benefits.
      • Legal aspects, such as health and safety regulations and employment issues.
      • Professional regulation, such as clinical governance, risk management and patient safety.
      • The business side of general practice, such as fees and accounts.
      • Regulatory frameworks within the NHS.
      • Effective use of resources, such as investigations and prescribing.
      • Information technology.

        To score well in this section, it is prudent to read the DVLA guidance, the Department for Work and Pensions guidance on fit notes, and online sources on completing benefit forms.

        Applying knowledge

        According to the RCGP, the AKT questions will focus mainly on higher-order problem-solving, rather than just the simple recall of basic facts.

        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.

        Consider the following true/false question:

        An 18-month-old child is brought in by their mother, having had an episode earlier in the day of shaking upper and lower limbs, impaired consciousness and a fever of 38.5°C. 

        Which of the following signs or symptoms is most likely to result in referral to hospital? Answer true or false for each statement.

        1. The child now appears to be fully recovered.
        2. The seizure lasted five minutes.
        3. The child has a vesicular rash and a history of chickenpox contact.
        4. The child is drowsy and has vomited twice.
        5. The child has a temperature of 39°C and a red, bulging tympanic membrane.

        This question attempts to test higher-order thinking – trainees’ ability to use clinical information from the history and examination to make a decision about referral to hospital. If trainees answer correctly, this is evidence that they are able to evaluate the data to synthesise an appropriate solution.

        The question above tests clinical management; different questions will be designed to test other specific skills, such as diagnosis, investigation or interpretation of data. The questions are derived from review articles and journals readily available to all GPs. In this case, the question was derived from a BMJ review on febrile seizures.

        Conclusion

        The key to effective preparation is starting revision in good time, using past AKT questions to identify learning needs, undertaking a combination of personal and group study, and after reading review articles aimed at GPs, making a summary of how to apply this knowledge to patients.

        • Dr Naidoo is a GP trainer in Oxford
        Resources

        RCGP information on the AKT
        For information on the format of the examination, how to apply to sit the AKT and assessment dates. This includes a PowerPoint presentation for trainees and trainers and a link to the InnovAit journal, which contains a bank of AKT-style questions. It also provides access to:

        A good starting point for the revision of clinical medicine is Simon C, Everitt H, Van Dorp F. Oxford Handbook of General Practice. Oxford, OUP, 2009.

        Greenhalgh T. How to read a paper – the basics of evidence-based medicine. Fourth edition. Oxford, Wiley-Blackwell, 2010.

        Medical Protection's advice on preparing for MRCGP exams has some useful preparation tips

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