GP training: How to succeed in the AKT

Dr Branavan Anandasundaram passed the AKT earlier this year with a score of 89.5%. He offers advice for GP trainees on how to prepare effectively for sitting the exam.

(Photo: Nutthaseth Vanchaichana/EyeEm/Getty Images)
(Photo: Nutthaseth Vanchaichana/EyeEm/Getty Images)

I sat the MRCGP AKT in May 2019 and was overjoyed to discover I had passed on my first attempt with a high score of 89.5% (90% in clinical medicine, 90% in the evidence section and 85% in the organisational domain).

Similar to other trainees, I was faced with a number of dilemmas in the early stages of preparation.

  • What resources do I use?
  • How do I plan my time?
  • Do I put more focus into answering questions or reading around the topic areas in the curriculum guide?

Having spent many months studying hard for the exam and using a variety of resources along the way, I wanted to shed light on some preparation tips. I hope this guide helps to kick start your revision in the right direction, and ultimately enables you to pass this exam with flying colours.

Structure of the exam

Before starting your preparation it is worth reminding yourself about the structure of the exam, to help streamline revision. The latest format features 200 questions in 3 hours and 10 minutes. 

  • 80 % of the paper is on clinical medicine (160 questions)
  • 10 % is on evidence interpretation (20 questions)
  • 10 % is on organisational questions/practice management questions (20 questions).

This should tell you that the majority of your time should be spent focussing on clinical medicine. At the beginning of this journey you may feel overwhelmed by the breadth of knowledge that you need to accumulate across the specialties, but effective organisation will help you remain positive and on track.

It is also easy to underestimate how much you already know from your clinical rotations, so take confidence from your real-life experience seeing patients – this will greatly help when sitting the exam!

Planning time during a busy rotation

I managed to sit the exam during a busy ST2 year with hospital rotations. Initially this felt very daunting and was incredibly busy at times, but I managed to do it with adequate planning around my rota, factoring in nights and on-calls where revision time was lessened.

I also planned my annual leave and study leave 2-3 months in advance to ensure I have adequate preparation time, especially in the final month leading up to the exam.

While the preparation time will vary from person to person depending on your rotation and other commitments, I would recommend 3-4 months to allow for comprehensive curriculum coverage, as well as maintaining a healthy work-life balance which is imperative in staying motivated and positive. If you’re someone like me, I need to factor in family time, so spending an hour or two with family is maybe the de-stress you need before you contemplate another spell of revision.

Clinical medicine

The secret to the exam is preparation. I started off by compiling a list of all the specialties and highlighting those in which I felt was weaker. Unsurprisingly these were areas that I had less clinical exposure to, such as ENT, dermatology and obstetrics and gynaecology.

I then began to tackle these areas first so that I allowed myself enough time to revisit these areas closer to the exam. Treat it like preparing for a marathon, with every week bringing you closer towards the bigger goal, so set yourself realistic targets of what topics you need to have covered each week.

The structure I used was to read the latest NICE/SIGN guidelines on key areas within a particular specialty, before answering questions. I found this to be a better all-rounded route to learning, rather than attempting to solely learn from answering questions.

The clinical questions in the exam are sampled evenly across the AKT curriculum guide (which you can download from the RCGP website), so it is imperative not to neglect revising seemingly ‘less common’ topic areas such as genetics and haematology, as questions can feature in these areas.

Remember the AKT not only tests common areas that we see day-day, but also potentially rare illnesses, where the implications of missing a diagnosis can be significant.    

Statistics and administration

The statistics and administration sections are more confined in terms of the curriculum, and therefore it is possible to master the key principles with targeted reading.

The first six chapters of the Oxford Handbook of General Practice are excellent for learning about GP contracts and QOF principles, for example, and don’t forget the latest fitness to fly and DVLA guidelines.

Make sure you are also familiar with the GMC Good Medical Practice guidance on key ethical issues, such as confidentiality and end-of-life care.

If you struggle to understand statistics, find a book that breaks down the key principles in layman terms and then constantly practise applying this to real-life scenarios. Medical Statistics Made Easy is a good reference guide, with key definitions at the back of the book, and each chapter neatly corresponding to a learning outcome such as sensitivity and specificity calculations.

  • More advice on useful resources you can use to prepare for all sections of the exam here.

The days leading up to the exam

Make sure you eat and sleep well - the exam is very time-pressured and you need to be able to keep your thinking hat on throughout.

Consolidation and repetition of your weaker areas is a good idea. Perhaps create small revision cards to help serve as easy reminders prior to the exam. For example, I wrote down mnemonics for enzyme inducers and inhibitors on small Post-it notes because it was a nemesis of mine.

Practise your timing. I practised two full 200-question mocks in the week leading up to the exam, to ensure I felt prepared and had the right mindset. This helped me keep on top of timing in the exam, which opened up some extra time for me to analyse the more challenging scenarios.

Pay due attention to carefully reading scenarios when you are in the exam as key information in the stem, such as a family history, or an occupational factor, may change your likely differential.

Get the boring bits out the way early – get your identification documents for the day ready to take to the examination venue in order to avoid any last minute stress.

  • Dr Branavan Anandasundaram is an ST3 GP trainee in London

Read more: Useful resources when preparing for the AKT

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