MRCGP - Revising for the AKT and CSA

Having a revision strategy and working in a group is the key to exam success, says Dr Leke Asong.

Being part of a revision group offers invaluable experience, as well as support and friendship, during your preparation for the CSA and AKT (Photograph: Istock)
Being part of a revision group offers invaluable experience, as well as support and friendship, during your preparation for the CSA and AKT (Photograph: Istock)

The applied knowledge test (AKT) and clinical skills assessment (CSA) are mandatory exams all GP registrars face at various stages of training.

The AKT can be done at any stage of GP specialty training, however, the RCGP advises attempting it in ST3 while working as a GP registrar.

The AKT comprises 200 questions styled as extended matched questions, single best answers, pictorial, table and algorithm formats.

The CSA can only be taken during the ST3 year. It comprises 13 simulated consultations using actor patients. Cases are identical to real GP cases, including home visits or telephone consultations.

I recommend tackling the AKT first, although some have attempted the CSA before the AKT.

Revision strategy
Time management and organisation skills are essential in everyday general practice, and are of the utmost importance when preparing for the AKT and CSA exams.

To sail through both these exams, a solid revision strategy is vital.

Learning on the job
Use your GP placement as a starting point for revision. After each consultation, dip into a valuable text or website if you come across something you are unsure of and remember to keep your ePortfolio up to date.

I recommend jotting learning needs into a notepad as well so you can discuss them with your GP trainer or other registrars.

Debrief sessions with your trainer are very beneficial. My trainer was an invaluable source of information and support during my training.

Make use of the partners in your practice by asking them to discuss any interesting or helpful cases. A partner at my training practice once showed me a patient with a blue/grey complexion. She was clearly stable, and not dyspnoeic. He told me the clue was in her joints, asking the lady to spread her fingers. I was clueless. It turns out she had rheumatoid arthritis, and had been treated in the past with auranofin (now discontinued in the UK) which leaves a blue/grey hue to the skin.

The above example could be a classic AKT question presented in any of the varied formats discussed. During your surgery break, read up on anything new you have come across. If you have another registrar in the same practice you can discuss cases or go through any multiple choice questions. Go through the answers together and learn simultaneously.

Group work
As the curriculum is vast, sharing knowledge through group revision is very beneficial. Everyone has different learning styles and after a few sessions together you will get to know your colleagues.

You will pick up on their different presentation styles and which colleagues are up to date on different specialties.

All these factors will help you decide who you can work with productively. As time goes on, you will drift towards people with a similar learning style to your own.

Once a group is established, consider where you can all easily meet to revise. As a group, decide meeting frequency and start times. Going out for an occasional drink or dinner is a good idea as it helps to build the team. Sadly, you will inevitably discuss the impending exams. This might be a good thing for some, as it keeps them on their toes and in the right frame of mind.

The real power of a working group comes when preparing for the CSA. To get the most from group revision, you must be prepared. Use the consultation observation tool criteria during each consultation and start videoing yourselves early - the more practice you have, the more you will be comfortable with a 10-minute consultation.

Your trainer will help you critique your consultations and guide you through the whole process. During surgery, write up a few interesting cases you think might be potential CSA cases. You can then use these for role play in your working group.

To maximise the usefulness of case discussions with your working group, it is worth deciding beforehand what type of cases to bring to the group to ensure a good variety. This ensures you are roughly spanning the curriculum.

Aim to start the consultation on time and have a stopwatch on standby. Swap roles between examiner, patient and doctor, and discuss each case thoroughly afterwards. Treat every consultation like the real thing. The more you do this, the easier it will become. After a few months, you will be fluent in your history taking and clinical examinations.

  • Dr Asong is a GP in Nottinghamshire.
Learning Points

1. Time management and organisation skills are essential with other trainees.

2. Ask GP partners to discuss interesting cases with you.

3. Debrief sessions with your trainer are very beneficial.

4. Share knowledge through group work.

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