MRCGP - Sitting the applied knowledge test

Dr James Larcombe describes what to expect in the AKT and how best to prepare for the big day.

Preparing for the AKT using a variety of guidelines, journals and magazines is one of the keys to success
Preparing for the AKT using a variety of guidelines, journals and magazines is one of the keys to success

The applied knowledge test (AKT) makes up one-third of the MRCGP licensing exam.

This computer-based test has replaced the multiple choice paper, and takes place at Pearson VUE test centres throughout the UK on a designated day in January, April or October. Its aim is to assess the application of knowledge and interpretation of information.

Developing the AKT
The AKT covers the general practice curriculum, testing the span of conditions that could be encountered working in primary care. A pass means your knowledge base is sufficient for independent practice.

Although the AKT and the clinical skills assessment are different, there is often a correlation between performances in the exams.

Examiners for all components of the MRCGP are GPs who have undertaken specific training in question development, as well as extensive training in examination techniques.

Questions are mostly evidence based although this is not always possible where an evidence base is lacking. All questions are peer-reviewed, not only to ensure their accuracy but also to ensure they are understandable, discriminatory and have a valid grounding in real-life general practice.

When the AKT was being developed, two pilots were carried out using examiners and GP trainers who had little time to prepare. Reassuringly, they all passed, so if you are preparing for the AKT and unsure of whether you are answering questions at a realistic standard, ask your trainer.

Visit our GP Registrar Resource Centre for more AKT practice questions


Eighty per cent of questions are based on clinical problems. Most are about common diseases encountered in everyday practice. However, some are about important diseases that GPs encounter rarely but need to be able to diagnose and manage, for example, meningitis.

Ten per cent of questions cover statistics, epidemiology and critical reading concepts.

The remaining 10 per cent cover administration and management. Those taking the AKT in ST2, rather than ST3, might find this latter section more difficult.

Most questions are 'single-best-answer'. In these, there is one correct answer and usually four other answers of varying plausibility. The AKT also includes questions on clinical photographs, flowcharts with missing items, extended matching questions and statistical graphs or tables to interpret.

Preparation is key. As clinical questions are based on evidence your revision should reflect this. NICE and SIGN cover many areas of practice. Read the clinical comments in a prescribing formulary. Medical journals and magazines and e-GP (on the RCGP website) are also useful.

Candidates are wary of statistical and clinical reasoning questions, but there are fewer facts to revise for this section so you should practice simple epidemiological calculations. You will have a whiteboard in the exam to help with your arithmetic.

For the management section, read GP and take an active interest in administrative affairs in your training practice.

The RCGP website has 50 practice questions and feedback on areas where candidates had difficulties. These areas are likely to be tested in the future.

You can test yourself on AKT-style questions through the 'essential knowledge challenge' on the RCGP website. You can also familiarise yourself with the Pearson VUE computer screens by downloading a tutorial from their website.

Exam day
Often, you wait in a 'quiet room' before or after the exam to make sure other candidates who have completed the morning session cannot exchange tips.

The assessment takes three hours. After booking in with your photo identity, you start by viewing a tutorial to help with navigating the test.

Don't expect to complete the exam in half the time - 200 questions in 180 minutes is less than one minute per question, and you often have to read a short scenario or study a picture.

The quickest way to tackle questions is to read the scenario, and, without looking at the options, see if an answer springs to mind. If your answer is listed, click it and move on as you will almost certainly be right.

If you cannot think of an answer in less than a minute move on, but flag it for review so that you can return to it if you have time to spare.

Check that you're keeping to time. Aim to complete 10 questions every eight minutes. This leaves 20 minutes for revisiting any flagged questions.

Don't leave any questions blank, there's no negative marking so it is best to leave an answer even if you are not sure.

Learning points

AKT exam

1. The applied knowledge test is a predominantly clinical exam with 80 per cent of questions about common conditions encountered in everyday practice or rare diseases.

2. Question types are mainly single-best-answer questions, but there are also clinical photographs, flowcharts with missing items, extended matching questions and statistical graphs or tables to interpret.

3. Prepare well by familiarising yourself with NICE and SIGN guidelines, prescribing formularies, journals and magazines, such as GP.

4. On the day, use your time well. Allot eight minutes for every 10 questions. If you don't know the answer to a question, move on and return to it at the end.

  • Dr Larcombe is an MRCGP examiner and a GP in Sedgefield, Durham

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