nMRCGP - Make sure you can ace the AKT

Dr Chris Elfes gives a trainer's perspective on how to pass the applied knowledge test.

The nMRCGP applied knowledge test (AKT) is little different from the previous MRCGP multiple choice paper.

This part of the triangulated assessment package of nMRCGP assesses the application of RCGP curriculum-based knowledge to a standard that a GP fit for independent practice should be performing against.

Setting the standard

The AKT is constructed by practising GPs who have undertaken extensive training themselves in order to try to create questions which are understandable, evidence based, discriminatory and above all valid questions grounded in real-life general practice.

Two exercises have helped to define whether the standards set are appropriate.

Two separate pilots were carried out whereby current nMRCGP examiners and current GP trainers from across the UK were asked to sit the exam with little preparation.

Reassuringly they all passed, so if you are preparing for the AKT and unsure of whether you are answering questions at a realistic standard, then ask your trainer.

Prepare well for the applied knowledge test by familiarising yourself with clinical guidelines

The AKT remains a predominantly clinical exam with 80 per cent of questions about common, low-impact diseases as well as rare, high-impact diseases. Ten per cent of questions remain on the ever unpopular - but easy to study for - subject of statistics and critical reading concepts.

The remaining 10 per cent of questions are based on the area of ethical, legal and GP administration such as driving regulations, sick certification and health and safety issues. It is this latter legal and administrative area that those who take the AKT in ST2 rather than ST3 might find more difficult.

Question types have remained similar over the first few rounds of AKT with mainly single best answer questions, but also clinical photographs, flowcharts with missing items, extended matching questions, statistical graphs or tables to interpret and potentially a couple of 'new format'-type questions being introduced.

This is a three-hour exam and you should not expect to whizz through in half the time. The main reason for this is that questions are not of the true/false type, but instead contain a lot of complex information to read about a clinical scenario or journal extract before being able to decide on the answer.

Prepare well
You are paying a significant sum of money to sit an exam on the whole of general practice, so do your groundwork thoroughly.

Be aware of national guidelines such as SIGN and NICE, learn to read MIMS and the BNF, use a simple medical statistics guide and learn to use the internet efficiently.

There are many websites offering practice MCQs - you may get helpful recommendations from fellow GP trainees - and you should also make use of the RCGP website, which has access to 50 questions and feedback from the exam board about areas where previous candidates had difficulties; such areas are likely to be tested in the future.

Apply early if you want to be sure to get your nearest local Pearson Vue test centre session of choice.

Plan your journey time
Research your journey well and consider the time of day you will be travelling to make allowances for this. Late arrivals are not allowed in. Several complaints to the RCGP have been made by candidates who claimed they arrived on time but were turned away; however subsequent analysis of the ever-present test centre surveillance cameras showed the true time of arrival.

Check your ID details
The name you use to register with the RCGP must match the photo ID (current driving licence or passport) and the secondary ID (credit card) that you take to the exam.

If it does not match, you will not be allowed to take the exam. If you think there may be a problem (for example, you just got married and are using two different names), please check the website instructions and contact the RCGP in good time to find out what to do.

Time management
The assessment takes three hours and this does not include the time taken to be booked in with your photo identity.

You are likely to have to wait in a 'quiet room' before or after the exam in order to make sure other candidates who have completed the morning exam, or those who are turning up after you cannot ask you for exam tips.

Some candidates are naturally good at this type of assessment and here are a few of the reasons why they might do better than average: good time management means 200 questions in 180 minutes gives you less than a minute per question (54 seconds to be precise).

Therefore, move on to the next question if you cannot answer one in less than a minute. The quickest way to tackle any question is to read the scenario/stem and, without even looking at the list of options, see if you come up with an instant answer. If the answer you come up with is found on the list of options, click it and move on as you will almost definitely have got it right. Don't leave any questions blank, and remember that there is no negative marking.

Dr Elfes is a GP trainer, course organiser and nMRCGP examiner

Learning points

1. The AKT is a predominantly clinical exam with 80 per cent of questions about common and rare diseases.

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

3. Prepare well by familiarising yourself with NICE and SIGN guidelines and MIMS.

4. On the day, use your time well. If you don't know the answer to a question, then move on and return to it at the end.


The Royal College of General Practitioners is a network of over 35,000 family doctors. It works to encourage and maintain the highest educational, training and clinical standards in order to improve care for our patients.



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