Preparing for the AKT: Clinical medicine

By Dr Pipin Singh on the 13 February 2019

In the first of a three part series, Dr Pipin Singh provides GP trainees with advice on preparing for the clinical medicine section of the AKT exam.

A study group can be useful (Photo: iStock.com/asiseeit)

The Applied Knowledge Test (AKT) forms one third of the assessments within GP training, the other two being the CSA and your e-portfolio.

The AKT is a summative knowledge-based exercise. It is computer based and involves answering 200 questions within three hours and ten minutes.

It is made up of 80% clinical medicine questions, 10% critical appraisal and 10% informatics. This article looks at the clinical medicine section, while parts two and three of this series look at critical appraisal and informatics.

Clinical medicine

The range of clinical medicine that could be covered is broad and will represent the RCGP curriculum statements. The questions are largely relevant and mainstream to general practice.

Questions will be focused on problem solving as opposed to factual testing and how you apply knowledge to common scenarios. The questions may reflect common conditions and also significant conditions that are less common.

Style of questions

Questions are likely to be asked in the following way.

Single best answer
Multiple best answer
Extended matching questions
Picture format - common conditions and typical appearances
Drag and drop style questions
Data interpretation
Free text answer
Rank ordering

Success will be determined by knowledge, its application and exam technique.

Familiarise yourself with the condensed statements in the RCGP curriculum to ensure you do not omit any crucial topics. You may wish to rate how confident you feel with each of these topics using a curriculum rating scale. You can download Excel spreadsheets to do this from the RCGP website here.

Using practice questions

Online questions will provide a good source of preparation and commonly used websites for preparation include passmedicine.com, onexamination.com, pastest.co.uk and the RCGP question banks. The RCGP question banks tend to be free to access, whereas other websites often have a charge attached.

It is important to practise a broad range of questions from different sections of the curriculum headings.

If you get questions wrong, avoid falling into the trap of memorising that particular question and then the answer. That question is unlikely to appear in the AKT. These questions are designed to test your knowledge and application of knowledge to a whole host of different scenarios, thus if you get a question wrong, try and unpick why this may have happened.

It may represent a lack of knowledge around the topic, in which case read around this. It may represent an inability to interpret data and thus you may need to read around some basic principles to allow you to approach this type of question differently.

There maybe other reasons so carefully explore this and decide how you want to improve knowledge in this area whether it be reading a journal article, a national guideline or attending a seminar on this topic.

You may wish to discuss it with your trainer and see if anything can be done to help within your clinical setting, for example sitting in with the practice nurse or a diabetes clinic.

Other resources for preparation

The questions are often written by practising GPs who will be familiar with national and local guidelines. Use commonly-known resources that make use of up-to-date evidence for common conditions. These include:

BNF or MIMS for commonly-used drugs and their side effects and common abbreviations, e.g PoM
NICE guidelines and SIGN guidelines for commonly-managed conditions such as diabetes or heart failure. The NICE quick reference guideline may be more useful to read.
Sign up to common online resources such as GPonline and MIMS Learning, where everyday topics and scenarios are covered using up-to-date evidence.
DVLA guidelines on assessing fitness to drive
Fitness to fly guidance
Oxford Handbook of General Practice
RCGP innovAiT magazines – you can access this via your MyRCGP account on the RCGP website.
BMJ
NICE Clinical Knowledge Summaries (CKS). Refer to this when you see cases where you are unfamiliar with management. Tying in the knowledge to real life experiences is more likely to help you retain this over and above just trying to remember it.
Also consider a GP update course that will provide latest evidence on common conditions.

Familiarise yourself with other common topics such as childhood milestones, immunisation schedule, consultation models, common incubation periods of infectious diseases and common notifiable diseases seen in primary care.

The list is long but sample a few of these and decide which you feel is most applicable to your own learning style.

Also be alert to common emails sent regularly to you whilst in practice. These may well contain useful updates on key topics, for example immunisation bulletins, MHRA updates on drug warnings.

Study group

You may wish to form an AKT group with other trainees to practise questions together and think through the steps required to reach an answer or take turns in presenting a new guideline on a common area of general practice, for example an asthma or CKD guideline. A group may also provide support at a time where you may feel overwhelmed by exam and work pressures.