nMRCGPnMRCGPApplied Knowledge TestApplied Knowledge Test

November 2007November 2007

Prepared by the AKT GroupPrepared by the AKT Group

AKT aimsAKT aims

• The AKT is designed to test the The AKT is designed to test the application of knowledge and application of knowledge and interpretation of informationinterpretation of information

• Each question is intended to explore Each question is intended to explore a topic of which an ordinary GP could a topic of which an ordinary GP could be expected to have a working be expected to have a working knowledge knowledge

BackgroundBackground

• Replaces the previous Multiple Replaces the previous Multiple Choice PaperChoice Paper (MCP) (MCP)

• Summative assessment of the Summative assessment of the knowledge base that underpins knowledge base that underpins independent general practice within independent general practice within the United Kingdom. the United Kingdom.

• Mapped to the Mapped to the RCGP CurriculumRCGP Curriculum

FormatFormat::

• An “evolution” from the current MRCGP An “evolution” from the current MRCGP MCPMCP

• A three hour, 200 item multiple-choice A three hour, 200 item multiple-choice testtest– No multiple true/false questionsNo multiple true/false questions– No negative markingNo negative marking

• Delivered on a computer terminal at an Delivered on a computer terminal at an invigilated test centreinvigilated test centre

• Offered initially three times a year Offered initially three times a year Oct/Nov, Jan/Feb, April/MayOct/Nov, Jan/Feb, April/May

Vital StatisticsVital Statistics

• October 2007 resultsOctober 2007 results– Pass mark = 70.5%Pass mark = 70.5%

– ST3 pass rate = 87%ST3 pass rate = 87%– ST2 pass rate = 75%ST2 pass rate = 75%

• Results may vary from one session to Results may vary from one session to anotheranother

RulesRules

• No limit to the number of attemptsNo limit to the number of attempts

• A pass will be valid for three years onlyA pass will be valid for three years only

• Can be attempted at any time during GP Can be attempted at any time during GP specialist training (GPST), but most specialist training (GPST), but most appropriately during the GPR year (ST3)appropriately during the GPR year (ST3)

Transitional ArrangementsTransitional Arrangements

• Will replace the Summative Will replace the Summative Assessment MCQ from August 2007Assessment MCQ from August 2007

• Is equivalent to the current MRCGP Is equivalent to the current MRCGP MCP for those completing the current MCP for those completing the current exam during 2007-8exam during 2007-8

The MRCGP Curriculum The MRCGP Curriculum StatementsStatements

Where to find themWhere to find them

• RCGP websiteRCGP website

http://www.rcgp-http://www.rcgp-curriculum.org.uk/curriculum.org.uk/

What are they?What are they?

• Series of papers, each covering different Series of papers, each covering different clinical and practice management areas, clinical and practice management areas, based on European Academy of Teachers in based on European Academy of Teachers in General Practice (EURACT) framework. General Practice (EURACT) framework.

• Written by a variety of GP experts and Written by a variety of GP experts and coordinated by RCGPcoordinated by RCGP

The MRCGP Curriculum The MRCGP Curriculum StatementsStatements continuedcontinued

How they are being usedHow they are being used

• Curriculum statements have ‘Intended Curriculum statements have ‘Intended Learning Outcomes (ILO)’. Questions and CSA Learning Outcomes (ILO)’. Questions and CSA cases are linked to specified learning cases are linked to specified learning outcomes within specified curriculum outcomes within specified curriculum statements.statements.

• This enables sampling from across the This enables sampling from across the curriculum, as cases can be mapped to the curriculum, as cases can be mapped to the curriculum statements (or nMRCGP blueprint)curriculum statements (or nMRCGP blueprint)

Paper Construction ensures:Paper Construction ensures:

• Reliability, validity and fairness.Reliability, validity and fairness.

• Adequate coverage of the topics Adequate coverage of the topics that appear in the blueprint.that appear in the blueprint.

• The correct balance of question The correct balance of question formatsformats

Principles of paper Principles of paper constructionconstruction• Relevance:Relevance:

The AKT should be relevant to general practice; The AKT should be relevant to general practice; any topic covered can be one which occurs any topic covered can be one which occurs commonly or one which is significant but less commonly or one which is significant but less commoncommon

• High prevalence: High prevalence: Low impact e.g. URTILow impact e.g. URTI

• High impact: High impact: Low prevalence e.g meningitisLow prevalence e.g meningitis

Question writingQuestion writing

• Scenarios derived from clinical workScenarios derived from clinical work• Practice issuesPractice issues• TopicalTopical

• All questions are referenced and the draft All questions are referenced and the draft questions are then carefully scrutinised by questions are then carefully scrutinised by a panel of other question writers.a panel of other question writers.

• All question writers are working GPsAll question writers are working GPs

Common Reference MaterialCommon Reference Material• Clinical EvidenceClinical Evidence• CochraneCochrane• BNFBNF• GP CurriculumGP Curriculum• NICENICE• SIGNSIGN• BMJ Review articles & original BMJ Review articles & original

paperspapers• BJGPBJGP• DTBDTB• GMPGMP

AKT subjectAKT subject contentcontent• Core clinical medicine and its application to Core clinical medicine and its application to

problem solving in a general practice context problem solving in a general practice context – 80% of items80% of items

• Critical appraisal and evidence based clinical Critical appraisal and evidence based clinical practicepractice– 10% of items10% of items

• Ethical and legal issues as well as the Ethical and legal issues as well as the organisational structures that support UK general organisational structures that support UK general practicepractice– 10% of items10% of items

Clinical Medicine (1)Clinical Medicine (1)• The broad topic of clinical medicine The broad topic of clinical medicine

is subdivided into groups of body is subdivided into groups of body systems, in approximately equal systems, in approximately equal numbersnumbers

• Each group will comprise sections Each group will comprise sections on on – disease factorsdisease factors– symptomssymptoms– investigationinvestigation– managementmanagement

Clinical Medicine (2)Clinical Medicine (2)

– CardiovascularCardiovascular– DermatologyDermatology– EndocrinologyEndocrinology– ENTENT– GastroenterologyGastroenterology– GeneticsGenetics– HaematologyHaematology– ImmunologyImmunology– InfectionInfection– Mental health & Mental health &

learning disabilitylearning disability

– Musculo-skeletalMusculo-skeletal– NeurologyNeurology– OphthalmologyOphthalmology– PaediatricsPaediatrics– RenalRenal– Reproductive Reproductive

male/femalemale/female– RespiratoryRespiratory– Therapeutic indications Therapeutic indications

and adverse reactionsand adverse reactions

Clinical Medicine (3)Clinical Medicine (3)

• Common, low impact – e.g. sore Common, low impact – e.g. sore throatthroat

• Rare, high impact – e.g. child abuseRare, high impact – e.g. child abuse

• Topical – e.g. controlled drugs Topical – e.g. controlled drugs regulationsregulations

Research, Epidemiology and Research, Epidemiology and Statistics (1)Statistics (1)• Understanding the principles of audit Understanding the principles of audit

and its application in assessing the and its application in assessing the quality of carequality of care

• Understanding the application of Understanding the application of critical appraisal skills which will be critical appraisal skills which will be tested in a number of formats e.g the tested in a number of formats e.g the interpretation of research datainterpretation of research data

Research, Epidemiology and Research, Epidemiology and Statistics (2)Statistics (2)

• Understanding and application of Understanding and application of terms used in both inferential terms used in both inferential statistics and evidence based statistics and evidence based medicine.medicine.

E.g as described in the appendices of E.g as described in the appendices of Clinical Evidence BMJ. Clinical Evidence BMJ. www.clinicalevidence.orgwww.clinicalevidence.org

Administration and Administration and ManagementManagement• Regulatory frameworks, e.g. PCOsRegulatory frameworks, e.g. PCOs• Legal aspects, e.g. DVLALegal aspects, e.g. DVLA• Social services, e.g. CertificationSocial services, e.g. Certification• Professional regulation, e.g. GMCProfessional regulation, e.g. GMC• Business aspects, e.g. GP contractBusiness aspects, e.g. GP contract• Prescribing, e.g. Controlled drugsPrescribing, e.g. Controlled drugs• Appropriate use of resources, e.g. drugsAppropriate use of resources, e.g. drugs• Health & Safety, e.g. needlestick injuryHealth & Safety, e.g. needlestick injury• Ethical, e.g. Mental capacity, consentEthical, e.g. Mental capacity, consent

Question FormatsQuestion Formats

• Single Best Answer (SBA)Single Best Answer (SBA)

• Extended Matching Questions (EMQ)Extended Matching Questions (EMQ)

• Table/AlgorithmTable/Algorithm

• Picture FormatPicture Format

• Data interpretationData interpretation

• Seminal TrialsSeminal Trials

New question formatsNew question formats

• Data interpretationData interpretation Interpretation of complex sets of data for Interpretation of complex sets of data for

patients with chronic conditions. Relevant patients with chronic conditions. Relevant risk tables are included if appropriate.risk tables are included if appropriate.

• Seminal trialsSeminal trials Familiarity with significant new researchFamiliarity with significant new research

e.g Knowledge of the ASCOT study which e.g Knowledge of the ASCOT study which has changed clinical practice. has changed clinical practice.

Single Best Answer (SBA)Single Best Answer (SBA)

• ““According to national guidelines” According to national guidelines” means recommended by nationally means recommended by nationally accepted guidelines or the BNF, not accepted guidelines or the BNF, not local practicelocal practice

• Often uses a clinical scenarioOften uses a clinical scenario

• Only ONE answer is correctOnly ONE answer is correct

• Other options may be Other options may be plausibleplausible

SBA example:SBA example:Respiratory diseaseRespiratory disease

• A 17-year-old student suddenly develops chest pain and A 17-year-old student suddenly develops chest pain and dyspnoea after a morning swim. There is hyper-resonance dyspnoea after a morning swim. There is hyper-resonance and decreased breath sounds on the right side.and decreased breath sounds on the right side.

• Which is the SINGLE MOST likely diagnosis? Select ONE Which is the SINGLE MOST likely diagnosis? Select ONE option only.option only.

• A. AsthmaA. Asthma• B. PneumothoraxB. Pneumothorax• C. Pulmonary embolusC. Pulmonary embolus• D. Left ventricular failureD. Left ventricular failure• E. Pulmonary haemorrhage.E. Pulmonary haemorrhage.

Extended matching questions Extended matching questions (EMQ)(EMQ)

• These questions have a list of possible These questions have a list of possible optionsoptions

• There will usually be 3 or more There will usually be 3 or more scenariosscenarios

• Choose the most appropriate option that Choose the most appropriate option that best matches each given scenariobest matches each given scenario

• Each option can be used once, more Each option can be used once, more than once, or not at all.than once, or not at all.

A Form Med 3

B Form Med 4

C Form Med 5

D Form Med 6

E Form RM 7

F Form SC 1

G Form SC 2

H Private certificateFor each patient described, select the SINGLE

most appropriate certificate from the list of options above. Each option may be used once, more than once, or not at all.

1 You see and examine a patient with back pain You see and examine a patient with back pain who has been off work for seven days. The who has been off work for seven days. The following day he requests a certificate to cover following day he requests a certificate to cover his absence from work for the day he saw you his absence from work for the day he saw you and the following day.and the following day.

EMQ example: EMQ example: CertificationCertification

A Form Med 3

B Form Med 4

C Form Med 5

D Form Med 6

E Form RM 7

F Form SC 1

G Form SC 2

H Private certificateFor each patient described, select the SINGLE

MOST appropriate certificate from the list of options above. Each option may be used once, more than once, or not at all.

2. A patient has been on long-term sick leave for 2. A patient has been on long-term sick leave for six months and has received a questionnaire prior six months and has received a questionnaire prior to the ‘all work test’. He requests the appropriate to the ‘all work test’. He requests the appropriate certificate from you.certificate from you.

EMQ example: EMQ example: CertificationCertification

Algorithm example:Algorithm example:Medical management of Medical management of menorrhagiamenorrhagia

For each of the numbered gaps above, select ONE option from the list below to complete the algorithm, based on current evidence. Each option may be used once, more than once or not at all.

Not requiring

contraception

Requiring contracepti

on

1 _______ 2 _______ Combined oral contraceptive pill

3 _______

Algorithm example:Algorithm example:Medical management of Medical management of menorrhagiamenorrhagiaAA Cyclical norethisteroneCyclical norethisteroneBB Copper-bearing intra-uterine deviceCopper-bearing intra-uterine deviceCC Inert intra-uterine deviceInert intra-uterine deviceDD Levonorgestrel releasing intra-uterine systemLevonorgestrel releasing intra-uterine systemEE Medroxyprogesterone acetateMedroxyprogesterone acetateFF Mefenamic acidMefenamic acidGG Nonoxinol ‘9’Nonoxinol ‘9’HH TiboloneTiboloneII Tranexamic acidTranexamic acid

Picture Format example:Picture Format example:Skin diseaseSkin disease

• A 32-year-old man A 32-year-old man has noticed has noticed painless non-itchy painless non-itchy patches of hair loss patches of hair loss on his beard area on his beard area and scalp. and scalp.

Picture Format example:Picture Format example:Skin diseaseSkin disease

• Which is the Which is the SINGLE MOST likely SINGLE MOST likely diagnosis? Select diagnosis? Select ONE option only.ONE option only.

AA Alopecia areataAlopecia areata

BB EczemaEczema

CC Lichen sclerosisLichen sclerosis

DD Tinea infectionTinea infection

EE VitiligoVitiligo

Ref: Dermnet.com

Data InterpretationData Interpretation

• Interpretation of complex sets of Interpretation of complex sets of data for patients with chronic data for patients with chronic conditionsconditions

• Interpretation of research and audit Interpretation of research and audit resultsresults

Data Interpretation exampleData Interpretation example

• The summary The summary findings of a findings of a systematic review systematic review which included six which included six separate studies are separate studies are show opposite. show opposite.

Ref: BMJRef: BMJ  2007;335:473  2007;335:473   

Data Interpretation exampleData Interpretation example

• Which SINGLE Which SINGLE study suggests the study suggests the WEAKEST WEAKEST association association between increased between increased whole grain intake whole grain intake and a lowered risk and a lowered risk of diabetes? Select of diabetes? Select ONE option only.ONE option only.

A FungA Fung

B MeyerB Meyer

C MontonenC Montonen

D NHS1D NHS1

E Van DamE Van Dam

ScoringScoring

• All question formats have equal All question formats have equal weightingweighting

• Each correct answer is awarded one Each correct answer is awarded one markmark

• Total score on the paper is the Total score on the paper is the number of correct answers givennumber of correct answers given

• No negative marking - ‘Fear factor’No negative marking - ‘Fear factor’

FeedbackFeedback

• Feedback will be provided to every Feedback will be provided to every candidate with their resultcandidate with their result– Their overall scoreTheir overall score– The pass markThe pass mark– Their performance in each of the 3 main subject Their performance in each of the 3 main subject

areasareas

• More general feedback on overall More general feedback on overall performance will continue to be forwarded performance will continue to be forwarded to all UK deaneries and placed on the RCGP to all UK deaneries and placed on the RCGP websitewebsite

Computer Based TestingComputer Based Testing

• Once candidates have registered with the RCGP Once candidates have registered with the RCGP to sit the AKT, they will be given a phone number to sit the AKT, they will be given a phone number to book with the Pearson VUE test centre.to book with the Pearson VUE test centre.

• It is recommended that candidates familiarise It is recommended that candidates familiarise themselves with the demonstration tutorial on the themselves with the demonstration tutorial on the Pearson Vue website :Pearson Vue website :https://www.pearsonvue.com/rcgp/https://www.pearsonvue.com/rcgp/

• The AKT also begins with a short tutorial to The AKT also begins with a short tutorial to remind candidates how to mark the answersremind candidates how to mark the answers

Computer Based TestingComputer Based Testing

• There are There are approximately 150 approximately 150 test centres test centres covering all parts of covering all parts of the UKthe UK

• Candidates will be Candidates will be able to book the AKT able to book the AKT at a local venue, on at a local venue, on “a first come, first “a first come, first served” basisserved” basis

Computer Based TestingComputer Based Testing• Security at each centre will Security at each centre will

be robustbe robust– Identity checks Identity checks – InvigilatedInvigilated– Video monitoringVideo monitoring

• Test forms are downloaded Test forms are downloaded to each centre on the test to each centre on the test dayday

• Separate morning and Separate morning and afternoon sittings with a afternoon sittings with a quarantine period at quarantine period at lunchtime. lunchtime.

• Morning candidates will Morning candidates will not be allowed to leave not be allowed to leave before the end of the testbefore the end of the test

Computer Based TestingComputer Based Testing

• Responses will be Responses will be uploaded to a uploaded to a central server and central server and then passed to the then passed to the RCGP for post test RCGP for post test analysisanalysis

• Following this, Following this, results and results and feedback feedback wwill be ill be sent individually tosent individually to ccandidatesandidates

Computer Based Testing Computer Based Testing RulesRules• Candidates must bring Candidates must bring

identity documents identity documents WHICH MATCH WHICH MATCH examination detailsexamination details

• Candidates should Candidates should arrive in good timearrive in good time

• Candidates who either Candidates who either arrive late or fail to arrive late or fail to provide matching ID, provide matching ID, will NOT be admitted will NOT be admitted to sit the AKTto sit the AKT