nMRCGP Applied Knowledge Test

1
nMRCGPApplied Knowledge Test

• August 2009
• Prepared by the AKT Group

2
AKT aims

• The AKT is designed to test the application of
  knowledge and interpretation of information
• Each question is intended to explore a topic of
  which an ordinary GP could be expected to have a
  working knowledge

3
Objectives

• To provide an overview of the content of the
  paper
• To describe, with examples, the current question
  formats
• To describe the principles of question
  construction in order to help candidates to
  answer them
• To advise on how best to prepare for and pass the
  paper - including feedback from recent papers

4
Background

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

5
Format

• A three hour, 200 item multiple-choice test
• No multiple true/false questions
• No negative marking
• Delivered on a computer terminal at an
  invigilated test centre
• Offered three times a year- see RCGP website

6
Rules

• No limit to the number of attempts
• A pass will be valid for three years only
• Can be attempted at any time during GP specialist
  training (GPST), but most appropriately during
  the ST2-ST3 years

7
Vital Statistics

• April 2009 results
• Pass mark 63.3
• Overall pass rate
• ST3 first time takers pass rate 83.8
• ST2 first time takers pass rate 86.3
• (This ratio varies in different diets of the AKT
  taken at different times throughout the training
  year)
• Cumulative pass rate for all those in ST3 after
  3 attempts is approximately 94

8
Candidates found some topics straightforward.
(AKT April 2009)

• Antenatal guidelines
• Contraception
• Mental health

9
A few questions proved difficult(AKT January
2009)

• Normal childhood development
• Prescribing in children
• Clinical governance medicines management
• Infectious diseases - management

10
A few questions proved difficult(AKT April 2009)

• Childhood asthma
• Breast and skin disorders
• Fitness to work / drive
• Emergency / lifesaving procedures

11
Question writing

• Scenarios derived from clinical work
• Practice issues
• Topical
• All questions are referenced and the draft
  questions are then carefully scrutinised by a
  panel of other question writers.
• All question writers are working GPs

12
Common Reference Material

• GP Curriculum
• GMC Good Medical Practice
• BNF
• NICE
• SIGN
• BMJ Review articles original papers
• BJGP
• DTB
• Cochrane

13
The MRCGP Curriculum Statements

• Where to find them
• RCGP website
• http//www.rcgp-curriculum.org.uk/
• What are they?
• Series of papers, each covering different
  clinical and practice management areas, based on
  European Academy of Teachers in General Practice
  (EURACT) framework.
• Written by a variety of GP experts and
  coordinated by RCGP

14
The MRCGP Curriculum Statements continued

• How they are being used
• Curriculum statements have Intended Learning
  Outcomes (ILO). Questions are derived from
  specified learning outcomes within specified
  curriculum statements.
• This enables sampling from across the curriculum,
  as cases can be mapped to the curriculum
  statements (or nMRCGP blueprint)

15
Paper Construction ensures

• Reliability, validity and fairness.
• Adequate coverage of the topics that appear in
  the blueprint.
• The correct balance of question formats

16
Principles of paper construction

• Relevance the AKT should be relevant to general
  practice
• High prevalence any topic covered can be one
  which occurs commonly
• High impact or one which is significant but less
  common

17
AKT subject content

• Core clinical medicine and its application to
  problem solving in a general practice context
• 80 of items
• Critical appraisal and evidence based clinical
  practice
• 10 of items
• Ethical and legal issues as well as the
  organisational structures that support UK general
  practice
• 10 of items

18
Clinical Medicine (1)

• The broad topic of clinical medicine is
  subdivided into groups of body systems, in
  approximately equal numbers
• Each group will comprise sections on
• disease factors
• symptoms
• investigation
• management

19
Clinical Medicine (2)

• Cardiovascular
• Dermatology
• Endocrinology
• ENT
• Gastroenterology
• Genetics
• Haematology
• Immunology
• Infection
• Mental health learning disability

• Musculo-skeletal
• Neurology
• Ophthalmology
• Paediatrics
• Renal
• Reproductive male/female
• Respiratory
• Therapeutic indications and adverse reactions

20
Clinical Medicine (3)

• Common, low impact e.g. sore throat, otitis
  media, impetigo
• Rare, high impact e.g. child abuse, meningitis,
  phaeochromocytoma
• Topical e.g. MRSA, Type 2 diabetes management

21
Research, Epidemiology and Statistics (1)

• Understanding the principles of audit and its
  application in assessing the quality of care
• Understanding the application of critical
  appraisal skills which will be tested in a number
  of formats e.g the interpretation of research data

22
Research, Epidemiology and Statistics (2)

• Understanding and application of terms used in
  both inferential statistics and evidence based
  medicine.
• e.g. as described in BMJ Learning modules
  http//learning.bmj.com/learning/channel-home.html
  

23
Administration and Management

• Regulatory frameworks, e.g. PCOs
• Legal aspects, e.g. DVLA
• Social services, e.g. Certification
• Professional regulation, e.g. GMC
• Business aspects, e.g. GP contract
• Prescribing, e.g. Controlled drugs
• Appropriate use of resources, e.g. drugs
• Health Safety, e.g. needlestick injury
• Ethical, e.g. Mental capacity, consent

24
Question Formats

• Single Best Answer (SBA)
• Extended Matching Questions (EMQ)
• Table/Algorithm
• Picture Format
• Data interpretation
• Seminal Trials

25
New question formats

• Data interpretation
• Interpretation of complex sets of data for
  patients with chronic conditions. Relevant risk
  tables are included if appropriate.
• Seminal trials
• Familiarity with significant new research
• e.g Knowledge of studies which significantly
  change clinical practice such as WHI, ALLHAT.

26
Single Best Answer (SBA)

• According to national guidelines means
  recommended by nationally accepted guidelines or
  the BNF, not local practice
• Often uses a clinical scenario
• Only ONE answer is correct
• Other options may be plausible

27
SBA exampleRespiratory disease

• A 17-year-old student suddenly develops chest
  pain and dyspnoea after a morning swim. There is
  hyper-resonance and decreased breath sounds on
  the right side.
• Which is the SINGLE MOST likely diagnosis? Select
  ONE option only.
• A. Asthma
• B. Pneumothorax
• C. Pulmonary embolus
• D. Left ventricular failure
• E. Pulmonary haemorrhage.

28
Extended matching questions (EMQ)

• These questions have a list of possible options
• There will usually be 3 or more scenarios
• Choose the most appropriate option that best
  matches each given scenario
• Each option can be used once, more than once, or
  not at all.

29
EMQ example Double vision
A Berry aneurysm B Cerebral glioma C Drug
induced D Graves disease
E Ischaemic stroke F Multiple sclerosis G Myasthen
ia gravis
For each patient described, select the SINGLE
MOST likely diagnosis from the list of options
above. 1. A 35-year-old man who is a
non-smoker, suddenly develops a severe headache
and double vision. His right pupil is fixed and
dilated.
30
EMQ example Double vision
A Berry aneurysm B Cerebral glioma C Drug
induced D Graves disease
E Ischaemic stroke F Multiple sclerosis G Myasthen
ia gravis
For each patient described, select the SINGLE
MOST likely diagnosis from the list of options
above. 2. A 48-year-old woman has transitory
double vision towards the end of most days. She
smokes 10 cigarettes/day. She has vitiligo and
hypothyroidism.
31
Algorithm exampleMedical management of
menorrhagia
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.
32
Algorithm exampleMedical management of
menorrhagia

• A Cyclical norethisterone
• B Copper-bearing intra-uterine device
• C Inert intra-uterine device
• D Levonorgestrel releasing intra-uterine system
• E Medroxyprogesterone acetate
• F Mefenamic acid
• G Nonoxinol 9
• H Tibolone
• I Tranexamic acid

33
Picture Format exampleSkin disease

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

34
Picture Format exampleSkin disease

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

• A Alopecia areata
• B Eczema
• C Lichen sclerosis
• D Tinea infection
• E Vitiligo

Ref Dermnet.com
35
Data Interpretation

• Interpretation of complex sets of data for
  patients with chronic conditions
• Interpretation of research and audit results

36
Data Interpretation example

• The summary findings of a systematic review which
  included six separate studies are show opposite.
• Ref BMJ  2007335473 

37
Data Interpretation example

• Which SINGLE study suggests the WEAKEST
  association between increased whole grain intake
  and a risk of type 2 diabetes? Select ONE option
  only.

• A Fung
• B Meyer
• C Montonen
• D NHS1
• E Van Dam

38
Scoring

• All question formats have equal weighting
• Each correct answer is awarded one mark
• Total score on the paper is the number of correct
  answers given
• No negative marking - Fear factor
• If a question performs poorly across the whole
  exam it will be removed from the scores of ALL
  candidates

39
Feedback

• Feedback will be provided to every candidate with
  their result
• Their overall score
• The pass mark
• Their performance in each of the 3 main subject
  areas
• More general feedback on overall performance will
  continue to be forwarded to all UK deaneries and
  placed on the RCGP website

40
Computer Based Testing

• Once candidates have registered with the RCGP to
  sit the AKT, they will be given information about
  booking with the Pearson VUE test centre.
• It is recommended that candidates familiarise
  themselves with the demonstration tutorial on the
  Pearson Vue website
• https//www.pearsonvue.com/rcgp/
• The AKT also begins with a short tutorial to
  remind candidates how to mark the answers
  screen shots follow of the live tutorial

41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
Computer Based Testing

• There are approximately 150 test centres covering
  all parts of the UK
• Candidates will be able to book the AKT at a
  local venue, on a first come, first served basis

46
Computer Based Testing

• Security at each centre will be robust
• Identity checks
• Invigilated
• Video monitoring
• Test forms are downloaded to each centre on the
  test day
• Separate morning and afternoon sittings with a
  quarantine period at lunchtime.
• Morning candidates will not be allowed to leave
  before the end of the test

47
Computer Based Testing

• Responses will be uploaded to a central server
  and then passed to the RCGP for post test
  analysis
• Following this, results and feedback will be sent
  individually to candidates

48
Computer Based Testing Rules

• Candidates must bring identity documents WHICH
  MATCH examination details
• Candidates should arrive in good time
• Candidates who either arrive late or fail to
  provide matching ID, will NOT be admitted to sit
  the AKT