AKT Top Tips Gareth Smith

What’s so scary? What were the main issues for me? Medical statistics! Time vs No of questions Driving guidelines Primary care admin

Aims Structure of AKT Applying for the exam Resources Where did other candidates struggle? Example questions

1) Structure of the AKT

The AKT test Is a 3 hr computer-based test Consists of 200 question items 80% clinical medicine 10% critical appraisal 10% health informatics & administrative issues (Works out at 54 seconds per question)

Clinical Medicine Biggest part of the exam (160 questions) Covers practically everything….. low impact & common conditions (e.g. sore throat, URTI’s) high impact & rarer (e.g. Child abuse, meningitis) Look at topical things (read new NICE guidance, check BMJ/BJGP) Refer to GP curriculum

Medical Statistics Only 10% of exam (i.e. 20 questions) Keep in perspective…. YES…difficult to pass exam if do not get any of these marks BUT…shouldn’t revise medical statistics to the detriment of clinical medicine Make sure you know the basics Mean/mode/median PPV/NPV Sensitivity/specificity Standard deviations

Health informatics & administrative issues Another 10% (20 questions) Includes…. Legal aspects (e.g. DVLA) Social services (e.g. Certification) Professional regulation (e.g. GMC) Business aspects (e.g. GP contracts) Prescribing (e.g. Controlled drugs) Health & safety (e.g Needle stick injuries) Ethical (e.g. Mental capacity & consent)

How many pass?

2) Applying for the exam

Applying Can be taken during or after the GPST2 A maximum number of 4 attempts will be permitted

Applying (2) AKT costs £465 ? Whether Associate in Training (AiT) payments contribute We pay three annual instalments of £135 £405 is available to put towards cost of exam

Where to take the test

3) Resources

Resources (1) GP curriculum BNF GMC Good Medical Practice RCGP Essential Knowledge Updates NICE Guidelines SIGN Guidelines BMJ review articles & original papers BJGP

Resources (2) Internet: Pastest (£50 for Oct, £78 for Jan) BMJ On examination (£50 - £120 for 1 – 6 months) Pass medicine (£25 for 4 months, £35 for 6 months) Books: Succeeding in the MRCGP AKT, C Mehta, M Williams and M Mehta (£19.99) Medical Statistics made easy, M. Harris & G. Taylor (£16)

What did I use? On examination Oxford Handbook GP Medical statistics made easy Dermnet NZ DVLA Guidance

When should you start revising? Everyone’s different BUT….remember there is a lot to cover The earlier you start the more you get out of Pastest/On examination

4) Where did others go wrong?

Feedback from Jan 2014 Areas causing difficulty for candidates 2.02 Patient safety and quality of care – DRUG INTERACTIONS “Candidates appeared unaware of hazards related to the use of over-the-counter supplements or certain foodstuffs in combination with commonly prescribed medication. We would encourage candidates to take a broad approach to the issue of drug interactions and contraindications.” 3.04 Care of children and young people - DEVELOPMENTAL MILESTONES “Candidates struggled to recognise when child development was deviating from normal. Gaining relevant knowledge in this important area may be difficult for candidates unless they are able to attend child health clinics and clinical supervisors may be able to facilitate this.” 3.17 Care of people with metabolic problems – DIABETES DIAGNOSIS/MANAGEMENT “Candidates had difficulty in answering questions related to management of type 2 diabetes, and in particular use of insulin. There also continued to be problems around diagnosis of diabetes.”

Feedback from Jan 2014 3.16 Care of people with eye problems – OPHTHALMIC EMERGENCIES “We expect candidates to be familiar with the diagnosis and management of those which present most frequently. This will include conditions related to trauma where urgent action may be required” 3.20 Care of people with musculoskeletal problems - OSTEOPOROSIS “Questions on osteoporosis, in particular relating to DEXA scans, were not well answered.” 2.03 The GP in the wider professional environment - CERTIFICATION “Candidates often struggle with questions related to certification, such as fitness to work certificates.” (Look on RCGP website  Exams  Exam summary reports  AKT)

5) Question Types

The questions All written by working GP’s All reference to NATIONAL not local guidelines Are not opinion – they can be supported with reference to facts & guidelines

Question types Single Best Answer (SBA) Extended Matching Questions (EMQ) Table/Algorithm Picture/Video Format Data interpretation Free text

Single Best Answer Single Best Answer (SBA) questions According to current evidence, in the management of croup in a 2-year-old child, which is the single most effective treatment to shorten the course of the condition? Select one option only. A Place the child in a steam filled bathroom B Administer inhaled budesonide C Prescribe amoxicillin 125 mg t.d.s. for five days D Administer inhaled salbutamol E Prescribe paediatric cough suppressant containing codeine F Administer inhaled tribavirin

Extended Matching Questions THEME: Reduced Vision Option list: A Basilar migraine F Occlusion of the central retinal vein B Cerebral tumour G Optic neuritis C Cranial arteritis H Retinal detachment D Macular degeneration I Tobacco optic neuropathy E Occlusion of the central retinal artery Instruction: For each patient with reduced vision, select the single most likely diagnosis. Each option may be used once, more than once, or not at all. Items: 1 A 75-year-old man, who is a heavy smoker, with blood pressure of 170/105, complains of floaters in the right eye for many months and flashing lights in bright sunshine. He has now noticed a ‘curtain’ across the vision of his right eye. 2 A 70-year-old woman complains of shadows, which sometimes obscure her vision for a few minutes. She has felt unwell recently with loss of weight and face pain when chewing food. 3 A 45-year-old woman, who is a heavy smoker, with blood pressure of 170/110, complains of impaired vision in the left eye. She has difficulty discriminating colours and has noticed that her eye aches when looking to the side.

Picture Format Picture Format THEME: Eye problems A 42-year-old woman who has previously had treatment For cervical CIN 2, has had a lump affecting her left upper lid for three months. It is asymptomatic. What is the single most likely diagnosis in this patient? Select one answer only A entropion B meibomian cyst C metastatic deposit D stye E xanthelasma

Algorithm completion THEME: Medical 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. Select ONE option only A Copper intra-uterine device B Cyclical medroxyprogesterone acetate C Cyclical norethisterone D Inert intra-uterine device E Levonorgestrel releasing intra-uterine system F Mefenamic acid G Nonoxinol ‘9’ H Tibolone I Tranexamic acid Not requiring contraception Requiring contraception (14) ------- (15) ------- Combined oral contraceptive pill (16) ---------

Data Interpretation A meta-analysis examines whether giving a new dietary supplement to patients who've recently had a myocardial infarction can help prevent a further attack. The meta-analysis consists of four randomised controlled trials and is summarised below: What is the most appropriate interpretation of the data? A. There is publication bias in studies looking into this question B. There is a non-significant trend that taking the supplement reduces the chance of a further myocardial infarctions C. There is a non-significant trend towards no benefit from taking the supplement in terms of reducing further myocardial infarctions D. Taking the supplement reduces the chance of a further myocardial infarctions E. Taking the supplement increases the chance of a further myocardial infarction E because black diamond shows that overall treatment is worse than control

Data Interpretation (2) A rapid finger-prick blood test to help diagnosis deep vein thrombosis is developed. Comparing the test to current standard techniques a study is done on 1,000 patients: What is the specificity of the new test? A. 680/880 B. 200/220 C. 680/780 D. 680/700 E. 200/300 DVT present DVT absent New test positive 200 100 New test negative 20 680

6) Types of question that caught me out…

Consultation Models Which one of the following consultation models advocates managing the presenting complaint, managing ongoing health problems and modifying health seeking behaviour? A. Neighbour B. Fraser C. Pendleton D. Stott and Davis E. Stewart Answer is D

BNF Questions The following symbol appears in the British National Formulary: What does it mean? A. Newly licensed medicine B. Not prescribable on the NHS C. Denotes a preparation that is less suitable to prescribe D. Should only be prescribed by a specialist E. Controlled drug

Thanks. Any questions?

And….GOOD LUCK