1. Dr Mark Feldman

2.  Money  AKT  CSA

3.  Become AiT£492  AKT£414  CSA£1389  Fee to PMETB£78

4.  AKT  Computer marked ‘multiple choice’ paper  CSA  Practical assessment of consulting skills

5.  Relevance: The AKT should be relevant to general practice; any topic covered can be one which occurs commonly or one which is significant but less common  High prevalence: Low impact e.g. URTI  High impact: Low prevalence e.g. meningitis  Topical: e.g. Controlled drugs

6.  Clinical Evidence  Cochrane Database  BNF  GP Curriculum  NICE  SIGN  BMJ Review articles & original papers  BJGP  DTB

8.  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

9.  Regulatory frameworks  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

10.  Know latest guidelines  Know the BNF  Know basic stats  Your core medical knowledge is probably already sufficient.

11.  1102 candidates  Mean score 71%  Top Score92%  Pass mark 63.3%  Pass rate 83.8% Pass rate ST286.3% Pass rate ST383.8%

12.  Clinical medicine 74%  Evidence interpretation 68.2%  Administration 60.1%

13.  Asthma – in childhood  Breast and skin disorders  Certification  Fitness to work and drive  Emergency medicine

14.  You must bring:  BNF, Stethoscope, Ophthalmoscope, Auroscope, Thermometer, Patella hammer, Sphygmomanometer (aneroid or electronic), Tape measure, Peak flow meter and disposable mouthpieces  There are no spares at the exam centre  Anything else you need is provided

15.  You have your own room.  You have a list of patients – your ‘surgery’ for the morning.  The list contains brief info about the patient.  It may or may not include PMH, drugs etc.  You probably wont know why they are coming.  You have never seen the patient before – but colleagues might have.

16.  Buzzer will sound and patient and examiner come in.  You have 10mins after which buzzer will sound again. Anything said or done after this will not count. The patient and examiner then leave.  There is no ‘1min/2min’ warning buzzer.  There is a 2 minute break between patients.  There is a 15min break after 7 patients seen.

17.  The examiner sits out of your line of site.  Examiner does not participate in the consultation. Ignore them.  All patients are played by actors who have been well briefed beforehand  They will almost certainly not have any physical signs to elicit on examination

18.  If you want to examine the patient say so and say what you are going to examine.  If they are testing this exam technique they will let you go ahead.  They will then give you the exam findings.  If they are not testing this exam they will just give you the findings and tell you not to examine.  They will only give you results of exams you say you will do.

19.  Examination is what you would normally do as a GP.  This means a lot of it can be done with the patient sitting in the chair.  It does not have to be exhaustive.  Eg. Chest exam – percussion and auscultation is fine.

20.  Any investigation results will be on the table in front of you or, more likely, will be brought in by the patient.  It will list normal levels so you don’t have to remember them.  Abnormal findings will be common GP tests.  Eg. Hb, HbA1c, urinalysis etc.  It will not be anything obscure.

21.  If you want to prescribe a drug you don’t have to write a prescription  All you need do is say  Eg. I will give you omeprazole 20mg once a day.  This is as good as having written it.  There are prescription pads on the table. Do not let these distract you.

22.  DON’T WRITE ANYTHING DOWN  There is no time  The prescription will be marked  There is no penalty for just saying it  You have to say what you are giving anyway

23.  The same applies for blood tests and sick notes and any other forms you might write.  Just say what you will do.  If you want to make a referral, ask the patient to wait in the waiting room and you will bring the letter/form out to them.  Leaflets can be ‘collected from reception’

24.  You have 10 minutes per case.  ‘Shows poor time management’ is a reason they can fail you at the station.  And they will.  You MUST be consulting at 10 minutes.

25.  Each case is marked in 3 domains : ◦ Data gathering, examination and clinical assessment skills ◦ Clinical management skills ◦ Interpersonal skills  All domains have equal weighting  Do not spend 8 minutes on history and examination – you will fail the station.

26.  But those domains have no meaning…  What are they actually looking for?

27.  DATA-GATHERING, TECHNICAL & ASSESSMENT SKILLS  Gathering & using data for clinical judgement  Choice of examination Investigations & their interpretation  Demonstrating proficiency in performing physical examinations & using diagnostic and therapeutic instruments

28.  CLINICAL MANAGEMENT SKILLS  Recognition & management of common medical conditions in primary care  Demonstrating a structured & flexible approach to decision-making.  Demonstrating the ability to deal with multiple complaints and co-morbidity.  Demonstrating the ability to promote a positive approach to health

29.  INTERPERSONAL SKILLS  Demonstrating the use of recognised communication techniques to gain understanding of the patient's illness experience and develop a shared approach to managing problems.  Practising ethically with respect for equality & diversity issues, in line with the accepted codes of professional conduct.

30.  The grades will be on a four point scale:  Clear Pass  Marginal Pass  Marginal Fail  Clear Fail  There are no merits or ‘grades’ at the end for the exam as a whole.  You pass or fail.

32.  Disorganised and unsystematic in gathering information from history taking, examination and investigation  Does not identify abnormal findings or results or fails to recognise their implications  Data gathering does not appear to be guided by the probabilities of disease  Does not undertake physical examination competently, or use instruments proficiently

33.  Does not make appropriate diagnosis  Does not develop a management plan (including prescribing and referral) that is appropriate and in line with current best practice.  Follow-up arrangements and safety netting are inadequate  Does not demonstrate an awareness of management of risk, and health promotion

34.  Does not identify patient’s agenda, health beliefs & preferences / does not make use of verbal & non- verbal cues  Does not develop a shared management plan or clarify the roles of doctor and patient  Does not use explanations that are relevant and understandable to the patient  Does not show sensitivity for the patient’s feelings in all aspects of the consultation including physical examination

35.  Disorganised / unstructured consultation  Does not recognise the challenge (e.g. the patient’s problem, ethical dilemma etc.)  Shows poor time management  Shows inappropriate doctor - centeredness

36.  Be in general practice for a few months  Consult at ten minutes

37.  Be Flexible  Scales of the consultation - Weigh your words [ not too many closed questions]

38.  The magic questions ◦ What can I do for you today...?  Silence / body language ◦ Is there anything else?  Silence / body language ◦ Have you any thoughts / worries about what this might be ?