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nMRCGP Applied Knowledge Test

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Title: 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

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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
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