The Ultimate Guide To The MRCGP Applied Knowledge Test

What is the MRCGP Applied Knowledge Test?

The Applied Knowledge Test (AKT) is one of three components of the Membership of the Royal College of General Practitioners (MRCGP) exam that all GP trainees must pass to complete their training. AKT examines the trainee’s problem-solving skills and application of knowledge in clinical medicine, health informatics and administration, and critical appraisal and evidence-based practice, all within the context of general practice in the UK. Clinical medicine comprises 80% of the questions, while the other two areas comprise 10% of questions each. 

Questions in the AKT exam may be either the single best answer, extended match questions, or free text answer. Single best answer questions will have multiple options and the candidate chooses the most suitable one. Extended match questions will include multiple scenarios and a longer list of answers, out of which candidates choose one. Free text answers require typing the answer in a textbox. Some questions include pictures, laboratory test results, or statistical data for interpretation, and an online calculator can be used for calculations. The candidates have 3 hours and 10 minutes to complete 200 questions, an average of 57 seconds per question.

 

When to take it?

Candidates can take the AKT anytime in ST2 or ST3. It can be sat 3 times a year, with exam dates usually set in January, April, and October/November. Maximum of 4 attempts at the AKT is allowed.

Deciding when to take the AKT can be difficult. Many candidates opt to take it in ST2 to tick it off their list before ST3 when they would have to take it alongside the other two components of the MRCGP: Clinical Skills Assessment (CSA) and Workplace based assessment (WPBA). Others leave it until ST3 when they have more clinical experience and improved knowledge of general practice after their placement. However, the pass rates are similar for those who take it in ST2 and those who opt for ST3, so the decision depends on each candidate’s personal preference.

 

How to apply

All candidates should be registered with the RCGP before applying. Application is via the RCGP website during a 5-6 day window 7-8 weeks before the corresponding exam date. Once a candidate has submitted their application and paid the £450 exam fee, they can choose their preferred exam centre. There are over 150 Pearson VUE testing centres across the UK, and it is best to apply early to secure a place at a nearby centre. Each exam date will have a morning session and an afternoon session. Candidates who require extra travel time should book the afternoon session.
 

How to prepare for the AKT

Dedicating enough time is crucial for AKT revision and many candidates who failed the exam blame lack of preparation. A minimum of 3 months should be dedicated to AKT revision, but more time is often required. 

Creating a realistic revision schedule is key when studying for the AKT. Candidates need to revise a vast amount of content, and adequate planning will help prevent feeling stressed or overwhelmed due to disorganised revision. The AKT examines contents of the GP curriculum, which is available on the Royal College of Physicians (RCGP) website. The RCGP curriculum is an excellent guide for revision planning to ensure all topics are covered.

Besides revising the curriculum, completing practice question banks is a useful revision tool for AKT candidates. A variety of question banks is available online, and practice questions with explained answers are available on the RCGP website. Question banks are a great way for candidates to familiarise themselves with the question types on the exam and develop good exam technique. However, candidates should avoid overusing question banks as they will not cover all the contents of the exam and they may leave some gaps in knowledge. Equally, only revising and learning the curriculum and not doing practice questions can lead to poor exam technique, therefore candidates should aim to include both methods in their revision.

Researching the current issues in general practice, taking note of the problems encountered daily in practice, and keeping track of Patient Unmet Needs and Doctor’s Educational Needs (PNUs and DENs) is an important part of revision for the clinical component of the exam. Candidates should also aim to stay up to date on the “hot topics” of general practice as these are often examined in the AKT. Reading journals such as the British Journal of Medical Practice is a good way to keep up with these topics. Additionally, it may be beneficial to take one of the available short online courses on currently discussed topics before taking the exam.

Although the clinical section of the exam is the biggest one, critical appraisal and administrative topics should not be overlooked. These are often the areas candidates perform poorly on. Critical appraisal is a good area to revise in a group with other trainees preparing for the exam. Some platforms offer webinars and short courses for evidence-based medicine and statistics which may be useful in preparation for this component of the exam. The RCGP curriculum covers all the key aspects of the administrative part of the exam.

Candidates might find it useful to read the past reports published on the RCGP website. These document the performance of candidates in specific areas examined in the AKT each year, identifying some of the topics most trainees found difficult. Some of these topics are very likely to be tested multiple years in a row, making this a useful guide when deciding what topics should candidates dedicate more time to.

The list below provides a summary of useful resources for AKT candidates, some of which have been mentioned previously in the article:

• RCGP curriculum

• RCGP past reports

• RCGP InnovAit journals (journals designed to support GP trainees)

• RCGP Faculty AKT-preparation courses

• Question banks:

• RCGP UK question banks with answers

• BMJ On Exam

• Pearson VUE testing tutorial and practice exam

• PasTest online revision packages 

• Many other platforms offer a wide variety of question banks

• Textbooks, for example:

• Applied Knowledge Test for the MRCGP. 4th edition. Nuzhet A-A. published 2017.

• Notes for the MRCGP: A Curriculum Based Guide to the AKT, CSA and WPBA. 4th edition. Palmer K, Boeckx N. published 2009. (slightly outdated now but still useful)

• NICE CKS guidelines

• Oxford Handbook of General Practice

• British Medical Journal

• British Journal of General Practice

• British National Formulary and Paediatric British national Formulary

• InnovAit AKT podcast

• Hot topics courses online (various platforms, e.g., GP Update or NB Medical)

 

On the day of the exam and receiving results

On the day of the exam candidates will need two IDs. Primary ID which must be photographic and secondary ID displaying at least the candidate’s name and signature. The name on the IDs should be identical to that on the application. If this is not the case, supporting documents showing a link between the different names must be brought. Candidates must arrive on time. All personal belongings will be left in a locker outside the test room.

Candidates will be required to sign a non-disclosure agreement before the start of the test. The exam is computerised, and all candidates will complete a short tutorial to get used to the computer system before the exam begins. No additional time will be given if candidates decide to leave the room for water or to use the bathroom.

Results are usually published in candidates’ portfolios 3 weeks after the exam.

 

Do’s and don’ts: How to do well in the AKT

Do:

• Make a revision plan: a structured revision plan ensures you cover all topics and helps avoid feelings of stress or panic before the exam.

• Identify personal weaknesses: establishing your weak points and dedicating more time to them from the very start rather than only spending time on favoured topics will build your self-confidence in those weaker areas and take away the pressure of revising the topics last-minute.

• Dedicate time accordingly: the clinical domain comprises 80% of the exam questions, and a corresponding amount of time should be spent on studying for this section, whilst ensuring you do not overlook critical appraisal and administration.

• Effectively use resources: solid revision should use a wide variety of different types of resources that best suit your learning style, whether it is textbooks, webinars, practice questions, or other.

• Get used to time pressure: you will have an average of 57 seconds per question during the exam. Doing timed mock exams will help getting used to the feeling of time pressure.

• Maintain motivation: setting some short- and long-term goals during the preparation period and establishing a rewards system can help you remain on track with their revision.

• Read the whole question carefully: it is common for the candidates to simply look at the question, see a “buzzword” and assume the answer without reading the question properly. Negatively phrased questions or questions looking for less common presentations of a condition often cause problems, and reading the question carefully avoids unnecessary mistakes.

Don’t:

• Always work alone: working in a group of other GP trainees preparing for the exam is a great way to revise for some components of the AKT. You can learn from each other’s mistakes and help and support each other.

• Underestimate the time needed for revision: at least 3 months are needed to revise for the AKT, but if your home life or your placement is particularly busy you should dedicate more time, trainees commonly start revising 4-6 months before the exam.

• Overuse specific resources: avoid for example only using one platform for practice questions. You may get used to seeing a certain style of questions which could trip you up on the exam.

Leave questions blank: there is no negative marking in the exam, so even if you are not sure of the answer, pick one that you think might be right. This will avoid spending too much time on questions you are unsure about, and you will keep your momentum in the exam.