More than one in four candidates fail the MRCGP AKT exam. E-Medica’s Dr Mahibur Rahman shares his secrets to help you pass.
Understand the basics
The exam lasts three hours and ten minutes, and consists of 200 questions; 80% relate to clinical medicine, 10% to evidence-based practice, and 10% the organisational domain. The exam is computerised, and there is now access to a basic on-screen calculator if needed. The majority of questions are single best answer and extended matching questions. Other formats include algorithm questions, short answer (you type the correct answer into a box), video questions, and picture-based questions.
Fail to prepare, prepare to fail
Allow enough time to revise all material in the exam – most candidates need three or four months to prepare. We help a lot of candidates prepare when they are resitting the exam. A common finding amongst those candidates is that they had not realised how long it would take to prepare.
The curriculum is large and covers a broad range of topics – try to have a systematic approach to allow you to cover all the important topics adequately.
Focus on the clinical domain.
Aim to spend the majority of your revision focusing on the clinical domain – this makes up 80% of the marks and questions (160 questions). Someone who scored very poorly in this area (under 60%) would usually fail the exam – even with 100% in the other domains.
Overall, a poor score in this domain is the most common cause of failure in the exam. This domain also takes the longest amount of time to cover as the bulk of the curriculum is focused on clinical topics. Questions can include those relating to making a diagnosis, ordering and interpreting tests, disease factors and risks, and management. It is important to have a good knowledge of key guidelines – NICE, SIGN, BTS etc.
Revise core statistics and evidence based practice
Ten per cent of the exam is evidence-based medicine, including basic statistics, graphs and charts and types of study. These offer easy marks if you make sure you have a good grasp of the basic concepts. Make sure you can calculate averages (mean, mode, median), numbers needed to treat, sensitivity and specificity as well as understanding absolute and relative risk, odds ratios, p values, 95% confidence intervals and standard deviation.
You should be able to interpret scatter plots, L’Abbe plots, Forest plots, funnel plots as well as Cates plots. Finally, you should be able to understand the usage of common study types including cross sectional surveys, case control studies, cohort studies and randomised controlled trials.
Don’t forget the organisational domain
This makes up 10% of the exam, and is the area that candidates tend to do worst on. These areas can be dull to read, but learning about practice management, QOF, certification, DVLA guidelines and the legal duties of doctors will not only get you easy marks, it will be useful when you qualify.
Learn from other people’s mistakes
Read through the examiners’ feedback reports to see which topics caused trainees problems, as they are usually retested in the next few exams. Having analysed every feedback report published so far, it is interesting to note that the same subjects get featured repeatedly. In the last feedback report, there was not a single topic that had not already featured as an area of poor performance in a previous report.
Make the most of your revision time
Effective revision should combine reading with practising questions. Try to practise questions to time, as time pressure is a big issue with this exam – you have about 57 seconds for each question. If you get a question wrong, try to read more broadly about the subject to gain a deeper understanding. By relating it to a question you have just answered, you are more likely to retain the information.
Concentration drops dramatically after an hour, so try to revise in chunks of no more than an hour at a time. Take a short break – even ten minutes to make a hot drink, or get some fresh air, is often enough to refresh you and improve concentration for the next burst of revision.
Learn the subject, not the question
Some candidates approach AKT revision by picking an online revision service and then go through all the questions multiple times. This can lead to a false sense of security and ultimately failure in the exam. Repeating the SAME questions multiple times provides very little additional benefit. Often complex questions such as data interpretation are answered the second time by remembering the pattern rather than understanding the subject.
In the exam, you will not get the same question, but a different one testing knowledge of the subject. A better approach is to read up on the subjects and explanations after doing a set of questions, and then once you complete all the questions, move on to a different set of questions from a different service or book. This will give you a better idea of how well you have understood the topic and retained the knowledge.
Read the question carefully
Many candidates that have a good knowledge base still fail the AKT by a few marks. This can be owing to poor exam technique. It is really important to read the question carefully to prevent losing marks for silly mistakes. This can relate to the instructions – some questions ask you to drag the right answer into a certain part of the screen. Clicking the right answer instead of dragging it will gain no marks.
It is important to watch out for and understand certain keywords – if the question asks for a characteristic feature, it means it is there in almost every case (90% or more), whereas if it asks for a feature that is commonly seen in a condition, it only needs to be there in around 60% or more of cases.
Keep to time
To complete the entire paper, you have just 57 seconds per question. Try to be disciplined – if you are not entirely sure of the best answer, it is better to put down your best guess after about 55 seconds and move on. You can flag questions for review, so you could try to come back if you finish a little early to look at those you are unsure of.
By being strict with your time, you will at least pick up all the easy marks for topics that you have covered in your revision. Candidates that spend 2-3 minutes struggling with a few really challenging questions often end up unable to complete the paper. They may have missed easy marks from questions at the end of the paper that they did not see. It is useful to have some pace checkpoints – try to finish 33 questions every 30 minutes. At this pace, you will have completed 66 questions after one hour, 99 at 1.5 hours, and complete the whole paper with just under ten minutes left to go over any questions flagged earlier.
Dr Mahibur Rahman is a portfolio GP and a consultant in medical education. He has been the medical director of Emedica since 2005 and has taught more than 20,000 delegates preparing for GP entry exams, MRCGP and on GP careers.
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