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Gold, incentives and meh

Tips and tricks for the AKT

In the eighth of her series on passing the nMRCGP, Dr Una Coales explains how speed-reading and advanced statistics can help you crack the Applied Knowledge Test.

In the eighth of her series on passing the nMRCGP, Dr Una Coales explains how speed-reading and advanced statistics can help you crack the Applied Knowledge Test.

In this series, let us return to AKT and offer explanations for the difference in RCGP published AKT 2008 pass rates for whites 92.8% vs Asians 73.9% (other ethnicities 74.1%). The next AKT exam will be held on October 28, and it is imperative to understand why specialist trainees fail and how to correct this.

The AKT exam consists of 200 questions to be answered in 180 minutes, which equates to 54 seconds a question. What candidates do not take into account is that the length of the stem of the question may be ½ t o ¾ of an A4 in length - so if your reading speed is not at least 60 pages an hour, you will not be able to complete the exam paper. The answer options may then be offered on the next page.

Therefore, read books on speed reading techniques. The AKT exam is a speed reading and comprehension test. This will adversely affect GPs who are non-English first language, worse still if you read Arabic, accustomed to reading right to left. If you are dyslexic, apply to sit a morning session and request 30 minutes of extra time with a doctor's note. Unfortunately no additional time is given for foreigners. My reading speed is 100 pages an hour with a maximum rate of 200 pages an hour, although the latter lends itself to nystagmus, eye strain and blurred vision.

Another tip is to speed through the paper, clicking answers to as many questions as possible and flagging questions which will take longer than 54 seconds to answer.

Another reason for GP specialist trainees failing AKT is that they discount statistics, which accounts for 10-20% of the exam and is THE deciding factor when I assess a GP's ability to pass AKT.

It is not just a matter of knowing the definition of mean, mode and median, but being able to calculate the figures in record time. For instance, can you calculate the mean of 9 numbers with the decimal points in different places without a calculator in 54 seconds? If not, then work on speed mental arithmetic, because there are GPs out there who can!

In fact one GPR could calculate statistics within seconds of the question being flashed on the overhead. No surprise, he earned a MRCGP with Distinction and went on to author his own AKT book. Another GPR took 10 seconds and confessed that she was the daughter of a Professor of Maths at the Univestity of Glasgow.

Although both English reading comprehension and Maths are compulsory in the forms of SATs for those who wish to attend university in the US (87.5% (700/800) each for entry into an Ivy-league university), to study medicine in the UK, unfortunately, maths is not a required A level. The level of knowledge of statistics required is postgraduate. So having mastered speed common entrance maths, one also has to be able to master Forest plots, L'Abbe plots, and Funnel plots. If you have no idea what I am talking about, then it's best to start reading statistics books, attend courses or ask for tuition from a professor of epidemiology at your local medical school (rates range from £40 an hour as a donation to the department to £100 an hour for private home tuition).

Why is it important for a GP to be able to interpret a Forest plot? I attended a press conference on rimonabant held by Sanofi Aventis in Paris and a Forest plot slide appeared on the overhead. I immediately raised my hand, stood up and challenged the interpretation of the data as it was incorrect. It is also useful in reading the fine print in research papers.

As a GP, an understanding of both research interpretation and pharmacology is integral to being a safe GP. How many GPs know that coproxamol consisted of 32.5 mg of dextropropoxyphene (structurally-related to methadone) and 325 mg of paracetamol? It is no wonder that coproxamol-related suicides had a high mortality, as few would know to administer naloxone, an opioid antagonist, rather than wait the 4 hours to check paracetamol levels. The opioid content in 12 tablets alone was fatal! How many GPs counsel their patients on the activation syndrome (CNS side-effects) of SSRIs, a selective serotonin-reuptake inhibitor? How many GPs warn adolescents of the potential side effect of neuropsychiatric disturbance on tamiflu, a neuraminidase inhibitor?

And so I advise those who wish to score 80% or above (a merit equivalent) in their AKT, and be a top-notch GP, to read the entire British National Formulary.

Dr Una Coales:

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