The MRCGP AKT is a challenging exam, with a significant number of doctors failing each sitting (the mean pass rate over the last 2 years has been about 67%). For a lot of doctors, this is the first time they have failed an important exam, and many aren’t sure of how to approach revising for the exam for subsequent attempts. In this article, Dr Pip Bell discusses how she passed her resit in the midst of the pandemic, and how she improved her overall score by 13% – including a huge increase in the clinical domain from 56.88% to 71.25%!

My 1st attempt:

I first sat my AKT in January 2020 having studied solidly since October 2019. I thought I had prepared well, learning the NICE CKS guidelines, using the RCGP Innovait magazine and practice questions and the RCGP Self-Test. I had been in a paediatric rotation which was well staffed and so I had managed to put in a lot of hours whilst at work. I came out of the exam knowing that I had got a lot wrong but hopeful that I had known enough to pass! Silly me! I was devastated to find out that I had failed as I had (no doubt like many other doctors!) never failed an exam in my life! I felt completely demoralised and wondered what on earth I needed to do differently… I basically asked anyone who had any kind of insight or opinion what resources/ advice they might have to help get me through it! Let’s face it… no-one wants to spend their life studying, or indeed lose almost £500 repeatedly for the pleasure!

How I prepared for my resit

I planned to resit again in April so started studying a week after I got my results. However, COVID-19 then arrived so this sitting was cancelled… Knowing what I know now I am SOOOOOO glad that this happened as there is simply no way I would have been ready to sit it by then! I then planned to sit in July so continued with my studies only to discover that I didn’t qualify for that sitting! Both of these delays meant that my studies were very protracted and I must admit that by July I was feeling mentally exhausted as I had maintained a very heavy study timetable, basically for 10months solid!

Having done so terribly in my first sitting with an overall score of 60%, (Clinical Knowledge 56.88%, Evidence Based Medicine 75%, Organisation and Management 70%), I realised I needed to do something different preparing a second time.

A colleague recommended the Fourteen Fish AKT preparation package which had lots of videos with mini tests in them. Fourteen Fish also recommended summarising the BNF introductory chapters. I formed a study group to break up the BNF to do these summaries as obviously it’s a massive job for one person! I did find the videos useful, albeit time consuming but I must admit to feeling that summarising the BNF was a complete waste of time and energy! I don’t think I learnt much from it and spent a huge amount of time on it!

I was becoming increasingly frustrated as, even with spending many hours watching videos and preparing BNF summaries, I still wasn’t getting my clinical scores up consistently… it was completely hit or miss whether I got even a half decent score on mock tests (mostly RCGP Self-Test)

By this stage I was so mentally exhausted that I knew I needed clear, concise, focused teaching to make the most of the time I had. I can’t remember where I found the Emedica resources but I remember signing up both for an RCGP webinar series and an Emedica high yield revision half day webinar which I think I had seen an advert for on Facebook. I attended the RCGP one and spent most of the time incredibly frustrated at the lack of focus of the course. It was meant to be covering stats and clinical and in the end most of the time was spent on stats with the clinical part simply being a set of questions for which the answers were provided but with no teaching or explanation as time had run out!! 9hours of my life I would never get back with very little achieved!

I then attended the Emedica high yield revision half day for half the price and half the time and was blown away by how much we covered so concisely! I was hooked! The focused, relevant teaching was exactly what I needed as my poor brain had no room for “niceties” by this stage. I just needed to get the knowledge I needed as quickly as I could to improve my clinical scores.

I was so impressed by all the free resources offered by Emedica as well. I used the 30 daily AKT challenge questions, lockdown learning webinars and also to direct help, support and encouragement from Dr Rahman himself (sorry for the multiple midnight panic emails!). I found these so helpful that I signed up for a Statistics, Admin and further Clinical webinar and also the AKT 200 question crammer course. I found these courses so useful as they gave me all the focused teaching I needed to really boost my scores. I passed on my second sitting with a score of 73% overall, 71.25% Clinical Knowledge (up from 51.88%), 65% Evidence based practice (interestingly the average was much lower this sitting at 67.23%) and 95% Organisation and Management.

Resources I found helpful

Ultimately in hindsight I realise that I initially spent a lot of time reading material that was “padding” and not helpful. For what it’s worth my advice would be that learning the NICE CKS Guidelines is an absolute must (although a lot of the Emedica resources do the summarising and consolidation of this information for you!) and I don’t regret any of the time spent doing that. I also found the Oxford Handbook of General Practice really useful and concise and wish I had started using that earlier in my studies. You need the extra detail from the NICE CKS Guidelines but the Handbook is a very good starter to cover the basics and ensure you have a good foundation on which to base your further studies. I think the BNF summarising was a complete waste of time so I wouldn’t recommend anyone does that!! I think the Fourteen Fish videos were useful but again pretty time consuming for the learning achieved. For me the Emedica courses were so focused and covered really key information concisely, increased my knowledge most efficiently and gave most “bang for buck”!! The Emedica AKT question bank was excellent and interestingly once I was consistently getting around 70% on those questions, I then found myself achieving nearer 80% on the RCGP Self-Test which gave me the confidence to go for it.

Learn about common drugs!

Some additional advice that I would give would be to learn the side effects, contraindications and monitoring requirements for the key/common medications you will prescribe. There always seem to be LOTS of questions on these things and I find it very difficult to remember them. I was advised to try to integrate this learning into daily practice to help make it stick, for example, if you are prescribing a statin for someone, take the time to have a look at the CIs/SEs/monitoring requirements so that you are learning it in context rather than simply trying to memorise it.

A few final tips…

I think ultimately for me it was also repetition that was required to some extent. I have passed over into my fourth decade (eek!) with 2 young children and for some reason my brain definitely seems to have slowed down! So repetition and consolidation definitely played a key role. With this in mind, my last piece of advice would be not to resit too quickly, especially if you have failed the clinical by a significant margin. It quite simply takes a lot of time to cover all the material, and if you are like me and need to go over it a few times for it to stick that adds up to a huge number of hours!!  Hang in there and as one of my colleagues said to me “don’t get off the bus until you’re there”… Keep trudging on and try and make your study time as focused and efficient as you can and you will succeed!

Now that Pip has passed her AKT, she can spend more time on the things she loves the most – spending time with her family and riding her horse!