Dr Dilini Srikantha passed the MRCGP AKT with an overall score of 93.5% in her first sitting. In this article she shares her experience of preparing for the exam, discusses her tips for revision, the resources she used and those that she found most helpful in her preparation.
From the moment I entered GP training, the AKT exam has loomed ahead of me as this terrifying formidable thing. The exam seemed horribly difficult, requiring not just an impossible-to-achieve breadth of knowledge but also an ability to practically apply that knowledge to clinical scenarios. Having emerged on the other side with a score of 93.5% (92.5% in clinical knowledge, 100% in statistics and 95% in admin), I can safely say that not only is it possible to pass it first time, but with the correct strategy and the right attitude, it’s possible to pass it well. I hope that by explaining my revision strategy, key resources and top tips, you will feel less nervous about the exam and more confident in planning your own approach.
When To Sit The Exam
The first step is to pick the right sitting. The AKT is an extremely broad exam – in just 200 questions, you will be expected to have an understanding of all clinical specialities (including diagnosis, investigations and management guidelines) as well as statistics and admin. To give yourself the best chance of passing, you will need to systematically cover all of these. How long this will take depends on how much time you can both afford to and are willing to dedicate to revision. Consider sitting the exam during a less busy rotation where you’ll have enough time and energy to study. Rotations with lots of on-call shifts and busy rotas are not ideal. Likewise, if you have lots of other responsibilities, e.g. children, consider leaving extra time so you can fit it all in, or if you have lots of events to attend, sit the exam when your revision won’t clash with these.
3 months is the figure usually stated but I would argue that to cover all the material thoroughly with some time to spare for general revision and last-minute cramming at the end, you should ideally leave 4-5months. Keep in mind though, with a longer time frame, you won’t feel as stressed and rushed, and can ease into revision whilst leaving enough time to ramp up the hours as the exam gets closer. You’ll also have enough time to mix up revision with fun activities/time off to keep you sane. If you try to fit it all into 3 months, you might find you have very little time to do anything but revise!
Planning Your Revision Time
My top tip for planning your revision is to create a revision timetable that outlines when and how you’ll cover all of the topics. You can be as detailed as you like – I personally don’t like to be too prescriptive, but by breaking down my revision into smaller goals with mini-deadlines it stopped me from being totally overwhelmed by how much there was to learn, and helped me feel it was achievable with the time I had. The timetable also meant nothing was left out.
Every time I sat down to revise, I would start by looking at the timetable, which kept me focused and motivated, when I otherwise would have been distracted or inefficient, thinking I had ‘plenty of time’ to make up for it later (probably not true when there’s so much material to cover!).
Account for your days at work and already-made plans and add in some free time/breaks to act as a buffer for if you fall behind. Don’t worry if you don’t stick to it rigidly, you can readjust it as you go if you need to. Alternatively, there are some pre-made AKT planners that you can find online, but consider that their outline may not be your preferred way of revising.
My second top tip is to leave at least 2-3 weeks at the end for general revision. The majority of your revision time will have been spent learning and understanding – this last period is for refreshing your knowledge (you’ll have forgotten what you learnt at the start), doing unfiltered questions and last-minute cramming of guidelines and topics that are pure rote learning (like DVLA and fitness to fly guidelines!).
How To Revise
By the time you come to sit the AKT, you’ll already have a great deal of revision and exam experience behind you, and will have probably done pretty well in most of them! This isn’t the time to reinvent the wheel – if you know what revision methods work for you, stick with them. Whichever methods you use, just try to be structured about it.
I revised each specialty in turn as it helped me understand it more thoroughly than jumping about. I’d recommend starting by creating a list of all the core conditions for that specialty to make sure you don’t miss anything out. I used previous medical school notes, combined with NICE CKS and Patient.co.uk to go through all the key diseases/conditions and then made notes on OneNote. It’s free to use and syncs online so it can be accessed from anywhere including your phone – handy for quick revision on the go.
Make sure you cover common conditions as well as rare but important ones. Your revision should also include going through key guidelines (e.g. asthma SIGN/BTS management guidelines) – NICE CKS is excellent for this. Bear in mind, that whilst the exam is from a general practice perspective, it also includes topics and information that you’d be expected to understand and explain to a patient, which may for example, include management steps that would never occur in primary care. Don’t omit revising something just because it might be outside the scope of your direct practice.
Finally, once I’d done my reading/note making for that specialty, I did questions on that topic to reinforce my learning. I used PassMedicine at this stage, as it has excellent summaries which also cover the guidelines quite well.
This was my personal approach and suited my style of learning, but use whichever method works best for you, as long as you’re balancing reading with doing questions. Doing only one or the other won’t be sufficient. If you prefer doing questions start with that, and then make sure you follow up with reading around the topics. Either way, just make sure you’ve covered all the topics in each specialty to give yourself the best chance on exam day! Remember, the clinical knowledge section is 80% of the exam, and your best chance of passing and doing well is by making sure you’ve covered the broad range of topics that might come up.
Statistics & Admin
These form 10% each and whilst they seem esoteric and maybe even boring, they’re also easy marks to pick up and boost your score. It might be tempting to not pay much attention to them, but a decent mark in each of these sections will give you much more leeway with your clinical score, which can be more challenging to get a high mark on.
It’s worth dedicating time in your revision schedule to tackle these. I used the Emedica statistics and admin webinars as my main revision for these, which can be purchased as a bundle and claimed from your study budget. The webinars were an excellent introduction to explain these topics, and I followed it up by going through the slides and post-course reading links which were sent after each webinar.
Statistics is largely calculations and data interpretation. Learn how to create the two-by-two tables for the main calculations and spend some time going through the common graphs and charts. Ultimately this is all about practice – the PassMedicine statistics questions were helpful for practicing the calculations again and again – keep practicing until you can do them in your sleep (or 57 high pressure seconds!). Keep in mind that the real exam will also feature lots of graphs and charts you will probably have never seen before, and that simply require you to interpret the data – these are straightforward marks if you can keep calm in the exam and look at them rationally.
The administration and organisation domain is largely just rote learning a lot of dry topics, but again these are some easy marks to pick up if you just dedicate some time to it. The Emedica admin webinar covered all of the key topics and question banks are also helpful for learning the minutiae.
The GP trainee study budget allows for one exam-related course so it makes sense to take advantage of this. I went on the Emedica full day AKT course, which was based on doing questions to time followed by a discussion of the topic, and covered high yield clinical topics alongside statistics and admin. It’s a great way to cover a range of important topics and also to check your progress with marked questions. Combining this with the stats, admin and clinical crammer webinars was a great adjunct to my own revision.
I’d also recommend mixing up your revision with YouTube videos, flashcards and online reading to keep reinforcing your learning through a variety of methods.
The Final Weeks
Hopefully you will have finished your core revision with a few weeks to spare. Use this remaining time to consolidate your revision by doing unfiltered questions (i.e. not by specialty) and refreshing your memory of the topic if you need to. You should also be doing timed questions and at least one or two full mock exams to build both speed and stamina.
GP SelfTest is an essential question bank and now would be a good time to use it if you haven’t already. The questions are very similar to the real exam (in fact, I remember seeing quite a few questions taken directly from it) and it’s a good way of seeing how you’re scoring as you get closer to exam day.
If possible, try to skim through the examiner reports from previous exams. The topics they mention as areas of weakness are frequently re-tested so it’s worth doing so to pick up some easy marks. Emedica have also got a list of high yield topics on their website that would be especially worthwhile covering as they’re often tested.
The night before, make sure you’ve packed your bag with your two forms of ID and then get a good night’s sleep. There’s a sample AKT test on the PearsonVue website you can do to familiarise yourself with the system and online calculator.
During the exam, the most important thing is to keep a close eye on the timer. You have 57 seconds per question if you want to finish bang on time, but ideally aim for 50 seconds a question and you’ll have 20 minutes left at the end to run through questions you’ve flagged. It’s a time pressured exam but if you keep track of your progress, you won’t run out of time. By and large, you either know the answer or you don’t – so if you’re stuck on a question, just give it your best educated guess and move on!
Exam technique is critical:
- Read the question first, then read the stem. Try and answer the question in your head before looking at the answers
- Make sure you identify the key words in the question – most likely, initial, definitive, always, never etc all change the answer dramatically – don’t lose marks to questions you know the answer to just because you haven’t read the question carefully enough
- Eliminate the answers you think are definitely wrong and that way, even if you don’t know the correct answer, your best guess is more likely to be correct
- Sometimes the correct answer really is to do nothing! They’re not trying to trick you, so a good approach would be to think ‘what would a sensible GP do?’
And there you have it – this was the approach that paid off for me. Ultimately, everyone will have their own style and methods, but fundamentally the key to not just passing but passing well is discipline and thoroughness. Consistent effort in an organised, structured way will ensure you cover all of the material and plenty of question practice will help reinforce the application of that knowledge. The time you spend planning your revision is almost as important as the revision itself! With a systematic plan and the discipline to enact it, you can walk into the exam confident in the knowledge you’ve done everything you can!
Dr Dilini Srikantha