Dr Jehane Le Grange passed his AKT with 89.5% overall, including a perfect 100% in stats, and 90% in the admin domain. He shares his experience and tips on how to pass this challenging exam.
Introduction
I am Dr Jehane Le Grange currently a GPST2 trainee, working for the Isle of Wight NHS Trust as part of the Wessex Deanery. I attempted the RCGP AKT for the first time in October 2023. At the time of the examination, I was in my second GPST2 placement, palliative medicine, working at our local hospice. I was able to achieve 89.5% overall (179/200). Breaking this down, I attained 100% for statistics, 90% for administration and 88% for clinical knowledge. Hopefully this article can provide some useful advice on my approach to this examination and guide other candidates in their journey. I share some of my perspectives about the exam, my gross strategy and things I think I could have done better.
Acknowledging your background and what worked for you in the past
Starting off in GP training we all already know, that come ST2, we will all be eligible and expected to take shot at clearing the AKT. Early on in our training we start to hear about the vast content that this examination covers and ‘horror’ stories of our seniors who have struggled to clear it. It’s not uncommon to hear panic stricken colleagues state, “They can literally ask anything.” Then throw in the fact that you’re likely new to primary care and unlikely to have had much exposure to it all, and suddenly you’re in a spin and feeling overwhelmed by it all questioning whether you’ve picked the right specialty. Alas, this feeling of despair is completely normal.
The first thing to consider, is that you are not alone, everyone feels like this at some point and success with AKT (and GP training as a whole) is under your control and easily achievable. You need to realise, that by this stage of your career, you’ve seen it all before. This is not your first medical examination and you’ve certainly already ‘been there, done that’. Knowing this, you need to reflect on what has worked for you in the past and what you’d like to do differently. We are all individuals and all learn and retain new information differently, so what worked for me certainly won’t work for everyone. I’ve always been a bit of a crammer, needing some ‘time-pressure’ to really knuckle down and cut out my procrastinating. My knowledge retention seems to increase exponentially when under pressure, and is not the case for everyone.
On top of this, we all come from different backgrounds and our experience matters and will certainly influence our examination preparation. Things like where you’re from, where you’ve studied, your previous training in the United Kingdom, previous rotations and ultimately your entire journey into general practice all play a part in determining what you need to work on to develop the knowledge and skills necessary to clear the examination.
In my case, I had a strong pre-hospital medicine background prior to going to medical school so my acute care and minor injuries knowledge was pretty decent. I then went on to study in a country with limited general practice or family medicine so my exposure to primary care was very limited throughout medical school. I completed foundation training (FY2 standalone) in the United Kingdom having passed the PLAB exam and rotated through trauma and orthopaedics, general & palliative medicine and finally emergency medicine.
Prior to my AKT, I had completed a rotation in general practice, an integrated training post with both general practice and psychiatry, a placement in obstetrics and gynaecology and was in a palliative medicine placement at the hospice while preparing for and passing my AKT. I should also add, that during my OBGYN placement, I also completed the Diploma of the Royal College of Obstetricians and Gynaecologists (DRCOG). I will explain how reflecting on my experience helped shape my strategy a little bit later on.
Knowing what’s ahead
At the start of my training I was so caught up in adapting to my new clinical environment (a very busy GP practice), and developing primary care skills and figuring out my portfolio requirements that I had very little time or energy to still consider an exam on top of everything else that was going on and stressing my out. However, I did have brief look at my proposed placements for the rest of my training and considered which placement would be the best to prepare for an examination. I also took into account that ST3 is notoriously busy, with added portfolio requirements and the MRCGP SCA examination too, so from day 1, I knew that I wanted to clear my AKT in ST2 (as opposed to leaving it to ST3). I then considered whether to attempt this in my first ST2 placement (OBGYN) or my second placement (Palliative medicine). Both placements were standard 40 hour weeks with no on-calls/out-of-hours shifts but given that OBGYN was a little more demanding I made my mind up that I would aim to do my AKT during the second half of my ST2 year, while in palliative medicine. I made this decision or set this goal early on in my GP training and then decided to forget about AKT until I started ST2. Planting the seed of what’s ahead and having a very general timeframe is quite important and keeps you subconsciously aware of what’s coming.
Picking a strategy and rough timeline
There really is no right or wrong answer to this and everyone will do something different but as I’ve already mentioned, the first step was to have a rough idea of when I wanted to clear the exam and where I would be at that time. Your study strategy will be completely different if you’re in a busy placement versus a less demanding placement, when it comes time to prepare and sit the examination.
As I started my ST2 year, I knew that I had to consider my approach to the exam as I’d set the goal of passing it later that year. I decided that I needed to get a better idea of what to expect from the AKT. I took some time to read the RCGP website and their content covering the AKT and backed this up by watching the Emedica YouTube videos on the AKT covering what to expect and how to prepare for the AKT, question formats and sample AKT revision questions, and the video on common mistakes that can lead to failure and how to avoid them).
I also spent loads of time speaking to my seniors at our monthly teachings, listening to their experiences. Overall, this gave me a good idea of what I was up against.
Identifying my strengths and weaknesses
My next task was to consider my background and what I thought my strengths and weaknesses were in the context of the RCGP curriculum and the make-up of the examination. I did this by looking at the RCGP self-test categories and without answering any of the questions, asked myself which topics I felt confident about and which I felt clueless about. This was influenced predominantly by what placements I had previously had (including my foundation training placements) and which topics I did well in during PLAB and MSRA preparation. I had also decided that I would undertake the DRCOG examination during my OBGYN placement so as to cover all the OBGYN and sexual health related content prior to formal AKT preparation. This was a big chunk of the AKT that I got out the way, successfully passing my DRCOG in April 2023. On top of this, I felt confident in areas such as urgent and unscheduled care, oncology, end-of-life/palliative care and dermatology. I immediately recognised that my knowledge on statistics and administration was poor at best (despite having really robust medical statistics training at medical school). Given that these covered 20% of the examination, I decided to speak to colleagues about what worked well for them and was relieved to know that through disciplined revision of some key topics, they were all able to achieve high scores in these domains (scoring 90% is definitely doable). I made my mind up that I would dedicate myself to these domains and strive to get them out the way first before moving onto clinical knowledge.
Knowing that by completing the DRCOG in April 2023 I would have covered a good chunk of specific AKT content too and that by starting early with the statistics and administration domains, I was left with deciding when to start serious clinical knowledge revision. This does come down to a number of factors. How much time you’re able to spend on revision daily might depend on your placement, your working pattern (full-time versus less-than-full time), and family commitments, etc. Realistically, I did not want to be doing more than 2-4 hours of revision a day and probably not more than 4-5 days a week, in the early stages. Of course I knew that this would change the closer I got to the exam and I also considered how much leave I would take to prepare prior to the examination.
Essentially, taking into account my personal circumstances, I roughly aimed to get the statistics and administration learning out of the way by mid-July before easing into more familiar topics initially and continuing with them for the remainder of July before then delving into the unknown throughout August and early September. From mid-September I started devoting more time, almost every day, to cover larger amounts of content. The final 30 days was really where I stepped things up dramatically (especially on weekends) and also took 10 days of leave immediately prior to the exam.
As I mentioned before, I have always been a crammer, and find that I really need a period of pressure immediately prior to an examination to truly retain the content. This will not work for everyone and I think many candidates will find my timeline quite daunting.
AKT resources
Having a general timeline in mind, I now had the task of deciding which resources to go with. It’s easy to get lost when Googling AKT resources. Simply put there are loads of really good resources out there, including some free ones, but it can be quite overwhelming deciding what is right for you. I had already used one popular question bank for my DRCOG preparation and was quite keen to use this again (the provider did offer a AKT question bank too) but decided that it was best to check with colleagues. I was already well aware of Emedica, having used them for my MSRA preparation and through partnerships with my medical indemnity provider. I was also very impressed by their YouTube content and the clear way everything was explained. Reviewing online testimonials also painted a very positive picture and many colleagues who had previously failed the exam gave my overwhelming positive feedback about how switching to Emedica had helped them finally clear the exam. Looking at the Emedica website, they have a fantastic range of MRCGP AKT specific products to suit everyone’s unique needs.
Given my proposed study timetable, I chose the Emedica Pass+ Online Package, which allowed me to work at my own pace and with the flexibility of accessing the content at any time. It was a comprehensive package, and the statistics and administration elements were very well presented and clear. The included Emedica AKT question bank was also very similar to what is found in the examination and gives a good of the breadth and depth of the knowledge you need to know. I supplemented these questions by also completing the entire RCGP self-assessment question bank twice. I will admit that I was quite heavily reliant on question banks, spending a significant amount of my revision time doing answering questions and only a small portion of the time going over content (such as NICE guidelines / Oxford Handbook of General Practice). I made peace with the fact that it would be difficult to read each guideline or chapter in detail and found that by developing a core understanding of the key concepts and covering key topics (especially the chronic disease guidelines) were sufficient to help you figure out answers even to questions that you might not have encountered before.
I found YouTube to be a great resource for topics that I struggled with, particularly for the statistics section, There are a host of detailed but easy to understand illustrative videos you can find by simply searching for the concepts that you’re struggling with. This theory does however need to be applied through practice using the question banks. I would say that if you can repeat the statistics questions from the Emedica AKT question bank a few times, and are confident with those concepts you’d be able to score very highly for the ones encountered in the actual exam.
To further solidify your core learning, I would recommend the Emedica High Yield Topics Checklist, especially as you enter the final 4-6 weeks of your preparation and use this as a guide on what to go deeper into.
Core knowledge of chronic disease diagnosis and management is particularly important and certain topics you’d certainly want to go over again. I would add that women’s health and sexual health (including urology) are particularly common in the exam and something I certainly focused on covering well (building on from my DRCOG).
I would like to add that of all the question banks out there, there are many that either go into far too much detail, making it difficult to retain key concepts (not to mention it can be extremely overwhelming) while others are too ‘shallow’ and might give you a false sense of security. In my opinion the Emedica AKT question bank struck a good balance and helped guide my overall revision.
How I structured my revision
Having a good structure to follow is important and it’s well worth spending some time getting organised. Again, I started pretty generally, guided mostly by the RCGP self-test curriculum breakdown. I would allocate certain topics more time than others, and would try and correlate this with the Emedica question bank. I tried to make sure that I covered the entire RCGP self-test question bank at least once and was then able to identify which areas needed a second review.
As I mentioned, I spent a vast amount of my time (at least 75%) just getting through questions and then used this to guide me on what areas required further reading and also helped me makes notes on topics or key points that I felt I needed to refresh just before the exam. The last 30 days or so were spent almost exclusively ploughing through the questions, especially focused on topics that I felt were likely to be high yield. I also used these last 30 days to complete some of the mocks and get a sense of where I was at. Ensure that you spend a fair amount of time doing timed questions.
Staying positive and maintaining a work-life balance
Despite my high score, and relatively robust planning and organising, I still found my AKT preparation to be stressful. In part this is due to my personality (I set a high standard for myself and my stress is often self-induced with false feelings of impending doom) but was also influenced by external factors. What I would say is that you’ve passed loads of exams before to get to this point and that the AKT is very doable, so despite the natural peaks and troughs in your confidence, try and stay positive and stick to your plan. Do not chop and change too much but rather settle for a little adaption as you encounter challenges. It’s completely normal to have days where you feel overwhelmed, try and still stay productive by perhaps settling for revision of more familiar topics to bring your confidence up again. Keep at it, it will all come together in the end.
I do think it’s relevant to add that although there will inevitably be a shift in your work-life balance (work or exam prep will inevitably take up more of your time than usual), it remains important to stay healthy and active and still have some semblance of a normal life. In my case, my mother visited from abroad during August 2023 and I was still able to spend a fair amount of time doing activities with her during her stay. I also ran a marathon in early October (before my exam), which required a fair amount of training at the same time of my examination preparation. I planned this intentionally so as to almost force myself to have another goal other than the exam, and allocate time to it. This gave my mind a good break from studying and meant I was refreshed and able to then come back and study more efficiently. I also ensured that I was eating healthily and sleeping well. Admittedly my social time was cut down, but I still ensured that I scheduled frequent events with my partner and friends, to ensure that I had other things to look forward to. Through good planning and a bit of discipline this is all possible and went a long way in ensuring exam success.
The days leading into the exam and the exam itself
The days leading into the exam can be daunting. Imposter syndrome crops up from time to time and you’ll have moments of self-doubt. Again, this is completely normal, stick to your plan, stick to your processes, it will all come together. The mock exams you do are only general guides and it is very difficult to draw conclusions between them and the examination. Also, be comfortable early on in your journey with the fact that you will not cover all the content thoroughly. General practice encompasses almost everything in medicine and the focus of the exam is to ensure your have core knowledge of commonly encountered complaints and presentations. The exam is not there to trick you or question you on rare things. Yes, there will be a few questions that cover uncommon topics but they are few and far between. Event if you don’t know an answer, you would have a fairly good idea of the topic and will be able to deduce the correct answer given questions you’ve previously encountered. Ensure you are mindful of the time when doing question banks. Be sure to practice exam technique and be familiar with the exam platform (the PearsonVue centres usually send an email ahead of the exam which serve as a tutorial, so you should know what to expect).
The day before the exam should be spent doing only light revision and I would suggest making sure it only really covers familiar topics to ensure that your confidence remains high. There is very little point trying to cram new topics or unfamiliar concepts the day before as it’s unlikely you’ll encounter them anyway and you’re bound to upset your confidence by doing that. Put it this way, there is very little that you can do on the final day that can truly impact your result significantly. Focus instead on keeping your mind refreshed. Ensure a good night’s sleep, and wake up well in advance of your exam. I made sure I had a light breakfast and arrived at my exam centre well in advance (ensure you have all the required documents prepared the night before so as to avoid any panic on the morning). Do not arrive late. In the lead up to the exam you really want things to be nice and stress free. This will give you the best chance of success.
Make sure you go through the computer tutorial at the start of the exam (this is not counted towards your exam time), to ensure that you are comfortable with the computer setup. Read each question carefully and the associated options. Most questions would be of familiar topics you’ve already covered and subconsciously you’ll have a good grasp of what the answer should be once you’ve gone through the options. No question bank may have duplicate questions from the examination but most of the questions will be very familiar or similar to what you’ve seen before. If you’re truly stuck on a question try not to waste too much time on it and sometimes it helps to go with your gut. Do not dwell on previous questions, try focus on the one in front of you. Stay mindful of the time. It’s vital that you complete the entire exam. Many candidates who fail, do so due to the fact that they run out of time. You can always flag a question and come back to it, but I suggest that even if you do this, you still put down a preliminary answer just in case you do not have time to come back to it, as you’ll then still have some chance of scoring a mark.
After the exam
As difficult as it may seem do not dwell on the questions and rather try to forget the exam. Do not discuss questions with colleagues as this goes against the RCGP policy and you can get into trouble. Try and distract yourself by staying busy with other activities in the days and first few weeks following the examination. Once the result is out and you’ve passed, you can then reflect on your preparation and choose to help other colleagues with theirs by giving general advice and suggestions (similar to what I have done here). It’s always rewarding helping others and does bring about a sense of closure. Don’t forget to celebrate, passing is a big achievement when considering the resources, time and effort that you would have devoted to the task. Lastly, don’t forget to claim your tax back on your RCGP membership fees and the exam fee at the end of the tax year!
In summary
My timeline and approach will not be for everyone but having a strategy and seeing it through is of the utmost importance. Having a plan is vital even if your plan is vastly different to your colleagues’. Try to remain consistent once you start and don’t forget to keep some form of balance in your lifestyle. Most importantly, don’t doubt yourself, you’ve been through this before having passed many examinations in the lead up to this one, back yourself!
