NMRCGP Applied Knowledge Test - How to Successfully Pass It

All general practice trainees must now sit the new membership of the Royal College of General Practitioners (nMRCGP) examinations, including the applied knowledge test (AKT), to qualify as general practitioners (GPs). Candidates who pass have demonstrated their competence in applying knowledge and interpreting information at a level sufficiently high for independent practice.

Format of the test

Candidates sit the AKT at any point in their GP specialty training. It is a computer-based three hour paper consisting of 200 questions and is taken at one of 150 Pearson VUE professional testing centres around the United Kingdom. The exam is offered three times a year.

The questions comprise single best answers, extended matching questions, and interpretation of data, diagrams, tables, and pictures. About 80% are on clinical medicine, 10% are on critical appraisal and evidence based clinical practice, and 10% are on health informatics and administrative issues.

In the AKT of April 2009, the mean candidate score was 143, with the top candidate gaining 183. The pass mark was 126 (63.3%), and 83.8% of 1102 candidates succeeded. Mean scores by subject were: clinical medicine 74%; evidence interpretation 68.2%; and administration questions 60.1%.

The subsequent report from the Royal College of General Practitioners identified gaps in candidate knowledge. For example, questions around management of childhood asthma (within curriculum statement (CS) eight, care of children and young people), gender specific health issues (CS10), and fitness to drive and work (CS15) were not well answered. Nor were questions on less common and potentially lifesaving procedures under CS7 (care of acutely ill people).

Preparation for the test

Start preparing three months before the exam. Make sure you are familiar with the Royal College of General Practitioners' curriculum and read up on any weak areas. We strongly recommend you familiarise yourself with statistics and research topics.

There are many revision sites with practice questions, such as OnExamination. There are also many good revision guides, such as nMRCGP Practice Papers: Applied Knowledge Test by Rob Daniels (ISBN 1905 635 354); nMRCGP Applied Knowledge Test Study Guide by Khan, Jabbour, and Rehman (ISBN 9781846192302);EMQs for the nMRCGP Applied Knowledge Test by Dawson and Trigell (ISBN 9781846192456); and Succeeding in the nMRCGP AKT by Mehta, Williams, and Mehta (ISBN 978-1-906839-10-9).

We also suggest the following resources: Oxford Handbook of General Practice; Oxford Handbook of Clinical Medicine; Oxford Handbook of Clinical Surgery; British National Formulary (BNF); Clinical knowledge summaries; Drug and Therapeutics Bulletin; British Medical Journal; Journal of Royal College of General Practitioners; and InnovAit.

Other advice

Draw up a revision timetable. Your e-portfolio can be used to help
Short periods of reading and self-testing are far better than marathon reading sessions followed by multiple mock exams
Self-testing is the only way to assess your knowledge
Group revision is more helpful for some people than others. Find out early if it works for you or not. Group sessions must be structured, and not just an opportunity to unwind, or wind each other up
Don't panic if your revision is not going to plan. Find a mentor to help you back on track, and stay positive. You may not know everything, but there is plenty you do know
Eat well and exercise. It is not healthy to shut yourself away for three months; or to party every weekend


For the day itself

Practice on the examination centre website beforehand to get a feel for the system
Get an early night
Arrive in good time
Bring all the documents requested
Read the questions properly
Enter the answers carefully
If unsure, skip a question and go back to it later
Guess unanswered questions at the end. There is no negative marking
Check for silly mistakes if you have time left
Watch the clock. Two hundred questions in three hours means 54 seconds each, but they vary in length and complexity, so some will take longer than others

Chirag Mehta is a GP trainee in the West Midland Deanery who qualified from Manchester University in 2006. He has articles published in the British Medical Journal, the GP trainee journal InnovAit and also in the journal Public Health. He is also the co-author of Succeeding In The nMRCGP AKT.