Thoughts from Kevin Yee about how to pass the nMRCGP AKT (1st time) and CSA (2nd time)!

AKT

What: The AKT basically tests one's knowledge as applied to written clinical scenarios. Therefore one has read around AND do MCQs.

How: There is a lot of stuff out there that could possible be read which is where targeted reading will come in; most will find that knowledge is 'locked in' after encountering a new clinical scenario in actual practice, discussing it with one's trainer, then reading up about it in a:

Textbook e.g. Oxford Handbook of General Practice
http://www.amazon.co.uk/Oxford-Handbook-General-Practice-Second/dp/0199553351/ref=sr_1_2?ie=UTF8&s=books&qid=

1229943642&sr=8-2

Online e.g. http://www.gpnotebook.co.uk/homepage.cfm
or http://www.netdoctor.co.uk
or http://www.gp-training.net

The main 2 textbooks of MCQs I used were as below:
One by Rob Daniels and the other by Khan, Jabbour and Rehman; both can be found on the link below:
http://www.amazon.co.uk/s/ref=nb_ss_w_h_?url=search-alias%3Daps&field-keywords=nmrcgp+akt&x=0&y=0

The main online resource of MCQs I used which incidentally was free was http://www.passmedicine.com People have told me it's better than http://www.onexamination.com/Exam-Revision/MRCGP.aspx which you have to pay for but you do get a discount if you're with the MDU.

When: I know some have done the AKT early even at ST1/2 level which is great if you pass it because you 'get it out of the way early'. However the knowledge that you gain from it is very useful for the CSA. My suggestion would be to have a look at the RCGP's curriculum http://www.rcgp-curriculum.org.uk before your ST3, then as you settle into GP-land, begin to try to marry up your clinical experience with the curriculum, ticking off things that you've seen and managed (and putting this in your e-portfolio). Also read NICE guidelines http://www.nice.org.uk/Guidance which will make sure your management plans are up to date with current best practice. Perhaps some 4 months into GP-land you may want to do the AKT. All this is just a suggestion however and I'm sure you will find your own path.

Where: See the Pearson Vue website for details: http://www.pearsonvue.com/rcgp. Some have gone to Sidcup or Croydon but there are other areas in the London area.

CSA
What: You have to score at least 8 stations out of 12. There are actually 13 stations one of which is a pilot station which does not count toward your final mark. The RCGP aim to make it slick so you can't tell which is the pilot station. To tell you the truth I failed the first time round which devastated me as this was the first time I'd failed any major exam in my life. BUT whatever does not kill you makes you stronger. It taught me that I was not patient centred enough.
How:
I geared myself up for a second go armed with 2 key books to read: (happy to say I passed 11 out of 12 stations the 2nd time!).
1) CSA Scenarios for the nMRCGP by Thomas Das
http://www.amazon.co.uk/CSA-Scenarios-new-MRCGP-Thomas/dp/190484264X/ref=sr_1_8?ie=UTF8&s=books&qid=

This book is great for rehearsing and making sure you have a plan even if your mind goes blank under exam stress = construct for yourself 2 lists as soon as you enter the exam room:
First list a) Open Question b) Closed Questions + Red Flags c) ICE + Effect on life d) Explain Dx and Shared Mx plan e) Safety net + Follow Up
Second list just ensures you cover the usual things in any medical hx: a) PC b) PMH c) DH d) FH e) SH
The key aspect is ICE + Effect on life. Many hidden agendas will be brought out which is where the next book comes in very handy.

2) Get Through CSA nMRCGP by Rushforth and Wass
http://www.amazon.co.uk/Get-Through-New-MRCGP-Assessment/dp/1853157368/ref=sr_1_9?ie=UTF8&s=books&qid=

1229945436&sr=8-9

Courses:
A number of them exist so take your pick. To be honest after having been to 2 of them, I can honestly say it does not matter whether you attend or not. The main reason for attending is psychological: you don't want to feel left out because everyone else has been to (at least) one lol! There is no substitute to practising with your peers. Give yourself 1-2months of weekly practice before the exam. However the 2 best courses in my opinion are: http://www.mrcgpcourses.co.uk and http://www.passmrcgp.com

When: When you feel you've given yourself enough time to bed down in GP-land. When you feel your videos represent you as being patient-centred. When your trainer feels you're ready. When YOU feel that you're ready! Practically speaking at about 6-8 months into ST3. This gives yourself enough time if you find yourself in the unfortunate position of failing the first time (like me!) to repeat it before the year's out in order to prevent the difficult procedure of extending your training.

Where: Sunny Croydon!
http://209.85.229.132/search?q=cache:sYM_ceqFLfIJ:www.rcgp.org.uk/docs/NP%2520Site%2520nMRCGP%2520Resources%

2520Getting%2520to%2520Croydon2.ppt+csa+croydon&hl=en&ct=clnk&cd=1&gl=uk&client=firefox-a

Simple tips for patient-centredness:
1) responding to cues by stating the obvious - if a patient looks sad, say 'you look sad' (then PAUSE)...similarly if they look or sound angry (angry patient scenario)
2) when breaking bad news, simple things which are effective would be - asking who they came with to the surgery, how much do they know already, giving them a warning shot, a gentle touch of condolence on their shoulder is a powerful gesture but don't over do it
3) for ICE - don't just say 'What are your IDEAS/CONCERNS/EXPECTATIONS?'. That per se may not score you any points. The key is to make it come out naturally especially if the patient may be giving you cues about that, eg they look worried. You could simply say 'You look worried about something' and it may well all come flooding out about how their headache is making them fear about a brain tumour, AND their father died of brain cancer, AND they wanted a CT scan ASAP.
4) EFFECT on LIFE is very very important to ask. E.g. tennis elbow and the guy is a tennis player...
5) Explaining Dx slickly, accurately and in very understandable layman's terms yet not sounding patronising comes with time and practice (Nikki calls it a patter). One way to help your patter along would be to read Patient Information Leaflets: almost every condition conceivable has a PILs and the best resource for that is http://www.patient.co.uk . They also have diagrams. I had an Asian gentleman patient who did not know what a prostate was; he came in with prostatism. Drawing him a simple diagram really helped cement in his mind what his possible diagnosis was.

Dr Kevin Yee
MBBS, BSc, DRCOG, DFFP (Theory)
Bromley GP Registrar LMC Representative Aug 08-Feb 09
GP Registrar
Addington Rd Surgery
West Wickham
Bromley BR4 9BG
Feb 2008-Feb 2009