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WPBA and Exams

GP Resident

Doctors in Training / GP Resident / WPBA and Exams

Applied Knowledge Test (AKT)

The AKT is a multiple-choice question (MCQ) summative assessment of the knowledge base that underpins independent general practice. It is an online test, which consists of 200 questions and lasts 3hrs10 mins (210mins).

When can you sit the AKT?

In ST2 or ST3 year * ST3 is a very busy year, so ideally sit the AKT exam in ST2.

3 Exam sittings per year: Jan, April, Oct.

Maximum number of 4 attempts permitted.

Exam content/format

200 Questions:

  • 80% Clinical Medicine- tests broad range of GP curriculum
  • 10% Evidence Interpretation (critical appraisal, statistics, research)
  • 10% Organisational (GP administration, legal+ ethical issue, health informatics)

Mixture of MCQ and Extended multiple answers, no negative marking.

How to prepare for the AKT exam

Review AKT section of RCGP website and allow at least 3 months to prepare for the exam.

Be organised – applications to sit the exam close approx. 1 month before the exam date.

Early Prep

The best preparation is through preparing to be a good up to date GP.

NICE CKS is an excellent place to start, augmented by Patient.co.uk (Professional resources sections) and then things like BMJ review articles NICE or SIGN guidance.

Register for a question bank and do lots of exam questions. Doing exam questions will help with becoming familiar with the question formats and with identifying areas of weakness

Question banks/Useful resources

  • Passmedicine – a low cost bank of approx 1100 questions with good explanations of answers and web links to relevant guidelines.
  • RCGP Self-Test Questions – helpful to save until closer to the exam and use as a mock test.
  • GP Notebook‘s excellent explanation of medical statistics.
  • AKT Feedback reports; useful to review – highlights areas where candidates did not do so well; these areas are likely to be tested again.

Recommended reading

There is a daunting variety available. We recommend any that help you address unmet learning needs, just don’t buy too many! Every year the following generic list proves reliable, but is not exhaustive. This does not mean knowing all the content, but does mean prioritising your learning and identifying the most relevant from any of the following:

  • BNF first few chapters – essential reading, plus the main drug classes
  • InnoVAIT journal
  • NICE guidance/pathways
  • NICE Clinical Knowledge Summaries
  • SIGN guidance
  • Oxford Handbook of General Practice
  • British Medical Journal
  • British Journal of General Practice
  • DVLA At a glance guide to the current medical standards of fitness to drive
  • Being a General Practitioners (RCGP Curriculum)
  • Good Medical Practice: Good Medical Practice (GMC)
  • Medical defence organisations’ educational resources

Clearly, there is a lot to do and this needs dedicated time. It can help significantly to the workload with your colleagues, each summarising the relevant primary-care take home messages from a different guideline. There is no need to read every page of every national guidance in detail! Revision time tables and study groups can be very effective – efficient, organised virtual online meetings with colleagues can be both productive and memorable.

Recorded Consultation Assessment (RCA)

The RCA has replaced the CSA, it is the clinical exam which is sat in ST3 year.

The RCA exam provides an objective assessment of clinical skills from real life settings provided across 13 consultations and undertaken by the candidate from their own current working environment.

The 13 recorded consultations may be any combination of audio, video or face to face consultations. Examiners will listen to the first 12 minutes of the consultation (after the consent has been taken).

6 Mandatory Cases – You must submit minimum of 1 and maximum of 2 cases for each of the following:

  1. Case involving child < 16 years
  2. Case involving adult over 65 years
  3. Maternal/ Reproductive Health
  4. Mental Health
  5. Long-term Condition
  6. Acute Case

The exam examines your ability in the domains of:

  • Data-gathering, Technical and Assessment skills
  • Decision Making and Clinical Management skills
  • Interpersonal skills

Each domain is marked out of 3, ensure adequate amount of time is spent on each- most residents tend to spend more time on data gathering and run out of time for clinical management.

Useful Resources

Top Tips for RCA

Record, record, record!

It is best to get into the swing of recording early in ST3 year, consultations do improve with time and you will become more proficient at consulting within 10-12 mins. Recordings can also be a valuable learning tool- to listen to with your trainer and get feedback

Involve the whole practice team in helping you gather cases

It is best to submit cases were the patient is presenting to you for the first time with a new problem. Ask reception staff to prioritise booking such patients in with you, and if they can reduce the number of patients booked in for medication review/ follow-up- as these are less likely to be suitable for submission. Triage lists are also a good place to look to get cases – be mindful not to be too selective though, as not everything is how the slot note suggests.

Be prepared

Arrive at work early on your recording days; this gives you time to look through your list of patients for the day and to bring up any relevant NICE CKS guidelines which you might find helpful.

Have a stopwatch at your desk

Be strict with time – by around 7-8 min mark you should move on to clinical management section.

Formulate a Crib Sheet

Having a crib sheet in front of you to refer to during the consultation helps to ensure that you stick to a good structure and helps avoid missing important questions.
Really listen to the patient; let the consultation flow naturally, be patient-centred rather than doctor centred. Explore the patient’s ideas, concerns and expectations and pick up on clues. Remember one third of the marks come from inter-personal skills

Joint consultations with your GP Supervisor

A good way to get feedback on consultation skills and good learning tool. Ask your trainer to be honest with you re consultation style

Work place-based Assessments (WPBA)

WPBA evaluates the trainee’s progress in areas of professional practice best tested in the workplace.

  • 3 Clinical Case Reviews per month
  • 1 Other Learning Log entry per month

Complete assessments regularly throughout the placement, including:

  • Mini-cex
  • CBD/CAT
  • MSF
  • CEPS (Complete throughout the 3 year training program)
  • QIP in ST1 and QIA annually
  • Prescribing assessment (ST3 only)
  • Leadership Activity and Leadership MSF (ST3 only)
  • PSQ (ST3 only)

Clinical Examination and Procedural Skills (CEPS)

Demonstrate a range of clinical skills, including 5 mandatory examinations: Breast exam, prostate exam, rectal exam, speculum and bimanual exam, male genital exam.

Case Based Discussions (CBD)

The CBD is a structured oral interview designed to access your professional judgement in a clinical case. The assessment assesses your performance against the capabilities and looks at how you made holistic and justifiable decisions in relation to the patient care.

CBDs can be carried out in hospitals by doctors ST4 and above, you choose who completes the assessments and it is advisable to have them completed by a range of doctors. Your named clinical supervisor should complete at least one CBD. In the primary care setting CBDs will be completed by GP Educational/ Clinical Supervisor. You should select the case you want to share with your supervisor and link with 3 or 4 capabilities.

A minimum of 4 CBDs are required in ST1 and 2.

Care Assessment Tool (CAT)

CBDs in general practice placements are being replaced by the CAT, which allows a greater range of information and performance to be recorded and assessed against the capabilities. A minimum of 5 CATs (which can include CBDs) are needed by the end of ST3.

CATs can include:

Mini-CEX

A Mini-CEX is an observed, real-life interaction between you and a patient. The Mini-CEX assesses your clinical skills, attitudes and behaviours. Mini-CEX assessments are completed in hospital placements.

Clinical Observation Tool (COT)

The COT is an expanded version of the Mini-CEX and considers your consultations with real patients in real time during the primary care placements. It assesses the clinical skills and professionalism necessary for good clinical care within your consultations and this includes your performance of the more holistic judgements needed to consult in General Practice.

COT assessments can be directly observed by your GP Trainer, or can be carried out using a recorded consultation.

Audio-COT

General Practice has evolved and more consultations are being carried out by phone. Audio-COT provides an additional tool to enable the assessment of your telephone consultation skills. The Audio-COT uses the same methodology and process of completing the assessment as the COT, but is used in a different setting.

Multi-Source Feedback (MSF)

The MSF tool is used to collect your colleagues’ opinions on your clinical performance and professional behaviour. You need to do an MSF in every year of training and you need a minimum of 10 respondents (5 clinical and 5 non-clinical) each time. In ST3 you need to complete 2 MSFs, with one being a leadership MSF.

Patient Satisfaction Questionnaire (PSQ)

The PSQ provides patient feedback on your empathy and relationship-building skills during consultations. It is completed once in ST3 and it is recommended that you do this in the second half of the year.

Leadership Activity and MSF

The leadership WPBA should be completed in ST3 year and gives residents an opportunity to gain practical experience in developing leadership skills in primary care. You can choose your own activity or select from the examples on the RCGP website. The proposed activity should be discussed and agreed with your Educational or clinical Supervisor to ensure its suitability. It should be recorded in your portfolio by writing a reflective entry using the specific leadership log entry template.

The 2Nd MSF in ST3 is a leadership MSF with questions specifically focused on obtaining feedback around your leadership skills. Ten respondents are required.

Quality Improvement Project (QIP)

The GMC recommends that all doctors demonstrate an involvement in Quality Improvement at least once a year. During your GP training you are expected to complete a QIP when you are in primary care placement, either ST1 or ST2 year and a quality improvement activity (QIA) in other training years.
By the end of ST3 you will need a minimum of 1 QIP and 2 QIAs

Prescribing Assessments

The Prescribing assessment is a formative exercise to reflect on prescribing practice, which should highlight trends and learning needs within your prescribing. By reflecting on errors identified t will enable learning plans to be put in place in order to improve your prescribing in the future.

  1. The resident searches on their last 50 retrospective prescriptions
  2. Using the prescribing manual, the resident reviews these prescriptions and maps them against potential prescribing errors
  3. The GP trainer / Supervisor reviews 20 of these prescriptions, maps these against potential errors and adds these to the spreadsheet
  4. The resident completes the resident reflection form in the ePortfolio and in particular reflects on their prescribing using the GP prescribing proficiencies
  5. The resident and GP trainer / Supervisor complete the assessment using the GP trainer/ Supervisor assessment form found in the ePortfolio
  6. Both the resident and GP trainer / Supervisor complete and submit the questionnaires
  7. The resident uploads the anonymised spreadsheet to their learning log=