“I didn’t give it enough respect”–an evaluation of preparation strategies used by GP trainees for the AKT

The Applied Knowledge Test (AKT) is one third of the licensing exam to become a General Practitioner in the United Kingdom. It is a computer-based, machine-marked multiple-choice examination with an overall pass rate of around 70%. Statistics reveal international medical graduates to have lower rates of passing. The aim of this evaluation was to determine the key features of preparation for the exam used by successful candidates. A questionnaire survey was sent to recently successful general practice trainees in Southampton. The results were further informed by a group interview and three in-depth interviews. A series of six areas were identified within the exam preparation that featured as common areas for all candidates. Further analysis showed the parameters around these areas suggesting the ability to maximise the candidates’ chances of success. The areas included: preparation; time management; expectations; peer support; change of approach and impact on trainee mental health. A period of at least 10 hours per week for at least three months revision, using four to six resources and using question banks to consolidate learning rather than as a primary tool were found to be the key parameters with successful candidates. When to take the exam should be discussed with the trainer, the difficulty of the exam needs to be acknowledged by candidates, working in study groups can be beneficial and planning of the approach to revision was found to be essential. The impact of failure on trainee mental health must not be underestimated.