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THE APPLIED KNOWLEDGE TEST CONTENT GUIDE 1 CONTENTS 1. Introduction p.3 2. Exam

THE APPLIED KNOWLEDGE TEST CONTENT GUIDE 1 CONTENTS 1. Introduction p.3 2. Examples of considering topics with the curriculum p.5 3. Section 1 ‐ Clinical Medicine p.10  Cardiovascular problems p.12  Digestive problems including nutrition p.14  Ear, nose and throat, oral and facial problems p.16  Eye problems p.18  Genetics p.20  Haematology problems p.21  Immunology problems p.22  Infectious diseases p.23  Intellectual and learning disabilities p.24  Mental health problems p.25  Alcohol and substance misuse problems p.26  Metabolic and endocrine problems p.27  Musculo‐skeletal problems including trauma p.29  Neurological problems p.30  Palliative and end‐of‐life care p.32  Pharmaco‐therapeutics p.33  Renal problems p.35  Respiratory problems p.36  Sexual health overlapping with p.37 o Men’s health p.38 o Women’s health p.39  Skin problems p.41  Children and young people p.43 4. Section 2 – Research, statistics and epidemiology p.45 5. Section 3 – Administration, ethical and regulatory p 48 frameworks 2 THE APPLIED KNOWLEDGE TEST CONTENT GUIDE  THIS IS A LEARNING RESOURCE FOR THE APPLIED KNOWLEDGE TEST (AKT)  IT SHOULD BE USED IN CONJUNCTION WITH THE RCGP CURRICULUM  IT CANNOT COVER EVERYTHING THAT MIGHT APPEAR IN THE AKT Purpose  The purpose of the Content Guide is to provide a summary of the knowledge base that is likely to be tested in the Applied Knowledge Test (AKT).  It should NOT be considered an exhaustive and complete list of general practice topics, and is provided as an aid to candidates and educators when preparing for the AKT.  Additionally, the Content Guide will help examiners as they construct a blueprint (‘content matrix/test specification’) to ensure that the AKT questions sample widely across the curriculum. Content Guide and RCGP Curriculum  The Content Guide is a resource to complement the RCGP Curriculum (current version 2013) (http://www.rcgp.org.uk/gp‐training‐and‐exams/gp‐curriculum‐overview.aspx), which defines the areas of competence, essential features, strategies and resources of the GP specialty training programme. The curriculum also defines the learning outcomes required to achieve a Certificate of Completion of Specialty Training in General Practice.  The Content Guide contains a list of topics that should be considered across the areas of competence described in the core curriculum statement, Being a General Practitioner: o Primary Care Management o Person‐centred Care o Specific Problem‐solving Skills o A Comprehensive Approach o Community Orientation o A Holistic Approach  The RCGP Curriculum Introduction and User Guide (which is structured in a different way from the Content Guide) provides detail on how to approach learning in these areas. http://www.rcgp.org.uk/gp‐training‐and‐exams/~/media/Files/GP‐training‐and‐ exams/Curriculum‐2012/RCGP‐Curriculum‐Introduction‐and‐User‐Guide‐2012.ashx  The core curriculum statement Being a General Practitioner provides the basis for the clinical examples which follow in the curriculum. http://www.rcgp.org.uk/gp‐training‐and‐exams/~/media/Files/GP‐training‐and‐ exams/Curriculum‐2012/RCGP‐Curriculum‐1‐Being‐a‐GP.ashx Layout and Alignment with the curriculum The Content Guide is based on body system classifications, and also contains lists of symptoms as well as conditions and diseases to prompt candidates to consider differential diagnoses for common presentations. However, patients in general practice often present with undifferentiated symptoms and complex disease combinations, so the list of symptoms should be considered as a totality rather than each one in isolation. Candidates and educators will note that the Guide does not contain a section for every clinical example statement (e.g. Care of Older Adults, Care of Acutely Ill People). The background 3 knowledge for these topics is covered within the systems and symptoms listed elsewhere in the Content Guide. Conversely, the Guide lists areas that are not given as clinical examples in the curriculum statements, where knowledge is nonetheless clearly required to meet the outcomes described in the core curriculum statement, Being a General Practitioner. When considering a topic not specified within the clinical example statements of the curriculum, the core statement (Being a General Practitioner) and the contextual statements (The GP Consultation in Practice, Patient Safety and Quality of Care, The GP in the Wider Professional Environment, Enhancing Professional Knowledge) will guide interpretation of the level and breadth of knowledge required in the AKT. Changing content The Content Guide will inevitably evolve over time as the content and context of general practice develop. Moreover, it will reflect continuing developments in the RCGP curriculum and in assessment methodology and policy. The RCGP therefore intends to update it on a regular basis BUT it is important to emphasise that it DOES NOT attempt to be a complete list of every topic that might be included in the AKT. Candidates should ensure that they refer to the version current at the time of taking the exam. Topic importance The Content Guide is a list of topics. There is no attempt to attach a weighting (or relative importance) to its various items, and the clinical sections are listed in alphabetical order. In the AKT, all questions have an equal score but consideration is given at the point of selecting the questions for each AKT to sample widely across the curriculum. There will be questions on conditions that are seen frequently in general practice (e.g. asthma) but also on rarer but important topics (e.g. meningitis) which every GP would be expected to recognise and know how to manage. Level of detail Candidates often wonder how much detail they need to know about a topic, and this is best understood by referring to the learning outcomes described in the curriculum. However, it is impossible to define learning outcomes for every condition and candidates should refer to the outcomes described in the core and contextual statements of the curriculum and consider the level of knowledge they would require working in day‐to‐day general practice. For example, this could include knowledge of the appropriateness of common hospital investigations that a patient may undergo but to which a GP may not have direct access e.g. MRI and CT scans. Relevance to UK General Practice The MRCGP is the licensing examination for the whole UK. There are differences in the structure and administration of the NHS in the four Home Countries (England, Scotland, Wales, Northern Ireland), and these differences are taken into account when the AKT questions are constructed. This is particularly relevant to questions within the Administration and Regulatory Framework section. Any variation in clinical guidelines between the devolved nations is accommodated during the question writing process. Feedback The Content Guide is a new addition to the learning resources for the MRCGP and we welcome feedback on its usefulness to candidates and educators. Please send any comments to exams@rcgp.org.uk 4 HOW TO CONSIDER TOPICS ACROSS THE DOMAINS OF THE CURRICULUM The two following examples (Asthma and Fitness to Drive) are a practical illustration of how the knowledge represented in this Content Guide might be applied to the areas of competence described in the core curriculum statement ‘Being a General Practitioner’. CLINICAL EXAMPLE – Asthma In order to demonstrate these core areas of competence for the topic of asthma, you will require knowledge, skills and attitudes in the following areas: The RCGP areas of competence As an example to help you understand how general practice knowledge can be applied to asthma, we have listed some of the items you should consider. These have been organised into the areas of competence described in the core curriculum statement:   Primary care management This area of competence is about how you manage your contact with patients, dealing competently with any and all problems that are presented to you.  Knowledge of the natural history, aetiology and epidemiology of asthma  Knowledge of the diagnostic criteria for asthma and the features that differentiate it from other diseases  Specific clinical knowledge of asthma investigations and principles of management of acute and chronic asthma in adults and children  Comprehensive knowledge of drug treatments including contraindications, adverse reactions and drug interactions. Use of BNF for drug therapy including devices, monitoring approaches, drug combinations and dosages  Comprehensive familiarity with current guidance – BTS/SIGN guidelines  Team approach – the role of chronic disease management clinics, care plans and when to refer to secondary care   Person‐centred care This area of competence is about understanding and relating to the context of your patients as individuals, and developing the ability to work in partnership with them.  Approaches to communication of diagnosis and tailoring of treatment to personal circumstances  Exploration of health beliefs as to why asthma has developed   Specific problem‐solving skills This area of competence is about the context‐specific aspects of general practice, dealing with early and undifferentiated illness and the skills you need to tolerate uncertainty, and marginalise danger, without medicalising normality.  Risk‐based assessment approaches for asthma diagnosis and management  Approaches to the management of the full spectrum of asthma presentations including childhood, pregnancy, routine care and emergency management of asthma  Techniques for improving asthma management in patients with chaotic lifestyles or complex background issues  Knowledge of how safeguarding concerns may present as poorly controlled asthma in children 5   A comprehensive approach This area of competence is about how you as a general practitioner must be able uploads/Management/ content-guide-august-2013.pdf