The thought of the gruelling Royal Australian College of General Practitioner (RACGP) written Applied Knowledge Test (AKT) and Key Feature Problems (KFP) examinations is enough to strike fear into the most prepared and sound general practitioner (GP) trainee. Why do we let this set of questions, this arbitrary marker of achievement, weigh over our lives for so long? It acts as an obstacle to realising two of the key fundamentals to our practice in medicine; career advancement and financial investment in training. It is understandable to feel that pressure of expectation, the unyielding anxiety and sleepless nights as the exam dates approach. Perhaps there are lessons to be learnt from those who have overcome this hurdle already?
I completed the written examinations earlier this year and hopefully my tips and tricks can make your exam preparation successful and straightforward.
If you don’t have the time to read all of them, here is a summary from which you can jump to specific tips.
Five tips pre-exam:
- Practice makes passable
- Practice diligently
- Surround yourself with support
- Time is not your enemy
- Check your progress.
Five tips for the exam:
- Sleep well the night before
- Have a relaxing lead up to the exam
- Read each question carefully
- Stay in the moment and trust your gut
- Relax, results won’t come any faster.
Five tips pre-exam:
1. Practice makes passable
This is the obvious tip that must take pride of place on any exam preparation list. Study will improve your preparedness and more importantly, your confidence. It also ought to improve your mark, however, we should all have the basic skills as practicing doctors to do well. Good study is about being confident in your knowledge and adjusting the finer points of practice.
Let me explain; we all should have a basic understanding of diabetes, so refreshing on chapters of pathophysiology and polyol pathways may not be the best approach to study. However, a far more sensible approach is to look at diabetes and cardiac interplay, understanding the RACGP recommendations on screening and diagnosis, and adopting an up-to-date approach to management with a medication flow-chart.
When I was studying, I always began with a statement in my mind: ‘what would I be expected to know in my office at work?’ Leave the esoteric for another day.
2. Practice diligently
Caution to those who block out chunks of the day for lengthy book revision; I encourage study through immersion instead. As mentioned above, we are all practicing doctors and we all see a breadth of presentations on any given day. The Bettering the Evaluation and Care of Health (BEACH) data is a reflection of general practice as a whole, but individually, we would all be seeing a relatively similar cross section of medicine. So the best study is that done at work. The real benefit of being a GP trainee is that we work in our field of knowledge. Spend a moment for condolences to our physician and surgical family who are often studying a large cross section of medicine whilst working in very sub specialised areas. Let’s make use of our unique position.
We should all be challenged regularly, and it is our response to these challenges which, I feel, identifies success in exam and in practice. When we have a challenging case this should spark a fire in us to expand our knowledge so that we can help our patient and any we see in future, with the added benefit of reinforcing this information for the exam.
3. Surround yourself with support
I myself am not a big proponent of group study; my style is more focused on solo revision. However, having supportive people and other likeminded colleagues around you who are going through the same thing is undoubtedly beneficial, and can be cathartic for debriefs.
4. Time is not your enemy
Twelve months of study? Six months of study? What is the golden number for appropriate revision? I don’t think there is a magic number. It is all so dependent on what will make you comfortable and confident. My feelings are that your preparation has been ongoing since medical school, which seems long enough.
5. Check your progress
The RACGP’s check program is a great tool and is so readily accessible for all college members. An independent education tool supported by the same college writing the exams? Seems to be the obvious choice for study. In fact, I would extend this recommendation to all case based learning. Study like you practice, with a STEM, with a patient and with a story. I myself did 12 months of check revision however, even more than the specific answers; it is about knowing what is reasonably expected of a general practitioner.
Five tips for the exam:
1. Sleep well the night before
Despite your nervous energy keeping you awake, try to get a good night’s sleep. It is a long day, it is a stressful day and it is physically and mentally exhausting. Replenish your sleep deficit in advance.
2. Have a relaxing lead up to the exam
Relaxation is important on the day of the exam; the questions are laborious enough without wasting energy on fretting over car spaces and rushing in peak hour traffic. Give yourself plenty of time to travel to the venue and when possible, have someone come with you or drop you off – distraction is beneficial here! Eat a full breakfast; it is amazing how little you will feel like between exams, And don’t be afraid to take a zen moment. Practice those deep breathing exercises we are always telling our patients to do, or maybe just listen to that favourite song, which will get you in the zone. The added part to this is, not to buy into the panic between exams. Sure, others will have answered slightly different to you or perhaps you did misinterpret something. Once the exam is done allow yourself to put it aside and focus on the next hurdle. Remember, it is ok to tell your colleagues ‘We can talk about this after’.
3. Read each question carefully
The importance of reading the question carefully and completely cannot be stressed enough. Understanding the tone of the STEM and identifying important clinical cues woven into otherwise sedating preamble is essential. As the exam progresses, each question looks more and more like the last, but a moment taken to reframe can help you respect the individual approach each question requires.
4. Stay in the moment and trust your gut
As doctors, we have spent years cultivating a ‘feeling’, that indescribable tendency to make judgements based on our uneasiness or hesitancy. The exam, I believe, brings out those same gut instincts I had when I was on nights relieving, as my extra medical ‘sense’ helped me land on the answer that ‘just felt right’. In this regard I would always say, trust your gut and move on. It is easy to over-focus and deliberate on a question, but in such an expansive exam, it is of little benefit. Focus on getting all of the questions finished and only then revisit any that you are unsure about.
5. Relax, results won’t come any faster!
Once you are finished, enjoy this time to reconnect with your family and friends who you sidelined whilst studying late into the night. Worry is a natural part of the post exam process, but sleepless nights will not make the results available any sooner. The other option is for you to distract yourself with Objective Structured Clinical Examination (OSCE) practice, in which case all of the foregoing points should be repeated – or you can refer to my previous blog post Are you prepared for the OSCE? Ten tips to triumph.
And don’t forget, you can locate additional resources through the RACGP website.