Preparing for the AKP exam

Preparation

Candidates can sit the RCPCH theory examinations in any order although most progress from FoP though TaS to the AKP exam. After six attempts, further attempts are only permitted if evidence of further study is provided. The AKP exam is usually first attempted by trainees who have accrued at least 12 months of paediatric training. However, for those in UK training schemes, there is a pressure to complete the theory exams during 3 years of full-time training as failure to do so will usually require an extension of training time. The AKP exam assesses clinical knowledge and decision-making skills, and an exposure to a broad range of general and specialty clinical paediatrics is therefore needed.

This is a UK examination and assesses understanding of UK laws, expectations and clinical practice. Question writers aim to produce questions that can be supported by published evidence, national guidelines of accepted practice and information in established and respected textbooks and journals.

It is important to remember that much of the AKP exam is aimed at assessing clinical understanding of paediatric medical practice encountered by candidates during their normal daily duties. Questions will ask about the presentation of clinical problems, possible differential diagnoses, appropriate common investigations and the interpretation of results. Answers to other questions will require a knowledge of management and long-term consequences of a broad range of conditions. The examination will also test the ability of candidates to establish clinical priorities and ensure that time-critical decisions are recognised and acted upon. All paediatricians will recognise that care occurs within the context of the family, and therefore an understanding of professional and legal obligations is necessary and assessed in the examination. Candidates will obviously need to build their knowledge base by further background reading.

Examination structure

The examination is a curriculum-driven, computer-based assessment that takes place three times each year. There are two separate papers sat on the same day with each paper lasting 2.5 hours. In total there are 120 questions across the two papers. The exam does not use negative marking—a wrong answer scores zero. The allocation of topics across the various syllabus headings is set by the “Theory Examination Blueprint” that allows specific mapping of questions to the syllabus and aims to provide a balanced selection of questions across the entire syllabus in each exam.

Question journey

The development of questions used and the building of each exam involves many separate steps to ensure that the questions are relevant and current and that the exam is well balanced. Before appearing in an exam, each and every question will have been individually scrutinised by at least nine separate, experienced paediatricians and will be reviewed again by a panel of another six to eight paediatricians after the exam has taken place.

The questions are generated at Question Setting Group meetings that occur throughout the year at various locations in the UK and abroad. The meetings are organised by RCPCH staff and are open to all paediatricians who already hold the MRCPCH diploma. Senior exam facilitators are part of the meeting and guide small groups to create the questions. Each question is then assessed by the Senior Theory Examiner for AKP and is reviewed again by two senior clinicians at RCPCH Examination Board. Following this review, the approved question is placed in the question bank for future use.

Following every exam, and before the results are finalised, a panel of paediatricians meet with the RCPCH psychometrician at the “post examination Angoff meeting” and review the performance of every question. This meeting scores the level of difficulty for each question and reviews any possible discrepancies or problem questions identified in the exam. If, for example, most candidates choose an answer different from the allocated correct answer, this suggests that the phrasing of the question is ambiguous and points to more than one acceptable valid answer. The panel would review that question in detail and, if it is agreed that phrasing of any part of the question is ambiguous and therefore unfair, then the question is removed from that examination. The question is sent for review rather than returned to the question bank.

Question types

There are different question types used in the examination. Examples of these can be seen on the RCPCH website and in Chapter 35 of this book. Some information on each question type is offered here.