MRCPCH AKP, May 2021 exam: Instant Insights

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Updated following the 2021/2 sitting.


It’s only a few days since the MRCPCH AKP May 2021 exam, but we’ve been hard at work talking to exam candidates and setting out the next round of development for our AKP resource, based on our recent findings. Here’s a rundown of our latest exam insights:

Many UK candidates had to make a shift to the online delivery of the exam, rather than travelling to a physical exam centre (42% off all survey respondents sat the exam remotely). The candidates that we spoke to said that despite a deluge of emails and information from the Royal College, the experience was reasonably painless (90% of respondents stated they felt adequately prepared for the online exam format), and most were glad to be able to attempt the exam this sitting, rather than having to wait until the next diet. 

MRCPCH AKP May 2021 Exam Content

Candidates reported that this was a particularly tricky exam, especially when compared to the sample papers provided by the RCPCH, although our question bank was representative of the exam content. They reported difficult second and third-order questions, which require you to not only make a diagnosis but to then take the next step into appropriate investigations and management/specialist referral. There were also a lot of red herrings present in the questions, particularly in the form of irrelevant aspects of a patient’s history.

No negatively phrased questions were contained in the exam. Ethnicity was sometimes mentioned and candidates believed it was always relevant to the diagnosis.

Metabolic Immunology and Statistics were frequently mentioned as the trickiest topics, so make sure to pay close attention to these during your exam preparation. Candidates were also surprised by a large number of questions on Safeguarding and Clinical Governance.

Image Interpretation is Important

Once again, images featured heavily in this exam. There were examples of dermatology, chest and abdominal x-rays, rashes and skin lesions to interpret and diagnose. Some candidates also reported seeing more obscure images than they would expect, including orbital CT scans, CXR, ECG, retina, facial dysmorphism and rashes.

Several image-based questions contained no vignette so felt more like a Spot Diagnosis. 

Long-form statistics questions were taken from the Lancet and Archives of Disease in Childhood (ADC).

The Online Exam Experience

We asked online candidates what advice they would give to future candidates. The most common responses were in relation to preparing your exam environment, such as ensuring that you’ve got a strong internet connection with no possibility of distractions. Check out the Pastest Blog: How to prepare for an Online Exam for more helpful advice.

Other candidate advice included:

  • Be careful when using a laptop trackpad – particularly on a Mac. It’s easy to use swiping or other gestures to switch windows, or even display other applications. Don’t risk giving the proctors any cause to flag your exam session for review.
  • Look out for the question’s category, which is displayed on the exam interface. This may give you an edge in detecting what the question is really testing, and therefore a better chance of identifying the appropriate answer.
  • Make sure to close all other browser tabs – including ones open in different user accounts. Ensure that all other users are logged out of your device prior to starting the exam.
  • If you lose connectivity for a moment, don’t panic. One candidate reported this problem, but found that his exam had auto-paused, and it was easy to resume when he made it back online.

Common topics

According to Pastest users, questions on the following topics have appeared at least twice in the last three MRCPCH AKP exams:

  • Hypoglycaemia management.
  • Consent for emergency procedures.
  • Immunodeficiency syndromes.
  • Heart murmurs.
  • Pericarditis ECG interpretation.
  • Causes of paediatric seizures.
  • Epilepsy management.
  • Chest X-ray interpretation.
  • Causes of lesions on CT head.


Read on to see more insights from previous exam sittings...


Insights from the January 2021 AKP exam:

  • Paper 2 was considered much more difficult, with long vignettes and a lot of data interpretation.
  • There were two long-form Statistics questions in the exam (there is an example in the RCPCH AKP sample paper) covering real abstracts from the Archive of Childhood Diseases (2009).
  • Look out for negatively-phrased questions, a couple were present in each paper.
  • There were plenty of image-based questions, often with no opening vignette or a very short vignette. Image topics included chest X-rays, abdominal X-rays, Dermatology and Ophthalmology.
  • Endocrinology questions, especially diabetes (i.e. insulin regimes) featured heavily in the exam.
  • The most difficult exam topics as voted by our customers were:
    • Statistics
    • Endocrinology
    • Dermatology
  • As well as difficult topics, many candidates said that choosing between two plausible options was the most difficult aspect of the exam.

Pastest Customer Outcomes

  • 77% of candidates who answered our survey passed the January 2021 exam.
  • Users that passed answered 330 more questions on average than users that did not pass.
  • Candidates that used our Mock Exams achieved a pass rate of 84.4%.

Common Topics from recent exams

The following topics were present in three consecutive sittings of the MRCPCH AKP exam – September 2020, January 2020 and September 2019:

  • Consent for emergency procedures
  • Causes of headache
  • Congenital adrenal hyperplasia
  • Maturity onset diabetes of the young (MODY)
  • Asthma management
  • X-ray interpretation - Pneumonia
  • Causes of seizure
  • Side effects of anticonvulsants
  • Odds ratio interpretation/calculations

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