Updated following the 2023/2 sitting.

It’s only a few weeks since the MRCPCH AKP May 2023 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:

MRCPCH AKP May 2023 Exam Content

- Spot Diagnosis style questions focusing on ECGs and CXR interpretations were highly prevalent in this diet compared to other recent sittings.

- Many questions provided limited information so ensure you're looking for whatever clues are there. 

- Cardiology was considered the trickiest subject for this diet, followed by Endocrinology and Nephro-urology.

- Quite a number of questions appeared comprising of presentation, clinical management, and medication-related questions to seizures and other neuro syndromes.

Customer Comments

- "Pastest has all the relevant topics for the exam in its questions bank. Secondly, question types are the same, given scenarios are similar including crucial details in them and it made me well prepared and confident on the day of my exam. I knew exactly what to expect."

- "It was so difficult to know if it was Bartters, or renal tubular acidosis and similar illness. The questions were asked in a way that made it difficult to streamline differentials"

- "Study the metabolic and immune syndromes. Being able to tell them apart are easy marks."

- "It is a very clinical exam and felt fair based on the experience I had. Some rogue questions as always but the majority were reasonable. If you have some paeds experience and do lots of questions it should be ok. Make a document of random syndromes and how they tend to come up in exams while you are doing questions (list info from the answer explanations)."

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.

- Heart murmurs.

- Pericarditis ECG interpretation.

- Epilepsy - management and side-effects of anti-epileptics.

- Chest X-ray interpretation.

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

MRCPCH AKP September 2022 Exam Content

- Many candidates that had sat previous diets felt this was an easier sitting than usual (not everyone though!). Vignette length and question type distribution followed typical exam patterns.  

- There were fewer images contained in the exam than normal, around 10-15% compared to normal feedback that there's 25-30% (although one candidate felt 50% of the exam questions contained images!)

- No negatively phrased questions were featured, ethnicity though was referenced and it was relevant to the diagnosis/differentials.

- Ethics and law was considered the trickiest topic in the exam with 20% of candidates ranking it the hardest, this was followed by Science of practice at 14% and Endocrinology and growth at 8%.

- Normal values were present for all tables, 6–20 investigations in each table, tables in 15–20% of Qs.

MRCPCH AKP September 2021 Exam Content

- Candidates mentioned this diet was mostly 1-2-line vignettes, and very few NofMs or CHDIs. This contradicts previous diets, in which the vignette length averaged ten lines and all Q types were represented. Because of this, timekeeping was even less of an issue, with 30 min–1 hr left after completing papers.  

- 20-25% of Qs had images. CXRs, AXRs, CT, MRI etc, no rashes in this diet.

- Ethics & Law was considered the trickiest topic in the exam by 15% of candidates, followed closely by Metabolism & Metabolic Medicine, and Endocrinology & Growth both with 13%.

- Overseas candidates stated they had difficulties with Ethics & Law in particular being unfamiliar with the laws of the UK.

- Normal values were present for all tables, 6–20 investigations in each table, tables in 15–20% of Qs.

Customer Comments

- "The statistics questions were very similar to those in the RCPCH website mock papers – with a study abstract and various conclusions in the answer options and the candidate has to select the most valid conclusion"

- "Some questions were worth a lot of marks individually… for example one question asking for an X-ray diagnosis worth 7 marks."

- "The candidate must have seen lots of real-life scenarios and must be up to date with current management guidelines. The exam is highly application level and bookish knowledge alone would not help. Doing the maximum no. of practice questions is the key to success."

- "Concentrate on common diseases and scenarios. Most of the questions are based on day-to-day clinical practice. work on X-ray reading skills as there were lots of X-ray-based questions."

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).

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