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The Applied Knowledge Test (AKT) is the online multiple-choice portion of the UK Medical Licensing Assessment (UKMLA). This exam tests the core knowledge required for all UK medical graduates.
The structure and type of questions contained in the AKT may be different from other single-best answer (SBA) examinations you have taken during your time in medical school. We’ve put together some top tips for passing the AKT. Good luck!
Structure of the UKMLA Applied Knowledge Test
The AKT exam contains 200 SBA questions split equally over two papers (100 questions each), which are sat on two consecutive days. Each paper is two hours in length (72 seconds per question).
The MLA content map outlines the content that can be tested within each paper. Each question is mapped to a condition or presentation within the MLA content map. These conditions and presentations are then divided into the 24 areas of clinical practice.
For more information, see the Geeky Medics guide to the UKMLA Applied Knowledge Test (AKT).
Read through the MLA content map
The MLA content map clearly outlines the presentations and conditions that can be tested within the AKT. It is best to focus your revision on these topics.
However, other topics (e.g. differentials of the listed conditions or presentations) may also appear as possible answers within the exam. A good understanding of these wider conditions can make it easier to rule out certain options.
There may also be some terms that you have not come across before, in which case, select the answer you think is most likely to be correct and move on.
Revise little and often
The AKT is not an exam to cram for! The key to success is consistent revision throughout your clinical years. Making time for some reading or practice questions most days of the week can minimise your stress closer to the exam and ensure the knowledge is fully cemented in your memory.
When the exam is close, try not to panic, and have faith in the years of work you have put in!
Practice, practice, practice!
As you build up an understanding of the topics covered in the AKT, it is important to incorporate exam-style questions into your revision. Completing practice questions steadily over time utilises active recall and spaced repetition to ensure the knowledge is easier to recall in the exam.
The Medical Schools Council has two practice papers with answers and justifications.
Take note of the practical aspects of medicine
Completing practice questions alone will not be enough to pass the AKT. There may be questions about the practical aspects of medicine that you will only have a good chance of answering correctly with regular placement attendance. These topics are found within the 12 areas of professional knowledge section of the MLA content map.
These may include ethical scenarios (e.g. DNACPR and advanced directives), psychological principles, infection control, research techniques, health economics, social science, and public health.
Improve your clinical reasoning
The AKT requires students to apply their knowledge to clinical scenarios, as opposed to memorising facts and spotting patterns or similarities to questions they have seen multiple times in question banks!
Many of the AKT questions are vague, with very few ‘buzz words’ that point you quickly to the correct answer (e.g. ‘thunderclap headache’ for subarachnoid haemorrhage or ‘barking cough’ for croup). Instead, a mixture of epidemiological information, risk factors, and signs and symptoms are most likely to point you toward a diagnosis.
Clinical reasoning is improved by seeing patients in real life and exploring the differentials of their presentation and what factors make each differential more or less likely. Taking histories, examining patients and producing management plans on placement allow you to develop these clinical reasoning skills using the knowledge you have gained from your revision.
Take note of overlapping content between paper 1 and paper 2
Each question can be blueprinted to multiple areas of clinical practice within the content map. This means that more conditions and presentations than you would think can appear in either paper. Therefore, it is not beneficial to separate your revision based on each paper’s contents.
Before sitting both papers, revise all of the areas of clinical practice with a mixture of topics at any one time (similar to what you will experience on exam day).
The day before each paper, you may find it useful to narrow the topics to the areas of clinical practice specific to that paper. However, do not forget your knowledge from paper one on day two, as these topics can still reappear!
Prepare for multi-step questions
Investigation and management questions do not often include a diagnosis. This multi-step approach requires you to examine the presentation, determine the diagnosis, and then answer the question. This can be more challenging for candidates with poor clinical reasoning.
When you are completing practice questions, try to work out the diagnosis (or the possible differentials) using as little information as possible. This will improve your diagnostic reasoning and ability to answer these multi-step questions.
Do not be afraid to do nothing
When working in any healthcare system, it is important to know when investigations are necessary. Over-investigation costs the NHS time, money, and resources and increases patient distress. Defensive medicine is not encouraged.
Consider whether any investigation is justifiable. In some questions, doing nothing or discharging the patient may be the most appropriate answer.
Appreciate the difficulty of the papers
The questions in the AKT exam are designed to test and stretch a senior medical student.
Internal SBA exams often contain a broad range of questions with varying difficulty, allowing students from all year groups to correctly answer some of these, with final-year students being able to answer most. However, the AKT is only sat by medical students at the end of their degree.
Do not be disheartened if the AKT feels more challenging than your internal medical school exams. The pass mark will be adjusted to reflect the knowledge required for a UK graduate.
Prepare for possible quarantine
As the AKT is a national examination sat concurrently across multiple centres, you may be quarantined until all have begun the exam. You will not be able to use your phone or electronic devices during this time.
Come prepared with food, drink, and something to do (e.g. board games, a book, etc.) if you are held at the exam venue.
Revision between exams?
Unlike many medical school exams, the AKT involves sitting two papers on two consecutive days. So after you have sat the first paper, what should you do? Revise more? Take the day off? Cram all night?
Except for that last option, there are no real right or wrong answers, and it depends on your revision style! Some people cannot think of anything worse than more revision after an exam. However, others find that not studying and trying to relax stresses them out more.
Any revision you do should not be too intense, as you will likely be very mentally tired from that day’s exam, and you need to retain your energy for the next day.
Get a good night’s sleep on both nights
Even though the days before an exam are very stressful, try to get some early nights in the run-up, especially the night before, so you feel bright and awake during the assessments. A good sleep schedule will also allow you to focus better in the final days of revision.
By the end of the second exam, with 4 hours of full concentration in total under your belt, you may feel mentally exhausted. Take some time to chill out post-exams and have some fun!
Useful resources for the UKMLA AKT
- Geeky Medics UKMLA AKT Question Bank (2500+ SBA Questions)
- List of MLA conditions mapped to Geeky Medics articles
- List of MLA presentations mapped to Geeky Medics articles
- GMC Medical Licensing Assessment content map
- Medical Schools Council MLA practice materials
Editor
Dr Jamie Scriven
References
- Figure 1. Medical Schools Council. Appendix 1: Medical Schools Applied Knowledge Test (MS AKT) Sampling Grid. Available from: [LINK].
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