MRCGP AKT Exam Guide for GP Registrars (2025–2026)

How to pass the Applied Knowledge Test — format, timing, content, and the most effective study strategies.

What is the AKT?

The Applied Knowledge Test (AKT) is a computer-based summative assessment that forms part of the MRCGP examination pathway for GP registrars in the UK. It is held three times per year (August, January, April).

Exam Format

• 200 questions across 3 hours 10 minutes
• Split approximately: 80% clinical medicine, 10% evidence-based medicine, 10% health informatics/administration
• Machine-marked — no negative marking
• Pass mark varies each sitting but typically 70–75%

What the AKT Tests

Clinical medicine (80%)

Real-world GP presentations — managing undifferentiated symptoms, interpreting results, prescribing, and following NICE guidance. Emphasis on primary care management, not hospital medicine.

Evidence-based medicine (10%)

Interpreting clinical trials, understanding NNT/NNH, sensitivity/specificity, likelihood ratios, and meta-analyses. You do NOT need advanced statistics — but you must understand core concepts.

Health informatics & administration (10%)

GMC Good Medical Practice, confidentiality, mental capacity, safeguarding, clinical governance, DVLA guidance, and fitness to work.

Key Differences from PLAB 1

AKT questions are set in a primary care context — you are the GP. This means:

• Follow NICE CKS (Clinical Knowledge Summaries) rather than hospital guidelines
• First-line treatments are the GP-level options (not what a specialist would do)
• Safety netting and referral decisions are tested frequently
• Chronic disease management (QOF targets, review parameters) appears regularly

Most Tested Topics

Based on RCGP blueprinting and candidate feedback:

1. Cardiovascular — AF, hypertension, heart failure, lipids (statins, NICE lipid guidelines)

2. Respiratory — Asthma (MART therapy), COPD (GOLD staging), pneumonia

3. Mental health — Depression, anxiety, antidepressants, safeguarding

4. Diabetes — Type 2 management (metformin, SGLT-2i, GLP-1), monitoring

5. Musculoskeletal — Back pain (red flags), OA management, gout

6. Women's health — Contraception, cervical screening, HRT (menopause guideline 2023)

7. Paediatrics — Immunisation schedule, fever in children, NICE traffic light system

8. Prescribing — Drug interactions, renal/hepatic dose adjustments, BNF knowledge

9. Evidence-based medicine — NNT, sensitivity/specificity, CONSORT trial design

10. Ethics/law — Gillick competence, Mental Health Act, Deprivation of Liberty

Study Strategy

Start 3–4 months before your sitting. A realistic study plan:

Months 1–2: Cover all major clinical topics using MLA-aligned question banks. Don't read textbooks — do questions and learn from explanations. Aim for 50–100 questions per day.

Month 3: Focus on weak areas identified by your performance analytics. Revisit questions you got wrong. Review NICE CKS summaries for your weakest topics.

Month 4: Full mock exams under timed conditions. Review every question — including ones you got right (you may have got them right for wrong reasons).

Evidence-based medicine: Study this separately — it requires a different mental model. Learn sensitivity/specificity, NNT, and how to read a 2x2 table. Practice 50–100 EBM questions.

Common Mistakes

• Treating it like hospital medicine. AKT is primary care. The answer that involves hospital admission or specialist referral is usually wrong if a GP-level option exists.
• Ignoring health informatics. 10% is significant. Know your DVLA guidance, GMC duties, and mental capacity Act basics.
• Under-using mock exams. A single full 200-question mock, marked and reviewed, is worth a week of passive reading.

Pass Rate

The AKT pass rate typically runs 65–70%. Early-stage trainees tend to underperform on clinical medicine; this is why starting early matters.

MedReadyUK is part of StudyCoach AI — an independent study resource, not affiliated with the GMC, RCGP or NHS. Guideline references reflect guidance at the time of writing; always confirm against the current source.