What is the AKT?
The Applied Knowledge Test (AKT) is a computer-based exam that tests your knowledge of evidence-based medicine, clinical guidelines, and primary care practice. It's one of the two exams required for MRCGP.
Updated Format (October 2025)
- Total questions: 160 (reduced from 200)
- Duration: 3 hours
- Question types: Single Best Answer (SBA) questions
- Content: Clinical Medicine, Evidence-Based Practice (EBP), and Patient-Centred Care (PCOM)
- Pass mark: Approximately 70% (varies by sitting)
3-Month Study Schedule: A Practical Roadmap
This schedule assumes you're studying alongside clinical work. Adjust the intensity based on your commitments, but aim to maintain consistency. Little and often beats cramming.
Month 1: Foundation & Knowledge Building
Goal: Build a solid knowledge base and understand the exam format. Don't rush this phase.
Week 1-2: System Overview
- Review major clinical systems: cardiovascular, respiratory, endocrine, mental health, women's health, child health
- Focus on common presentations in each system (e.g., chest pain, breathlessness, fatigue)
- Read NICE guidelines for top 10 conditions (hypertension, diabetes, depression, asthma, COPD, heart failure, etc.)
- Start with untimed question practice - aim for 20-30 questions per day
- Keep a notebook of topics you get wrong - these are your learning priorities
Week 3-4: Deep Dive
- Focus on your weak areas identified in weeks 1-2
- Use CKS (Clinical Knowledge Summaries) for quick reference - bookmark common topics
- Continue untimed questions but start timing yourself - aim for 1.5 minutes per question
- Review BNF sections on common medications (antihypertensives, antidepressants, inhalers)
- Start making flashcards or notes for key facts (drug doses, diagnostic criteria, referral thresholds)
💡 Month 1 Tip: Don't worry about speed yet. Understanding the reasoning behind answers is more important than getting them right quickly.
Month 2: Consolidation & Speed Building
Goal: Increase speed while maintaining accuracy. Identify and address knowledge gaps.
Week 5-6: Timed Practice
- Switch to timed mode - aim for 1.125 minutes per question (160 questions in 3 hours)
- Practice 50-80 questions per day in timed conditions
- Focus on EBP topics: learn formulas (ARR, RRR, NNT, NNH) until you can calculate them quickly
- Review PCOM topics: ethics, capacity, consent, NHS structure
- Create a weak topics list - revisit these weekly
- Start doing mini mock exams (40 questions in 45 minutes) to build stamina
Week 7-8: Targeted Revision
- Focus heavily on your weak areas - spend 30-40% of study time here
- Do full mock exams (160 questions in 3 hours) - aim for 1-2 per week
- Review every question you get wrong - understand why, don't just memorize
- Practice time management - if stuck on a question, mark it and move on
- Review NICE guidelines for conditions you're struggling with
- Keep a formula sheet for EBP - review daily
💡 Month 2 Tip: Speed comes with familiarity. The more questions you do, the faster you'll recognize patterns and recall information.
Month 3: Exam Conditions & Final Prep
Goal: Peak performance. Build confidence and exam technique.
Week 9-10: Full Mock Exams
- Do 2-3 full mock exams per week under strict exam conditions
- No notes, no looking up answers, timed exactly (3 hours)
- After each mock: review ALL questions (right and wrong) - understand the reasoning
- Identify recurring mistakes - are you misreading questions? Rushing? Not knowing guidelines?
- Focus on high-yield topics that appear frequently (diabetes, hypertension, depression, asthma)
- Practice exam technique: read questions carefully, eliminate obviously wrong answers first
Week 11-12: Final Polish
- Continue mock exams but reduce intensity - avoid burnout
- Review your formula sheet daily (EBP calculations)
- Quick revision of key NICE guidelines (hypertension, diabetes, depression pathways)
- Review common drug doses and contraindications
- Practice mental preparation: visualize exam day, plan your approach
- Rest - don't study the day before the exam
💡 Month 3 Tip: By now, you should be consistently scoring above the pass mark in mocks. If not, consider postponing - it's better to take it when ready.
Study Schedule Tips
- Consistency beats intensity: 1-2 hours daily is better than 8 hours once a week
- Active learning: Don't just read - do questions, make notes, explain concepts to yourself
- Review regularly: Revisit topics you've covered - spaced repetition works
- Track your progress: Keep a log of mock exam scores - you should see improvement
- Take breaks: Burnout hurts performance - rest is part of preparation
- Adjust as needed: If you're struggling with the pace, extend the schedule - it's better to take longer and pass
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⭐ PRO FEATURE
IMG AKT Success Guide: Master UK GP Thinking
This is a very high-yield area. IMGs who understand these points often gain 10–15% extra marks without learning new medicine. The AKT isn't just testing medical knowledge—it's testing UK GP thinking. Here's how to bridge that gap:
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1. The UK GP Mindset: Less is More
The biggest mistake IMGs make: Over-investigating and over-referring. UK GPs manage more in primary care than many countries. If a question asks "next step" and you're thinking "refer to specialist" or "order expensive test"—stop. Think: "What can I manage here? What's the NICE guideline?"
💡 Practice Tip: For every case, ask: "Would a UK GP manage this in primary care?" If yes, that's likely the answer.
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2. NICE, CKS, BNF: Your Holy Trinity
These aren't just resources—they're the answers. Every AKT question is based on UK guidelines. If you're guessing between options, ask: "What does NICE say?" Memorize common pathways: hypertension (ABPM first), depression (watchful waiting for mild), diabetes (HbA1c targets).
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3. EBP: Your Secret Weapon (If You Master It)
Many IMGs struggle with EBP—but if you master it, you'll gain easy marks. Memorize these formulas: ARR = Control rate - Treatment rate. NNT = 1/ARR. RRR = (Control - Treatment) / Control. Practice until you can calculate in your sleep.
⚠️ Common Mistake: Confusing ARR (absolute) with RRR (relative). ARR is what matters clinically. NNT uses ARR, not RRR.
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4. PCOM: Understanding UK Healthcare Values
PCOM questions test UK healthcare culture, not just medical knowledge. Key concepts: patient autonomy (patients decide), shared decision-making (not paternalistic), capacity (presume capacity unless proven otherwise), consent (informed and voluntary).
🎯 Remember: In UK primary care, the patient is the expert in their life. Your job is to provide information and support their decision—not make it for them.
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5. Time Management: The 1.125-Minute Rule
160 questions in 3 hours = 1.125 minutes per question. If English isn't your first language, this is brutal. Practice speed reading. Don't get stuck on one question—mark it, move on, come back if time allows.
⏱️ Strategy: First pass: answer all "easy" questions. Second pass: tackle harder ones. Don't leave any blank—guess if you must.
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6. Common Pitfalls to Avoid
❌ Over-investigation: UK GPs do fewer tests. Think "watchful waiting" first.
❌ Wrong drugs: BNF is different. Learn UK drug names and protocols.
❌ Over-referral: UK GPs manage more in primary care. Refer only when necessary.
❌ Terminology: Learn UK terms (e.g., "GP" not "family doctor", "consultant" not "attending").
🎓 Your Action Plan
- Month 1: Master NICE guidelines for top 20 conditions
- Month 2: Practice EBP calculations daily. Join IMG study groups.
- Month 3: Full mock exams. Focus on UK-specific question banks only.