Guide to the UKMLA
The UKMLA is two-part assessment, consisting of:
An Applied Knowledge Test (AKT) – a written/computer-based exam.
A Clinical and Professional Skills Assessment (CPSA) – a practical clinical exam.
Both parts cover content from the MLA Content Map (explained later) and together evaluate whether you possess the necessary knowledge and skills for safe practice. The exact format may differ slightly for UK students compared to international candidates, but the components are equivalent and held to the same standard. Here’s what each part involves:
Applied Knowledge Test (AKT) 💻
What: The AKT is an on-screen, multiple-choice exam designed to evaluate your applied medical knowledge. It employs Single Best Answer (SBA) questions: for each question, you will receive a clinical scenario, a lead-in question, and five answer options, of which only one is the best choice. This format closely resembles what you have encountered in medical school exams.
Structure: The exam consists of approximately 200 SBA questions in total. In practice, this is often organized as two papers of 100 questions each (likely intended to break up the testing period) . For instance, you might have Paper 1 (100 questions) and Paper 2 (100 questions), which could be scheduled on the same day with a break, or spread over two days . Each paper is typically time-limited – about 2 hours for 100 questions is the guideline (roughly totaling 4 hours of testing time) . This means you need to stay focused and pace yourself through a large number of questions.
Content coverage: The AKT encompasses a wide range of clinical topics across all fields of medicine, reflecting the breadth of a junior doctor’s knowledge. Questions will cover areas such as internal medicine (cardiology, respiratory, gastroenterology, etc.), surgery, paediatrics, obstetrics and gynaecology, psychiatry, general practice, public health, medical ethics and law, and more. Both papers ensure comprehensive coverage of all major domains; for example, one paper may contain more questions on cardiovascular, respiratory, and elderly medicine, while the other addresses areas like psychiatry, OBGYN, and ethics. Some overlapping areas (such as acute emergencies, primary care, imaging, etc.) are assessed in both papers. The focus is on the application of knowledge: expect clinical vignettes where you apply your understanding to diagnose, investigate, or manage patients rather than merely recalling random facts.
Administration: If you’re a UK medical student, your AKT will be organised by your medical school (they conduct it on campus or at an exam centre, on dates they determine) as part of your finals. The content and standards are set nationally, but you’ll take it with your cohort under exam conditions supervised by the university. If you’re an IMG, the AKT (equivalent to PLAB Part 1) is administered by the GMC. The GMC offers the test multiple times a year (approximately four sittings annually) at various locations worldwide – similar to how PLAB1 has been conducted. All candidates, whether UK or IMG, will take the AKT on a computer, and the GMC will establish a common passing standard for everyone.
Clinical and Professional Skills Assessment (CPSA) 🩺
What: The CPSA is a practical clinical exam where you demonstrate your clinical skills, communication, and professional behaviour in simulated scenarios. It’s essentially an OSCE-style examination (Objective Structured Clinical Examination). In some universities, it might be referred to by a slightly different name (e.g., an OSCE, an OSLER – Objective Structured Long Examination Record, etc.), but the concept remains the same. You’ll rotate through a series of stations or clinical scenarios where you may take a history from a patient, perform a physical examination, interpret results, carry out practical procedures, or manage an acute situation – all while being observed by examiners.
Structure: The exact format (number of stations, length of stations, etc.) can vary by medical school for UK students. Each medical school will design a circuit of stations to test a range of skills, but all CPSAs must meet the GMC’s common requirements and standards for the MLA. Therefore, whether you’re at University X or University Y, your practical exam should assess comparable skills with similar rigour. Typically, expect several stations (often around 10–20 stations in OSCEs), each lasting about 8–10 minutes, covering history, examination, communication (e.g., breaking bad news or obtaining consent), procedural skills (like cannulation and suturing), interpretation of data (ECGs and X-rays), and handling ethical or professionalism scenarios.
Delivery: For UK students, the CPSA will be conducted by your medical school, typically during the final year as part of your clinical finals. In practice, this is generally just your standard final OSCE, but now it counts towards the MLA. Don’t worry, you won’t be taking two separate clinical exams! The school’s OSCE is the CPSA, as long as it meets the GMC’s requirements. The GMC will oversee or audit schools to ensure the exam is consistent and fair nationally. For international graduates, the CPSA is administered through the GMC. This essentially equates to PLAB Part 2, which is an OSCE held at the GMC’s Clinical Assessment Centre in Manchester. IMGs will navigate a series of stations with simulated patients and examiners, very much like the UK med school OSCEs, testing the same types of skills. The GMC has indicated that the MLA CPSA for IMGs will be similar to the current PLAB 2 exam in format. For reference, PLAB 2 consists of an 18-station OSCE.
Assessment areas: The CPSA will evaluate hands-on clinical abilities and professional skills. This includes your practical clinical skills (such as examining a patient, performing procedures, resuscitation skills, etc.), communication (with patients and colleagues), clinical reasoning, and decision-making in real-time, as well as professionalism (maintaining patient safety, respect, and ethics). Essentially, it ensures you can effectively apply your knowledge to care for patients in person, not just theoretically. For example, you might be assessed on taking a history from a patient with chest pain, examining an abdomen, demonstrating how to perform a lumbar puncture on a manikin, interpreting a set of blood results, or explaining a diagnosis and management plan to a patient actor. You’ll also be expected to exhibit good ethical practice and bedside manner during these interactions. The CPSA content is derived from the same MLA content map as the AKT, so stations can cover any condition or scenario a new doctor should manage. The goal is to ensure each new doctor meets a minimum competency standard in core clinical skills before they begin work.