Guide to the UKMLA
The MLA is designed to evaluate the knowledge, skills, and behaviours essential for safe practice as a new doctor. To outline what this entails, the GMC has created a detailed MLA Content Map. This content map serves as the syllabus/curriculum for the exam – it specifies the range of topics and competencies that may be tested in either the AKT or CPSA. Here’s an overview of what it covers and why it exists:
Basis of the Content Map:
The MLA content map isn’t created out of thin air – it’s built on existing UK medical education standards. It aligns with key guidance like the GMC’s Outcomes for Graduates (which defines what new UK doctors should know and do), Achieving Good Medical Practice, and the Generic Professional Capabilities Framework. It also considers scenarios typically encountered in the UK Foundation Programme (the first two years of a doctor’s career). In short, the content map reflects real-life, day-to-day medical practice at the junior doctor level. The GMC updates the content map to keep it current with medical practice and guidelines. Therefore, the MLA will assess factors that matter for patient care, not obscure trivia.
Three Core Themes:
The content map is underpinned by three broad themes that the MLA emphasises:
Readiness for safe practice – Are you prepared to practise safely as a new doctor? This includes patient safety, understanding your limits, teamwork, and more.
Managing uncertainty – Can you make sound decisions with the information available and manage the uncertainties inherent in medicine? For example, how do you handle ambiguous symptoms or wait for test results?
Delivering person-centered care – Can you provide care that is compassionate, ethical, and tailored to the unique needs and preferences of patients? This theme underscores the significance of communication, professionalism, and prioritizing the patient in decision-making.
Six Domains of Content:
The content map is divided into six sections (domains) that detail what you need to know or be able to do. Think of these as different dimensions of competence that the MLA can test:
Areas of Clinical Practice – These are the various fields of medicine and surgery. For example, general medicine (including specialties such as cardiovascular, respiratory, neurology, etc.), surgery (with its subspecialties), paediatrics, obstetrics and gynaecology, psychiatry, general practice, emergency medicine, and others. The MLA will include questions or scenarios from all major specialties and patient groups (children, adults, the elderly, mental health, etc.) to ensure comprehensive coverage. This domain ensures you have a broad base of clinical knowledge across common conditions in each area of practice.
Areas of Professional Knowledge – This covers the foundational sciences and the principles that underpin medical practice. It includes biomedical sciences (anatomy, physiology, pharmacology, pathology, etc. – especially as they relate to clinical scenarios) and also addresses topics such as medical ethics and law, evidence-based medicine, and population health. In essence, it encompasses the core knowledge that supports clinical decisions, along with an understanding of professional duties (e.g., consent, confidentiality, public health responsibilities).
Clinical and Professional Capabilities – These are the critical skills and aptitudes needed to be a doctor. Examples include taking an effective history, examining a patient, clinical reasoning, formulating differential diagnoses, ordering and interpreting investigations, making management plans, prescribing safely, assessing and managing risk, and safeguarding vulnerable patients. It also encompasses communication skills and teamwork. The MLA will evaluate these capabilities through both AKT questions (e.g., asking what the next investigation is, or how to handle a difficult communication scenario) and CPSA stations (actually performing the tasks). Essentially, this domain assesses how you apply knowledge in practice and interact professionally.
Practical Skills and Procedures – This domain refers to the hands-on procedural skills that new doctors must perform safely. The GMC has a specific list of practical skills (such as venepuncture, IV cannulation, catheterization, CPR, suturing, prescribing medications, etc.) that all graduates should be competent in – it’s the same list attached to Outcomes for Graduates . The MLA can test these in the CPSA (you might be asked to perform or simulate a procedure) or even in the AKT (a question might ask about the steps in managing a scenario that involves a practical skill). For reference, some common skills include taking blood, giving injections, managing an airway, scrubbing for surgery, and interpreting an ECG, etc. You can find the full list of practical skills on the GMC website – it’s a great checklist for your OSCE preparation.
Patient Presentations – This domain focuses on the symptoms and clinical presentations that patients present with. It outlines the typical presenting problems a foundation doctor encounters, such as chest pain, shortness of breath, abdominal pain, confusion, rash, and fever. There is a defined list of presentations, with the content map outlining 212 distinct patient presentations that may arise. For example, a patient may present with breathlessness or a breast lump – these are considered presentations. The MLA ensures that you can evaluate common presentations appropriately. In the AKT, you might encounter a question stem describing a patient’s presenting complaint, requiring you to diagnose or manage it. In the CPSA, you may actually meet a patient (actor) with that complaint and have to address it. Focusing on presentations is crucial because it evaluates your approach to clinical problems rather than just isolated diseases.
Conditions – Finally, this domain covers the specific diseases and diagnoses that a new doctor should be familiar with. The content map includes a list of around 311 key conditions (illnesses) that could be tested– everything from common conditions like asthma, diabetes, and pneumonia to important but less common ones like acute leukemia or pulmonary embolism. For example, conditions listed include asthma and eating disorders as ones a new doctor might encounter in early practice. These conditions are typically those encountered during a foundation year rotation or in a general practice setting. The MLA will assess your ability to recognize and manage these conditions. In combination with “presentations,” this means you need to understand that, for instance, chest pain (presentation) could be caused by myocardial infarction or pulmonary embolism (conditions), and you should know how to handle each.
Why these domains?
Together, the six domains ensure that the MLA covers all aspects of competence: from theoretical knowledge to practical skills, and from understanding patients’ symptoms to managing confirmed conditions. The emphasis is on what is essential for safe practice as a junior doctor. By passing the MLA, you demonstrate that you can handle the common and important situations a foundation doctor will face in a manner that is safe, ethical, and effective. It is about ensuring that you are ready for the wards and clinics in the UK. The content map is comprehensive, but remember, it encompasses everything you have been learning throughout medical school. If it is in your curriculum or in Outcomes for Graduates, it is fair game for the MLA. The breadth (311 conditions, 200+ presentations, etc.) may sound intimidating, but it essentially represents the universe of “things a new doctor should know. " The good news is that if you have made it to your final year, you are already studying most of this for finals anyway!
(Fun fact: The GMC content map is a public document – you can actually download it and see the full lists of topics. It’s a useful revision checklist!)