MRCGP · the written exam
The AKT, explained
The Applied Knowledge Test is the written half of the MRCGP: 160 single-best-answer questions in 2 hours 40 minutes, sat on a computer at a Pearson VUE test centre, four times a year. You can take it from ST2 onwards. It tests whether you can apply what you know to the decisions a GP makes every day, not whether you can recite it.
- 160questions
- 2h 40mno breaks
- ST2eligible from
- 4 / yrJan · Apr · Jul · Oct
One paper, to scale. Every sitting is built to these proportions.
What's in the paper
Every AKT is built to the same recipe. Of 160 questions, 128 are clinical medicine across the whole GP curriculum, 16 are evidence-based practice and 16 are the organisational side of general practice. Each block has a course written for it.
Diagnosis, investigation and management across every system, plus curriculum images: rashes, ECGs, X-rays, fundi. This is where the exam is won.
90% Clinical Knowledge courseStatistics, study design, critical appraisal, reading a forest plot.
Statistics SecretsCertification, prescribing rules, ethics, the law, the contract.
Admin SecretsSplit as published by the RCGP for sittings from October 2025. Before then the paper was 200 questions in 3 hours 10 minutes; the proportions were the same.
How a question works
A sample item, modelled on the test-centre screen. The RCGP's own words: the AKT tests "higher order problem-solving rather than the recall of basic facts". Every item is a decision, and the layout is built around making it.
A 58-year-old man with type 2 diabetes attends for review. He takes metformin 1 g twice daily and ramipril. He has no history of cardiovascular disease. His BMI is 31 kg/m².
| HbA1c | 64 mmol/mol | (20–41) |
| eGFR | 52 mL/min/1.73m² | (>90) |
| Urine ACR | 4.1 mg/mmol | (<3) |
Which is the SINGLE MOST appropriate next step in management?
- Add gliclazide
- Add pioglitazone
- Add an SGLT2 inhibitor
- Increase metformin to 1 g three times daily
- Start basal insulin
Sample item written by Royal Medicare in the exam's format. Not an RCGP question.
- 1
The scenario
A real presentation with the details a GP would have: age, history, medication, examination. Everything in it is there for a reason.
- 2
Data to interpret
Blood results with reference ranges, a growth chart, an audiogram, a screening 2×2. Expect to calculate, not just recall. The on-screen calculator is there for a reason too.
- 3
Single best answer
Four to ten options, several of them plausible. Pick the one a competent GP would choose against current NICE, SIGN and RCGP guidance. No negative marking, so answer everything.
- 4
Flag for review
Unsure? Flag it, move on, and come back with whatever time is left. Candidates who leave the hard ones to the end score higher than those who sit on them.
- 5
The clock
160 questions in 160 minutes: one minute each, no breaks. Images, ECGs and guideline flowcharts take longer, so bank the quick ones early.
The layout is modelled on the candidate screen at Pearson VUE test centres. Royal Medicare is not affiliated with Pearson VUE or the RCGP.
Pass mark, pass rate and attempts
The pass mark is set for each paper by a panel of GPs, so it moves a little between sittings. Recent papers: 109 of 160 in October 2025, 108 in January 2026, 107 in April 2026. Plan for 73–75% and you have margin.
Six attempts if you entered GP training from 2 August 2023, four if you were already in training before then. Every attempt costs the full fee, so the first one is the cheap one.
Results are released at 17:00 on the published day, about four weeks after the sitting, in your MRCGP Trainee ePortfolio. Pass marks and pass rates are published by the RCGP with each set of results.
0%
of all candidates passed the April 2026 sitting, and around 88% of UK graduates sitting for the first time.
- April 2026107 / 160
- January 2026108 / 160
- October 2025109 / 160
Recent pass marks.
When
The next sitting is 26 January 2027
Sittings run in January, April, July and October. Booking closes about eight weeks before each one, then a separate ten-day window opens to choose your Pearson VUE test centre. Miss either and you wait a quarter.
- StatusBooking open
- Book & pay by1 December 2026
- Test centre7–16 December 2026
- Results24 February 2027
How to prepare, in the order the marks come
The paper's own proportions tell you where the time should go. Cover the 80% properly, then bank the 20% that most candidates guess at.
- 1
Clinical medicine, system by system
Work through the curriculum as the exam does: cardiology, respiratory, endocrine and so on, with the guideline "next step" for each common presentation. Dr Omar's 80% Clinical Knowledge course does exactly this live, three sessions a week, recorded for the nights you're on call.
- 2
Statistics and admin, learned not guessed
Thirty-two questions are decided by whether you can calculate a PPV or know who signs a cremation form. They are the most predictable marks on the paper. The Statistics Secrets and Admin Secrets courses cover them in a handful of sessions each.
- 3
Questions under time
One minute a question, no breaks. Sit at least two full-length timed mocks in the final month and review every wrong answer against the guideline, not the mark scheme. Our MCQ bank and timed mocks are built for this.
AKT questions, answered
What does AKT stand for?
Applied Knowledge Test. It is one of three parts of the MRCGP, alongside the Simulated Consultation Assessment (SCA) and Workplace Based Assessment (WPBA). You need all three to complete GP training in the UK.
When can I sit the AKT?
During or after ST2. Most trainees sit it in ST2 or early ST3, leaving time for a resit before the end of training if needed. There are four sittings a year, in January, April, July and October.
What is the AKT pass mark?
It is set separately for each paper. Recent pass marks have been 107 to 109 out of 160, roughly 67% to 68%. The RCGP publishes the pass mark with each set of results.
What is the AKT pass rate?
Around three quarters to four fifths of all candidates pass a given sitting. First-attempt UK graduates pass at close to 90%. The rate is lower for resits and for international medical graduates, which is why structured preparation matters.
How many attempts do I get?
Six if you started GP training on or after 2 August 2023, four if you started before. The limit is set by the GMC for all national professional exams.
What kind of questions are in the AKT?
Single best answer questions built around a clinical scenario, often with a table, image, chart or a set of results to interpret. The RCGP is explicit that questions test problem-solving rather than recall.
Is negative marking used?
No. A wrong answer scores the same as a blank one, so you should answer every question.
How long should I prepare for?
Twelve to sixteen weeks of steady work suits most people: cover the clinical curriculum system by system, learn the statistics and admin content properly rather than hoping to guess it, then do timed mocks in the final month.
Facts checked against the RCGP's AKT pages on 15 September 2026. The RCGP is the authority on eligibility, fees and attempts; treat this page as the guide, their site as the rulebook. The consultation exam is covered in the SCA guide.