PLAB 1 is the gateway to UK medical practice for international medical graduates. It is also harder than many candidates expect — the 2025 pass rate was approximately 62%, meaning more than a third of candidates failed. The exam has been aligned to the MLA (Medical Licensing Assessment) content map since 2024, which means old PLAB-specific study materials are increasingly outdated.
Passing first time is not just desirable — it is strategically essential. You have a maximum of 4 attempts. Each resit costs money, time, and momentum. This guide covers the complete first-time strategy.
The Format
180 single best answer questions. 3 hours. Computer-based, delivered at Pearson VUE centres in the UK and at international centres (British Council-run) worldwide. Fee: approximately £273-283 (2026). Offered approximately 4 times per year.
The pass mark is variable, set by standard-setting methods, but typically falls around 60-65% (approximately 110-116 correct answers out of 180). No negative marking. Every question has five options with one best answer.
The exam is now aligned to the MLA content map — the same framework that UK medical students are assessed against. This means the content covers the conditions and presentations a Foundation Year 2 doctor is expected to manage competently.
What PLAB 1 Tests
PLAB 1 tests applied clinical knowledge in a UK context. The questions assume you are a doctor working in the UK NHS with access to standard UK investigations, treatments, and referral pathways. They test management decisions, not just diagnosis — "what do you do next?" is the recurring question structure.
The highest-yield topic areas are acute medicine (sepsis, ACS, PE, stroke, DKA, acute abdomen), chronic disease management (hypertension, diabetes, asthma, COPD — all following NICE guidelines), ethics and professionalism (capacity, consent, confidentiality, GMC Good Medical Practice), pharmacology (first-line treatments, drug interactions, prescribing safety), mental health (depression, psychosis, eating disorders, risk assessment), and paediatrics and obstetrics (safeguarding, common presentations, emergencies).
The Study Timeline
3-month plan (full-time study): Intense but achievable. 6-8 hours daily. Cover the MLA content map systematically. Complete 2,500-3,000+ Q-bank questions. 3-4 full mocks.
6-month plan (working alongside): 2-3 hours daily. Covers the same material at a sustainable pace. Recommended for most candidates.
The resource stack:
Primary Q-bank: Choose an MLA-aligned PLAB Q-bank (MedRevisions, Medibuddy, or equivalent). Ensure it is based on the MLA content map, not the old PLAB blueprint.
Clinical reference: Ask iatroX. Instant NICE/CKS/BNF-grounded answers for every wrong Q-bank answer. This builds the UK-guideline-aligned knowledge that PLAB 1 questions are built from — and it is free.
Adaptive revision: iatroX Q-Bank provides adaptive spaced repetition targeting your weaknesses. The clinical content tested in PLAB 1 overlaps substantially with the generalist clinical knowledge iatroX's Q-Bank covers.
Guidelines: NICE CKS (free online) for every condition in the MLA content map. The BNF for prescribing questions. GMC Good Medical Practice for ethics questions.
Exam Day Strategy
Time management. 180 questions in 180 minutes = 1 minute per question. This is tight. Do not deliberate for 3 minutes on any single question. Select your best answer and move on. Flag uncertain questions for review if time permits.
The two-pass approach. First pass: answer every question, flagging uncertainties. Second pass: return to flagged questions with remaining time. Never leave a question blank — there is no negative marking.
Read the question stem carefully. PLAB 1 questions often include specific contextual details (UK setting, NHS resources available, patient preferences) that determine the best answer. Missing these details leads to selecting a clinically correct answer that is not the best answer in the UK context.
Logistics. Arrive 30 minutes early. Bring valid ID matching your GMC registration. No phones, watches, or notes. You receive earplugs and a locker.
The UK-Guideline Alignment Principle
The single most important preparation principle for PLAB 1 is this: the correct answer is the UK-guideline answer. Not the answer your medical school taught. Not the answer that is clinically reasonable in another healthcare system. The answer that NICE, the BNF, or the Resuscitation Council recommends for a doctor working in the UK NHS.
Ask iatroX provides this alignment instantly — for every clinical question, the answer is grounded in the UK guideline with a citation. Build the habit during preparation: every wrong Q-bank answer gets verified against the UK recommendation. By exam day, the UK-guideline answer will be instinctive.
iatroX is free, available on mobile, and designed for exactly the preparation challenge PLAB 1 candidates face. Use it from day one.