The MRCGP Applied Knowledge Test is the written component of MRCGP — and the exam where scoring confusion leads to wasted preparation. Candidates study without understanding what determines the pass mark, how the three domains are weighted, or why the pass rate fluctuates between sittings. This article explains all of it.
The Format (Updated October 2025)
From October 2025, the AKT consists of 160 questions in 160 minutes (reduced from 200 questions in 190 minutes). Question types: single best answer (SBA), extended matching questions (EMQ), and free text answers. One mark per correct answer. No negative marking. Computer-based at Pearson VUE centres. Fee: £470. Held 4 times per year. Maximum 4 attempts.
The domain weighting is approximately 80% clinical medicine, 10% evidence-based practice and statistics, and 10% organisational/administrative topics. This weighting is critical for preparation: clinical medicine generates 8 out of every 10 marks. Statistics and admin are important but secondary.
How the Pass Mark Is Set: Modified Angoff
The AKT does not have a fixed pass mark. The pass mark is set using the modified Angoff standard-setting method — and understanding this process explains why pass rates fluctuate.
A panel of experienced GPs (MRCGP examiners, Training Programme Directors, Deanery representatives, and lay members) independently reviews every question in the paper. For each question, each panellist estimates the probability that a "just competent" GP trainee — one who is minimally safe for independent practice — would answer it correctly. These probabilities are averaged across panellists and then summed across all questions to produce the pass mark.
If the paper is harder (more difficult questions), the Angoff pass mark is lower. If the paper is easier, the pass mark is higher. This means the same level of competence passes every time — the method compensates for variation in paper difficulty.
The Angoff process is refreshed at least every three years or when exam circumstances change (for example, when a calculator was introduced, or when the format changed from 200 to 160 questions in 2025). Between Angoff refreshes, linear equating using common anchor questions maintains the standard across sittings.
What This Means for You
The pass mark typically falls between 60% and 70% — but you cannot predict the exact pass mark for your specific sitting in advance. Aiming for 70%+ on mock exams gives you a comfortable margin regardless of where the pass mark falls.
The 80% clinical medicine weighting means that clinical knowledge is overwhelmingly the determinant of pass or fail. Candidates who invest disproportionate time in statistics or admin at the expense of clinical knowledge are making a strategic error. Study clinical medicine first and foremost — then supplement with statistics and admin.
Domain-Level Performance: What the Feedback Reports Reveal
The RCGP publishes AKT feedback reports after every sitting, identifying areas where candidates performed well and areas where they struggled. Consistent themes across recent reports include strong performance in acute presentations and common conditions, weaker performance in data interpretation (forest plots, funnel plots, NNT/NNH calculations, sensitivity and specificity), weak areas in drug monitoring requirements (lithium, DMARDs, amiodarone, carbimazole), and underperformance in organisational topics (referral pathways, screening programmes, NHS structure).
These feedback reports are free on the RCGP website and are among the highest-yield preparation resources available — they tell you exactly what candidates get wrong, which is where your preparation should focus.
How to Prepare Strategically
Clinical medicine (80% of the exam): Use a comprehensive AKT Q-bank (Pastest with 3,400+ questions, or equivalent). Supplement with iatroX Q-Bank for adaptive spaced repetition — the algorithm targets your weakest clinical topics automatically. Verify every wrong answer against NICE CKS using Ask iatroX.
Statistics and evidence (10%): Learn NNT, NNH, sensitivity, specificity, PPV, NPV, likelihood ratios, and study design hierarchy. Practise interpreting forest plots and funnel plots. These concepts are finite and learnable — invest 10-15 focused hours.
Admin and organisation (10%): Know the NHS cervical screening programme, the childhood immunisation schedule, fitness-to-drive rules (DVLA), fit note regulations, referral pathways for urgent suspected cancer (2-week wait), and NHS structure basics. Again, finite and learnable.
Use the RCGP feedback reports to identify the specific topics that candidates consistently underperform in — and make these your revision priorities.
iatroX provides the clinical reference layer that underpins AKT success. Ask iatroX delivers NICE CKS and BNF answers instantly — the same sources that AKT questions are built from. Use it during study and during clinical shifts to build the guideline-aligned knowledge the Angoff panel expects of a competent GP.