Finishing an AKT practice set late tells you that pacing needs attention. It does not tell you why. A calculation with an unclear denominator, a clinical question with two attractive options and an unfamiliar organisational rule can all consume several minutes for different reasons.
Useful timing review starts with those differences. The aim is to make the reasoning more efficient while preserving accuracy. Reading every stem faster is unlikely to solve a missing knowledge problem, and doing more arithmetic will not resolve uncertainty about what the question asks.
Understand the time budget without imposing a rule on every item
The RCGP AKT introduction describes the current examination as 160 questions in 160 minutes. That creates an average of one minute per question, not a requirement to give every item exactly sixty seconds. Some decisions can be made quickly; others need more careful interpretation.
Consider an illustrative twenty-question practice set. If four questions consume three minutes each, they use twelve of the available twenty minutes. The remaining sixteen questions then have only eight minutes between them. This is not an argument for abandoning every difficult item immediately. It shows why a small number of prolonged decisions can dominate the whole session.
Practise within the current official time allowance and familiarise yourself with the available test controls. Use the RCGP preparation resources and current candidate guidance to understand the assessment, rather than assuming that a question bank reproduces every feature of the examination interface.
Collect enough information to identify the bottleneck
After a timed session, review slow answers alongside incorrect answers. Include slow correct answers: obtaining the right answer does not make an inefficient process invisible. Equally, a quick wrong answer may indicate that you overlooked an important detail rather than worked efficiently.
You do not need a timing measurement for every sentence. A short note beside a few outliers is enough: repeated reading, uncertain diagnosis, unclear task, calculation setup or prolonged comparison of two options. Record whether the explanation supplied new knowledge or merely reorganised information you already knew.
If you cannot access item-level timing, mark the questions that felt disproportionately difficult and review them after the set. Avoid interrupting every question to maintain a detailed log. The record should help explain the session, not become another task competing with it.
Repeated reading may signal an unclear decision
Suppose you read a clinical stem three times because each detail seems equally important. Before trying to increase reading speed, state the task in plain language. Are you choosing a diagnosis, the next investigation, immediate treatment or a longer-term management change?
Then organise the case around that task. For an investigation question, identify what has already been established and what uncertainty remains. For immediate management, identify stability and time-sensitive findings. This can reduce the need to hold every detail at the same level of importance.
During review, write a one-sentence summary of the patient and the decision. If it leaves out a feature that changes urgency, revise it. The aim is selective attention supported by understanding, rather than a shortcut that discards inconvenient information.
Missing knowledge requires repair before speed practice
A candidate who does not know a prescribing restriction may spend several minutes trying to infer it from the options. More timed exposure to the same gap can repeat the problem without fixing it. Identify the rule, check the relevant primary guidance and practise applying it in a different context.
Keep the repair specific. "Read all of prescribing" is too broad to complete after one session. A narrower task might compare the monitoring requirements of two medicines or distinguish a contraindication from a situation requiring caution. Record the condition that changes the action.
Return to the concept later without the reference open. If you can explain it but still take too long in mixed practice, the remaining problem may be recognition rather than storage. Ask which feature in the stem should have brought the relevant knowledge to mind.
Calculations are often slowed by setup
Consider an original audit example: 800 patients are invited to complete a questionnaire, 600 respond, and 240 respondents report a particular difficulty. The question asks what proportion of respondents reported it. The denominator is 600, giving 40%. Using all invited patients would give 30% and answer a different question.
The main challenge here is not division. It is identifying the population specified in the question. Before calculating, write the required quantity in words and assign units where appropriate. Then estimate the expected size of the answer. This makes an incorrect denominator or a misplaced decimal easier to notice.
If the calculation itself remains slow, practise that operation separately for a short period. If the arithmetic is quick but you choose the wrong inputs, use more interpretation examples. Treating those as separate skills gives your next session a clear target.
Two plausible options need a deciding feature
Long indecision often occurs when both options are clinically reasonable in some circumstances. The useful question is what makes one more appropriate for this patient, in this setting, at this point in the pathway. Search the stem for evidence that separates the choices.
For example, an intervention may be appropriate after a diagnosis is confirmed but premature when the question asks how to establish it. Another option may suit stable outpatient care but not a patient with acute deterioration. Naming that distinction is more productive than repeatedly rereading two familiar option labels.
When the information does not resolve your uncertainty during practice, make a choice within the session's time budget and investigate afterwards. The review should produce a discriminator you can reuse. If no clear discriminator emerges, check whether the item or its explanation is ambiguous rather than inventing a universal rule from it.
Review answer changes and fatigue separately
Changing an answer can be justified when you notice a missed finding or correct a calculation. Changing it solely because the first decision felt too quick deserves a different review. Compare the evidence available before and after the change, rather than judging the process only by whether the final choice was correct.
Also compare when prolonged decisions occur. If they cluster late in long sessions or after a demanding shift, practise under realistic but sustainable conditions. A rested timed set and a short post-shift review serve different purposes. Neither needs to become an endurance exercise every day.
Choose one bottleneck for the next few sessions, then return to mixed timed work to see whether the improvement transfers. The iatroX Socratic Tutor can help unpack a slow decision, while spaced review can revisit the missing distinction. Judge progress by clearer reasoning and fewer recurring delays across unfamiliar questions, rather than one unusually fast set.
Frequently asked questions
Should I stop after exactly one minute on every AKT question?
No. One minute is the average created by the current overall time allowance. Develop a workable pacing approach through realistic practice, allowing for differences between items and following the official examination controls.
Is a slow correct answer a problem?
It can be worth reviewing if it uses time needed elsewhere. Find out whether the delay arose from uncertainty, repeated reading or unnecessary calculation before deciding what to change.
How can I tell whether a timing strategy is working?
Look across several unfamiliar mixed sets. A useful strategy improves completion and reduces recurring delays while maintaining the quality of your decisions. One faster session is not enough to establish a reliable change.
Use the iatroX MRCGP AKT question bank to practise under time limits and review the reasoning behind the questions that slow you down.