This plan suits GP registrars preparing for the MRCGP Applied Knowledge Test while working a full clinical rota. Since October 2025 the AKT has been 160 single-best-answer questions in 160 minutes, split 80% clinical medicine, 10% evidence-based practice and 10% primary-care organisation and management. The constraint is time: a registrar's week is full, so the plan integrates preparation into working weeks rather than assuming protected study leave, and it makes a point of protecting the two smaller domains that quietly cost passes when time is short.
Your situation
You are in a full clinical role — surgeries, visits, on-calls and training commitments — with limited dedicated study time. The clinical domain overlaps with your daily work, which helps, but the evidence-based-practice and organisation-management domains do not, and they are easy to defer precisely because they feel peripheral to seeing patients. You need a plan that fits into evenings and gaps, sustains over the months before your sitting, and rebuilds pacing for the 160-question format, which is tighter than it looks at roughly a minute per question.
What goes in the mix
Anchor on a comprehensive question bank — PassMedicine and Pastest are both well used for the AKT. Use the RCGP's own self-test material to calibrate to the official question style and standard. Use iatroX as the adaptive layer alongside these: its engine surfaces your weakest domains so your limited time targets gaps, it grounds clinical answers in current NICE, CKS, SIGN and NHS guidance, and its spaced repetition keeps the volatile statistics and organisational facts warm. The clinical breadth comes from your bank and your daily work; the adaptive layer makes the scarce study time efficient and stops the small domains going cold.
How to build the run-in
Plan across the months before your sitting with a short, sustainable daily minimum rather than a late sprint. In the main phase, work clinical questions most days — a focused block, properly reviewed — and let an adaptive engine point you at your weak topics rather than re-covering strengths. Crucially, give the two 10% domains a little time every other day from the start: a handful of evidence-based-practice questions and a handful of organisation-and-management questions, spaced so they return before you forget them. In the consolidation phase, in the final weeks, add timed 160-question mocks to rebuild pacing for the real format. The weekly minimum is a daily clinical block plus the two small domains kept warm on alternate days, with a timed mock roughly weekly as the exam nears. The discipline is protecting the small domains against the constant temptation to spend every minute on clinical medicine.
A week on the ground
Here is a concrete version — picture a working week of surgeries and visits. On most evenings you do a thirty-to-forty-minute clinical block, adaptive so it targets your current weak area, reviewing each miss against current guidance rather than racing through questions. On alternate evenings you tack on ten to fifteen minutes of the small domains — statistics one day, organisation and management the next — so neither ever goes cold, which is the single habit that most reliably prevents a narrow fail. You keep a clinical theme across several days so it consolidates. On a quieter evening or a day off, you sit a timed set that approaches the 160-question format, both to rehearse pacing at roughly a minute a question and to surface weaknesses under pressure. On balance, the week's clinical work dominates, as it should given the 80% weighting, but the small domains get their steady trickle of time, and the timed practice rebuilds the speed the format demands. Mapping it this way means none of it waits for protected study leave that a full rota rarely grants.
How iatroX fits in
iatroX is positioned as the free, adaptive layer beside your main AKT bank, rather than a replacement for its breadth. Its engine removes the need to triage your own weaknesses, its grounding in current UK guidance targets the threshold questions that move as guidelines change, and its spaced repetition keeps the easily-forgotten statistics and organisational content warm through a busy rota. The Socratic Tutor works back through the reasoning behind a borderline GP decision rather than handing over a model answer, and Ask iatroX settles a current threshold from a sourced corpus when a management item, not a fact, was the problem.
When to rethink it
If you fall behind the daily minimum on a heavy clinical week, shrink the block rather than abandoning it, because the habit matters more than any single session. If your mocks show the small domains lagging, give them a larger share — they are where narrow fails happen. Train for the 160-question format specifically rather than longer mocks, so your pacing matches the exam. The warning sign is spending every minute on clinical medicine because it feels most relevant; the two small domains are the ones most likely to cost you the result.
Common questions
How is the AKT structured now? Since October 2025 it is 160 single-best-answer questions in 160 minutes, split 80% clinical, 10% evidence-based practice and 10% organisation and management.
Which domain should I protect when time is short? The two 10% domains — they are easiest to neglect on a rota and a common cause of narrow fails.
How should I rebuild pacing? With timed sets that match the 160-question format, so you are comfortable at roughly a minute per question.
Is iatroX free for the AKT? Yes — the AKT bank is free, so it adds an adaptive daily layer alongside your main bank at no cost.