The UK Medical Licensing Assessment is the single licensing threshold for all doctors seeking to practise in the UK. Whether you are a UK medical student approaching finals or an international medical graduate navigating the PLAB-to-UKMLA transition, the MLA determines whether you can join the medical register.
The exam changed significantly in 2026. The MLA content map expanded from approximately 311 to 430 conditions. The mapping grid that previously restricted which conditions could appear in which clinical contexts was removed — meaning any condition can now be tested in any specialty setting. New topics including transgender health, genetics, updated sepsis guidance, and social determinants of health have been integrated. And from September 2026, all PLAB sittings are based on the updated MLA content map, completing the convergence between PLAB and UKMLA.
This guide covers everything: the format, the updated content map, the best resources, and a 16-week revision plan that works.
What Is the UKMLA and Who Sits It?
The UKMLA is the GMC's standardised licensing assessment — a single threshold for safe medical practice in the UK. It replaced the previous system where UK medical students were assessed through variable medical school finals while IMGs sat the PLAB.
Two groups sit the UKMLA, through different routes.
UK medical students take the AKT as part of their finals — questions are drawn from the MSCAA (Medical Schools Council Assessment Alliance) question bank, which is the same bank used for the IMG AKT. The CPSA is delivered by each medical school as their finals OSCE (format varies by school but all map to the same GMC requirements). UK students must pass both components as part of their medical degree before the GMC grants provisional registration.
International medical graduates sit the AKT and CPSA independently through the GMC. Currently, the booking portal may still label these as "PLAB 1" and "PLAB 2" — but the content is aligned to the MLA content map. From September 2026, all PLAB sittings are fully based on the updated 2026 content map.
The convergence is complete: UK graduates and IMGs are assessed against the same standard, the same content map, and questions drawn from the same bank. The label differs; the exam does not.
AKT Format — What You Are Actually Facing in 2026
For IMGs: 180 SBAs, 3-hour sitting at Pearson VUE centres (UK and international via British Council). Fee: approximately £270-283. Multiple sittings per year (typically January, May, August, November). Maximum recommended 4 attempts.
For UK students: Format varies by medical school but all map to the same MLA content map. Questions drawn from the MSCAA bank. Pass/fail — no ranking, no Foundation Programme implications (your UKMLA score does not affect FP allocation).
Question style: Clinical vignette presenting a patient scenario, followed by a question ("What is the most appropriate next investigation?" / "What is the most likely diagnosis?" / "What is the best management?"), with five options — one best answer.
Domains tested: Areas of Clinical Practice (medicine, surgery, paediatrics, psychiatry, obstetrics and gynaecology, primary care), Areas of Professional Knowledge (ethics, law, patient safety, public health), and Clinical and Professional Capabilities (communication, managing uncertainty, escalation).
Standard setting: Angoff methodology — pass mark varies by sitting difficulty, typically falling between 53% and 60%. No negative marking.
The 2026 MLA Content Map — What Changed and Why It Matters
The GMC updated the MLA content map in January 2026, and the changes are substantial.
Expansion from approximately 311 to 430 conditions. The core conditions list grew by nearly 40%, with significant additions in women's health, genetics, and safety-critical areas. This is not a minor revision — it represents a substantial volume of new examinable material.
212 clinical presentations. The content map is presentation-organised, not disease-organised. The exam's entry point is always a clinical presentation (chest pain, breathlessness, headache, altered consciousness) — not a specific diagnosis. This reflects how real doctors encounter patients: presentations first, diagnoses later.
The mapping grid is gone. Previous versions restricted which conditions could appear in which clinical context (e.g., paediatric conditions only in paediatric settings). The 2026 update removes this restriction — any condition can now be tested in any clinical specialty context. Sepsis can appear in a paediatric, obstetric, surgical, or general practice scenario. This prevents silo-study and rewards cross-contextual clinical reasoning.
Key additions: Genetics integration (inherited conditions, genetic counselling, pharmacogenomics), transgender health (hormone therapy, mental health, referral pathways), updated sepsis guidelines (2024 Surviving Sepsis Campaign), social determinants of health (deprivation, health inequalities, housing), and enhanced emphasis on managing uncertainty (knowing when to escalate rather than guessing a diagnosis).
The "indicative and non-exhaustive" caveat: The GMC explicitly states that the 430 conditions are priority content, but the exam can test uncommon-but-critical conditions not explicitly named if they follow general clinical principles. This prevents purely tick-box revision strategies.
Implication for revision: Materials published before January 2026 may not cover the updated content map. Ensure your Q-bank reflects the 2026 update. iatroX Q-Bank is mapped to the 2026 MLA content map.
The 430 Conditions — High-Yield Priorities
The content map contains 430 conditions, but they are not equally likely to appear. Prioritise by frequency and safety-criticality.
High-frequency primary care presentations: Hypertension, type 2 diabetes, asthma, COPD, depression, anxiety, UTI, back pain, headache, upper respiratory tract infection. These are the conditions every doctor encounters daily — the exam tests whether you can manage them according to current NICE guidelines.
Safety-critical regardless of frequency: Sepsis, pulmonary embolism, meningitis, anaphylaxis, STEMI, stroke, ectopic pregnancy, testicular torsion, cauda equina syndrome, diabetic ketoacidosis. Missing these diagnoses can kill patients — the exam tests whether you recognise the red flags and escalate appropriately.
Paediatric presentations (~20% of the paper): Febrile child, wheeze, developmental delay, non-accidental injury, neonatal jaundice, childhood infections. Approximately one in five questions involves a paediatric patient — this is consistent across all UKMLA/PLAB iterations.
Red flags and escalation: Heavily tested across all presentations. For every major presentation, know when to escalate — what findings should prompt emergency referral, same-day review, or urgent investigation. The UKMLA tests safe doctors, not encyclopaedic ones.
CPSA Preparation — The Practical Component
The CPSA tests communication, clinical examination, and professional capabilities through 18 OSCE stations, 8 minutes each.
For IMGs: Sits at the GMC's assessment centre in Manchester. Fee: approximately £980-1,000. Book early — slots are competitive.
For UK students: Delivered by each medical school as their finals OSCE. Format varies between schools but all assess the same GMC-defined competencies.
Common station types: History-taking (focused, structured), clinical examination (cardiovascular, respiratory, abdominal, neurological, MSK), communication skills (breaking bad news, explaining a diagnosis, shared decision-making, obtaining consent), procedural skills (basic procedures — IV cannulation, urinary catheterisation), data interpretation (blood results, imaging), and professional capabilities (ethics dilemmas, safeguarding identification, capacity assessment).
Common failure areas: Safeguarding identification (failing to recognise non-accidental injury triggers), ethics dilemmas (capacity assessment under the Mental Capacity Act, confidentiality conflicts), breaking bad news (rushing through without allowing the patient to process), and safety-netting (failing to provide clear return-if-worse instructions).
Resources: Geeky Medics (1,400+ OSCE stations, clinical skills guides, AI virtual patients) is the strongest CPSA preparation resource. iatroX Brainstorm develops the structured clinical reasoning that CPSA stations demand. Peer practice is essential — the CPSA cannot be revised the same way as the AKT.
The Best UKMLA AKT Revision Resources in 2026
iatroX — Free Adaptive Q-Bank
iatroX provides a free adaptive Q-bank mapped to the 2026 MLA content map. The adaptive engine is not a rotation or daily feed — it analyses your performance across every content map topic and dynamically targets your weakest presentations. If you are strong in cardiovascular but weak in psychiatry, the engine serves more psychiatry questions until your proficiency improves.
Every explanation is grounded in NICE, CKS, SIGN, and BNF through a RAG (Retrieval-Augmented Generation) layer — meaning answers reference the current UK guideline with citations. When guidelines update, explanations update. Ask iatroX provides instant guideline clarification when you get a question wrong — faster than searching CKS manually and ensures you understand the UK management pathway.
Performance dashboard shows proficiency by content map area. Mobile app (iOS and Android) designed for micro-revision. Free for all UKMLA candidates at iatrox.com/boards. MHRA-registered medical device.
Passmedicine
Large static Q-bank, affordable, trusted. Good question density across clinical topics. No adaptive engine, no NICE integration. Best use: volume practice as a complement to iatroX's adaptive layer.
Quesmed
Clean app, daily flashcard feed, offline access, solid question volume. Adaptive element is a scheduling algorithm (spaced repetition) rather than performance-based targeting. Strong for UKMLA; no niche diploma coverage. Best for: app-first learners who prefer a structured daily routine.
MedRevisions
The IMG community's go-to since 2019. Mirrors exam reasoning style with "twisted" questions that test clinical reasoning rather than recall. Extensive question variety. Useful for candidates who want challenging, exam-style practice.
BMJ OnExamination / Medibuddy
Large institutional platforms with reliable content. BMJ brand trust. Medibuddy offers an adaptive PLAB 1 Q-bank. More expensive than iatroX (which is free for UKMLA). No guideline integration.
GMC Official Resources
Practice papers, content map, and the Exam-Write platform provide official question style familiarisation. Essential regardless of which Q-bank you use — these are written by the exam setters.
The Recommended Revision Stack
Primary Q-bank: iatroX (free, adaptive, NICE-integrated). Supplementary volume: Passmedicine or Quesmed. Guideline reference: Ask iatroX / NICE CKS directly. CPSA: Geeky Medics + peer practice sessions. Mock exams: GMC official practice papers under timed conditions.
A 16-Week AKT Revision Plan
Weeks 1-2: Content map audit + baseline. Download the 2026 MLA content map. Run an iatroX baseline diagnostic across all content areas — let the adaptive engine map your starting proficiency. Identify your weakest presentation clusters.
Weeks 3-8: Systematic coverage by presentation cluster. One cluster per week: respiratory, cardiovascular, neurological, paediatric, women's health, mental health, surgical, primary care. 30-40 iatroX questions daily + supplementary volume from your secondary Q-bank.
Weeks 9-12: Mixed-presentation adaptive sessions + NICE guideline verification. Shift from systematic topic coverage to mixed-topic sessions simulating exam conditions. Use Ask iatroX to verify every wrong answer against the UK guideline. Review the GMC official practice papers for format familiarisation.
Weeks 13-15: Mock papers under timed conditions. Complete 3-4 full mocks (180 questions, 3 hours). Analyse by presentation area. Target remaining weak areas with iatroX adaptive sessions.
Week 16: Light reinforcement. No new content. Review safety-critical presentations (sepsis, PE, meningitis). Familiarise yourself with the Pearson VUE platform. Rest before exam day.
IMGs — Specific Considerations
UK clinical context. The UKMLA assumes NHS clinical practice — NHS referral pathways, consent law (Mental Capacity Act), NICE guidelines, and the GP-as-gatekeeper model. Knowledge from other healthcare systems does not transfer directly — you must learn the UK-specific management pathways.
The PLAB to UKMLA transition. From September 2026, all PLAB sittings are based on the updated 2026 MLA content map. If you are preparing for "PLAB 1" in 2026, you are effectively preparing for the UKMLA AKT. Old PLAB-specific study materials (pre-August 2024) are outdated and may teach incorrect management for specific NICE-mapped conditions.
Language. The exam tests communication in NHS-standard clinical English. For IMGs whose primary medical qualification was not in English, daily exposure to UK clinical English during preparation is essential.
iatroX's NICE integration is particularly valuable for IMGs. Every explanation is grounded in the UK guideline — ensuring all knowledge is UK-guideline-aligned from the first question, not just clinically correct in a generic sense. Ask iatroX bridges the gap between international training and UK exam expectations instantly.
Frequently Asked Questions
UKMLA vs PLAB: what is the difference now? Functionally, very little for IMGs. PLAB 1 and the UKMLA AKT are both based on the MLA content map. PLAB 2 and the CPSA test the same clinical skills. The labels are converging — by late 2026, the distinction is administrative rather than substantive.
Can I use old PLAB books? Materials published before August 2024 may not cover the updated MLA content map and may teach management pathways that have since been updated by NICE. Use resources mapped to the 2026 content map.
Is there negative marking? No. Attempt every question.
How many times can I sit the AKT? The GMC recommends a maximum of 4 valid attempts. For UK students, university policies may vary — check with your medical school.
When are 2026 sitting dates? Multiple sittings per year — typically January, May, August, November for IMGs. Check the GMC portal for current dates and availability.
Try iatroX UKMLA bank free — adaptive, guideline-grounded, and mapped to the 2026 MLA content map.