The UK Medical Licensing Assessment is the most significant change to medical licensing in decades. It creates a single standard of competence for every doctor entering UK practice — whether they graduated from a UK medical school or qualified internationally. The ambition is straightforward: one standard, one exam framework, one licensing threshold.
The execution has been less straightforward. The transition is ongoing, terminology overlaps with the old PLAB system, and candidates from different backgrounds face different administrative pathways to the same standard. This guide cuts through the complexity.
What the UKMLA Is
The UKMLA is a two-part assessment framework.
The AKT (Applied Knowledge Test) is a computer-based exam testing clinical knowledge and reasoning. 200 questions (for UK graduates; 180 for IMGs sitting via PLAB 1) across 3 hours. Single best answer format. The curriculum is the MLA content map — approximately 430 core conditions organised around clinical presentations rather than diseases. The standard is FY2 level: can you safely and effectively manage common and important clinical presentations as a foundation doctor?
The CPSA (Clinical and Professional Skills Assessment) tests clinical and communication skills through standardised patient encounters — the OSCE component. For UK graduates, this is administered through their medical schools. For IMGs, it is PLAB 2 — held at the GMC's assessment centre in Manchester.
Both components must be passed for GMC registration and the right to practise medicine in the UK.
Who Needs to Sit It
UK medical students: Your medical school finals are now aligned to the MLA standard. When you pass your finals, you have met the UKMLA requirement. The MSCAA (Medical Schools Council Assessment Alliance) ensures that the questions used in finals are calibrated to the MLA AKT standard. You do not sit a separate "UKMLA exam" — your finals are the UKMLA.
International medical graduates: You sit PLAB 1 (which meets the AKT standard) and PLAB 2 (which meets the CPSA standard). The content and standard are identical to what UK graduates face. The administrative pathway (booking through the GMC portal, sitting at British Council centres internationally for PLAB 1, sitting at Manchester for PLAB 2) differs from the UK medical school route, but the assessment standard is the same.
European graduates (post-Brexit): EEA graduates who previously had automatic recognition of their medical qualifications must now demonstrate MLA equivalence. The GMC assesses whether your qualification meets the standard; if not, you may need to sit PLAB. See the dedicated section below.
The MLA Content Map
The MLA content map is the curriculum — the definitive guide to what can be tested. It covers approximately 430 core conditions across six domains: clinical practice areas (medicine, surgery, paediatrics, O&G, psychiatry, GP), professional knowledge (ethics, law, technology), professional and clinical skills (safeguarding, risk management), practical skills and procedures, patient presentations (signs, symptoms, investigations), and conditions.
The map is organised around clinical presentations rather than diseases. You start from "the patient presents with X" and differentiate. This mirrors real clinical practice and rewards clinical reasoning over pattern-matching.
The content map was updated in January 2026, expanding the condition list and adding new areas in women's health, safety-critical presentations, and mental health.
How to Prepare
The preparation approach is the same regardless of whether you are a UK student or an IMG: build clinical knowledge aligned to the MLA content map, develop clinical reasoning through scenario-based practice, and verify your understanding against UK guidelines.
iatroX provides free, MLA-mapped preparation across all components. The Q-Bank uses adaptive spaced repetition to target your weaknesses. Ask iatroX provides instant NICE/CKS/BNF-grounded answers with citations. Brainstorm develops the clinical reasoning the AKT tests. The Knowledge Centre enables systematic coverage of the content map by condition.
Add a paid Q-bank (Quesmed, Pastest, or PLABable for IMGs) for exam-volume practice. The combination of adaptive precision (iatroX) and exam-volume breadth (paid Q-bank) is the preparation profile that the exam demands.
Key Dates and Costs
PLAB 1 (for IMGs): Multiple sittings per year at international British Council centres. Fee approximately £270-300. Book via the GMC portal 3-4 months in advance.
PLAB 2 (for IMGs): Held at the GMC's Manchester assessment centre. Fee approximately £980-1,000. Book well in advance — slots fill quickly.
UK medical school finals: Dates set by individual medical schools. No separate fee beyond tuition.
PLAB 1 validity: 3 years for progression to PLAB 2.
FAQ
Is the UKMLA harder than the old PLAB? The standard (FY2 level) is the same. The question style has shifted toward longer vignettes testing clinical reasoning rather than isolated recall. The content map is broader (430 vs 311 conditions). Candidates who prepare for reasoning rather than memorisation find it comparable.
Can I still call it PLAB? Yes. The GMC portal still uses "PLAB" for IMG bookings. The content is MLA-aligned regardless of the label.
Do I need to pass both AKT and CPSA? Yes. Both components are required for GMC registration.
Is there a separate UKMLA exam for IMGs? No. PLAB 1 and PLAB 2 are the IMG pathway to the same MLA standard.
When will PLAB be renamed to UKMLA? The GMC has signalled a gradual transition. The timing is not confirmed. The name does not affect the content or validity of your pass.