MRCGP AKT: question practice and revision.

Choose a topic for focused revision and check your plan against the official specification.

• Cardiovascular medicine
• Respiratory and ENT
• Mental health
• Women's, sexual and reproductive health
• Children and young people
• Musculoskeletal and rheumatology
• Older adults and end-of-life
• Dermatology
• Gastroenterology, renal and urology
• Endocrinology, metabolic and neurology
• Evidence-based practice and statistics (EBP block)
• Health informatics, administration, professional integrity

Mapped to the published RCGP curriculum and prioritised using item-density signals across the iatroX bank.

• Cardiovascular risk and prevention — QRISK3 thresholds (≥10% for primary prevention statin offer per NICE NG238), absolute CVD risk modifiers (CKD, FH, severe mental illness), HFrEF four-pillar therapy per NICE NG106
• Mental health — stepped care for depression and anxiety per NICE NG222 and CG113, antidepressant choice and switching, suicide risk frameworks, sectioning under the Mental Health Act
• Women's health — contraceptive choice (UKMEC categories), HRT in menopause per NICE NG23, cervical screening intervals (5-yearly HPV primary), urgent suspected cancer referrals (postmenopausal bleeding, breast)
• Diabetes — Type 2 diabetes algorithm per NICE NG28 (metformin → SGLT2 inhibitor in those with CV/renal disease → GLP-1 agonist), QoF targets, ketoacidosis recognition, GAD/MODY differential
• Prescribing safety — pregnancy and breastfeeding categories, polypharmacy interactions, controlled drug regulations, MHRA Drug Safety Updates (sodium valproate, JAK inhibitors)
• Evidence-based practice — sensitivity, specificity, PPV/NPV at different prevalences, NNT, hazard ratios, study design (RCT vs cohort vs case-control vs cross-sectional)
• NHS structure, regulation and admin — fitness to practise, duty of candour, never events, social prescribing, primary care networks, Quality Outcomes Framework (QOF) indicators
• Recent NICE pathway shifts — gestational diabetes (NG3), atrial fibrillation (NG196 CHA₂DS₂-VA), eating disorders (NG69), suspected cancer (NG12 updates)

Observations from UK GP trainees and recent AKT candidates under the new 160-question format. Verify against current NICE, CKS and BNF guidance.

Candidate-reported observations — not official guidance.

1. Format change from October 2025 — older revision banks using the 200-question, 190-minute format teach the wrong pacing. The new format is 160 questions in 160 minutes (60 seconds per question). Each question now carries proportionally more weight.
2. Statistics and EBM — 10% (16 marks) but consistently under-prepared. Mantel-Haenszel, NNT, sensitivity calculations, PPV at low prevalence (e.g. cancer screening). Practise without a calculator.
3. NHS structure and administration — referral pathways, QOF indicators, GMC fitness to practise, recent changes to PA regulation. Many IMG candidates lose marks here.
4. Mental Capacity Act and Mental Health Act — capacity assessment, Section 5(2) and 5(4) holding powers, IMCA referrals, sectioning under MHA in primary care. Routinely tested.
5. Calculation questions — NNT, screening test interpretation, drug dose calculations (paediatric weight-based, methotrexate folic acid timing). Speed under time pressure matters.
6. Out-of-date NICE guidance — NICE refreshes guidance regularly. Older revision banks lag, particularly in cardiovascular drug choice, eating disorders, gestational diabetes, atrial fibrillation.
7. Safeguarding — recognising abuse and neglect across the lifespan, FGM duty to report, escalation pathways, Working Together to Safeguard Children 2023 update.
8. Dermatology and skin of colour — recognising eczema, psoriasis, urticaria, melanoma, BCC, SCC on varied skin tones. Image-based items are commonly muddled.

A pragmatic phased approach used by recent UK GP trainees who passed the new-format AKT first time.

1. Weeks 1–3

   Foundation pass across all 12 blueprint topics. 30-40 questions/day with the iatroX adaptive engine. After 400-500 attempts, the diagnostic dashboard surfaces your bottom three areas. Review current authoritative primary-care guidance for the weakest topics.

2. Weeks 4–5

   Targeted weak-area drilling. Daily EBP/statistics block (sensitivity, specificity, NNT, hazard ratios). Map QOF indicators, recent NICE updates and MHRA Drug Safety Updates. Drug calculation practice.

3. Weeks 6–7

   Two timed 160-question mock exams under exam conditions weekly. Practise the new pacing — 60 seconds per question is comfortable for clinical items but tight for EBP. Review every incorrect answer in detail.

4. Week 8

   Bookmark review only. Light reading on administration, NHS structure, current PA/AA regulation, FGM/safeguarding statutory updates. Confirm Pearson VUE booking. Sleep, hydrate, do not learn new material.

Dedicated MRCGP AKT question practice with answer explanations, guided Tutor review and study planning.

• Focused question practice — Choose the relevant bank and use your answers to identify what to study next.
• Guided reasoning — Explore a difficult answer with Tutor, then apply the distinction independently.
• Review and timed practice — Return to important mistakes and choose a timed practice set where available.

Choose the relevant bank and use the official exam guidance to plan your preparation.

Full MRCGP AKT bank access is included in all-access. Up to 10 new sample questions per day are shared across exams, with no account required. A verified free account includes one guided Tutor session; continued Tutor use is included in all-access.

The AKT moved from 200 questions in 190 minutes to 160 questions in 160 minutes. The RCGP framed this as an inclusivity adjustment — slightly more time per item (60 vs 57 seconds) to reduce the speed-reading burden. The content blueprint is unchanged: 80% clinical, 10% EBP, 10% organisation. Each question now carries proportionally more weight.

The AKT uses criterion referencing — the pass mark is set by panel review of item difficulty rather than a fixed percentage. Recent diets have settled around 70%, but the cut score varies per sitting based on item difficulty. The aim is to identify the standard expected of a doctor entering independent UK general practice.

Most candidates sit during ST2, with a smaller number sitting in ST3. ST1 attempts are not permitted. RCGP training records must show ST2 or ST3 status at the time of booking. Most candidates take it in ST2 to reduce pressure in the final training year when SCA is also due.

£481. From 1 April 2026 the RCGP introduces compulsory staged payments — 25% six months before the exam, 25% twelve weeks before, and balance at booking. Both intermediate payments are refundable if you change plans before the final booking deadline.

A maximum of 4 attempts for trainees who entered GP training before August 2023, and 6 attempts for trainees who entered after. Most candidates pass within 1-2 attempts. After exhausting attempts, candidates would need to apply for ARCP-related processes.

MRCGP has three mandatory components: AKT (knowledge), SCA (clinical — Simulated Consultation Assessment), and WPBA (Workplace-Based Assessment, ongoing throughout training). All three must be passed to gain CCT in general practice.