What is it?
The UKMLA (UK Medical Licensing Assessment) is a new examination that ALL medical students graduating from medical schools in the UK will need to pass. It is designed to test the core knowledge all new graduates are expected to have before starting their foundation training.
The assessment will be mandatory from the 2024-2025 academic year onwards.
International students and doctors applying to join the UK medical register will still sit the PLAB exam, but it will become compliant with the UKMLA in 2024, so this information will still be relevant.
It will consist of two parts:
- The applied knowledge test (AKT) - a multiple-choice exam
- The clinical and professional skills assessment (CPSA) - an OSCE/OSLER style exam
How will you take the exam?
The two exams will be delivered by your medical school, and will take place on dates that they choose.
The AKT is planned to be an “on-screen” exam administered by medical schools working with the Medical Schools Council (MSC) and GMC using the “Exam-Write” platform. It consists of two 100-question (200-question total) single-best answer (SBA) question papers with questions chosen from a question bank.
The CPSA (which may be called an OSCE or OSLER by your medical school) will be set and run by individual medical schools, but there will be clear guidelines about the criteria it must meet.
UK students will not have to pay to sit the UKMLA and it will be covered by universities as part of your course. However, some universities may charge students fees if they need to resit the exam.
It has not been set yet, but the GMC expects to set a maximum permitted number of attempts at the UKMLA and an appeal system. Individual medical schools will continue to manage mitigating circumstances and reasonable adjustments.
The UKMLA will be a pass/fail exam. Results will be released by universities, but the GMC has said that detailed feedback on individual performances will not be made available.
The UKMLA content map
The content map for the MLA sets out the content that might be tested in the AKT and CPSA. It is split into three broad categories and some subsections:
Areas of clinical practice (e.g. mental health, haematology, respiratory) - 24 areas
- Patient presentations (e.g. breast lump, chest pain) - 212 possible presentations listed
- Conditions (e.g. asthma, migraine, pulmonary embolism) - 311 possible conditions listed
Clinical and professional capabilities (e.g. assessing risk, safeguarding of vulnerable patients)
Practical skills (e.g. venepuncture, 12-lead ECG)
- Areas of professional knowledge (e.g. biomedical sciences, ethics)
These are all listed in the content map which is published on the GMC website:
https://www.gmc-uk.org/-/media/documents/mla-content-map-_pdf-85707770.pdf
I would recommend familiarising yourself with this and using it to guide your revision!
The AKT
The AKT will consist of 200 SBA-style questions divided evenly between two papers, each 2 hours long. The papers will be sat over two consecutive days and there will be multiple versions of each paper in use for each academic year.
The two papers will each cover different specialities from the MLA content map:
Paper one
Cardiovascular
Respiratory
Gastrointestinal
Medicine of older adult
Neurosciences
Ophthalmology
Endocrine and metabolic
Renal and urology
Infection
Dermatology
Paper two
Cancer
Breast
Haematology
Palliative and end-of-life care
Peri-operative medicine and anaesthesia
Musculoskeletal
Emergency medicine and intensive care
Ear, nose and throat
Child health
Mental health
Obstetrics and gynaecology
Sexual health
Social/population health and research methods
Medical ethics and law
Both papers will also cover acute medicine, primary care, surgery, and clinical imaging generally. Questions may test knowledge from multiple areas of the content map—for example, a limping child question may be mapped to either musculoskeletal or child health.
The MSC has also published a sampling grid, which gives an indication of the minimum number of questions that will relate to the above areas of practice. Each paper is split into two 50-item clusters, with a number of specialities being assessed in each. This can potentially help you to prioritise your revision topics, as you can see which areas are likely to have a larger number of questions.
Paper 1
- Cluster one (50 items)
- Cardiovascular (≥10)
- Respiratory (≥10)
- Gastrointestinal (≥10)
- Medicine of older adult (≥10)
- Cluster two (50 items)
- Neurosciences (≥8)
- Ophthalmology (≥2)
- Endocrine (≥8)
- Renal and urology (≥10)
- Infection (≥8)
- Dermatology (≥4)
Paper 2
- Cluster one (50 items)
- Cancer (≥8)
- Breast (≥2)
- Haematology (≥4)
- Palliative care (≥2)
- Peri-operative medicine and anaesthesia (≥2)
- Musculoskeletal (≥10)
- Emergency medicine (≥8)
- Ear, nose and throat (≥4)
- Cluster two (50 items)
- Child health (≥12)
- Mental health (≥12)
- Obstetrics and gynaecology (≥10)
- Sexual health (≥2)
- Social/population health and research methods (≥2)
- Medical ethics and law (≥2)
The central question bank that universities can take questions from to construct their AKT will be kept separate from any other national medical school question bank that exists. The question format will be standard, with each one consisting of:
- A stem (clinical case)
- A lead in question
- 5 answer options
Remember that an SBA is different from a standard multiple-choice question. Multiple options may be correct or plausible answers; your job is to select the most appropriate option for the question.
For example, a question may ask about the likely diagnosis in a patient presenting with acute abdominal pain. Multiple options may be possible diagnoses, but the clinical and demographic information in the stem should allow you to work out which is most likely. For example, a young patient with no medical history is unlikely to present with acute diverticulitis; however, they may well have acute appendicitis.
The question stems should not contain excessive or irrelevant detail, so if it is included in the stem, it is probably there for a reason!
Make sure that you read the question carefully and pay attention to exactly what it asks for—the initial and definitive management of conditions may be very different, and it's very easy to trip up on small details!
Consider the following example below:
An 82-year-old man is brought to the emergency department with severe, colicky abdominal pain. An ECG taken on arrival shows no discernable p waves. Examination reveals a capillary refill time of 4 seconds and generalised abdominal tenderness. His observations are as follows:
- Heart rate 110/min
- Respiratory rate 23/min
- Saturations 96% on air
- BP 96/49mmHg
- Temperature 37.1 C
Given the likely diagnosis, what is the most appropriate ______ management?
- Admit for monitoring
- Analgesia
- Emergency endoscopy
- Emergency laparotomy
- IV fluids
The final wording of the question will impact the answer. This case describes a fairly typical history of mesenteric ischaemic related to atrial fibrillation (the lack of p waves on ECG). This patient is showing signs of shock (delayed capillary refill time, tachycardia and hypotension), so if the question were asking for immediate management, then IV fluids would be the most appropriate option. However, if it were asking for definitive management, then an emergency laparotomy would be most appropriate.
There is an example 200-question practice exam available on the MSC website, with explanations and rationale included for the answers:
https://www.medschools.ac.uk/medical-licensing-assessment/preparing-for-the-ms-akt/practice-exam-for-the-ms-akt
The CPSA
Unlike the AKT, the CPSA will not have a national exam, so there will be variability in how it is run between medical schools. However, each medical school has to submit its plans for the CPSA to the GMC, which will approve them and may suggest recommendations. Details of each medical school's review are available on the GMC website if you need reassurance!
Your medical school should inform you about the structure and format of this exam, but it is likely that the majority will adapt their existing finals OSCEs/OSLERs to meet the CPSA requirements.
While it is impossible to give any specifics on individual medical schools’ exams, you should use the UKMLA content map to guide your revision. Each station needs to be matched to the content map in some way.
Remember that it consists of three overarching themes:
- Readiness for safe practice
- Managing uncertainty
- Delivering person-centred care
And alongside this there is a list of patient presentations and conditions that you should know. There is also a list of practical skills/procedures you can use as ideas:
- Physiological observations
- Peak expiratory flow rate
- Direct ophthalmoscopy
- Otoscopy
- Blood cultures
- Arterial blood gas
- Venepuncture
- Capillary blood glucose
- Urine multi-dipstick test (urinalysis)
- 3- and 12-lead ECGs
- Take and/or instruct patients on how to take a swab
- Perform surgical scrubbing up
- Setting up an infusion
- Moving and handling patients
- Instructing patients in the use of devices for inhaled medication
- Prescribe and administer oxygen
- Prepare and administer injectable drugs (IM, SC, IV)
- Intravenous cannulation
- Blood transfusion
- Male urinary catheterisation
- Female urinary catheterisation
- Wound care and basic wound closure and dressing
- Nasogastric tube placement
- Local anaesthetics
My main advice is to continue preparing for the CPSA as you would for any OSCE. Practice things based on the information given to you by your medical school, and just make sure you are confident performing the practical skills listed above. While revising, you can also consider how certain station types or procedures could be matched up to the various conditions and presentations listed in the content map.
It is impossible to practice every possible scenario (particularly given that one of the overarching domains is now how you manage uncertainty!), so try to develop a general approach to station types or patient presentations and focus on doing the basics well. After all, they are assessing whether you are a safe FY1, not a consultant!
Where can you find more information?
There is a lot of information available on both the GMC and MSC websites, including some example papers and a number of useful documents:
Best of luck with your preparations!
Dr Jess - Lilies Medics Teaching Lead
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