Bradford VTS - AKT with Confidence
Everything you ever wanted to know about the Applied Knowledge Test
Welcome to Bradford VTS AKT Resources
Your free, comprehensive resource for AKT preparation
🎉 Updated for 2025-2026!
This resource has been comprehensively updated with all the latest changes including the new 160-question AKT format (effective October 2025), July exam month addition, updated childhood immunisation schedules, new notifiable diseases, and current NICE guidelines.
The Bradford VTS AKT section is a free, comprehensive resource designed to help GP trainees prepare for the MRCGP Applied Knowledge Test with confidence. Created by Dr. Ramesh Mehay and team, this resource combines:
📚 Comprehensive Content
Evidence-based clinical summaries, exam technique guides, and practice resources
🎯 Practical Focus
Real GP experience, patient-centered learning, and examiner insights
🤝 Supportive Community
Chat room, neurodiversity support, and guidance for those who struggle
AKT Exam Details
Complete overview of the Applied Knowledge Test format and requirements
🚨 CRITICAL UPDATE - New Exam Format (October 2025)
The AKT exam format changed significantly from October 28, 2025 (AKT 57 onwards):
- 160 questions (reduced from 200)
- 160 minutes (2 hours 40 minutes, reduced from 3 hours 10 minutes)
- 60 seconds per question (slightly increased from 57 seconds)
- Content breakdown remains the same (80% clinical, 10% evidence-based, 10% admin)
Exam Structure Updated 2025
| Component | Details |
|---|---|
| Total Questions | 160 multiple-choice questions |
| Duration | 160 minutes (2 hours 40 minutes) |
| Time per Question | 60 seconds average |
| Clinical Medicine | 80% of questions (~128 questions) |
| Evidence-Based Practice | 10% of questions (~16 questions) |
| Primary Care Admin & Management | 10% of questions (~16 questions) |
Exam Schedule July Added
Four sittings per year: January, April, July, and October
Exams are held at Pearson Vue test centers across the UK so you can take one near you easily
Pass Requirements & Standard Setting
How is the pass mark determined?
The AKT uses sophisticated, internationally recognized methods:
- Modified-Angoff methodology: Expert panel judges difficulty of each question
- Item Response Theory (IRT): Statistical analysis introduced February 2025 for greater precision
- Criterion-referenced: You're assessed against a standard, not competing with other candidates
- No negative marking: Wrong answers don't lose points
⚠️ Common Misconception
The pass mark is NOT a fixed "66-72%" range. It varies for each sitting based on exam difficulty. Recent examples:
- January 2025 (AKT 54): 139/200 = 69.5%
- October 2025 (AKT 57): 109/160 = 68.13%
How many attempts do I get? Updated Policy
Attempt limits changed based on your training start date:
Training ON or BEFORE August 1, 2023
- 4 attempts maximum
- 5th attempt possible in exceptional circumstances with approval
Training ON or AFTER August 2, 2023 New Policy
- 6 attempts maximum
- Significant policy change providing additional opportunities
What is Item Response Theory (IRT)?
IRT is a sophisticated statistical method introduced in February 2025:
- Provides higher reliability and precision in exam scoring
- Better assesses candidate ability around the pass mark
- Ensures consistent examination difficulty over time
- Identifies underperforming questions more effectively
✅ Impact on You
NONE! This is a behind-the-scenes improvement. No changes needed to your revision planning or exam technique. The content, curriculum coverage, and passing standards remain unchanged.
Accessibility & Reasonable Adjustments Corrected
♿ Dyslexia & Learning Difficulties Support
Extra time available: 25% extra time (NOT a fixed 45 minutes)
- For 160-minute exam: 25% = 40 minutes extra (total 200 minutes)
- Most common reasonable adjustment for dyslexia and specific learning difficulties
- Routinely provided based on professional evidence (educational psychologist report)
Other adjustments available:
- Extra breaks during exam
- Colored overlays for reading
- Adjustable screen contrast
- Separate room for minimal distraction
- Morning or afternoon session preference
Exam Logistics
- Test Centers: Pearson Vue centers across the UK
- Eligibility: ST2+ trainees (not recommended for ST1)
- Identification: Biometric (photo + palm vein scan)
- Provided Materials: Erasable noteboard and marker
- Tutorial Time: ~15 minutes (NOT counted in exam time)
- Virtual Tour: Available at Pearson VUE website
Exam Fees & Payment New from April 2026
Staged Payment System (Effective April 1, 2026)
- 25% Deposit: Due 6 months before exam (or at reservation if within 6 months) - Refundable
- 25% Second Payment: Due 12 weeks before exam - Refundable
- 50% Final Payment: Due at final booking deadline - Non-refundable
Current Fee: £481 (subject to change)
This system provides greater financial flexibility and ability to secure your place with smaller initial payment.
When to Take the AKT & How to Prepare
Strategic timing and comprehensive preparation approach
Ideal Timing
❌ Not Recommended
ST1 (First Year)
Focus on clinical experience and settling into GP training
✅ Recommended
End of ST2 or Beginning of ST3
After 4-6 months of GP clinical experience
💡 Why This Timing?
By ST2/ST3, you'll have:
- Solid foundation in common GP presentations
- Experience applying knowledge in real consultations
- Understanding of primary care organization and management
- Enough clinical exposure to make revision meaningful
Preparation Timeline
Start preparing 4-6 months before your chosen exam sitting (adjust based on personal workload and learning style)
6 Months Before: Foundation Phase
- Review RCGP AKT information and curriculum
- Download and familiarize yourself with content areas
- Create a revision schedule covering all domains
- Begin tracking learning needs from consultations
- Start reading RCGP Knowledge Updates
4-3 Months Before: Building Knowledge
- Systematic study of NICE Clinical Knowledge Summaries
- Work through clinical topic areas methodically
- Begin MCQ practice (identify weak areas early)
- Attend AKT prep course if desired
- Read BJGP, InnovAIT, and other GP journals
- Focus on high-yield topics (see Clinical Topics section)
2-1 Months Before: Intensive Practice
- Intensive MCQ practice (aim for 1000+ questions)
- Review and learn from every wrong answer
- Focus on weak areas identified through practice
- Review RCGP examiner feedback from last 2-3 years
- Master statistical concepts and evidence-based medicine
- Review administrative topics (DVLA, immunisations, etc.)
Final Week: Consolidation & Admin Topics
- Focus on administrative topics (see Pre-Exam 72 Hours section)
- Review quick-reference materials
- Light practice questions to maintain sharpness
- Rest adequately - sleep is crucial for memory consolidation
- Confirm exam logistics (location, time, ID requirements)
Core Preparation Strategy
🎯 The Bradford VTS Approach: Lifelong Learning
As emphasized by Dr. James Heathcote (GP Trainer and AKT Examiner):
"Read widely and learn from the patients you see, and you'll pass the AKT. The exam tests knowledge you need as a GP, not obscure facts. Focus on common conditions encountered in real practice."Essential Steps:
- Patient-Centered Learning: Treat every consultation as a revision opportunity. After seeing a patient, look up their condition in NICE CKS or other resources.
- Use Self-Assessment Tools: RCGP curriculum self-assessment to identify weak areas early.
- Practice MCQs Extensively: Books and online question banks. Analyze every wrong answer deeply.
- Focus on High-Yield Topics: Cardiovascular disease, respiratory, diabetes, mental health, pediatrics (see Clinical Topics section).
- Master Evidence-Based Medicine: Statistics, study design, critical appraisal.
- Learn Administrative Essentials: DVLA, immunisations, notifiable diseases, certificates, Mental Health Act.
- Read Examiner Feedback: Last 2-3 years' reports identify areas where candidates struggle.
- Random Case Analysis: Ask your trainer to randomly pick patient cases and quiz you on knowledge gaps.
Clinical Topics & NICE Guidelines
Comprehensive coverage across all GP specialties with links to authoritative sources
🌟 NICE Clinical Knowledge Summaries - Your Primary Resource
370+ topics covering common and significant primary care conditions, updated weekly.
NICE CKS is purpose-built for primary care, providing pragmatic, step-by-step guidance. This should be your first-line reference for clinical revision.
High-Yield Clinical Topics Focus Areas
Based on RCGP examiner feedback and curriculum emphasis, these topics appear frequently in AKT:
Cardiovascular Disease Prevention & Management
NICE Guideline: NG238 (December 2023) | CKS Topics: Multiple
Key Updates for AKT:
- QRISK3 tool recommended for CVD risk assessment (ages 25-84 without established CVD)
- Lower threshold for statins: Can consider even if 10-year QRISK3 <10% (previously ≥10%)
- Primary prevention target: >40% reduction in non-HDL cholesterol
- Secondary prevention target: LDL ≤2.0 mmol/L OR non-HDL ≤2.6 mmol/L
- Non-HDL preferred over LDL (no fasting required, more comprehensive)
Common AKT Topics:
- Hypertension management (including resistant hypertension)
- Atrial fibrillation (anticoagulation decisions, CHA2DS2-VASc, HAS-BLED)
- Heart failure (diagnosis, BNP, treatment)
- Stable angina vs acute coronary syndrome
- Statin prescribing and monitoring
- Antiplatelet therapy
Respiratory Conditions
NICE Guidelines: NG115 (COPD), NG80 (Asthma) | CKS Topics: Multiple
COPD (NG115)
- Diagnosis: Post-bronchodilator spirometry essential (FEV1/FVC <0.7)
- Reversibility testing: NOT routinely needed
- Management: Smoking cessation priority #1
- Multi-dimensional assessment: FEV1 + symptoms + exacerbations + systemic features
- BODE index better predictor than FEV1 alone
- Pulmonary rehabilitation highly effective
Asthma (NG80)
- Joint guidelines reducing BTS/SIGN/NICE confusion
- Covers diagnosis, monitoring, chronic management
- Key differentiator: Variable symptoms, typically <40 years onset
- Good response to bronchodilators
- Night-time symptoms common
- ICS critical for uncontrolled asthma mortality prevention
📊 Asthma vs COPD - High-Yield AKT Topic
| Feature | Asthma | COPD |
|---|---|---|
| Age of onset | Typically <40 years | Usually >35 years |
| Smoking history | Not necessarily present | Usually present |
| Symptom variability | High | Lower |
| Night-time symptoms | Common | Uncommon |
| Response to bronchodilators | Usually good | Variable |
Mental Health in Primary Care
NICE Guidelines: CG123 (Common mental health), NG218 (Depression in adults), Various | CKS Topics: Multiple
Screening Tools (Essential for AKT)
Depression Screening:
Whooley Questions (2 questions):
- "During the last month, have you been bothered by feeling down, depressed, or hopeless?"
- "During the last month, have you been bothered by having little interest or pleasure in doing things?"
If YES to either: Use PHQ-9 for severity assessment
Anxiety Screening:
- GAD-2: Initial screening (2 questions)
- GAD-7: If GAD-2 positive (7 questions, severity grading)
Stepped-Care Model
- Least intrusive effective intervention first
- Clear criteria for escalation
- Routine outcome monitoring
IAPT (Improving Access to Psychological Therapies)
- Self-referral available in most areas
- Evidence-based psychological treatments (CBT, counseling)
- Increased access since 2007 for depression and anxiety
Common AKT Topics:
- Depression diagnosis and management (including treatment-resistant)
- Anxiety disorders (GAD, panic, phobias, OCD, PTSD)
- Suicide risk assessment
- Antidepressant prescribing and side effects
- Mental Health Act sections (see Pre-Exam 72h)
Diabetes & Endocrine Conditions
NICE Guidelines: NG28 (Type 2 diabetes), NG17 (Type 1 diabetes), NG18 (Diabetes in pregnancy) | CKS Topics: Multiple
Type 2 Diabetes Management
- Diagnosis: HbA1c ≥48 mmol/mol (6.5%) on two occasions (single if symptomatic)
- Targets: Individualized based on patient factors
- First-line treatment: Metformin (if eGFR permits)
- Cardiovascular risk: Prioritize cardiovascular disease prevention
- Annual review: HbA1c, lipids, BP, albuminuria, foot check, retinal screening
Thyroid Disorders
- Hypothyroidism: High TSH, low/normal T4; levothyroxine replacement
- Hyperthyroidism: Low TSH, high T4/T3; Graves' disease, toxic nodular goiter
- Monitoring and dose adjustments
Other Common Topics:
- Polycystic ovary syndrome (PCOS)
- Osteoporosis and DEXA scanning
- Vitamin D deficiency
- Adrenal insufficiency
Children & Young People
NICE Guidelines: NG218 (RCPCH/NICE collaboration), Various | CKS Topics: Multiple
⚠️ High-Difficulty Area (RCGP Examiner Feedback)
Candidates frequently struggle with:
- Cancer red flags in children
- Acute illness assessment (sepsis, meningitis recognition)
- Safeguarding recognition and reporting
Childhood Immunisations Updated 2025-2026
CRITICAL CHANGES effective July 2025 & January 2026:
- MenB: Now at 8 and 12 weeks (changed from 8 and 16 weeks)
- PCV13: Now at 16 weeks (changed from 12 weeks)
- Hib/MenC (Menitorix) DISCONTINUED at 12 months for children born July 1, 2024 onwards
- NEW 18-month appointment (from Jan 2026): 4th hexavalent dose + 2nd MMR
- 2nd MMR brought forward: From 3y4m to 18 months (for children born July 1, 2024 onwards)
See Pre-Exam 72 Hours section for complete schedule chart.
Developmental Milestones
Know age-specific expectations and red flags for concern.
Safeguarding
- Recognition of abuse (physical, emotional, sexual, neglect)
- Reporting pathways (Local Authority, police, MASH)
- Child protection medical examinations
Common AKT Topics:
- Fever in children (traffic light system)
- Meningitis/sepsis red flags
- Asthma in children
- Eczema and allergies
- Gastroenteritis and dehydration
- UTI in children
Neurology
NICE Guidelines: Various | CKS Topics: Multiple
⚠️ Important Neurological Presentations (Examiner Feedback)
Focus on recognition and appropriate management of:
- Stroke/TIA (time-critical interventions)
- Meningitis/encephalitis
- Headache red flags
- Peripheral neuropathy
Stroke & TIA
- Recognition: FAST (Face, Arms, Speech, Time)
- Action: Immediate 999 ambulance for suspected stroke
- TIA: Urgent specialist assessment within 24 hours (high-risk) or 7 days
- Secondary prevention: Antiplatelet, statin, BP control
Headaches
- Primary headaches: Migraine, tension-type, cluster
- Red flags: Sudden severe, focal neurology, fever, temporal artery tenderness, progressive
Epilepsy
- Classification: Focal vs generalized
- First seizure management
- AED monitoring and side effects
- DVLA implications (see DVLA section)
Other Common Topics:
- Parkinson's disease
- Multiple sclerosis
- Peripheral neuropathy
- Bell's palsy
- Vertigo (central vs peripheral)
All Clinical Specialties Covered
Bradford VTS provides condensed 'at-a-glance' guides across all RCGP curriculum areas:
- Allergy and Immunology
- Cardiovascular Health
- Children and Young People
- Dermatology
- Ear, Nose and Throat
- Eyes and Vision
- Gastroenterology
- Genomic Medicine
- Gynaecology and Breast
- Haematology
- Infectious Disease & Travel Health
- Kidney and Urology
- Maternity & Reproductive Health
- Metabolic Problems & Endocrinology
- Mental Health
- Musculoskeletal Health
- Neurodevelopmental Disability
- Neurology
- Older Adults
- People at End of Life
- Respiratory Health
- Sexual Health
- Smoking, Alcohol, Substance Misuse
- Urgent and Unscheduled Care
Emerging Contemporary Topics
These modern primary care issues are increasingly appearing in AKT:
Long COVID (NICE NG188)
- Definition: Symptoms persisting >12 weeks post-COVID infection
- Common symptoms: Fatigue, breathlessness, cognitive impairment ("brain fog"), PEM (post-exertional malaise)
- Assessment: Holistic, multidisciplinary approach
- Management: Rehabilitation, symptom management, social prescribing
ME/CFS (NICE CKS May 2025)
- NEW NICE Clinical Knowledge Summary published May 2025
- Key feature: Post-exertional malaise (PEM)
- Management: Energy management (pacing), not graded exercise therapy
- Diagnosis typically after 3 months of symptoms
Genomic Medicine in Primary Care
- Familial hypercholesterolaemia: Screening and referral
- BRCA testing: Family history of breast/ovarian cancer
- Referral pathways to genetic services
Social Prescribing
- Non-medical interventions for health and wellbeing
- Link workers connecting patients to community resources
- Evidence base growing for mental health, loneliness, multimorbidity
Health Inequalities & Inclusion Health
- Core20PLUS5: NHS England framework for reducing health inequalities
- Focus on most deprived 20% of population + specific groups
- Vulnerable populations: homeless, asylum seekers, Gypsy/Roma/Traveller, sex workers
Antimicrobial Stewardship
- TARGET resources: RCGP antimicrobial stewardship toolkit
- Delayed prescribing: Evidence-based strategy for self-limiting infections
- Safety netting: Clear advice on when to use delayed prescription
AKT Resources & Downloads
Comprehensive collection of books, online tools, and practice materials
Essential Reading & Publications
🌟 Primary Resources (Must-Have)
- NICE Clinical Knowledge Summaries - 370+ topics, updated weekly (cks.nice.org.uk)
- RCGP Knowledge Updates - Essential online subscription for current clinical updates
- RCGP Learning Modules - Interactive online learning with CPD certification
- InnovAIT - AKT questions in every issue, journal of RCGP
- RCGP GP Curriculum (2023) - Current curriculum framework
Journals & Regular Reading
- BJGP (British Journal of General Practice) - Research and clinical articles
- Drugs & Therapeutics Bulletin - Independent prescribing advice
- Pulse - GP news and clinical updates
- BMJ (British Medical Journal) - General medical updates
Books
- Oxford Handbook of General Practice (4th edition) - Especially organizational chapters
- Medical Statistics Made Easy by Harris & Taylor - Essential for evidence-based medicine questions
Reference Resources
- BNF (British National Formulary) - Prescribing, poisoning, palliative care sections
- Green Book - "Immunisation against infectious disease" by UKHSA
Digital Platforms & Websites
Clinical Decision Support
- NICE Evidence Search - Comprehensive search tool with primary care filters
- BMJ Best Practice - Step-by-step clinical guidance
- GP Notebook - Extensive clinical encyclopedia (registration via Univadis)
- eGuidelines - Free clinical summaries
- Cochrane Library - Systematic reviews and evidence summaries
RCGP Official Online Resources
- RCGP Learning - Including RCGP Self Test, Knowledge Updates, InnoVAIT
- RCGP ePortfolio - Learning needs tracking
- eGPLearning - Free NHS platform
Statistical Tools
- Statistics by GP Notebook - Quick reference for common statistical concepts
- Sensitivity, specificity, PPV, NPV calculators
Question Banks & Practice Materials
💡 Practice Strategy
Aim for 1000+ practice questions during your preparation. Analyze every wrong answer deeply - they're the most valuable learning opportunities.
Online Question Banks Updated for 160Q Format
- PassTest MRCGP AKT - Large question bank, updated for new format
- StudyPRN AKT - Online platform with performance tracking
- Arora Medical Education - Question bank and revision courses
- RCGP Home GP Self Test - Official RCGP practice questions
- Fourteen Fish AKT Package - Comprehensive online resource
Past AKT Papers & Examiner Feedback
- RCGP Examiner Feedback Reports - Last 2-3 years essential reading
- Identify areas where candidates struggle
- Understand examiner expectations
Downloadable Resources from Bradford VTS
Extensive library of guides, templates, and reference materials:
AKT Guides & Advice
- AKT Preparation Guide
- AKT Advice from Trainees Who've Done It (PPT)
- AKT and When to Take It (DOC)
- AKT Guide by Youssef Beaini
- Preparing for the AKT by Wessex (PDF)
- Preparing for the AKT by Bromley
MCQ Technique
- How to Do MCQs (DOC)
- Approaching the MRCGP MCQ Paper (PPT)
- MCQ Terms (PPT)
- Question Spotting for MRCGP MCQ (PDF)
- Filling in the Blanks Type Questions (DOC)
Learning Needs & Tracking
- AKT Learning Needs from Seeing Patients (DOCX/PDF)
- RCGP Curriculum Self-Assessment - Find Your Weak Spots (XLS)
- Learning Needs Log from MCQ Practice (DOCX)
Mock Papers & Practice
- Mock Papers Collection
- RCGP Examiners' Feedback Reports
⚠️ Note on Resources
Some downloadable files may be dated. Always cross-reference with current RCGP guidelines and NICE CKS for the most up-to-date clinical information. We've removed the 2013 AKT Content Guide as it's severely outdated.
Mobile Applications
📱 AKT FLASH App
Official Bradford VTS mobile app for AKT preparation
- Available on Android and iPhone
- Practice questions on the go
- Quick revision flashcards
📚 Other Useful Apps
- NICE CKS App - Offline access to clinical summaries
- BNF App - Prescribing information offline
- BMJ Best Practice App - Clinical decision support
- Medscape - Medical reference and news
AKT Preparation Courses
Consider attending an AKT prep course 2-3 months before your exam:
- RedWhale - Popular AKT courses
- NB Medical Education - Comprehensive AKT preparation
- Arora Medical Education - Question banks and courses
- PassTest - Online courses and question banks
Quick-Reference 'At-a-Glance' Guides
- DVLA at a Glance
- Flying at a Glance
- Childhood Immunisations
- Child Developmental Milestones
- Maternity Schedule
- Incubation Periods of Infectious Diseases
- Notifiable Diseases
- Mental Health Act Sections
- Consultation Models Summary
- Statistics for GPs
- Certificates & Forms in GP
Top AKT Preparation Tips
Evidence-based strategies from successful candidates and examiners
🎯 Examiner's Wisdom
"Read widely and learn from the patients you see, and you'll pass the AKT. Focus on common conditions encountered in real GP practice. Avoid overreliance on NICE guidelines - focus on practical application."1. Patient-Centered Learning
Every consultation is a revision opportunity
- After seeing a patient, look up their condition in NICE CKS
- Ask yourself: What's the evidence base? What are the guidelines?
- Keep a learning needs log from consultations
- Discuss interesting cases with your trainer
2. Targeted Study Approach
Focus on weak areas, not rote learning
- Use RCGP curriculum self-assessment to identify gaps
- Prioritize weak areas over comfortable topics
- Don't read textbooks cover-to-cover
- Quality over quantity - understand deeply, not superficially
3. Practice MCQs Extensively
Aim for 1000+ questions
- Start MCQ practice early (4-3 months before exam)
- Use multiple question banks for variety
- Learn from wrong answers - they're gold dust
- Analyze WHY you got it wrong, not just the correct answer
- Track performance to identify weak areas
4. Master Common Conditions
High-frequency topics in real GP practice
- Asthma, COPD, diabetes, hypertension
- Depression, anxiety, mental health
- Cardiovascular disease prevention
- Pediatric presentations and safeguarding
- Know these inside-out - they appear frequently
5. Evidence-Based Medicine
10% of AKT, but causes difficulty
- Sensitivity, specificity, PPV, NPV
- Study designs (RCT, cohort, case-control)
- Critical appraisal basics
- Number needed to treat (NNT)
- Use "Medical Statistics Made Easy" book
6. Administrative Topics
10% of AKT, highly testable
- DVLA regulations (especially new 2025 updates)
- Childhood immunisations (know 2025-2026 changes)
- Notifiable diseases (8 new ones added April 2025)
- Mental Health Act sections
- Certificates and forms in GP
7. Read Examiner Feedback
Understand what examiners are looking for
- Download last 2-3 years' RCGP examiner feedback reports
- Note areas where candidates struggle
- Focus revision on these difficulty areas
- Understand common misconceptions
8. Random Case Analysis
Test knowledge gaps with your trainer
- Ask trainer to randomly pick patient cases
- Test your knowledge on the spot
- Identify gaps you didn't know you had
- Simulate the unpredictability of the exam
Common Difficulty Areas (RCGP 2025 Feedback)
⚠️ Areas Where Candidates Struggle
Focus extra attention on these topics identified in recent examiner feedback:
Clinical Topics:
- Side-effects of long-term medication and monitoring
- Pediatric cancer presentations (red flags)
- Acute pediatric illness (sepsis, meningitis)
- Safeguarding recognition and reporting
- Important neurological presentations (stroke, meningitis, headache red flags)
Non-Clinical Topics:
- Confidentiality guidance (when to breach, safeguarding scenarios)
- Prescribing safety (interactions, contraindications, dose adjustments)
- Leadership, management, and administration
- Evidence-based practice (data interpretation, study design)
- Continuity and quality of care
Areas Where Candidates Do Well
Good performance typically seen in:
- Assessment of acute ill health in adults
- Common gastrointestinal problems
- Eye problems
- Interpreting haematology results
- Chaperone guidance
Pre-Exam 72 Hours: Quick-Reference Topics
High-yield administrative and regulatory topics for last-minute review
📚 Strategy for Final 72 Hours
In the final 3 days before your exam, focus on high-yield administrative and regulatory topics that are easily memorized but commonly tested. Avoid intensive clinical revision - trust your preparation. Use this time for quick-reference materials.
DVLA Regulations Nov 2025
Key Principles:
- Group 1: Cars and motorcycles (standard license)
- Group 2: Lorries and buses (substantially higher standards)
- Driver's legal duty: Notify DVLA of relevant conditions
- GP's duty: Advise patients; potentially notify DVLA if patient won't/can't (GMC guidance)
- Risk thresholds: 20% for Group 1, 2% for Group 2 (sudden disabling events)
November 2025 Updates:
Diabetes Mellitus - MAJOR UPDATE:
- Continuous Glucose Monitoring Systems (CGMS) now legally allowed for Group 2 drivers (lorries/buses)
- Healthcare professionals including specialist nurses can complete DVLA medical questionnaires for diabetes
- D4 Medical Examination Reports still require GMC-registered doctor
Common Testable Conditions:
| Condition | Group 1 | Group 2 |
|---|---|---|
| First Seizure | 6 months off driving | 5 years off, then neurologist assessment |
| Epilepsy (controlled) | 1 year seizure-free | 10 years seizure-free, off medication |
| Stroke/TIA | 1 month off (must notify DVLA) | 1 year off, full recovery, specialist assessment |
| Visual acuity | Read number plate at 20m (both eyes, with glasses if worn) | 6/9 both eyes, 6/12 better eye |
| Visual field | 120° horizontal (homonymous/bitemporal hemianopia disqualifies) | More stringent requirements |
Childhood Immunisations 2025-2026 Changes
🚨 CRITICAL CHANGES
Two major schedule changes affecting AKT content:
- July 1, 2025: MenB and PCV timing changes; Hib/MenC discontinued
- January 1, 2026: New 18-month appointment with 4th hexavalent + 2nd MMR brought forward
Current UK Childhood Immunisation Schedule (2025-2026):
| Age | Vaccines | Notes |
|---|---|---|
| 8 weeks |
• 6-in-1 (DTaP/IPV/Hib/HepB) - 1st dose • MenB - 1st dose • Rotavirus - 1st dose | |
| 12 weeks |
• 6-in-1 - 2nd dose • MenB - 2nd dose • Rotavirus - 2nd dose | Changed July 2025 MenB now at 12 weeks (was 16 weeks) |
| 16 weeks |
• 6-in-1 - 3rd dose • PCV13 (pneumococcal) | Changed July 2025 PCV now at 16 weeks (was 12 weeks) |
| 1 year |
• Hib/MenC • MMR - 1st dose • PCV13 booster • MenB booster | Hib/MenC DISCONTINUED for children born ≥1 July 2024 |
| 18 months |
• 6-in-1 - 4th dose • MMR - 2nd dose | NEW from Jan 2026 For children born ≥1 July 2024. MMR brought forward from 3y4m |
| 3 years 4 months |
• 4-in-1 pre-school booster (DTaP/IPV) • MMR - 2nd dose (if not given at 18 months) | |
| 12-13 years | • HPV (2 doses, 6-24 months apart) | Boys and girls |
| 14 years |
• 3-in-1 teenage booster (Td/IPV) • MenACWY |
Key Points for AKT:
- Rotavirus: LIVE vaccine, oral, max age 24 weeks for first dose
- MMR: LIVE vaccine, contraindicated in immunosuppression and pregnancy
- BCG: Given at birth to high-risk groups (not routine)
- Flu vaccine: Annual, from 2 years (live attenuated nasal spray 2-17 years)
- Contraindications: Severe immunosuppression (live vaccines), anaphylaxis to previous dose
Green Book Reference: "Immunisation against infectious disease" by UKHSA - authoritative UK immunisation guidance
Notifiable Diseases 8 New Diseases April 2025
🚨 CRITICAL: 8 New Notifiable Diseases Added April 6, 2025
Legal requirement: Registered medical practitioners have statutory duty to report suspected cases immediately to UKHSA.
Urgency: Telephone within 24 hours for urgent cases, online report within 3 days for non-urgent.
NEW Notifiable Diseases (April 2025):
- Middle East respiratory syndrome (MERS)
- Influenza of zoonotic origin (e.g., avian flu in humans)
- Chickenpox (varicella)
- Congenital syphilis
- Neonatal herpes
- Acute flaccid paralysis (AFP) or acute flaccid myelitis (AFM)
- Disseminated gonococcal infection (DGI)
- Creutzfeldt-Jakob disease (CJD) - all forms
Complete List of Notifiable Diseases (England):
- Acute encephalitis
- Acute flaccid paralysis/myelitis New
- Acute infectious hepatitis
- Acute meningitis
- Acute poliomyelitis
- Anthrax
- Botulism
- Brucellosis
- Chickenpox New
- Cholera
- Congenital syphilis New
- COVID-19
- Creutzfeldt-Jakob disease New
- Diphtheria
- Disseminated gonococcal infection New
- Enteric fever (typhoid/paratyphoid)
- Food poisoning
- Haemolytic uraemic syndrome (HUS)
- Infectious bloody diarrhoea
- Influenza of zoonotic origin New
- Invasive Group A streptococcal disease
- Legionnaires' disease
- Leprosy
- Malaria
- Measles
- Meningococcal septicaemia
- MERS New
- Mumps
- Neonatal herpes New
- Plague
- Rabies
- Rubella
- SARS
- Scarlet fever
- Smallpox
- Tetanus
- Tuberculosis
- Typhus
- Viral haemorrhagic fever (VHF)
- Whooping cough
- Yellow fever
How to Report:
- Urgent cases: Telephone local UKHSA Health Protection Team within 24 hours
- Non-urgent: Online notification within 3 days
- Report based on clinical suspicion - don't wait for lab confirmation
- Failure to report is a breach of statutory duty
Mental Health Act Sections
📢 Note: Mental Health Bill 2025
Major reforms are progressing through Parliament (introduced November 2024), with staged implementation from 2026/27. However, current AKT questions will be based on Mental Health Act 1983 (as amended) which remains in force. Learn current sections below.
Key MHA 1983 Sections for AKT:
| Section | Duration | Purpose | Who Can Apply |
|---|---|---|---|
| Section 2 | Up to 28 days | Assessment (± treatment) | AMHP or nearest relative + 2 doctors (1 Section 12 approved) |
| Section 3 | Up to 6 months | Treatment | AMHP or nearest relative + 2 doctors (1 Section 12 approved) |
| Section 4 | Up to 72 hours | Emergency assessment | AMHP or nearest relative + 1 doctor |
| Section 5(2) | Up to 72 hours | Doctor's holding power (inpatient already in hospital) | Doctor in charge of treatment or nominated deputy |
| Section 5(4) | Up to 6 hours | Nurse's holding power (inpatient) | Registered mental health or learning disability nurse |
| Section 135 | Up to 72 hours | Warrant to remove from private premises to place of safety | Police with magistrate's warrant |
| Section 136 | Up to 24 hours (extendable to 36) | Police power to remove from public place to place of safety | Police officer |
| Section 117 | N/A | Aftercare duty (for patients previously detained under S3, S37, S47, S48) | Local authority + NHS |
Key Points:
- Section 12 approval: Psychiatrist or GP with special MHA training
- AMHP: Approved Mental Health Professional (usually social worker)
- Place of safety: Designated place (usually hospital, NOT police station unless necessary)
- Section 117 aftercare: Free of charge, joint responsibility of local authority and NHS
Maternity Schedule & Screening
Antenatal Appointments:
- Booking (8-12 weeks): Full history, BP, BMI, urine dipstick, blood tests (FBC, blood group, antibodies, infections)
- 16 weeks: Review, BP, urine
- 20 weeks: Anomaly scan, BP, urine
- 25 weeks (nulliparous): BP, urine, symphysis-fundal height (SFH)
- 28 weeks: BP, urine, SFH, blood tests (FBC, antibodies)
- 31 weeks (nulliparous): BP, urine, SFH
- 34 weeks: BP, urine, SFH, information on labor
- 36 weeks: BP, urine, SFH, presentation check
- 38 weeks (nulliparous): BP, urine, SFH
- 40 weeks: BP, urine, SFH, discuss options if overdue
- 41 weeks: Membrane sweep offered, discuss induction
Antenatal Screening:
- Combined test (11-14 weeks): Nuchal translucency + blood (β-hCG, PAPP-A) for Down's syndrome
- Quadruple test (14-20 weeks): If missed combined test
- Anomaly scan (18-21 weeks): Structural abnormalities
- Infectious disease screening: HIV, syphilis, hepatitis B (booking), rubella immunity
Mental Health Screening:
Whooley Questions asked at booking and postnatally:
- "During the last month, have you been bothered by feeling down, depressed, or hopeless?"
- "During the last month, have you been bothered by having little interest or pleasure in doing things?"
If YES to either: Further assessment with Edinburgh Postnatal Depression Scale (EPDS)
Contraception Quick Reference
UKMEC Categories:
- UKMEC 1: No restriction (use method in any circumstances)
- UKMEC 2: Advantages generally outweigh risks (use method)
- UKMEC 3: Risks usually outweigh advantages (use with caution, alternatives preferred)
- UKMEC 4: Unacceptable health risk (do NOT use)
Common UKMEC 4 Scenarios (Do NOT Use):
- Combined hormonal contraception (CHC): Breast cancer, VTE, migraine with aura, BP ≥160/100, smoking >35 years + >15 cigs/day
- Copper IUD: Current PID, cervical/endometrial cancer
Starting Rules (Quick Start):
- CHC: Day 1-5 of cycle = immediate protection. After day 5 = condoms 7 days
- POP: Anytime if reasonably certain not pregnant. Condoms 2 days
- IUD/IUS: Anytime if reasonably certain not pregnant. Copper IUD effective immediately. LNG-IUS: condoms 7 days
Missed Pill Rules (CHC):
- Missed 1 pill (<24h late): Take missed pill ASAP, continue as normal. No extra precautions needed.
- Missed 2+ pills (≥48h late): Take most recent missed pill, continue pack, condoms 7 days. If pills missed in week 1: consider emergency contraception.
Emergency Contraception:
- Copper IUD: Most effective. Up to 5 days after UPSI or up to 5 days after earliest ovulation
- Levonorgestrel (Levonelle): Up to 72 hours (3 days) after UPSI
- Ulipristal (ellaOne): Up to 120 hours (5 days) after UPSI. More effective than levonorgestrel
Child Developmental Milestones
| Age | Gross Motor | Fine Motor/Vision | Speech/Hearing | Social |
|---|---|---|---|---|
| 6 weeks | Raises head prone | Follows face/object | Quietens to voice | Social smile |
| 6 months | Sits with support | Reaches for toys, palmar grasp | Turns to sounds, babbles | Stranger awareness |
| 9 months | Sits unsupported, crawls | Pincer grip | "Dada/mama" non-specific | Waves bye-bye |
| 12 months | Stands with support, cruising | Neat pincer grip | 1-2 words with meaning | Separation anxiety |
| 18 months | Walks independently | Tower of 3 cubes, scribbles | 6-10 words, points to body parts | Feeds self with spoon |
| 2 years | Runs, kicks ball | Tower of 6 cubes, circular scribble | 2-word phrases, 50+ words | Parallel play |
| 3 years | Pedals tricycle, stands on one leg briefly | Tower of 9 cubes, copies circle | 3-word sentences, talks in sentences | Cooperative play, toilet trained |
| 4 years | Hops on one leg | Copies cross, draws person with 3 parts | Asks questions, tells stories | Imaginative play |
Red Flags for Concern:
- 6 months: Not smiling, poor eye contact
- 12 months: Not sitting, no babbling
- 18 months: Not walking, no words
- 2 years: No 2-word phrases
- Any age: Loss of skills, parental concern
High-Risk Drug Doses (Emergency)
Anaphylaxis - Adrenaline (IM):
- Adult & Child >12 years: 500 micrograms (0.5ml of 1:1000)
- Child 6-12 years: 300 micrograms (0.3ml of 1:1000)
- Child <6 years: 150 micrograms (0.15ml of 1:1000)
- Repeat after 5 minutes if no improvement
Acute Asthma (Severe/Life-Threatening):
- Oxygen: High-flow to maintain SpO2 94-98%
- Salbutamol: Nebulized 5mg (adult), 2.5-5mg (child)
- Ipratropium: Nebulized 500mcg (adult), 250mcg (child) if severe
- Prednisolone: 40-50mg PO (adult), 1-2mg/kg (child, max 40mg)
- Hydrocortisone IV: If unable to take oral (100mg adult, 4mg/kg child)
Status Epilepticus:
- Buccal midazolam: 10mg (adult), 0.5mg/kg (child, max 10mg)
- Rectal diazepam: 10mg (adult), 0.5mg/kg (child)
GP Certificates & Forms
- Fit Note (Statement of Fitness for Work): Replaced sick notes. Can state "fit for work" with adjustments or "not fit for work"
- MatB1: Maternity certificate, completed from 20 weeks gestation, required for statutory maternity pay/allowance
- Med 3: Death certificate (Medical Certificate of Cause of Death)
- Cremation forms: Form 4 (medical certificate for cremation) and Form 5 (confirmatory medical certificate)
- DS1500: For terminally ill patients claiming benefits (Special Rules for Terminal Illness)
Flying & Air Travel
When is Flying Unsafe?
- Recent MI: Wait 7-10 days (uncomplicated), longer if complicated
- Recent stroke/TIA: Wait 2 weeks (uncomplicated)
- Pneumothorax: Wait 2 weeks after successful drainage, 7 days after resolution on X-ray
- Recent surgery: Abdominal 10 days, chest 21 days
- Pregnancy: Most airlines restrict after 36 weeks (32 for twins)
- DVT: Defer until stable on anticoagulation (at least 24 hours)
Cabin Pressure Effects:
Cabin altitude equivalent to ~2400m (8000ft). Gas expansion ~30%. Consider effects on:
- Pneumothorax (absolute contraindication if untreated)
- COPD/respiratory disease (may need in-flight oxygen if SpO2 <95% at sea level)
- Anaemia (Hb <7.5 g/dL may need assessment)
Incubation Periods of Common Infectious Diseases
| Disease | Incubation Period |
|---|---|
| Chickenpox | 10-21 days (usually 14-16) |
| Measles | 10-14 days |
| Mumps | 14-21 days (usually 16-18) |
| Rubella | 14-21 days |
| Whooping cough | 6-20 days (usually 7-10) |
| Scarlet fever | 2-4 days |
| Gastroenteritis (viral) | 1-3 days |
| Food poisoning (bacterial) | 1-36 hours |
| Meningococcal disease | 2-10 days (usually 3-4) |
| Influenza | 1-4 days (usually 2) |
| COVID-19 | 2-14 days (median 5-6) |
| Hepatitis A | 15-50 days (average 28) |
| Malaria | 7 days to months (depends on species) |
Exam Day Time Management
Strategic pacing for the 160-question format
⏱️ Updated for 160-Question Format
160 questions in 160 minutes = 60 seconds per question
You have slightly MORE time per question compared to the old format (57 seconds). Use this to your advantage!
Pacing Strategy
📊 Recommended Pacing: 40 Questions per 40 Minutes
Check the clock every 40 minutes and ensure you've completed these milestones:
| Time Elapsed | Questions Completed | Time Remaining | Questions Remaining |
|---|---|---|---|
| 40 minutes | 40 questions | 120 minutes | 120 questions |
| 80 minutes | 80 questions | 80 minutes | 80 questions |
| 120 minutes | 120 questions | 40 minutes | 40 questions |
| 160 minutes | 160 questions | 0 minutes | 0 questions |
Exam Technique
If You're Running Behind
- Don't panic - it's recoverable
- Speed up slightly but maintain accuracy
- If completely stuck on a question after 50 seconds, make your best guess and move on
- Flag uncertain questions to review later if time permits
- Prioritize completing all questions over perfecting each one
If You're Running Ahead
- Excellent - you have buffer time
- Don't rush - use the full minute per question when needed
- You'll have time to review flagged questions at the end
- Don't second-guess yourself excessively on review
Dealing with Uncertain Questions
- Flag the question using the Pearson VUE interface
- Make your best educated guess (no negative marking!)
- Move on - don't dwell for more than 60 seconds
- If time permits at the end, return to flagged questions
- Trust your first instinct unless you have clear reason to change
Guessing Strategy
✅ No Negative Marking
There is NO penalty for wrong answers. Always guess if you're unsure rather than leaving blank!
Educated Guessing Technique:
- Eliminate obvious wrong answers first
- Look for absolute terms (always, never, all, none) - often incorrect
- Choose answers that reflect safe, patient-centered practice
- When in doubt about clinical management, choose conservative/observational approach over aggressive intervention
- For drug questions, choose safer, more commonly prescribed options
Pearson VUE Test Center Experience
- Arrival: Arrive 30 minutes before appointment time
- ID Check: Photo ID + biometric palm vein scan
- Locker: All personal items stored (phone, watch, notes, bags)
- Provided: Erasable noteboard and marker for rough work
- Tutorial: ~15 minutes to familiarize yourself with interface (NOT counted in exam time)
- Breaks: No scheduled breaks, but you can leave for bathroom (clock continues running)
- Results: Typically available within 2-4 weeks
🚫 Prohibited Items
- Mobile phones and smartwatches
- Study materials, notes, books
- Food and drinks (water may be allowed at some centers)
- Bags and personal belongings (use locker provided)
Day Before Exam
✅ Final Preparations
- Light revision only - review quick-reference materials from Pre-Exam 72h section
- Avoid intensive studying - trust your preparation
- Get good sleep - sleep deprivation significantly impairs cognitive performance
- Prepare your ID - photo ID that matches your booking name exactly
- Check test center location and travel time
- Eat well - balanced meals, stay hydrated
- Relax - watch a movie, spend time with family, gentle exercise
Exam Day Morning
- Eat a good breakfast (complex carbs for sustained energy)
- Arrive at test center with plenty of time (30 mins early)
- Use the bathroom before starting
- Take a few deep breaths to calm nerves
- Remember: You've prepared well. Trust yourself!
Support & Neurodiversity
Help for those struggling, exam stress, and neurodiversity support
If You Failed Your AKT
"Failures lie not in falling down, but in not getting up."Failing the AKT is not the end. Many successful GPs failed on their first attempt. What matters is learning from the experience and adjusting your approach.
Immediate Actions:
- Talk to your Trainer and TPD (Training Programme Director) immediately - they can help redesign your study plan
- Request feedback if available - understand which areas you struggled with
- Avoid rote learning methods like reading books cover-to-cover - they rarely work
- Identify your learning style - visual, auditory, kinesthetic? Adjust resources accordingly
- Consider dyslexia assessment if repeated attempts suggest hidden learning difficulty (25% extra time may help significantly)
- Focus on MCQ practice - extensive practice with deep analysis of wrong answers
- Link learning to clinical practice - learn from patients you see, not just textbooks
Common Reasons for Failure & Solutions:
Insufficient Practice Questions
Solution: Aim for 1500-2000+ practice questions for next attempt. Use multiple question banks. Analyze every wrong answer deeply.
Poor Time Management in Exam
Solution: Practice timed mock exams. Strict 60-second rule per question. Don't dwell on difficult questions.
Weak in Evidence-Based Medicine
Solution: Focus on "Medical Statistics Made Easy" book. Practice sensitivity, specificity, PPV, NPV calculations. Understand study designs.
Insufficient Clinical Experience
Solution: Ensure adequate GP clinical time before next attempt. Learn from every patient consultation. Discuss cases with trainer.
Exam Anxiety/Stress
Solution: See "Coping with Exam Stress" section below. Consider counseling/CBT. Practice relaxation techniques. Mock exams in test conditions.
Undiagnosed Learning Difficulty
Solution: Request educational psychology assessment. Dyslexia, ADHD, and other conditions can significantly impact exam performance. Reasonable adjustments (25% extra time) can make a crucial difference.
Exam Stress, Nerves & Pressure
Exam anxiety is normal and common. However, excessive stress can impair performance. Here's how to manage it:
Before the Exam
- Start preparation early (4-6 months) - reduces last-minute panic
- Create realistic, achievable study plan
- Take regular breaks - burnout reduces performance
- Maintain work-life balance
- Exercise regularly - proven stress reducer
- Practice relaxation techniques (mindfulness, deep breathing)
- Get adequate sleep throughout preparation period
During the Exam
- Deep breathing if feeling overwhelmed (in through nose, out through mouth)
- Focus on one question at a time - don't think about the whole exam
- If panicking, close eyes for 10 seconds and reset
- Remember: Some questions are meant to be hard - everyone struggles
- Trust your preparation
- Keep moving forward - don't fixate on one difficult question
💚 Seek Professional Help If Needed
If exam anxiety is severe and affecting your daily life, consider:
- Speaking to your GP
- Occupational health services
- Cognitive Behavioral Therapy (CBT) - evidence-based for exam anxiety
- Your training program's support services
Neurodiversity & Learning Differences
Many trainees have dyslexia, ADHD, dyspraxia, or other neurodevelopmental conditions. These should not prevent you from becoming an excellent GP!
Available Support:
Reasonable Adjustments for AKT:
- 25% extra time (40 minutes for 160-question format)
- Extra breaks during exam
- Colored overlays for easier reading
- Adjustable screen contrast and brightness
- Separate room for minimal distraction
- Reader/scribe (in exceptional circumstances)
Application: Apply through RCGP with professional evidence (educational psychologist report, consultant letter, etc.). Routinely approved with appropriate documentation.
Getting Assessed:
- Educational psychologist assessment - can diagnose dyslexia, ADHD, processing difficulties
- Available through NHS (longer waiting times) or privately (faster, but costly)
- Many trainees discover learning difficulties for the first time during GP training
- Assessment provides recommendations for learning strategies and exam adjustments
✅ Neurodiversity Screening Available
Bradford VTS offers neurodiversity screening and support. Don't suffer in silence - getting the right support can transform your learning experience and exam performance.
Mental Health & Wellbeing During Training
GP training is demanding. Look after your mental health:
- Regular supervision with your trainer - discuss struggles openly
- Peer support - talk to fellow trainees
- Work-life balance - maintain hobbies and social connections
- Recognize burnout signs - cynicism, exhaustion, reduced efficacy
- Professional support available: BMA counseling, GP health services, occupational health
Remember:
You are more than your exam results. Struggling with exams doesn't mean you'll be a poor GP. Many excellent GPs faced challenges during training. What matters is resilience, seeking support when needed, and continuous learning.
Community & Discussion
Connect with fellow AKT candidates
AKT Chat Room
💬 Join the Conversation
Unmoderated discussion forum for AKT candidates to share experiences, ask questions, and support each other.
Golden Rule: Start a discussion, not a fire. Please post with kindness.
What You Can Discuss:
- Share study tips and resources
- Discuss difficult MCQ topics
- Ask for advice on exam preparation
- Share experiences of the exam
- Recommend preparation courses and question banks
- Support each other through the stress
- Celebrate successes!
Social Media & Mobile App
📱 AKT FLASH App
Official Bradford VTS mobile app
- Available on Android and iPhone
- Practice questions on the go
- Quick revision flashcards
📘 AKT FLASH Facebook
Join the community on Facebook
- Connect with other candidates
- Updates and tips
- Peer support network
Quick Links & External Resources
Official RCGP Resources:
Preparation Courses:
- RedWhale - Popular AKT courses
- NB Medical Education - Comprehensive preparation
- Arora Medical Education - Question banks and courses
- PassTest - Online courses and extensive question banks
- Fourteen Fish - Comprehensive AKT package