Multiple Choice Questions (MCQs)
"Because 'I guessed and got lucky' is not a revision strategy — but smart guessing very much is."
📥 Downloads
Handouts, guides, and teaching extras — ready when you are. Includes writing good MCQs, Bloom's taxonomy applications, and formative use in teaching.
path: MCQ
A hand-picked mix of official guidance and real-world GP training resources — because sometimes the best pearls are not hiding in the official documents.
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GP TRAINING
Bradford VTS — AKT Pages
Comprehensive AKT revision guide, frameworks, question banks, and study approach — our own detailed AKT resource. -
OFFICIAL
RCGP — Preparing for the AKT
Official RCGP guidance for AKT preparation, including data interpretation resources and examiner advice. -
OFFICIAL
Taking Multiple Choice Tests — Loma Linda University
Practical strategies for approaching MCQ exams in medical education. -
EXAM
MCQ Theory — Spot the Fault in These Questions (LITFL)
Educational critique of poorly written MCQs — teaches you to think like a question writer, which helps you answer as a candidate. -
RESEARCH
Does the MCQ Make the Grade? — Research Paper
A good research paper examining whether MCQs are valid assessment tools in medical education. -
RESEARCH
Assessment of Higher Order Thinking — MCQs & MEQs (MedEdPublish)
Compares MCQs and modified essay questions for assessing clinical reasoning and higher-order skills. -
DEANERY
NHS England North West — AKT Resources
Practical advice from a UK deanery, including what to do when you do not know the answer. -
DEANERY
Barnet GP VTS — AKT Preparation Guide
Practical tips including reading examiner feedback and building exam pacing skills. -
RESOURCE
A Strategic Approach to Clinical Case-Based MCQ Exams — PMC
Peer-reviewed article presenting a structured six-step approach to answering case-based MCQs. -
RESOURCE
Educated Guessing Strategies for MCQ Tests — UWSP
A concise guide covering specific guessing techniques when you are not 100% sure of the answer. -
OFFICIAL
RCGP AKT General FAQs (2025 PDF)
Official RCGP FAQs on AKT format, scoring, and the October 2025 changes.
MCQs are not just a memory test. Modern medical MCQs — including the AKT — test whether you can think like a doctor and apply knowledge to real clinical situations. Here are the essentials at a glance.
The Most Important Single Principle
The best way to reduce 5 options to 2 is active elimination, not hoping you remember the answer. Cross off what you know is wrong. What remains is almost certainly closer to the truth.
Top 8 Revision Essentials
- Start early: 4–6 months of regular study beats a two-week panic every time.
- Read the question last: In complex vignettes, read the final question first, then read the stem with purpose.
- No negative marking: Never leave a question blank — always guess if you have to.
- Elimination is your superpower: Remove two obviously wrong answers and you have a 50:50 chance, not 1 in 5.
- Stats and admin are free marks: These are finite topics. Learn them properly and they are almost guaranteed marks.
- Use question banks to test, not just learn: Read the explanation for every single wrong answer.
- Watch for absolute language: Words like "always" and "never" in answer options are almost always wrong.
- Flag and move on: Spending 5 minutes on one difficult question loses you time for five easy ones.
MCQs vs Essay Questions
In an essay, you create the answer from nothing. In an MCQ, the answer is already in front of you — you just need to identify it. This sounds easier, but there is a catch:
- Distractors are designed to look plausible
- MCQs cover a much broader range of topics than essays
- You cannot bluff or "write around" a gap in knowledge
- One small detail can change the correct answer completely
What Makes a Good Distractor?
Question writers deliberately design wrong answers to trap people who partially know the topic. Common distractors include:
- A related condition that looks similar
- The second-line treatment instead of first-line
- A number that is close but not the threshold
- An answer that is true in a different context
- An action that is reasonable but not the best
Why MCQ Exams Can Be Harder Than They Look
- Every mark counts — each question has equal weight
- Time pressure: 1 minute per question in the AKT
- Breadth: the curriculum is the entirety of GP medicine
- Contextual questions test application, not just recall
- An ambiguously worded question can fool even experts
The Good News
The AKT has no negative marking. Every unanswered question is a wasted opportunity. Even a complete guess gives you a 1 in 5 chance. Smart guessing, using the techniques below, can turn that into much better odds. Always answer every question.
The AKT uses two main question formats. Understanding their structure before exam day removes one source of confusion entirely — leaving your brain free to focus on the actual clinical content.
The most common format in the AKT. You are given one question (sometimes with a clinical scenario) and 5 answer options. Select the ONE BEST answer.
- There may be more than one plausible answer
- You must choose the most appropriate — not just a reasonable one
- The scenario gives you the context to decide
- Can test any level of Bloom's taxonomy
A longer list of options (sometimes 10–12) matched to several clinical scenarios. You select the single best option for each scenario from the same list.
- Options can be used once, more than once, or not at all
- Good for testing differentials and pattern recognition
- Approach: read the scenarios first, then the list
- Often tests clinical pattern recognition across a group
Numerical questions involving drug doses, statistics (NNT, NNH, sensitivity, specificity), or interpretation of results. A calculator is provided but usually not needed.
- Maths is usually straightforward if you understand the concept
- Often based on NICE guidelines or common GP thresholds
- Stats questions are predictable — learn the formula once
- EBP accounts for 10% of marks — do not neglect this
Clinical photographs, ECG traces, X-rays, or algorithm images may be shown. These appear most often in dermatology and cardiology.
- Common dermatological conditions regularly appear
- ECG interpretation is tested — practise the basics
- Knowing when NOT to treat is as important as when to treat
- Good image question banks are worth using here
🔬 SBA Example — Simple (Low Bloom's Level)
A palpable left parasternal impulse suggests which abnormality?
Answer: a) Right ventricular hypertrophyThis is a straightforward recall question. You either know it or you don't. This style of question is becoming less common — modern MCQs test higher-order thinking far more frequently.
🏥 SBA Example — Complex Contextual (Higher Bloom's Level)
A 29-year-old woman comes to see you as her GP complaining of tremors and palpitations. She says she has lost weight without dieting. Her pulse rate is 100/min and regular, BP 142/89 mmHg, BMI 19. ECG confirms sinus tachycardia. What is the most useful next investigation?
Answer: d) Thyroid function testsThis is an application question. You must recognise the clinical picture (weight loss + palpitations + tremor + tachycardia = thyrotoxicosis) and decide on the best next step. This is the type of question you will see most often in the AKT.
🔗 EMQ Example
Options include: Radio-femoral delay · Pan-systolic murmur · BP 220 mmHg · Tapping apex beat · Chest pain eased by GTN in 5 minutes · Third heart sound · Splinter haemorrhages · Breathlessness eased by lying flat · Slow-rising carotid pulse · Bradycardia with pulse 20 bpm · GTN takes over an hour to work
Match each patient to the most likely finding:
- A 65-year-old man collapses when running. Sustained heaving apex beat, ejection systolic murmur. → Slow-rising carotid pulse (aortic stenosis)
- An 80-year-old woman has excruciating interscapular pain. Right radial pulse present but not left. → Radio-femoral delay (aortic dissection)
- A 70-year-old man with previous MI now has breathlessness worse lying flat, basal crepitations. → Third heart sound (heart failure)
- A 65-year-old woman increasingly breathless over years. Loud first heart sound, mid-diastolic murmur. → Tapping apex beat (mitral stenosis)
💡 Approach: read each scenario, think of your diagnosis first, then find the matching option in the list. Do not read the options list first — it is designed to confuse you.
Not all MCQs test the same type of thinking. Bloom's Taxonomy describes a hierarchy of cognitive skills — from simple recall of facts at the bottom, to complex evaluation and creation at the top. Modern medical MCQs, including those in the AKT, deliberately test at multiple levels.
Why does this matter for you? Because your revision strategy needs to match the level at which you will be tested. Memorising facts is fine for Level 1, but the AKT regularly tests Levels 3 and above — which requires you to understand why, not just what.
⬆ Higher order thinking (harder to guess) · ⬇ Lower order thinking (easier to recall)
Practical Insight
When you revise, ask yourself: "Am I just memorising this, or do I understand it well enough to apply it in a case I've never seen before?" The AKT regularly presents familiar conditions in unfamiliar patient contexts. Understanding beats memorising every time.
| Bloom's Level | What it Looks Like in an AKT Question | Revision Tip |
|---|---|---|
| 1. Recall | "What is the first-line antibiotic for uncomplicated UTI in a non-pregnant woman?" | Flash cards, memorisation, repetition |
| 2. Comprehend | "Which of these findings would you expect in hypothyroidism?" | Understand the mechanism, not just the list |
| 3. Apply | "A 55-year-old with known COPD presents breathless. What is your next step?" | Practise applying guidelines to cases |
| 4. Analyse | "A trial shows NNT of 12. What does this mean for this patient?" | Do statistics properly — they come up |
| 5. Evaluate | "Which study design best answers this research question?" | Learn EBM concepts, not just terms |
The Myth of the Question Bank
Many trainees who fail the AKT had done thousands of question bank questions. Completing 2,000 MCQs without understanding the explanations is less useful than doing 500 with full understanding. Question banks are a testing tool, not a learning shortcut.
💡 Specific Preparation Tips
Passive reading (highlighting, re-reading notes) creates the feeling of learning without much actual retention. Active learning is far more effective for MCQ preparation. Here is how to make it work:
- Make tables and lists as you read. The act of organising information forces you to process it at a deeper level.
- Test yourself without looking at the answer first. Retrieve the information before you check — this is called the testing effect and dramatically improves long-term memory.
- Break complex topics into stepwise pathways. For example: what is the management of UTI in a non-pregnant woman vs a pregnant woman vs a man vs a child? Compare them side by side.
- Explain concepts out loud — to yourself, a colleague, or even an imaginary patient. If you cannot explain it simply, you do not understand it well enough yet.
- Use spaced repetition. Review material at increasing intervals. What you see once today, you may forget tomorrow. What you see weekly over 3 months, you own.
GPs who sit the AKT with no preparation often still pass. Research has shown that time spent in real GP surgeries is an incredibly powerful form of AKT preparation — because you are applying guidelines to actual patients every single day.
- After every consultation, ask: "What is the NICE guidance on this? What would the AKT say is the right answer here?"
- When a clinical question comes up in clinic, look it up. You will remember it far better than if you read it from a textbook.
- Debrief with your trainer regularly. The best AKT preparation happens in tutorials, not just in question banks.
- Every prescribing decision is an opportunity to understand pharmacology in context. Why this drug? Why this dose? What are the key interactions?
Question banks are useful tools when used correctly. Here is the right and wrong approach:
- ✅ DO: Read the full explanation after every question — even the ones you got right. Understanding why an answer is correct (or wrong) is the real learning.
- ✅ DO: Use question banks to identify gaps, not to fill them. When you identify a weak area, go back to the primary source (NICE CKS, BNF) and learn it properly.
- ✅ DO: Use timed mode occasionally to build exam pacing skills.
- ❌ DON'T: Treat a high question bank score as a guarantee of AKT success. Many candidates who failed the AKT had high mock scores.
- ❌ DON'T: Do 3,000 questions in one sitting mode without reflection. Volume without understanding is noise.
Yes — with the right structure. Teaching something to someone else is one of the most powerful consolidation tools available. Study groups work best when:
- Each member prepares a topic and presents it to the group
- The group writes questions for each other and tests themselves
- Discussion focuses on understanding, not just right or wrong answers
- Members hold each other accountable to a revision schedule
Study groups are less useful when they become revision avoidance — social gatherings disguised as study sessions. Be honest with yourself.
Below is a distillation of insight from real UK GP trainees who sat the AKT and passed — many with scores above 90%. These accounts come from GP training forums, trainee blogs, and online communities focused on UK GP training. Every insight here has been checked against official RCGP and deanery guidance. Nothing below contradicts what the examiners themselves advise.
Why This Section Exists
Official guidance tells you what to revise. Trainees who have been through the exam tell you how it actually felt — and what they wish someone had told them six months earlier. Both matter.
🔍 What Separated Those Who Passed from Those Who Struggled
This pattern emerged clearly across multiple high-scorer accounts. It is not about intelligence. It is about strategy.
| Those Who Struggled | Those Who Passed Well |
|---|---|
| Started revising 4–6 weeks before the exam | Started light revision from ST1, then ramped up over 4–6 months |
| Did thousands of question bank questions — the same bank, over and over | Used question banks to identify gaps, then went back to the primary source to fill them |
| Ignored stats and admin because "they're only 10% each" | Tackled stats and admin first — treated them as "free marks" with a defined endpoint |
| Revised passively: re-read notes, highlighted text | Revised actively: wrote flow charts, tested themselves, taught topics to colleagues |
| Studied on the sofa in the evening while half-watching TV | Used a dedicated desk in a quiet space — kept study and rest areas separate |
| Kept thinking in hospital medicine mode | Actively shifted to "GP mindset" — primary care first, community context always |
| Never read the RCGP examiner feedback reports | Read the last 2–3 years of examiner feedback and targeted those specific areas |
| Took the exam as a "feeler" attempt with minimal preparation | Sat the exam only when genuinely ready — after discussion with their Educational Supervisor |
| Tried to cover every NICE guideline (there are over 300) | Chose a focused list of ~80–100 core guidelines for common conditions |
| Revised entirely alone, never discussing cases or questions with anyone | Used study groups, peer discussion, and asked their trainer to run AKT-style case discussions |
🗺 The Revision Journey — A Realistic Roadmap
Multiple trainees described a similar arc. It is not about doing more — it is about doing the right things at the right time.
Look up conditions after each consultation. Use NICE CKS on your phone during or after surgeries. No formal revision yet — just build the habit of linking patients to guidelines. This is the foundation that makes everything later much easier.
Take a baseline mock exam. Do not panic at the score — this is information, not a verdict. Identify your three weakest domains. Build a simple revision timetable with mini-deadlines per topic. Tackle stats and admin first — they have a defined endpoint, unlike clinical medicine, which is endless.
Work through clinical topics by specialty. Combine reading with questions — never do one without the other. For every wrong answer, look up the topic in a primary source (NICE CKS, BNF). Do not repeat the same question bank endlessly. Move to a second bank to genuinely test retention, not pattern recognition.
Sit full 160-question mocks under exam conditions. Build your pacing — know how it feels to work at 1 minute per question for 2 hours 40 minutes without stopping. Re-read your notes on topics you keep getting wrong. Read the RCGP examiner feedback from the last 2–3 sittings now if you have not already.
Review your own notes on high-yield topics. Rote-learn the remaining pure-memory topics (DVLA time periods, Mental Health Act sections). Do not try to learn new material in the last 48 hours. Sleep is worth more than any new fact learned the night before. Arrive at the test centre early. Do the on-screen tutorial before the exam starts — it is not counted as exam time.
🧠 The GP Mindset Shift — The Moment It Clicks
This theme came up again and again. The trainees who scored highest described a specific shift in how they read questions — and it changed everything.
- "This patient has chest pain — refer to cardiology."
- "Abnormal bloods — urgent specialist review."
- "Not sure — admit for further workup."
- Order the most thorough investigation battery
- Escalate early and often
- "Is watchful waiting safe and appropriate here?"
- "What is the most likely diagnosis in this community context?"
- "What is proportionate and patient-centred?"
- The targeted, indicated investigation — not a scatter-gun panel
- Safety-net well and let the patient come back
The Single Most Repeated Insight from High Scorers
Multiple trainees described exactly the same thing: "Once I stopped thinking like a junior doctor on call and started thinking like a GP in a 10-minute consultation, everything felt clearer. Watchful waiting stopped feeling like giving up and started feeling like the right answer." If you are coming straight from hospital medicine, this shift takes deliberate practice — but it is the most valuable thing you can do.
🔤 Language Traps — Words That Changed the Correct Answer
These are the keyword distinctions that experienced GP educators and high-scoring trainees flag as the most common source of avoidable errors. One word in a question can completely change what you are being asked.
"Characteristic" vs "Commonly Seen"
These two phrases mean very different things in MCQ language.
Many trainees miss marks by answering a "characteristic" question with a feature that is common but not universal.
"MOST Likely" vs "MOST Appropriate"
Two very different questions, even when the clinical scenario is the same.
"INITIAL" vs "DEFINITIVE" vs "NEXT STEP"
The time frame embedded in the question changes everything.
A very common error: answering "initial management" questions with the long-term treatment plan instead of the immediate safety step.
Hidden "NOT" and "EXCEPT"
The most dangerous trap of all — missing the negative in a question.
"According to NICE Guidance…"
This preamble is not decorative — it is a direct instruction.
Drag-and-Drop and Free-Text Instructions
A trap that is nothing to do with knowledge — purely exam mechanics.
📊 Stats and Admin — The "Free Marks" Nobody Takes
The Tragedy Trainees Describe
"I failed by 3 marks. My clinical score was fine. I got 40% in stats and 45% in admin. If I'd spent just two or three focused evenings on each, I would have passed comfortably." This story is one of the most commonly shared in UK GP training communities — and it is completely avoidable.
Why Stats is Easier Than It Looks
Statistics questions in the AKT always use the same small set of concepts: NNT, NNH, sensitivity, specificity, PPV, NPV, relative risk, absolute risk reduction. The maths is always simple. The challenge is knowing which formula to apply. Learn the formulas once, practise applying them, and these questions become reliable marks — not a minefield.
Why Admin is Pure Rote — and That Is a Good Thing
DVLA time periods, Mental Health Act sections, consent thresholds, NHS contract types, GMC duties — these are lists. There is no reasoning required. You either know the answer or you do not. The good news is that a targeted revision session on these topics will stick because the material is specific and memorable. High scorers consistently describe getting 90–100% on admin by spending concentrated time on it.
A Note on YouTube for Stats
Trainees consistently mention that short YouTube videos on statistics concepts helped when reading alone did not. A 5-minute visual explanation of sensitivity versus specificity, or NNT versus NNH, is often clearer than a paragraph of text. Search for the specific concept you are struggling with. The RCGP also has its own video series on data interpretation by Professor Michael Harris — free and excellent.
📐 The 2×2 Table — Draw This First in Every Stats Question
Trainees who consistently score well on stats questions describe drawing this table every time, filling in the numbers from the question, then calculating. It takes 30 seconds and eliminates confusion. Practise it until it is automatic.
| Disease PRESENT | Disease ABSENT | |
|---|---|---|
| Test POSITIVE | True Positive (TP) | False Positive (FP) |
| Test NEGATIVE | False Negative (FN) | True Negative (TN) |
TP ÷ (TP + FN)How good at detecting disease?
TN ÷ (TN + FP)How good at ruling out disease?
TP ÷ (TP + FP)If positive, how likely is disease?
TN ÷ (TN + FN)If negative, how likely is no disease?
1 ÷ ARRPatients needed to treat to prevent one event
CER − EERAbsolute Risk Reduction (Control minus Event)
🌍 Specific Advice for International Medical Graduates (IMGs)
Many UK GP trainees qualified outside the UK. Several high-scoring IMGs have shared what they found most challenging — and how they overcame it. If this is you, you are far from alone.
The NHS Context Takes Time
NHS structures (ICBs, PCNs, QOF, GMS contracts) are not intuitive for doctors trained elsewhere. But they are finite and learnable. Spend a morning with your practice manager. Ask them to explain how the practice is funded and organised. It will make the organisational questions feel real, not abstract.
UK-Specific Medico-Legal Topics
The Mental Health Act, Mental Capacity Act, DVLA regulations, and GMC duties are very specific to UK practice. Doctors trained in other countries often find these unfamiliar. Dedicate focused time to each. They are not conceptually difficult — they just require learning the UK-specific rules.
Primary Care Is Its Own Specialty
Many IMGs come with strong hospital backgrounds but limited primary care experience. The AKT is testing GP-level decision-making — not hospital medicine. Time spent in actual GP surgeries, seeing real patients, builds the clinical instinct that is extremely hard to get from books alone. Use your clinical time as revision.
Your Background Is an Asset
IMGs who have experience in specific specialties (O&G, paediatrics, psychiatry) often score highly in those AKT domains. One high scorer described passing the DRCOG during their O&G rotation precisely to cover that chunk of AKT content at the same time. Think creatively about how your prior experience maps to the curriculum.
🏠 The Study Environment — Small Things That Made a Big Difference
These practical details come from trainees reflecting honestly on what helped them focus and what got in the way. They are small things, but they add up.
- A proper desk and chair — not the sofa. The desk signals to your brain that it is study time.
- Study sessions of 45–60 minutes with a short break — concentration drops sharply after an hour.
- Phone in another room during revision sessions — or at least notifications off.
- Revision on your phone on the go — bus, train, waiting rooms. Small sessions add up to hours.
- A study group — meeting weekly with peers doing the same exam, each presenting a topic.
- Scheduled time off — deliberate rest is not laziness, it is recovery. Trainees who maintained exercise and social life consistently described revising more efficiently when they did sit down.
- Revising in bed or on the sofa — associated with rest and sleep. Concentration is poor.
- TV or radio in the background — even background noise reduces the depth of encoding in memory.
- Social media during study sessions — more damaging to concentration than most trainees realise.
- Endless question banks without reading — creates an illusion of productivity while learning little.
- Revising new material the night before — the anxiety is not worth the marginal gain. Sleep wins.
- Comparing yourself constantly to others — every trainee's timeline, learning style, and prior knowledge is different. Your plan is yours.
Wellbeing Is Not Optional
Trainees who passed well were unanimous on this: maintaining exercise, sleep, and social connection during revision made them more productive — not less. One high-scorer ran a marathon in the week before his exam. Another described weekly dinner nights with friends as essential to staying sane. Revision is a marathon, not a sprint. Protect the things that restore you.
💎 What High Scorers Wish Someone Had Told Them Earlier
These are the insights that came up most often when trainees reflected on what they would do differently. Some are surprising. None of them are in the official guidance.
"The questions are written by real GPs seeing real patients."
AKT questions come from genuine clinical scenarios seen in actual GP surgeries. If it is common, important, or dangerous not to miss — it will appear. That means your patients are your revision. Every consultation is an opportunity to think: "What would the AKT ask about this?"
"The examiner feedback reports are gold — and nobody reads them."
Every AKT sitting produces a publicly available feedback report on the RCGP website. It describes what candidates found difficult and which areas were most commonly answered incorrectly. These topics are very often retested. Reading two or three reports takes an hour and focuses your revision like nothing else.
"Repeating the same 2,000 questions is not revision — it is memorising answers."
On a second or third attempt at the same question bank, your score improves because you remember the answers — not because you have learned the topic. In the actual exam, the questions are different. Use multiple question banks, and read the explanation for every wrong answer before moving on.
"GP trainers who sit the exam with no prep still pass."
Research has shown that experienced GPs who sit the AKT without revision often pass — because they have spent years applying clinical knowledge in a primary care context. That is the skill the AKT is testing. Your clinical time in GP surgery is not a distraction from revision — it is the most powerful form of revision available to you.
"Timing the exam well matters more than people admit."
Sitting the exam during a hectic on-call-heavy rotation, in the middle of a stressful period, or as a "feeler attempt" without real preparation consistently produces poor results. Pick a rotation where you have the headspace to revise. Take it when you — and your Educational Supervisor — genuinely feel you are ready.
"Talk to people who passed — not people who are panicking."
The most useful conversations are with trainees who sat the exam in the last year or two and passed. They can tell you which topics actually came up, what the format felt like on the day, and what they wish they had done differently. Seek those people out. The panicking peer group, while entirely understandable, is not your best source of information.
Thinking Hospital, Not GP
Many candidates have just come from hospital training. The AKT tests GP-level decision-making. Admitting, specialist referral, or ordering complex investigations is often not the right first step in a GP scenario.
Leaving Everything to the Last Minute
The AKT covers every aspect of clinical medicine across all specialties. 4–6 months of steady revision consistently produces better results than an intense 4-week sprint. You cannot cram a curriculum that broad.
Ignoring Stats and Admin
These 32 questions (20% of the exam) are consistently described as the reason trainees fail by a small margin. They are finite and learnable. Ignoring them because "they're not clinical" is a costly mistake.
Memorising Without Understanding
AKT questions are frequently set in novel contexts. A drug name memorised without understanding its mechanism, interactions, or contraindications is useless in an application-level question.
Not Reading Examiner Feedback
RCGP publishes feedback from every sitting on their website. Trainees who read this feedback identify which topics are repeatedly tested and where candidates consistently lose marks. This is public, free, and very few trainees read it.
Using Old Guidelines
Guidelines change. The AKT tests current guidance. If you are using revision materials more than 2 years old, some of your answers will be wrong. Always verify with the current NICE CKS or BNF before the exam.
Even with excellent knowledge, poor exam technique can cost you marks. These strategies help you express what you know as effectively as possible.
Pace Yourself
You have 1 minute per question. Set checkpoints: by 40 questions you should have ~40 minutes remaining. If you fall behind, speed up — but never rush to the point of misreading.
Flag and Move On
Mark a gut-instinct answer and flag difficult questions. Do not spend 5 minutes on one question. Return to flagged questions only if you have time. Your first instinct is often right.
Read the Question Carefully
Many mistakes happen because candidates misread the question. Cover the options, read the stem, form an answer in your head — then look at the choices. This prevents early distraction by plausible-looking wrong answers.
Watch for Key Words
The word "NOT", "EXCEPT", "MOST likely", "LEAST likely", "INITIAL", "NEXT" can completely change the correct answer. Underline these in the question if the system allows it.
The Changing Your Answer Trap
Research consistently shows that your first instinct is correct more often than not. Only change an answer if you have a clear, specific reason — not because you feel anxious on review. Second-guessing without new information usually makes things worse.
| Situation | What to Do |
|---|---|
| You are completely sure of the answer | Select it immediately and move on |
| You know some but not all of the topic | Use elimination + intelligent guessing (see below) |
| You have no idea at all | Select something (never blank), flag, move on |
| The question looks very long or complex | Read the question stem last — what is actually being asked? |
| Two answers both look correct | Look for the "most appropriate" — consider the GP context specifically |
| There is a calculation or data question | Attempt it — mark it for review, come back with fresh eyes if needed |
| You have already answered and are reviewing | Only change if you spot a clear error — not due to uncertainty |
Intelligent Guessing — How to Narrow 5 Options Down to 2
Here is the key insight: reducing five options to two transforms a 20% chance into a 50% chance. That is not luck — that is strategy. These techniques are used by high-performing candidates in every MCQ-based medical exam in the world. None of them substitute for knowledge, but when knowledge runs out, these will serve you well.
The Core Principle
You do not need to know the right answer to improve your odds. You only need to identify what is wrong. Eliminating two clearly wrong answers from five options gives you a 50:50 chance from what remains. That single habit is worth more marks than any other exam technique.
🗑 Category 1 — Elimination Techniques
These techniques help you spot and discard clearly wrong answers quickly.
Cross Off the Ridiculous
Some options are included purely as fillers. If an answer makes no clinical sense whatsoever, strike it off without hesitation. Most questions have at least one clearly implausible option.
Beware of "Always" and "Never"
In medicine, absolute statements are almost never true. Answer options containing "always", "never", "every", "all patients", or "no exceptions" are usually wrong — because medicine is rarely that absolute.
The GP Filter — "Would a GP Do This?"
The AKT tests GP-level decision-making. Options that are only appropriate in a hospital specialist setting, or that require specialist resources not available in primary care, are usually wrong.
The Proportionality Check
Match the response to the severity of the clinical situation. An extremely invasive or dramatic option is rarely correct for a stable, routine presentation. Equally, a trivial response is unlikely correct for something clearly urgent.
NICE Logic — What Would the Guideline Say?
Even if you do not remember the exact guideline, ask: "Which of these sounds like what NICE would say?" NICE consistently favours: safety first, least invasive first, patient-centred choices, and evidence-based options over tradition.
"All of the Above" and "None of the Above"
"All of the above" is more likely to be correct than wrong — if you believe two of the other options are correct, "all of the above" often is the right choice. "None of the above" is generally less reliable and is more often wrong than right. But: the AKT uses these options less frequently than older-style exams.
🔤 Category 2 — Language and Wording Clues
Question writers follow patterns. Understanding those patterns helps you spot clues within the structure of the question itself.
The Longer Answer Rule
Examiners tend to provide more detail and qualifying language in the correct answer to ensure it is unambiguously right. A longer, more specific option is often (though not always) the correct one.
Keywords Repeated in Stem and Answer
If a specific word or phrase from the question stem appears in one of the answer options, that option often deserves a second look. Examiners sometimes signal the answer through deliberate repetition of key diagnostic terms.
Watch for "NOT", "EXCEPT", "LEAST"
These negatively-phrased questions require you to identify the one wrong or least appropriate answer. This completely reverses the logic of the question. Read these very carefully — they are a common source of careless errors.
Two Similar Options = One Is Likely Right
If two answer options are very similar — differing only in one specific detail — this is a strong signal. Examiners use this pattern to test whether you know the exact distinction. One of these two similar options is almost certainly correct.
🔢 Category 3 — Numerical and Data Clues
When numbers are involved, specific patterns can help you narrow down the answer.
The Middle Number Strategy
When five numerical answer options are given and you are unsure, the extreme high and extreme low values are often designed as obvious distractors. The correct answer is frequently one of the middle three values.
Check the Number Makes Clinical Sense
Sometimes a numerical answer looks plausible on its own but is wildly incorrect in context. Ask: "Is this number clinically reasonable for this situation?" An outrageous number attached to an otherwise sensible answer sentence should be crossed off.
Statistics Questions — Use the Formula, Not Intuition
For sensitivity, specificity, NNT, and similar statistics questions, do not guess intuitively — the numbers are deliberately designed to mislead. Use the formula. The maths is always straightforward in the AKT. Write out the 2x2 table if it helps.
🧠 Category 4 — Logic and Clinical Reasoning
These higher-level techniques use clinical logic and exam psychology to direct your guessing.
Try to Answer Before You See the Options
Cover the answer options with your hand (or mentally block them out). Read the question and generate your own answer first. Then reveal the options and look for your answer. If it is there, it is almost certainly correct. This prevents you being seduced by plausible distractors.
Opposites Rule
If two of the five options are direct opposites (e.g., "increase the dose" vs "decrease the dose"), one of those two opposites is very likely to be correct. Focus your remaining energy on deciding between them.
The "Most Inclusive" Option
When one answer option encompasses or includes the other options, it is often correct. This is the "big picture" principle — a comprehensive answer that contains within it several other reasonable actions is often the best answer.
B and C are Slightly More Likely to Be Correct
This is a weak heuristic but backed by some evidence in MCQ design: question writers tend to "hide" the correct answer in the middle of the list. Option A is least likely to be correct; options B and C are very slightly more likely. Only use this as an absolute last resort.
The "What Would a Sensible GP Do?" Test
If all else fails, ask yourself: what would a calm, thoughtful, experienced GP do in this situation? Not what a specialist would do. Not the most dramatic intervention. The safest, most proportionate, most patient-centred response.
Read the Stem Question First in Long Vignettes
For long clinical vignettes, read the final question (the question stem) BEFORE reading the full scenario. This tells you what information you actually need to find. You can then read the case actively, looking for the specific details that answer the question.
Use Clues Across Questions
Occasionally, information or context in one question can help you answer a different question you were unsure about. This does not happen often, but in longer exam sections covering a case series, the later questions may provide clues for the earlier ones.
Recognise Clinical Pattern Clusters
Many AKT questions are built around a recognisable clinical picture. Train yourself to spot the cluster of features that point to a diagnosis, even in an unfamiliar presentation. The presentation may be dressed up differently, but the underlying pattern is the same.
The "Half-Right, Half-Wrong" Trap
A common distractor technique is an answer that is partially true but contains one wrong element. If any part of an answer option is wrong, the entire option is wrong — even if the rest is accurate.
Important Caveat — These Are Not Rules, They Are Heuristics
Modern exam writers are increasingly aware of these patterns and deliberately write questions to counteract them. Use these techniques as a last resort when your knowledge runs out — never instead of genuine revision. A candidate who knows the topic will always beat a candidate using guessing techniques alone.
AKT High-Yield Tips — For GP Trainees
Updated October 2025 exam format: 160 questions · 160 minutes · SBA + EMQ format
October 2025 Format Change — What You Need to Know
From October 2025, the AKT changed from 200 questions (190 minutes) to 160 questions (160 minutes). You now have exactly 1 minute per question — slightly more than before. The content, curriculum coverage, and pass standard remain unchanged. There is still no negative marking.
🏆 The High-Yield Domains — Where Most Marks Are Won and Lost
| Domain | % of Exam | No. of Questions | Common Mistakes | Strategy |
|---|---|---|---|---|
| Clinical Medicine | 80% | ~128 | Hospital thinking in a GP context; missing first-line GP options | Focus on common primary care presentations; use GP clinical time |
| Evidence-Based Practice | 10% | ~16 | Neglecting this domain entirely; confusing sensitivity with specificity | Learn all statistics formulas once, properly. NNT, NNH, sensitivity, specificity — these are easy marks if you know the formula. |
| Organisational/Administrative | 10% | ~16 | Ignoring medico-legal, DVLA, GMC duties, NHS contract structures | These are finite, learnable topics. Make a checklist and learn them. DVLA fitness to drive, consent, capacity, sick notes — all appear regularly. |
Insider Tip — The 20% That Is Free Marks
Stats and admin questions (20% of the exam = 32 questions) are finite, predictable, and entirely learnable in a focused revision session. Many trainees neglect them because they feel less interesting than clinical questions. Those trainees regularly fail by a small margin. Do not be one of them.
🔥 Common AKT Traps to Watch For
A question starting with "According to NICE guidance..." is NOT asking what you would do in real life. It is asking what the guideline specifically states. Experienced GPs sometimes get these wrong because they trust their clinical experience over what the guideline actually says.
Always ask: "Does the guideline say X, or does common practice say X?" These are not always the same thing.
- Real-world practice may deviate from the guideline — in the AKT, the guideline wins.
- Look for recently updated guidance — the answer that was correct 3 years ago may now be wrong.
- Read examiner feedback reports — they consistently flag topics where trainees apply "what we do in clinic" instead of "what NICE says".
These questions ask you to rank appropriateness or likelihood. There may be more than one reasonable answer — you must select the single best one. Common traps:
- Choosing a reasonable but not optimal response (e.g., the second-line treatment instead of the first)
- Anchoring on an early feature in the stem and missing the overall clinical picture
- Selecting an intervention that is appropriate but not yet indicated at this stage
The word "most" is always doing a lot of work in these questions. Do not stop at "this could be right" — ask "is this the best, or is something else better?"
Statistics questions are among the most predictable in the AKT. The same concepts appear repeatedly. Learn these once, properly:
| Term | Definition | Formula / Key Point |
|---|---|---|
| Sensitivity | How good is the test at detecting disease when disease is present? | True positives ÷ (True positives + False negatives). High sensitivity = few missed cases. |
| Specificity | How good is the test at excluding disease when disease is absent? | True negatives ÷ (True negatives + False positives). High specificity = few false alarms. |
| PPV | If the test is positive, how likely is the patient to actually have the disease? | Depends heavily on prevalence — same test has different PPV in different populations. |
| NPV | If the test is negative, how likely is the patient to be disease-free? | High NPV is what makes a screening test useful for ruling out. |
| NNT | How many patients need to be treated to prevent one event? | 1 ÷ Absolute Risk Reduction. Lower NNT = more effective treatment. |
| NNH | How many patients need to be treated to cause one adverse event? | 1 ÷ Absolute Risk Increase. Higher NNH = safer treatment. |
| Relative Risk Reduction | Proportional reduction in risk compared to control group | Can be misleading without knowing baseline risk — ARR is more clinically meaningful. |
These are finite, learnable topics. They appear in 10% of the exam — that is 16 questions worth of marks. Many trainees fail the AKT by a narrow margin and describe regretting not knowing these.
- DVLA fitness to drive: Common conditions and their notification requirements — epilepsy, diabetes, MI, visual standards. Know the specific time periods.
- GMC duties: Good Medical Practice, raising concerns, confidentiality principles, consent, capacity.
- Mental Health Act: Sections 2, 3, 4, 5(2), 5(4), 136. Who can use which section and for what purpose.
- Capacity and consent: Mental Capacity Act 2005, best interests decisions, lasting power of attorney, advance decisions.
- Prescribing responsibilities: Controlled drugs, FP10 prescriptions, repeat prescriptions, remote prescribing.
- NHS structures: ICBs, PCNs, GMS/PMS/APMS contracts, QOF, CQC inspections.
- Sick notes / Fit notes: Who can issue them, what they say, when they are required.
- Child protection: Section 47, safeguarding thresholds, Gillick competence vs Fraser guidelines.
Visual questions appear in the AKT and catch many candidates off guard. Here is how to approach them:
- Dermatology: Common conditions recur. Learn to recognise: eczema, psoriasis, melanoma, BCC, SCC, rosacea, shingles, pityriasis rosea, molluscum contagiosum, impetigo, tinea. "Knowing when NOT to treat" is specifically mentioned by RCGP examiners as commonly tested.
- ECG: Learn the basics well — sinus rhythm, AF, VT, SVT, heart block (1st, 2nd, 3rd degree), LBBB/RBBB, ST changes, STEMI vs NSTEMI patterns. You do not need to be a cardiologist — you need to be a safe GP who knows what is urgent.
- Other images: Fundoscopy (diabetic retinopathy, papilloedema), peripheral blood films (microcytic vs macrocytic), joint X-rays.
Use an image-based question bank for at least a few weeks before the exam. Seeing the real appearance of conditions once is worth a hundred text descriptions.
✅ High-Yield Revision Checklist for AKT
Have You Covered These?
- All statistics formulas (NNT, NNH, sensitivity, specificity, PPV, NPV)
- DVLA guidance for common conditions (epilepsy, diabetes, MI, visual acuity)
- Mental Health Act sections (2, 3, 4, 5(2), 136)
- Mental Capacity Act key principles
- GMC duties: confidentiality, consent, raising concerns
- QOF structure and common indicators
- Child safeguarding threshold and Gillick/Fraser principles
- First-line antibiotic choices for common infections (per current NICE CKS)
- Drug interactions for common GP prescriptions
- Screening programme details (cervical, breast, bowel, AAA, diabetic eye)
- RCGP examiner feedback for the last 2–3 sittings
👨🏫 For Trainers — Teaching MCQ Technique
MCQ technique is a learnable skill that many trainees have never been explicitly taught. A short tutorial dedicated to this can significantly improve a trainee's performance — not just in the AKT, but in their clinical reasoning generally.
- Run a "Blind MCQ" exercise. Give a trainee 10 MCQs on a topic they have not yet revised. Ask them to talk aloud through how they arrived at their answer. This reveals their reasoning patterns — and the errors in them — far more effectively than reading a score.
- Discuss distractors, not just correct answers. For each wrong answer, ask: "Why did the question writer put this here? What would someone need to believe to choose this?" Understanding why an option is wrong is as valuable as knowing why the right answer is right.
- Use the examiner feedback reports in tutorials. Bring the RCGP's own feedback to a tutorial and discuss why trainees made the mistakes the report describes. This is highly contextualised learning.
- Encourage active recall over passive revision. If your trainee is reading through notes without testing themselves, suggest flash cards, self-testing, or teaching-back exercises instead.
- Watch for the "high question bank score, poor AKT result" pattern. If a trainee is getting 75–80% on question banks but struggling in mock exams, they are likely recognising answers without understanding them. Deepen understanding with case discussions rather than more questions.
- Discuss Bloom's taxonomy explicitly. Show your trainee the pyramid above. Help them identify whether they are being tested at recall level or application level — and adjust their revision strategy accordingly.
Tutorial Prompt Questions
Try these during a tutorial: "Without looking at the options — what do you think the answer is?" · "Why might someone choose option B instead of option D?" · "What would a safe, thoughtful GP do in this situation?" · "What does NICE actually say about this, and does that match what we do in clinic?"
Leave this page better prepared. Here are the most important points to carry with you.
- 1Modern MCQs test thinking, not just memory. The AKT regularly tests at Bloom's application level and above — understand the why, not just the what.
- 2Never leave a question blank. There is no negative marking. A guess is always better than an empty answer.
- 3Elimination is your most powerful tool. Remove two clearly wrong answers and your odds improve from 20% to 50%. That single habit is worth more than almost any other exam technique.
- 4Stats and admin are free marks. 32 questions covering finite, learnable topics. Many trainees fail by a small margin and wish they had spent a week on this.
- 5Read the examiner feedback reports. RCGP publishes them after every sitting. The topics trainees struggled with are very often retested. This is free, public information — use it.
- 6Try to answer before seeing the options. Generate your own answer from the stem before looking at the choices. This prevents distraction by plausible-looking wrong answers.
- 7The new format has 160 questions in 160 minutes. You have 1 minute per question. Practise under timed conditions. Know how pacing feels before exam day.
- 8Use your clinical time as revision. Every GP consultation is an opportunity to apply guidelines, understand drugs in context, and build the working knowledge the AKT tests.
- 9Beware of absolute language in answers. "Always" and "never" are almost always wrong in a clinical context. Treat them with suspicion.
- 10If truly stuck, think like a sensible GP. The safest, most patient-centred, most proportionate option that fits current NICE guidance is almost always correct.
Bradford VTS · Teaching & Learning · MCQ and Exam Technique
Content verified against RCGP, NICE, and current UK GP training guidance · Last updated April 2025
Bradford VTS is a free resource created by Dr Ramesh Mehay. All educational content is provided for learning purposes only. Always verify clinical information against primary sources.