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03.03.2023

UK Medical Licensing Assessment (UKMLA) Exam Ultimate Guide

What is the UKMLA?

The UK Medical Licensing Assessment (UKMLA) is a standardised medical licensing exam in the United Kingdom. You can think of it as a UK equivalent to the USMLE, which is an American standardised medical licensing exam that you must take if you wish to practise medicine in the United States. If you would like to see our YouTube video summarising the main changes, click here.

The idea behind having an exam like this is to ensure all medical graduates qualify to the same standards. This is because currently, medical schools are otherwise allowed to set their own finals exams, and to some extent, curricula, which means there can be slight variance in what you study and how you are assessed depending on which medical school you go to. The UKMLA will align all medical schools to the same curricula and provide a consistent style and form of examination.

The UKMLA is designed to assess the knowledge and skills of medical graduates to ensure that they meet the required standards for safe and effective practice as doctors. It is a new exam that the General Medical Council (GMC) has introduced from 2024 onwards, and this post goes through what the exam is, who has to take it and how to prepare for it!

Who Takes the UKMLA?

The UKMLA is taken by all medical graduates who wish to practise medicine in the UK, regardless of whether they trained in the UK or abroad. This includes international medical graduates (IMGs), and those who are completing their medical degrees in the UK.

For medical students in the UK, you will sit the UKMLA around the time you have your finals exams. Some medical schools implemented a ‘pilot’ UKMLA exam in the 2022-2023 academic year to give students an idea of what the exam will be like.

For International medical graduates, it will eventually replace the PLAB (estimated to take place in early 2024) and you can consider the terms interchangeable for the purposes of this blog post, especially when we get to the format and content of the exam, whereby the PLAB blueprint will be replaced by the UKMLA content map.

Exam Format

The UKMLA consists of two main components: the Applied Knowledge Test (AKT) and the Clinical and Professional Skills Assessment (CPSA). For UK-based medical students, these are the equivalent of ‘Finals’ and ‘OSCEs/OSLERs’ respectively. For IMGs, these are very similar to PLAB 1 and PLAB 2 respectively.

The AKT is a written exam that assesses your knowledge of medical science, clinical reasoning, and professional practice. For UK medical students this will be two 100 single best answer (SBA) question exams, taken on a computer, with each exam lasting 2 hours long. This would be the equivalent of PLAB 1 and you will see that the content maps reflect that. The two papers will examine clinical topics in the following format.

On the other hand, the CPSA evaluates your clinical and professional skills through a series of practical assessments. This part of the exam can take place at various clinical sites and is designed to reflect real-life scenarios. You will be given time to read a brief which will lay out a clinical scenario and ask you to perform a certain task(s). In most UK medical schools this is referred to as an OSCE/OSLER, or PLAB 2 for IMGs.

Content

The GMC have produced a content map covering each specialty that will be examined in the UKMLA AKT and CPSA, consisting of core presentations and conditions for each. Although a long document, please don’t be alarmed - in the UK this is very much aligned with your medical school curricula and similarly if you have trained abroad this is likely to be the case too.

The content map is based on the GMC’s ‘Outcomes for Graduates (2018)’, the GMC’s ‘Generic Professional Capabilities Framework (2017)’, and lastly, common scenarios you may face as a Foundation Doctor working in the UK.

The Outcomes for Graduates refers to three themes which helped shape the UKMLA content map:

Readiness for safe practice
Managing uncertainty
Delivering person-centred care

Additionally, the content map is then organised into six main domains:

Areas of clinical practice
Areas of professional knowledge
Patient presentations
Patient conditions
Clinical and professional capabilities
Practical skills and procedures

Here’s an example of what you can find in the content map. At Quesmed, our knowledge library is aligned to the UKMLA, covering exactly what you need to know for the exam:

Exam fees

In terms of cost, for UK medical students this cost is covered in your tuition fees. For IMGs, the cost of taking the UKMLA may vary, so it's important to check the GMC website for the most up to date information.

Resits

The UKMLA is a pass/fail exam. If you don't pass the UKMLA on your first attempt, you can resit the exam. However, there may be limitations on the number of resits allowed, and you'll need to meet certain eligibility criteria.

UKMLA Preparation

Having a quick read of some of the official guidance on the UKMLA that we have referenced in this post will help familiarise yourself with the format and content of this exam. When you see the list of conditions and presentations you need to know, on a first-read, this may seem quite overwhelming - however, don’t be alarmed - it is very likely your university curriculum is already largely aligned to the UKMLA content map.

Cover/uncover method

When approaching SBA questions, let’s first start with the cover/uncover approach. With this method you should cover the answers first, and this will allow you to break things down a bit more in the question. Have a look at the question below, we have deliberately covered the answers:

Here you can see that you have someone with an ejection systolic murmur loudest on expiration at the left intercostal space which radiates into the carotid arteries, and without looking at the answer you can probably tell that it's most likely to be aortic stenosis. Then when you uncover and then you find that AS is one of the options you can select it with confidence knowing you are probably right.

Let’s look at a harder question - have a look at the question below:

So this is a question that asks a lot and the point here is that if you look at the answers first you may freak out because there’s quite a bit of text so what I suggest is that you cover once again.

Read through the question - this person has weight loss, a cough, bloody sputum and he's a smoker - could this be lung cancer? They are also feverish, sweating, more thirsty than usual, finding it difficult to pass stool and confused. Could this be lung cancer with something else, like a complication of lung cancer? So in this scenario the latter group of symptoms is suggesting hypercalcemia - the patient is passing more urine, they’re constipated and confused, and the clubbing goes hand in hand (pun intended) with lung cancer.

The answer here is hypertrophic pulmonary osteoarthropathy, which is associated with squamous cell lung cancer.

This is a hard question so don't worry about it if you didn't get it but it's important to recognise that if you break things down, you may first come to the conclusion that this is probably lung cancer and it could be that it's related to something else. You could also figure out that it's related to hypercalcemia and then if you have all the information you will know B is the answer.

Here you require a lot of steps to get the diagnosis but if you break it down and cover the answers first, you can take a bit more time to think about it without being stressed by lots of wordy different answers.

Location – GP v Emergency

Emergencies are very important and the emergency curriculum is important for examiners to assess your practice so if on day 1 an emergency happens you escalate accordingly. There's lots of guidelines that are very helpful such as ALS guidelines but also the back of the Oxford handbook I've always found very useful and as a junior doctor I used to look into it in my first couple of months as an F1 doctor.

It’s important to understand what's in the question and the clues that will help you to answer it correctly. If you are in an outpatient or GP clinic that is different from the emergency department. For example if you're in the clinic the question will test knowledge of long term treatments, when you need to escalate and when you need to do things a bit more urgent. Whereas in the emergency department it will focus on A-E, and making sure that the important complications are dealt with early. The other aspect of demographics is knowing who the patient is so if it's a 70 year old you will have a different differential diagnosis to a 20 year old, so make sure that when you're looking at the presenting complaint you consider your differentials first and then which features are those that help make the diagnosis because lots of questions will ask you to weigh between different things, some of which could be completely unrelated.

Investigations

Investigations form quite a big chunk of most exams and you’ll often be asked to differentiate between definitive investigations to confirm the diagnosis or, the next best or initial investigation.

For example a tissue biopsy in coeliac disease is the best or gold standard investigation, however if you were in primary care the initial investigation you may do is a panel of bloods including anti-tTg antibodies. Sometimes it's helpful to use guidelines for that however sometimes you have to use your clinical judgement.

The other way to approach these questions is thinking ‘what will harm the patient most severely’ in the first instance. What you're doing here is trying to make sure that you can tell the examiner that you know what's safe and you know what you need to rule out early in terms of complications and that you are safe to manage patients on your own, and with help and escalating appropriately.

A framework mnemonic I use for investigations is BBBII - not the catchiest but it helps me remember that the first thing to do is to check the background: history and examination, then bedside tests like ECG or blood glucose. Then you have blood tests, imaging, and invasive investigations - the point is we're usually opting for the least invasive stuff early which causes the least amount of harm and then the more invasive stuff later on.

Similarly with management. After taking into account urgency, you are always trying to make sure to do the conservative stuff first then consider medical options and then surgical and that's how we think about management options in clinical practice too e.g. in emergencies again A-E first and then everything else.

Exam technique

As for the best practises for answering SBA there is a lot to say about exam technique and the key is to make sure that you are prepared so that on the day you have come through this many many many times so that you are not stressed. You probably will still be stressed in any case but this hopefully will give you a bit more about how you can minimise that on the day.

Time management

You have about a minute to answer each question and you have to balance between trying to answer questions quickly but also reading them properly and considering your options appropriately. What you should be doing early on in your revision is taking your time with questions, trying to think through the answers thoroughly, and then closer to the exam you should be going through timed quizzes to simulate the exam environment.

Balancing between time management and taking in the question will come with practice and if you're not getting it early on that's fine it will come after a few weeks or months of work, so make sure you have enough time to make that transition from very slow reading to slightly faster and trying to work within exam conditions.

Demographics

For medical exams it’s quite useful to have some rules of thumb in your mind about different demographics because it allows you to raise your index of suspicion for certain diseases. So if the question mentions ‘a 22 year old athlete collapsing’ the first thing you are or hopefully will be thinking is ‘is this hypertrophic obstructive cardiomyopathy’ because it's something you may have come across before. It's fine to have that initial thought in your head but you need to make sure that you are thinking about the rest of the question and whether or not it supports or doesn't support your diagnosis.

Conclusion

So that’s everything that I wanted to cover on the UKMLA exam and how to approach answering the questions you will be encountering in the AKT part of it, thanks for listening and if you have any further questions our email is in the description. With over 12,000 AKT questions and 250 practical CPSA stations, Quesmed is the single best resource for preparing for the UKMLA and your medical school finals. Our SBAs and CPSA stations cover all of the core presentations and conditions in the content map. We have 4 brand new UKMLA mock exams with input from students who sat the pilot UKMLA last year. Look out for lots more content from us which will help you with your UKMLA preparation and follow our socials for updates. We wish you the best of luck here at Quesmed!

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