AKT Preparation: An Applied Approach for GP trainees

 Many trainees are told to “revise more” for the AKT. That advice isn’t wrong — but it isn’t enough. The AKT is an applied exam, and preparation works best when it reflects how you actually practise. This guide highlights approaches that consistently help trainees perform well.

 The AKT is an applied exam — a computer-based assessment of 160 SBA questions taken over 2 hours 40 minutes. Approximately 80% of questions assess clinical knowledge, 10% evidence and data interpretation, and 10% primary care organisation and management. You cannot pass the AKT unless your clinical knowledge is secure.

Practising GPs pass the AKT without revision. Why?

Because the exam tests what you do every day in general practice:

·       Apply knowledge safely

·       Recognise clinical thresholds

·       Make proportionate decisions

·       Use guidance appropriately

·       Prioritise decisions effectively

Preparation is not just about revision. It is about deliberate use of your clinical exposure.

Outlined below are approaches and knowledge that consistently help trainees perform better in the AKT.

Understand What the AKT Really Tests

Most of the AKT is clinical. If your core clinical knowledge is weak, it will be reflected in your exam performance.

Knowledge needs to be secure. However, this is an applied exam, so knowledge alone is not enough — you must demonstrate applying it in clinical situations.

The exam tests whether you can:

• Apply clinical thresholds
  (e.g. BP targets, HbA1c cut-offs, referral criteria)

• Adjust decisions for context thresholds
  (age, pregnancy, safeguarding, co-morbidity, polypharmacy)

• Choose the initial step, not the ideal long-term plan

• Avoid over-investigating or over-prescribing

• Commit under time pressure

Applied reasoning also includes interpreting data and risk — translating graphs, percentages and scores into clinical decisions — but most errors arise from clinical decision-making.

Strong clinical foundations remain the biggest driver of performance.

Use Your GP Placement Deliberately

Seeing patients is preparation. Every clinic is an opportunity to strengthen AKT performance — if you use it intentionally.

After each surgery, ask yourself:

• Why did I choose that management plan?

• What threshold influenced my decision?

• When would I have referred?

• What would change the plan?

• Which guideline supports this?

Discuss one or two patients per day with your supervisor through an AKT lens.

This is how applied reasoning develops. If you treat clinics as service only, you lose a major advantage. If you treat clinics as structured preparation, the exam becomes an extension of your practice.

Study Deliberately

Effective preparation includes:

• Reading and understanding key guidelines.

• Knowing why clinical thresholds are set where they are.

• Strengthening weaker clinical areas.

• Revisiting topics after seeing real patients.

• Integrating learning into day-to-day practice.

• Spaced repetition rather than short bursts of intensity.

Question banks are also widely used by trainees — and they can be helpful.

They are particularly useful for:

• Becoming familiar with exam-style wording.

• Identifying weaker areas.

• Practising pacing.

• Reinforcing pattern recognition.

 But they have limitations:

• They can narrow your learning.

• They may encourage recall without depth.

• They can create false confidence.

• They do not always reflect the nuance of the real exam.

 Understanding their strengths and weaknesses allows you to use them deliberately:

• Small, regular sets.

• Review answers immediately.

• Identify why you were wrong.

• Return to weak areas rather than avoiding them.

 Question banks support preparation. They do not replace structured study and clinical exposure.

Develop Your Exam Technique

Even strong clinicians can underperform if exam behaviours are unstructured.

Practise:

• Reading the full stem before committing.

• Identifying key wording:
  “most appropriate”, “initial”, “least likely”, “NOT”.

• Avoiding unnecessary answer changes.

• Answering every question (there is no negative marking).

• Pacing at roughly 1 minute per question.

If you consistently run out of time, address it deliberately. It is a pattern — not bad luck.

Plan Your Sitting Deliberately

GP trainees can sit the AKT in either ST2 or ST3. There is no single “correct” time.

Consider:

• Are you currently in a GP post with regular clinical exposure?

• How secure are your clinical foundations?

• Do you have 4–6 months of structured preparation time?

• What else is happening in your life?

• When will you have the best support at home?

Discuss your timing with your trainer or the educator you see most regularly. Have an honest conversation and plan to sit at a time that gives you the best opportunity of success — not simply the earliest opportunity.

Learning Difficulties, Neurodivergence, & Health Conditions in the AKT

You may be eligible for reasonable adjustments if you have:

• Dyslexia

• ADHD

• A specific learning difficulty

• A medical or physical condition, including neurodivergent diagnoses

• A temporary circumstance affecting performance

Please note this list is not exhaustive, nor a guarantee of accommodations – it is simply signposting that you may be eligible for accommodations and it is worth approaching the RCGP to find out.

 Applications must be made separately for each sitting and usually before or early in the booking window. Evidence is required. Plan early. Do not leave this to the last minute. Refer to the RCGP website for the most up-to-date guidance.

When You Get Your Results

If you pass — congratulations.

Take time to celebrate what you have demonstrated: applied clinical reasoning under pressure.

Then sit down with your trainer and plan what comes next. There is still learning ahead — whether that is preparation for the SCA, strengthening areas within your WPBA, shaping your PDP, or simply keeping up to date in a profession that never stands still.

Passing the AKT is not the end of learning. It is evidence of progress.

If you do not pass — that’s tough. Give yourself some time & space.

Then arrange time with your trainer (or another educator you trust). Have an honest conversation. Reflect. Identify what worked and what did not.

 Preparing for and taking the AKT is experiential learning. You take what was effective, change what was not, add what was missing — and when the timing is right, you prepare again with greater clarity than before.

You do not need to navigate this alone.

 The AKT rewards strong clinical foundations, deliberate use of your GP placement, thoughtful application of knowledge and steady exam behaviour.

Consolidate your clinical understanding first, then refine how you apply it in everyday practice. Preparation that reflects real general practice leads to confident performance.