If you're a UK medical student or an International Medical Graduate (IMG) hoping to practise as a doctor in the UK, the chances are you'll have heard of the UKMLA/MLA...but might not necessarily know exactly what it is! This blog provides an overview of key information about this new exam, including its format, cost, and how and when it will be delivered.

Read on to find out more about the UKMLA and how it will affect medical student examinations moving forward. This blog post will regularly be updated as and when new information about the UKMLA is released.

What is the UKMLA?

The UK Medical Licensing Assessment (UKMLA) is a brand new exam that will test the knowledge, abilities and behaviours required to work as a doctor in the UK.

The Medical Licensing Assessment (MLA) will set a common standard for competent medical practice in the UK. Starting in the 2024-25 school year, UK medical students must pass the MLA to get their degrees, which is a key step in their journey to becoming doctors. HEE medical apprentices will also have to take the exam.

The MLA's launch aims to boost the trust that patients and employers have in new UK doctors, no matter where they studied or trained. As a result, the current Professional and Linguistic Assessments Board (PLAB) exam will end, and the UKMLA will become a must for UK medical graduates. People who want to practise medicine in the UK need to know about the UKMLA and how to prepare for it.

The rollout of the UKMLA is a key part of the General Medical Council's (GMC) goal to uphold strict standards for UK medical students, ensuring they have the skills needed to deliver medical care. What's more, the UKMLA will have a big impact on keeping patients safe by checking that all doctors meet the required levels of knowledge and ability to practise medicine without risk.

Who is the UKMLA for?

The UKMLA applies to doctors who studied in the UK and those who studied abroad. The test ensures all doctors meet the same safety standards, no matter where they went to school. It sets the same rules for getting a licence for UK medical students, and doctors applying from other countries.

How will the UKMLA exams work?

The exam will be split into two forms depending on your place of graduation – the MLA for International Medical Graduates, which will be made and delivered by the GMC, and the UKMLA which will be run by the Medical Schools Councils and delivered via local medical schools. Both exams, although very similar, will be derived from separate question banks and will run in parallel with each other.

When will the UKMLA come into effect?

The MLA will first be sat in early 2024 by IMGs who would previously have completed PLAB as part of their application to practise in the UK.

In order to be eligible to register as doctors, UK medical students graduating in academic year 2024-25 will be expected to pass the UKMLA as part of their medical school degree, however, there will be pilot schemes running before this across numerous universities.

What is the format of the UKMLA?

The UKMLA will be delivered in two parts - the Applied Knowledge Test (AKT) and the Clinical and Professional Skills Assessment (CPSA) - both of which assess a range of knowledge and competencies, outlined in the MLA learning outcomes.

Questions will focus on being able to make a diagnosis, formulate a management plan, and understand the underpinning science – almost all questions will have a clinical scenario, the language will be clear, not using more words than necessary, and no negative phrasings. Questions may have a history, examination findings, and investigation results.

The AKT will be composed of 150 to 200 single-best-answer (SBA) questions drawn from a central bank controlled by the GMC, and will be similar in content and difficulty level to Medical Finals exams and PLAB 1. The CPSA is a practical exam that assesses clinical skills and professionalism, similar in format and marking to the UK medical school Objective Structured Clinical Examination (OSCE) and PLAB 2.

The MSC intends to produce at least one, and possibly more, complete practice papers with answers and indicative standards.

What does the UKMLA test for?

The UKMLA will test for fundamental knowledge, abilities, and conduct required for safe medical practice, and to establish a uniform and consistent standard for all doctors licensed to practise in the UK.

The UKMLA will consist of two exams:

AKT

The AKT exam will be an on-screen, multiple-choice exam to test the application of medical knowledge across various scenarios.

Clinical and professional skills assessment (CPSA)

Medical schools will conduct and oversee the assessment of clinical and professional skills, referred to variably as an Objective Structured Clinical Examination (OSCE) or Objective Structured Long Examination Record (OSLER) - with all CPSAs adhering to uniform standards.

UKMLA for international students

International medical graduates can sit for the PLAB test until the MLA is introduced in September 2024, for those who wish to register with a licence to practise in the UK. The details outlined below explain the situation for candidates who have finished either one or both sections of the PLAB test before the MLA comes into effect.

Passed both parts of the PLAB test

This won't change. As you normally would, you'll need to get your application for registration with a licence to practise in the UK approved within two years after passing PLAB 2.

Passed PLAB 1 but not attempted PLAB 2

If you have passed PLAB 1, instead of taking PLAB 2 you’ll take the CPSA. You’ll need to pass this within your PLAB 1 validity period, which at the time of writing, is three years.

When you pass the CPSA, you'll be able to apply for registration with a licence to practise, which must be approved within two years of passing the CPSA.

Attempted PLAB 1, but not passed it

You'll be able to sit the AKT. There will be a maximum of 4 attempts to pass, and any previous attempts at PLAB 1 will count towards the maximum number. When you pass the AKT, you will need to take the CPSA within the 2-year AKT validity period

Passed PLAB 1 and attempted PLAB 2, but not passed

You won’t need to take the AKT if your PLAB 1 pass is still within the validity period. Currently, a PLAB 1 pass is valid for 3 years.

You'll be able to take the CPSA. There will be a maximum number of four attempts and any previous attempts at PLAB 2 will count towards the maximum number. When you pass the CPSA, you'll be able to apply for registration with a licence to practise, but you’ll need to do so within two years of passing the CPSA.

UKMLA content map explained

You’ll need to refer to the MLA content map - which was designed based on typical scenarios doctors may face. This is divided into three categories:

• Areas of clinical practice
• Areas of professional knowledge
• Clinical and professional capabilities

When does the UKMLA need to be sat?

In the UK it is intended for the AKT element to replace the Medical Finals exam for students, with assessment periods held four times a year. Similarly, following a quality assurance assessment to determine whether medical schools' practical exams (e.g. OSCEs) comply with GMC requirements, the CPSA will be fully integrated into the existing exam system. Individual medical schools can pick when to sit their exam from set assessment windows.

This means for UK medical students no additional exams will need to be sat to complete the UKMLA, however individual medical schools may still require additional exams to complete graduation.

The exam will be delivered digitally at each individual university via the platform Exam-Write, in an invigilated (not remote) setting. The number of times that the candidate can sit the exam will be set by the individual medical school, usually, an in-year resit will be available - however, MSC/GMC recommends no more than four attempts in total.

For IMGs, as the AKT is a computerised test the UKMLA will be readily available in test facilities all over the world. The CPSA, however, can only take place in Manchester which may pose a barrier to IMGs not currently residing in the UK.

How much will the UKMLA cost?

As yet, there has been no official announcement from the GMC on this. In the UK, medical schools are likely to bear the cost of the first attempt at the UKMLA (though potentially not a resit), however, IMGs are expected to be required to pay a fee (for reference, it currently costs around £1000 to sit PLAB 1).

Why is the UKMLA being introduced?

The aim of the GMC is to treat every candidate fairly, whether they are from the UK, Europe or anywhere else in the world, and regardless of the school that awarded their medical degree (they will however have to be on a list of GMC-recognised universities).

The UKMLA will be a way of standardising the process of enabling candidates to practise in the UK in a way that is inclusive and transparent.

How is the UKMLA scored?

The UKMLA (AKT) will be a pass/fail exam (just like its US equivalent USMLE Step 1). Candidates will need to pass the AKT before progressing to the CPSA.

There is no set pass mark and will use some form of criteria reference standard setting; also there is no fixed percentage of the number of people who will pass or fail – 100% of takers can potentially pass.

Are UKMLA questions different to MSCAA questions?

UKMLA questions are likely to be a hybrid of the questions curated by the Medical Schools Council Assessment Alliance (MSCAA) - already used by partner medical schools to formulate their Finals exams - and existing PLAB 1 questions, in terms of both content and depth.

Will UKMLA be harder than PLAB?

The short answer is - "Probably, yes!" While it can sometimes be easy to arrive at an answer to a PLAB 1 question even if all the information isn't available, UKMLA questions are more challenging. The new exam is also likely to have a higher pass threshold than PLAB 1.

Fear not, though, as at Pastest we will be launching a comprehensive and accurate UKMLA (AKT) resource in 2023 that will give candidates the best possible chance of passing the exam at the first attempt.

Will results be made public?

The GMC has stated that although individual student scores won't be released, some data will be made public. For example, medical schools may be able to rank themselves and view their positions in league tables based on student performance.

What happens following the completion of the UKMLA?

After completing the UKMLA as part of their study at a UK medical school, students will be able to apply to join the GMC’s medical register. IMGs will be required to meet the GMC’s other conditions, such as providing evidence that they have an acceptable primary medical qualification, clinical experience and the necessary knowledge of English.

Will I have to pay for the UKMLA?

Students at UK medical schools will not be charged to take the UKMLA. Your university will cover the cost of the exam, but you may be required to pay for resits.

While we wait for UKMLA…

Throughout 2023 at least, UK medical students and IMGs will be sitting their exams as normal. Pastest offers high-quality and highly affordable resources and UKMLA practice papers for the Medical Student Finals and PLAB 1 exams - sign up today and enhance your chance of exam success.

Need further information? The MSC provided a webinar in November 2022 to clarify a few points raised, access here.