AKT vs CPSA: The Two Parts of the UKMLA Explained

The AKT and CPSA are the two halves of the UKMLA, and they test genuinely different things: the AKT is a written knowledge test, the CPSA is a practical OSCE. Passing one does not predict passing the other, which is why the biggest risk for many final-year students is over-preparing for the AKT and under-rehearsing the CPSA. This guide compares the two directly and shows you how to prepare for both without one crowding out the other.

For the full picture of the OSCE half, see our guide to the UKMLA CPSA and UKMLA CPSA explained.

What is the difference between the AKT and the CPSA?

The Applied Knowledge Test (AKT) is a computer-based exam that assesses whether you have the knowledge a safe new doctor needs, tested through single-best-answer style questions. The Clinical and Professional Skills Assessment (CPSA) is a practical OSCE that assesses whether you can apply that knowledge live: taking a history, examining a patient, communicating a diagnosis, or managing an acute scenario, in real time, in front of an examiner. Together, the AKT and CPSA make up the UKMLA, and the GMC requires both to be passed to meet the national licensing standard.

AKT vs CPSA: format comparison

	AKT	CPSA
Format	Computer-based, single-best-answer questions	OSCE: multiple timed stations with simulated patients/examiners
What it tests	Applied medical knowledge	Applied clinical and communication skills, in action
Delivered by	Sat as a national computer-based test	Delivered by your own medical school, to GMC standards
Content basis	GMC MLA content map	GMC MLA content map, applied practically
Preparation style	Question banks, spaced repetition, content coverage	Rehearsal out loud, structured feedback, mock circuits
Marking approach	Scored against a set knowledge standard	Marked across domains (data gathering, management, communication) per station
Typical failure mode	Knowledge gaps, poor question technique	Weak structure, poor communication, running out of time in station

Exact station numbers, timings and local pass criteria for the CPSA vary by medical school, so check your own school's handbook for the specifics.

When do you sit the AKT and CPSA in final year?

Scheduling is set by the GMC's national UKMLA calendar for the AKT, and by your own medical school for the CPSA, so exactly when each falls in your final year depends on your school's timetable. Some students sit them with a reasonable gap between; for others they land closer together. Rather than assuming a standard gap, check your school's assessment calendar early in the year so you can plan your revision timeline around the real dates rather than a general assumption.

How preparation differs: knowledge bank vs rehearsal

The single biggest mistake students make with AKT vs CPSA preparation is treating them as the same kind of studying, just with different content. They are not.

AKT preparation is fundamentally a knowledge-bank exercise. You are building and consolidating a body of applied medical knowledge, largely through question practice, spaced repetition, and working systematically through the MLA content map. Progress is visible in your question-bank percentage, and most final-year students already have a reasonably well-worn process for this from years of written exams.

CPSA preparation is fundamentally a rehearsal exercise. Knowing the correct answer silently, in your head, is not the same skill as delivering it out loud, in a structured way, to a simulated patient, inside a time limit, while an examiner is also watching how you communicate and behave professionally. This is a performance skill, and like any performance skill, it only improves with repeated, active practice and feedback, not with more reading.

Why students over-prepare for the AKT and under-rehearse the CPSA

This pattern is extremely common, and it is understandable. Question banks are familiar, quantifiable, and can be done alone at any hour. CPSA rehearsal typically requires a study partner, a room, and the willingness to feel awkward practising a consultation out loud, which makes it easy to keep deferring. The result is a final-year student who has driven their AKT question-bank score steadily upward for months, while their CPSA preparation consists of a handful of rushed practice runs squeezed in shortly before the exam.

The fix is structural, not motivational: build CPSA rehearsal into your weekly schedule from early on, at the same priority level as AKT question practice, rather than planning to "get to it" once AKT revision feels done.

Why passing one doesn't predict the other

It is entirely possible to sit comfortably in the top half of your cohort's AKT question-bank scores and still struggle in the CPSA, or the other way round, and this surprises a lot of students. The reason is that the two assessments draw on genuinely different cognitive skills. The AKT rewards recognition and recall: given a scenario and a set of options, can you identify the best answer under exam conditions. The CPSA rewards generation and delivery: given an undifferentiated patient in front of you, can you construct the right approach yourself, in real time, while also managing rapport, time, and your own nerves.

Students who have spent years excelling at written exams sometimes assume that skill transfers automatically to a practical assessment, and are caught off guard when it doesn't. Equally, students who find question banks slow and frustrating but are naturally comfortable talking to people can find the CPSA plays to their strengths more than the AKT does. Knowing which pattern is more likely to apply to you is useful, precisely because it tells you where to put more of your limited revision time.

What examiners and question-writers are each actually checking

It helps to think about what each assessment is designed to catch. AKT question-writers are checking whether you hold the knowledge a safe FY1 needs across the breadth of the MLA content map: correct diagnoses, correct first-line management, appropriate investigations, and recognising when a presentation is dangerous. CPSA examiners are checking something adjacent but distinct: whether you can be trusted, right now, to sit with a real patient. That includes your knowledge, but also your structure, your communication, your safety-netting, and your professionalism, observed directly rather than inferred from a multiple-choice answer.

This is why a station can go wrong even when your underlying knowledge is sound. You might know the correct management plan perfectly well but fail to communicate it clearly, or run out of time before covering safety-netting, or come across as reciting a script rather than genuinely engaging with the patient in front of you. None of that would show up in an AKT question on the same topic.

A realistic weekly structure for combined prep

A simple way to keep both moving without either being neglected is to timebox them separately within the same week rather than letting whichever feels more urgent dominate:

• Early-to-mid week: AKT-focused sessions, working through question-bank blocks tied to content map topics you haven't consolidated yet.
• Two to three sessions a week, fixed and non-negotiable: full CPSA station rehearsal, spoken aloud, ideally with a partner, tutor, or a structured practice tool, not silent read-throughs of a checklist.
• Weekend or a longer session: a timed mock, alternating between an AKT-style timed question block and a multi-station CPSA circuit, so both skills are regularly tested under realistic pressure rather than only practised in low-stakes conditions.

The specific split matters less than the principle: both categories appear in your calendar every single week, from early in the term, rather than CPSA rehearsal being something you intend to "start properly" once AKT feels under control.

How to run AKT and CPSA prep in parallel

• Timetable both every week, not sequentially. Protect specific weekly slots for full, out-loud CPSA station practice alongside your ongoing AKT question-bank work, rather than finishing one before starting the other.
• Let AKT content feed CPSA rehearsal. When you learn a new condition or guideline for the AKT, immediately rehearse explaining or managing it out loud in a mock station. This reinforces both skill sets from the same study time.
• Use realistic rehearsal tools for the CPSA half. Reading a mark scheme is not rehearsal. Practising against AI voice patients that respond in real time, with feedback broken down by domain, closes the gap between "I know this" and "I can deliver this under pressure" far faster than solo practice with a script.
• Run timed mocks for both. Full-length, timed mock OSCE circuits build the stamina and pacing the real CPSA demands, in the same way timed question-bank sittings build AKT exam technique.
• Track both separately. Do not let a strong AKT percentage give you false confidence about the CPSA, or vice versa. They are different skills and need to be monitored, and rehearsed, as such.

Final thoughts

The AKT and CPSA are not the same exam wearing different clothes: one tests what you know, the other tests whether you can apply it live, safely and clearly, in front of a patient and examiner. The students who do best treat both as equally serious, running knowledge-bank work and out-loud rehearsal side by side from early in final year, rather than leaving CPSA practice until the last few weeks. Start rehearsing full CPSA stations with domain-based feedback on the UKMLA CPSA hub.

This article is general exam-preparation guidance, not clinical advice. Always confirm your exact AKT and CPSA dates, format and pass criteria with your medical school and the GMC's official MLA pages.