Chapter 1 – The Applied Knowledge Test (MCQ/SBA)

Overview of the AKT/MCQ

The Applied Knowedge Test will be centrally set for all UK medical schools with a common format, test standard, delivery process and policy framework. It seems highly likely that these will be in a format similar to that already set for the GMC Professional and Linguistics Board (PLAB) exam.

Question structure

The Medical Schools Council Assessment Allaince has produced comprehesnive guidance for the writing of MCQs and those in the PLAB are written in this format. Each question comprises a clinical scenario (‘the stem’), a single line stating the question itself (‘the lead-in’) and a list of five options (one correct answer and four distractors).

The stem will be written in the present tense and only contain information that pertains to the question. They should be more more than 100 words (ideally 50) and be worded in the simplest form possible.

The lead in to each question will be writtens such that a student should be able to arrive at the correct answer without being able to see the options. This means there should not be questions that are worded ‘which of the following statements are correct’. They also want to focus on the positive and avoid the negative: they should not have phrases such as ‘which is the least likely diagnosis’.

The five options should all be plausible and realistic: there should not be any that you can immediately dismiss as incorrect, and be relevant to the stem and related to the lead in.

Tips and tricks


  • SBA require recall of facts, which are usually descriptive and factual
  • You need to know the material well – Use the MLA content map and the St Emlyn’s Undergraduate Curriculum (for actue care) as a starting point
  • Revision for the SBA requires learning lots of facts. Use different methods to learn these to try to avoid getting bored/stale. Spend some time writing facts, discuss with colleagues, even set each other a quiz.
  • Spaced repetition will help, but this does mean starting revision early.
  • Share the revision load and buddy up.

On the day

  • Eat; drink and toilet break before.
  • TEST CENTRE: Make sure you have a water tight plan on how you are getting there; ensure plenty of time and that you have correct identification.  

When revising

  • It’s still important to understand concepts and not just to memorise definitions.
  • Use flash cards or phone apps to revise on the go. Instead of looking at social media in a spare few minutes revise a fact or two. There are apps available with prepared cards.

The exam

You will have already developed strategies for your own SBA technique during previous years at medical school. The medical school publises guidance as to how SBAs should be written. Read this several times as it helps you get into the mind of the question setter.

There are many strategies for maximising your success on multiple choice exams. The best way to improve your chances, of course, is to study carefully before the exam, but however well you prepare you can still make silly mistakes in the heat of battle.

Here are a few tips to help reduce those potential perils. 

  1. Read the stem very carefully – this may seem obvious, but a single word can change the entire question. Answer what it asks, not what you want to to ask.
  2. If you find yourself taking a long time over one question, skip it and come back later. 
  3. If you return to a question you have skipped and are still struggling, try a process of elimination. Eliminate any alternatives which are: obviously wrong, completely unfamiliar to you from the course, the same ie, two answers that mean the same thing, grammatically/semantically inconsistent (ie, don’t make sense).
  4. Be sure that you have filled out the answer sheet according to the instructions given. Answer every question.
  5. Take time to check your working before you hand in the answer sheet. A multiple choice exams offers you no opportunity for ‘partial credit.’ If you ticked, circled or filled in the wrong option, your answer is 100% wrong, and you may be penalised. 

Collated Resources

In this section you will find  a collation of links useful not only for the AKT but also for the OSCE.  It is divided into adult and paediatric sections, with each area broadly divided by specialties. NICE guidelines are found in the first half of each speciality with other guidelines, in the second half. The links are regularly checked to ensure they still work and are current.

The Royal College of Paediatrics and Child Health (RCPCH) recently released a pdf document that contains links to the latest NICE; SIGN and RCPCH guidelines, it can be found here

A number of the topics are relevant to both adult and paediatric medicine. These will be found in the adult section.

Adult Guidelines

Paediatric Guidelines

Other resources: Adult and Paediatric

Cite this article as: Iain Beardsell, "Chapter 1 – The Applied Knowledge Test (MCQ/SBA)," in St.Emlyn's, April 12, 2021,

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