Core Revision
How difficult is the AKT, really?
Dr Laura YoungSpecialist Adviser, Educational Design & Neuro-inclusion · 3 min read
Written August 2026
Roughly three quarters of candidates pass the AKT at each sitting, and close to nine in ten UK graduates pass on their first attempt. By the standards of postgraduate medical exams that is not a brutal exam. It does not always feel that way, and there are reasons for that worth understanding.
“How difficult is it?” is really two questions wearing one coat. How hard is it to pass, and how hard does it feel while you are preparing? The answers are quite different.
Across the four most recent sittings, overall pass rates ran between 70.6% and 80.2%. For UK graduates sitting for the first time, between 86.2% and 89.2%. Most people who prepare properly and sit when ready pass first time.
That is worth sitting with for a moment, because the number people carry around in their head is usually much bleaker. Failure is visible and success is quiet, so the exam acquires a reputation out of proportion to its statistics.
Sitting the AKT? Try twenty questions free.
Twenty original AKT questions in the exam's 80/10/10 split: sixteen clinical, two on evidence-based practice and two on organisation and management, with the reasoning after every one and a marked report. Free, no card and the first five are open to all.
The pace, not the content
160 questions in 2 hours 40 gives you about a minute each, and some of those minutes have to absorb a data interpretation item or a long stem. Most doctors sitting it know far more medicine than the paper requires. What they have often not practised is deciding at that speed, repeatedly, for nearly three hours. Difficulty and time pressure feel identical from the inside.
It rewards judgement, not recall
The College is explicit that questions target higher-order problem-solving rather than recall of basic facts. That undoes a strategy that has worked for most doctors since school. You can know the guideline and still get the question wrong, because the question is about what you would do with this patient. Revision that consists of re-reading will not touch it.
Nobody talks about the fifth that is not clinical
10% is evidence interpretation and 10% is practice organisation and management. Candidates who are strong clinically often leave both to the end, then discover that a fifth of the paper is on ground they have not covered. It is not conceptually difficult. It is just unfamiliar, and unfamiliar close to an exam feels like hard.
Almost everyone you are comparing yourself against is also finding it uncomfortable and mostly not saying so. Cohort confidence is a poor measure of cohort readiness. Your timed practice scores are a much better one, and they are the only comparison that tells you anything actionable.
The exam that feels hardest is usually the one where the format is unfamiliar rather than the content. Removing the unfamiliarity is cheaper than acquiring more knowledge, and it is what most people leave until last.
— Dr Laura Young, Specialist Adviser, Educational Design & Neuro-inclusion
The honest summary: the AKT is a fair exam that most well-prepared candidates pass first time, sat under time pressure that catches people who have only practised untimed. Prepare for the pace as deliberately as you prepare for the content, and the difficulty comes back down to size.
