MRCGP exams

Why will there now be fewer items in the AKT examination?

The RCGP is committed to reducing the burden of assessment on candidates. Both the GMC and the Academy of Medical Royal Colleges have openly supported reviews of assessments to achieve this aim. We also recognise the potential impacts on differential attainment with lengthy examinations.

We have conducted a very thorough review in anticipation of this move, which has been supported by external assessment reviews, multiple stakeholder views and an AKT Fairness Review conducted in 2023. We have been able to demonstrate to the GMC that we can still maintain comparable levels of curriculum coverage, reliability and validity by reducing the burden on candidates. In doing so, we can be confident that there will be no adverse impact on the passing standard or to the safety of patients. 

Will there be the same amount of time per item?

Candidates sitting the AKT from October 2025 will experience a shorter examination but with a slight increase in the time available per item. We consider this an inclusive adjustment for candidates, irrespective of whether English is spoken as a first language, or whether there are differences in information processing between individual candidates. 

Candidates will benefit from:  

• an increased amount of time available overall per item
• a reduced total amount of time reading and processing information
• an expected reduction in the already small number of candidates omitting to answer items near the end of the examination. This will be due to the small amount of extra time available overall, and a less tiring total examination length

How will these changes benefit candidates with a diagnosed disability?

This change from October 2025 will mean:

• more inclusive test centre availability as morning and afternoon examination sessions will now also be equally available for: 
  • candidates granted the reasonable adjustment of +25% extra time
  • candidates with medical evidence supporting a morning rather than afternoon sitting
• subject to test centre availability, single rooms will now be available in both morning and afternoon examination sessions for candidates granted this reasonable adjustment.

Will it be harder to pass the examination?

It is important to remember that all postgraduate training and assessments are regulated by the General Medical Council (GMC). We are required to demonstrate detailed submissions, which include multiple equality and diversity impact assessments. The GMC has approved these changes, which therefore ensure that the passing standard of the examination will remain the same, even with fewer items, and that the overall curriculum coverage and reliability of the examination remains as high as before.

Should I wait until October for taking my AKT?

You should sit the AKT when you and your educational supervisor believe you to be ready. The RCGP provides sufficient capacity for over 8000 candidate sittings of the AKT each academic year, which is well in excess of the usual 6400 candidate sittings expected each year. However, if no candidates sat the examination in April and/or July there would not be enough capacity for every candidate to sit the examination in October.

Whilst there are fewer items in the examination, the standard will remain unchanged and so the decision should remain one around which date is the best fit with current training plans. For many candidates it will be preferable to pass the AKT and focus attention on the SCA.

Will the method of setting the pass mark/standard of the AKT be changing?

The AKT results will continue to be analysed by independent psychometric experts but now we will be using the well-established, international ‘gold standard’ of Item response Theory (IRT). Historically, the AKT has always been analysed by using Classical Test Theory (CTT), in accordance with international good practice. CTT has allowed accurate analysis of item performance and underpinned the maintenance of the passing standard over many years.

Over the past year, we have extensively modelled and piloted IRT as a background process to ensure that there are no unintended consequences of implementing changes to an already very reliable assessment.

Why is IRT being implemented?

As examination volumes have increased, the use of IRT has been seen as a logical next step to bring about enhanced analysis of examination candidate data. IRT is a more sophisticated analysis method and brings many immediate benefits, including: 

• being instrumental in ensuring that the shorter AKT will be at the same standard and maintain the same very high levels of reliability 
• even more precision and confidence around candidate ability, particularly around the pass mark
• even higher certainty about the maintenance of equivalent examination difficulty over time
• additional item performance information, which in turn adds another layer of quality assurance to existing processes including: 
  • even better identification of underperforming items
  • sharper focus of item writing
  • simpler process of improving items

IRT will also help to future proof the AKT in opening a wider range of potential future options, which the RCGP can explore, including:

• automatic test assembly 
• increased examination frequency
• practice-based examination delivery 

When will the RCGP begin using IRT for standard setting?

We will begin to use IRT as the prime statistical analysis of item performance, and the maintenance of the AKT passing standard, from February 2025. We will still use CTT in the background to ensure the transition is efficient, effective and most importantly delivers comparable results.

How will a move to IRT impact examination candidates?

There are no consequences for GP Registrars taking the AKT from February 2025 onwards. This important background change does not affect item content, curriculum coverage, nor the assessment of the passing standard. 

Revision planning and examination technique should not be planned any differently.

There are no changes to the style of single best answer items, multiple best answer items, free text and extended matching items. There will still be one mark awarded for each correct answer, and there will still be no negative marking.

Importantly as well, our extensive submission to the GMC highlighted that there was no adverse impact on any demographic candidate groups. 

Will the passing standard of the examination change?

No, the standard required to pass the examination will remain the same. The Angoff method will continue to be used to set the overall standard of doctors progressing into independent General Practice. More detail on this is readily available in the general Standard Setting FAQs (PDF file, 182 KB).

As there are now fewer items in the AKT, will the fee be reduced?

The RCGP already outlines on the website how the MRCGP is funded by candidate fees and that the College makes no profit from the examination. The costs of moving to IRT and undertaking the data analysis have been significant. There are no immediate cost savings made in moving to IRT and reducing the assessment length.

There are now four sittings per year, and we increased the number of sittings in July without increasing candidate fees. We will still offer examinations over four sittings and continue to develop the same number of items into the item bank of those used in tests to continue to offer the same levels of reliability. The number of reasonable adjustments continues to rise.