Updated: Sep 9, 2021

The UK Medical Licensing Assessment (UKMLA) is an exam that will be coming into effect for medical students graduating in 2024-25 and probably introduced as a pilot in the academic year prior. UK medical graduates from then on will need to pass the UKMLA before joining the medical register. International medical graduates will be required to pass from early 2023 (it will replace the Professional and Linguistic Assessments Board test - PLAB). The UKMLA has been produced to make sure that UK medical graduates can demonstrate that they meet a common and consistent threshold for safe clinical practice.

What the assessment involves 

It’s a two-part assessment made up of an applied knowledge test and a clinical and professional skills assessment. We will have to sit both parts at our own medical schools on dates chosen by them.

1) The applied knowledge test (AKT) 

  • This is planned to be an on-screen (computer) exam, run by each medical school, with multiple-choice questions. It will test our ability to apply medical knowledge to different scenarios, similar to the types of testing we have had throughout our medical education.

  • Find out more about the AKT in the GMC's joint statement with the Medical Schools Council.

2) The clinical and professional skills assessment (CPSA)

  • This is a practical assessment of our clinical skills and professionalism, which each medical school will set and run. It will run in an OSCE (Objective Structured Clinical Examination) format.

UK medical graduates will still be required to sit the Situational Judgement Test (SJT) but may not need to sit the Prescribing Safety Assessment (PSA) (as this is planning to be incorporated into the UKMLA).


  • The SJT is based on the core material in the GMC’s Good Medical Practice guidelines and studying the practice questions and answers on the official UKFPO website.

  • The SJT is designed to test decision-making skills and predict behaviour on the wards as a doctor.

The Prescribing Safety Assessment (PSA)

  • The Prescribing Safety Assessment (PSA) is a pass/fail assessment of the skills, judgment and supporting knowledge related to prescribing medicines in the NHS.

  • The PSA assesses the prescribing skills of final-year medical students and is based on the competencies identified by the General Medical Council outlined in Outcomes for graduates. These competencies include writing new prescriptions, reviewing existing prescriptions, calculating drug doses, identifying and avoiding both adverse drug reactions and medication errors, and amending prescribing to suit individual patient circumstances.

Preparing for the UKMLA

  • The GMC says that our degree course is the best preparation for the UKMLA - and that we won’t need to learn anything beyond what's already covered in our medical school’s curriculum.

  • The MLA content map can be viewed here and shows the topics and areas that the assessments will cover.

  • It’s all based on the Outcomes for graduates, which sets out what newly qualified doctors from UK medical schools must know and be able to do. Every medical school already needs to make sure their graduates are meeting these outcomes – so hopefully, our medical schools are preparing us already!

Intercalating decisions

  • Intercalation involves taking a year out of the regular medical degree to study a different subject or take on research in an area you are interested in.

  • If you’re considering intercalating, this could mean that you will return to your medical degree when the UKMLA is introduced (the situation I am currently in). However, the GMC encourages students to continue with their intercalation plans - at the end of the day, if you've found an intercalated degree you really like, it offers the possibility of getting an extra qualification and contributes points towards the score used to rank Foundation Programme entrants. Don't miss out on that opportunity just to avoid sitting the UKMLA.

UK medical students will not be required to pay to take the UKMLA, as the costs will be incurred by their respective universities. However, some medical schools may charge for resits.

IMG candidates will have to pay test fees to sit the assessment, as they currently do for PLAB.

Resitting the UKMLA

  • The UKMLA will be part of the requirements for our degree. If you fail it, just as if you fail any other degree requirement, you won’t graduate. In the same way, if you pass the UKMLA but don't meet the other requirements set by your medical school for your degree, you won’t be able to graduate.

  • There will be chances to resit but these have not yet been determined.


The UKMLA and the USMLE are medical licensing exams for the UK and the US respectively. Both will work on a pass/fail basis in the future.

The formats of UKMLA vs USMLE differ in various ways. The USMLE is made up of 3 steps (approximately £900 each) taken by both US and international medical graduates to practice Medicine in the US. The exam assesses your ability to apply medical knowledge as well as your patient-focused skills to ensure you are fit to practice safe and effective medical care.

From the UK, you apply to take USMLE by registering with the Educational Commission for Foreign Medical Graduates (ECFMG). You’ll then need to take USMLE Step 1 (Basic Medical) and Step 2 (Clinical Knowledge) – these can be taken while you’re studying for your Medicine degree. Afterwards, you can take USMLE Step 2 (Clinical Skills). After you’ve passed all three of these stages, you’ll receive a Standard ECFMG certificate. Graduates need full ECFMG certification to apply for Graduate Entry Medicine (GEM) programmes in the US, and completion of one to three years of GEM is required to practice Medicine. The final stage, USMLE Step 3, is then usually taken after the first year of GEM. After your graduate entry programme, you can apply for a license from the US state you wish to practice Medicine in you are applying to take USMLE outside the US, your medical school must be listed on the World Directory of Medical Schools.

The UKMLA, as far as we know, only exists of two exams (the AKT and the CPSA).

Since it seems as though the UKMLA is following in the footsteps of the USMLE, it may make life easier for students hoping to practice as doctors in the USA. In 2024, the ECFMG for foreign medical graduates hoping to come to the USA requires medical school accreditation for students to emigrate from the UK to take up residency posts in the US.

More information can be found here:

Since the UKMLA will be coming into effect around the same time, I don't see why the GMC wouldn't apply for accreditation by an WFME Recognition agency. But for students currently studying for the USMLE and hoping to practice in the USA:

  • Individuals who apply for ECFMG Certification prior to 2024 will continue the examination and certification process under current ECFMG policies, including that their medical school must be recognised by the appropriate government authority in the country where the school is located. Graduates of the medical school must also be eligible to practice medicine in that country, among other criteria.

  • Individuals already certified by ECFMG will not be impacted by this requirement.

Further reading:

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