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The UKMLA
Updated: Mar 26
The UK Medical Licensing Assessment (UKMLA) is an exam that will be coming into effect for medical students graduating in 2025 and probably introduced as a pilot in the academic year prior. It was originally scheduled for 2024 but due to COVID-19, the GMC had to postpone preparations.
UK medical graduates from 2025 onwards will need to pass the UKMLA before joining the medical register. International medical graduates will be required to pass from early 2024 (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 2-part assessment made up of an applied knowledge test and a clinical and professional skills assessment. Medical students will have to sit both parts on set dates chosen by their medical school.
1) The applied knowledge test (AKT)
Planned to be an on-screen (computer) exam, run by each medical school, with 150-200 single best answer questions (similar to what is done currently).
All UK medical schools + the Medical Schools Council will develop the AKT.
Universities will decide on exact dates for AKT to be taken.
Questions will be approved and quality assured by the GMC.
Will test students' ability to apply medical knowledge to different scenarios (again similar to the types of testing we have had throughout our clinical years medical school).
Find out more about the AKT in the GMC's joint statement with the Medical Schools Council.
Final year medical students will need to pass the AKT before they take their CPSA
2) The clinical and professional skills assessment (CPSA)
This is a practical assessment of clinical skills and professionalism, which each medical school will set and run. It will run in an OSCE (Objective Structured Clinical Examination) format and will be integrated into current processes.
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
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 and incoming students
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 intercalating in the year 2022/23 (e.g. between your 3rd and 4th year), you will be the first cohort to sit the UKMLA (graduation in 2025), along with anyone else graduating that year onwards.
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 I wouldn'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.
Foundation programme & ranking
The GMC admits that it will be possible to rank each student on the basis of their performance in the UKMLA, but it is unclear whether this information will be shared with medical schools or the public. Introducing league tables of performance in the UKMLA could increase competitiveness between medical schools, and they might start marketing themselves as institutions that offer prospective students a higher chance of passing the UKMLA.
It is not currently confirmed that the UKMLA will be used to rank medical students as the SJT will remain to do that. However, it is likely that since the UKMLA is replacing finals, it will make up the EPM. There may be a standardised weighting of this as part of the EPM instead of universities deciding themselves.
The UKMLA vs. USMLE
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.
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: https://www.ecfmg.org/accreditation/
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 or who have started the process will not be impacted by this requirement.
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