UKMLA AKT Paper 1 vs Paper 2: Key Differences | MedRevisions

Paper structure at a glance

• Paper 1 — 100 SBAs in 2 hours. That's 1m 12s per question. Sat in the morning of the exam window.
• Paper 2 — 100 SBAs in 2 hours. Same pacing, but sat after Paper 1 in the same window. Stamina matters.
• Both papers are sat sequentially with a structured break between them. Treat them as one continuous exam day, not two separate exams.
• Both papers draw from the same MLA Content Map but with different specialty emphasis (see below).

Where Paper 1 weights more heavily

• Acute and emergency medicine — chest pain, sepsis, stroke, anaphylaxis, DKA, acute abdomen, head injury, mental-health emergencies.
• Surgical decision-making — when to operate, when to image, how to escalate.
• Clinical reasoning under uncertainty — what's the most likely diagnosis given limited data?
• Pharmacology and prescribing — first-line agents, common interactions, contraindications.
• Investigation choice — which test next? At what point in the pathway?

Where Paper 2 weights more heavily

• Chronic disease management — long-term diabetes, asthma, COPD, hypertension, heart failure, IBD, CKD.
• Ethics and professional standards — capacity, consent, confidentiality, escalation, team dynamics, patient safety.
• Communication-heavy stems — breaking bad news, complaints, family conflicts, MDT discussions.
• Public health and prescribing safety — community-level decisions, polypharmacy, medication reconciliation.
• Population-level reasoning — screening, immunisation, public-health interventions.

Pacing rules that actually work

• On Paper 1, 1m 12s/question feels tight because acute stems are detail-rich. The trap is over-investing in the first 30 questions and running out of time at the end.
• On Paper 2, the same 1m 12s/question feels easier because the content is denser-but-familiar — the trap is fatigue. Most students lose 4-8 marks on Paper 2 to drift, not to knowledge.
• If a question takes more than 90 seconds, flag it and move on. Returning fresh saves more marks than forcing a decision while uncertain.
• Aim to finish each paper with 5-8 minutes spare — that's your buffer for the 5-10 flagged stems you'll want to revisit.

How to prep each paper differently

• Front-load Paper 1 prep with acute medicine and surgery. Use the platform's specialty filter to build daily 30-50 SBA blocks across emergency presentations.
• Back-load Paper 2 prep with ethics, chronic disease, and communication. These topics are often under-rotated through in school placements but heavily tested.
• Sit at least 2 chained Paper 1 + Paper 2 mocks before exam day. The first one will hurt — that's the point. Stamina is a skill you build deliberately.
• Use the exam debrief after each chained mock to compare your accuracy distribution between Paper 1 and Paper 2. The bigger gap is where the bigger top-up effort needs to go.

Common mistakes the AKT punishes

• Treating Paper 2 as 'more of Paper 1'. The content emphasis genuinely shifts — bring different mental energy to it.
• Anchoring on diagnosis when the stem asks for management. Read the question stem carefully; AKT stems often ask 'what's the next step?' not 'what's the diagnosis?'.
• Ignoring ethics and professional-standards practice because it 'isn't medicine'. It's a bigger Paper 2 weight than most students appreciate, and it's testable in a structured, predictable way.
• Skipping prescribing-safety questions because they look like noise. They're a recurring theme on Paper 2 and a fast way to lose marks if you haven't drilled them.