Reasonable adjustments for AKT

Before reading the list below, please visit the Comfort Aid List from Pearson VUE (external PDF). This provides all the items that you are allowed to take into a Pearson VUE Test Centre without needing pre-approval.

Water is allowed in the testing area but must be in a clear (free of labels) and resealable container with a sports cap, of no more than 750ml, which will be subject to visual inspection by an invigilator prior to being taken into the testing room.

• Example image of water bottle (PDF file, 145 KB)

Ergonomic chairs - Most Pearson VUE Test Centres have ergonomic chairs as standard; however specific seating cannot be guaranteed due to facilities varying across sites. Please contact exams.accoms@rcgp.org.uk after you have booked your test centre if you require an ergonomic chair and we will be able to confirm your test centre’s seating arrangements.

When requesting reasonable adjustments, please only list the items/requirements that are not on the Comfort Aid List.

Please note that these reasonable adjustments will only be considered and approved if there is clear information about their requirement in your supporting evidence.

• Extra examination time*
• Extra breaks* - extra time will be added to the examination but the clock will not stop, and you will have to manage your breaks yourself
• Permission to access snacks/drink
• Wheelchair access
• Separate room - please note that these are not soundproofed. We cannot guarantee a room in the Pearson VUE test centre you have made your booking in. There is the possibility of you having to move to another centre in order to accommodate this request.
• Permission to bring coloured overlay and fixative e.g. blu-tack
• Adjustable contrast and font (font size, background colour) - this will be added to your examination, and you can make the adjustments to suit your needs.
• Reader, scribe or reader scribe **
• paper examination – paper examination candidates are only able to sit the AKT at the RCGP office in London.

*Please note that, from October 2025, candidates with adjustments of extra breaks or extra time of up to 25% extra added time will be able to sit the AKT examination in the morning and the afternoon. Any candidate with adjustments that lead to more than 25% extra time being added to the examination, will be able to sit the examination in the afternoon.

** A Reader reads the questions & answer options to the candidate; a Scribe types the candidate's answers and Reader Scribe reads the questions & answer options to the candidate and types the candidate's answers. In exceptional circumstances the use of a reader/scribe/reader scribe (a person, not software) may be available. However, this would require the candidate to demonstrate a genuine need and in this regard, we would expect that they could demonstrate the regular use of an adjustment of this kind, or a comparable adaptation, within their workplace.

Some topics that are commonly raised about reasonable adjustments:

Provision of a paper version of the examination

Decisions are made on a case-by-case basis and, in exceptional circumstances, a paper version of the AKT examination may be provided and sat at the RCGP, 30 Euston Square, London. Pearson VUE cannot accommodate paper examinations.

Reasonable adjustments must be proportionate, and the routine provision of paper examinations is costly and challenging, particularly as some question formats are specifically designed for computer-based delivery and marking. It should also be remembered that GP Registrars are required to use computer-based medical records on a daily basis and so a candidate who requests a paper version would need to be able to demonstrate the comparable adjustments that are made for them in the workplace to accommodate this.

Provision of more than 25% extra time

For specific learning difficulties, such as dyslexia, the RCGP, in line with current national practice, routinely offers extra 25% examination time. This is almost always justified by the supporting professional evidence and adequate to ensure a level playing field with other candidates. The RCGP has a responsibility to ensure that candidates with a specific learning difficulty are supported and are not disadvantaged due to their disability, however it also has the responsibility of making sure that such a candidate does not receive any unfair advantage over other candidates. The standards expected of a high stakes national licensing examination such as the AKT cannot be compromised for reasons of patient safety.

In order to consider more than 25% extra time, the RCGP would need to see more supporting evidence. The RCGP must be able to clarify what impact the learning difficulty is having on day-to-day functioning and the adjustments that are in place to support the candidate within their usual workplace.

RCGP would only accept more than 25% extra time under exceptional circumstances where significant workplace adjustments have been made to accommodate the learning difficulty. Such significant extra time can make examinations last more than five hours, which some candidates could then find very tiring.

It is worth remembering that candidates often find other adjustments helpful, such as screen overlays, background colour changes and font size changes etc. These, along with the 25% extra time, are more than sufficient for the vast majority of applicants.

Provision of extra time for candidates for whom English is an additional language

This section is relevant when considering English for Speakers of other languages (ESOL).

Candidates with a specific learning difficulty are entitled to extra time in the examination, provided that they submit a report from an educational/chartered psychologist or an appropriately qualified specialist teacher (PATOSS) who endorses this.

This assessment needs to be in English and be undertaken post-16 years of age. If it involves a candidate for whom English is an additional language then the assessor, needs to include details of their experience in assessing individuals with this characteristic.

If one of their recommendations is for extra time, then it needs to be clear that this is due to the candidate's underlying disability (as defined by the Equality Act 2010) rather than the fact that English is an additional language.

Use of text-to-speech

The RCGP is not able to offer the use of text-to-speech software as an adjustment. This is due to practical reasons, including the use of pictures and graphs, the use of medical terminology and the security considerations of Pearson VUE centres in allowing additional software to be added to their computer systems.

Before completing our online form with your adjustment requests for the AKT, please check the AKT comfort aid list. The AKT Comfort Aid List has a list of items you may bring into your examination without pre-approval from the RCGP.

To request reasonable adjustments for the AKT you must:

1. Submit an AKT request for reasonable adjustments online form
2. Submit supporting evidence of the requested reasonable adjustments to exams.accoms@rcgp.org.uk

Please note that we need both the online form and the supporting evidence in order to make a decision regarding your requests. If your supporting evidence is being submitted at a later date, please make sure it can be submitted before the deadline date, which is 15 working days before the booking window.

If you are unable to meet the deadlines for the submission of requests (see deadlines at top of the page) you can choose to sit at a later date or book and take the examination without adjustments. Note that submitting your reasonable adjustments late will not entitle you to request that the examination is voided. Please check the void examinations following a diagnosis of disability section of this website for further information.

Requests can be submitted at any point after starting training, or after a new diagnosis. We encourage you to submit your request as soon as possible.

Please note that we need both the online form and the supporting evidence in order to make a decision regarding your requests. If your supporting evidence is being submitted at a later date, please make sure it can be submitted before the deadline date, which is 15 working days before the booking window.

If you are unable to meet the deadlines for the submission of requests (see deadline dates on the reasonable adjustments page) you can choose to sit at a later date or book and take the examination without adjustments. Note that submitting your reasonable adjustments late will not entitle you to request that the examination is voided. Please check the void examinations following a diagnosis of disability section of this website for further information.

Requests can be submitted at any point after starting training, or after a new diagnosis. We encourage you to submit your request as soon as possible.

For pregnant and breastfeeding candidates, we suggest reading through the comfort aid list for the AKT. The AKT Comfort Aid List has a list of items you may bring into your examination without pre-approval from the RCGP.

Information for pregnant candidates

We provide reasonable adjustments for candidates who demonstrate that they are 32 weeks pregnant or further along in their pregnancy at the date of the examination. If you are less than 32 weeks into your pregnancy but experiencing specific symptoms and wish to request a reasonable adjustment, we will require a letter from your GP confirming the diagnosis of the symptoms you are experiencing.

Pregnant candidates who need drinks/snacks available during the examination and/or more frequent access to toilet facilities can request a rest break. The application process is identical to all other reasonable adjustment applications and supporting evidence will be required.

Please be advised that extra rest break time is not granted as standard and is instead considered on a case-by-case basis. Decisions will vary according to the exact nature of the request.

If a pregnancy-related condition means that a pregnant candidate must cancel their AKT sitting at short notice then please refer to the cancellations and refunds policy.

Information for breastfeeding candidates

For test security reasons we are unable to facilitate candidates breastfeeding during the AKT. Children are not permitted to enter Pearson VUE Test Centre premises nor can candidates leave the premises whilst under examination conditions.

Information for breastfeeding candidates wishing to express/pump breast milk

Breastfeeding candidates wishing to express/pump breast milk during the examination can request a rest break and suitable space to do so during the examination. The application process is identical to all other reasonable adjustment applications and supporting evidence will be required.

Breastfeeding candidates are provided with a private space to pump at Pearson VUE Test Centre sites. "Private" means that the space has either a door that closes or a privacy screen to provide a secure environment. Please note, not all sites will have this type of private space, and we are therefore unable to guarantee that a candidate's preferred location will be able to accommodate this adjustment. Please let us know as soon as you have booked your Pearson VUE Test Centre so that we can enquire about the suitability of the test centre for your needs. There is the possibility of you having to move to another centre in order to accommodate this request.

Please ensure to request for any reasonable accommodations as early as possible.

The MRCGP consists of two examination-based and one workplace-based assessment components. All three components need to be passed for a candidate to be considered to have satisfactorily completed specialty training for general practice and be competent to enter independent practice in the United Kingdom without further supervision. Satisfactory completion of the MRCGP is a pre-requisite for the issue of a certificate of completion of training (CCT) by the General Medical Council and full membership of the RCGP.

The two examination-based components are the Applied Knowledge Test (AKT) and the Simulated Consultation Assessment (SCA). It is for these two components that candidate often seek reasonable adjustments for an underlying disability. In order for you to be able to tailor your recommendations to the demands of the examinations we would appreciate it if you could take the time to read this short guide for the AKT examination (you can find the SCA short guide in the SCA section of this website), which will hopefully increase your understanding of what the examinations involve.

The AKT is a multiple-choice examination that tests the candidate's application of knowledge and is normally taken prior to the Simulated Consultation Assessment (SCA). It is computer-delivered in Pearson VUE professional testing centres across the four nations. The examination contains 160 questions, and the standard time allocation is 2 hours and 40 minutes.

There are a number of different formats to the questions:

• Single best answer (SBA)
• Extended matching questions (EMQ)
• Picture/table/chart format
• Data interpretation
• Free text

You can find examples of these on the MRCGP candidate presentation (PPTX file, 3.4 MB).

Some of the questions will involve interpreting information that will be displayed in a similar format to that seen regularly in common medical journals. Some may also require simple arithmetical calculations.

Examples of commonly requested reasonable adjustments can be found in the following sections of the website:

• Reasonable adjustments available - AKT
• Reasonable adjustments webpage