PLAB 1 Preparation in 2026: Booking, Syllabus and a 12-Week Plan
PLAB 1 is a three-hour paper of 180 single best answer questions, run four times a year by the General Medical Council. The fee is £283 for bookings made on or after 1 April 2026, you get four attempts, and you can sit it overseas — including at British Council venues in Pakistan, India and Nigeria. Most doctors need 10–14 weeks of question-led preparation to pass first time. This guide covers eligibility, booking, the content blueprint, a 12-week study plan and the traps that cost overseas graduates marks.
Where PLAB 1 sits in the GMC route
PLAB is the standard route to registration for international medical graduates whose degree does not carry an exemption. The order is fixed: an acceptable primary medical qualification (listed in the World Directory of Medical Schools), then evidence of English, then PLAB 1, then PLAB 2 in Manchester, then registration with a licence to practise. You cannot book PLAB 1 until GMC Online shows both your qualification and English evidence as accepted.
For English, most candidates use IELTS Academic with 7.5 overall and at least 7.0 in each skill, or OET (Medicine) with grade B in all four sub-tests — in both cases the certificate must normally be under two years old. Many doctors find OET's clinical scenarios easier to score on — see our OET vs IELTS comparison and our guide to OET Medicine requirements for GMC registration.
Two deadlines run through the whole route. You must pass PLAB 2 within two years of passing PLAB 1, or the result expires and you sit PLAB 1 again — the pandemic-era three-year window ended on 31 March 2025. Your registration application should then be approved within two years of passing PLAB 2; with an older pass, the GMC asks for extra evidence. Both clocks run from the date you sat each exam, not the date results were issued. Pass PLAB 1, drift for eighteen months, and you pay twice.
PLAB 1 format, fee and rules in 2026
Since August 2024, PLAB 1 has been delivered as the Applied Knowledge Test (AKT) of the Medical Licensing Assessment (MLA). The paper is written to the MLA content map — the same blueprint UK final-year medical students are assessed against — with professional behaviour questions anchored to the GMC's Good Medical Practice. The GMC refreshes the content map periodically — check the version for your sitting and that your question bank is updated.
| Item | Detail (2026) |
|---|---|
| Questions | 180 single best answer (one right answer from five options) |
| Time allowed | 3 hours (an average of one minute per question) |
| Fee | £283 for bookings from 1 April 2026 — check the current fee before you pay |
| Blueprint | MLA content map and Good Medical Practice |
| Attempts | 4, plus one final attempt by application after 12 months of evidenced further learning |
| Pass mark | Set separately for each sitting by standard-setting — no fixed percentage |
| Validity | Pass PLAB 2 within 2 years of PLAB 1; registration approved within 2 years of PLAB 2 |
There is no negative marking, so never leave a question blank — and because the pass mark is set fresh each sitting, do not chase a rumoured percentage.
Booking: 2026 dates, centres and refund rules
PLAB 1 runs four times a year. In 2026 the 12 February and 21 May sittings came first, with August and November following the usual pattern; each date and its booking window is published in GMC Online.
You book through the 'My Tests' section of GMC Online. Seats are released in batches, and overseas centres sell out fastest — often within hours. Have your English evidence accepted and be logged in when a release is announced. If you hold an NHS job offer that depends on GMC registration, contact the GMC's PLAB team for help securing a place; fee help also exists for refugee doctors.
Sittings outside the UK and EU run at British Council venues; UK and EU exams are delivered by the GMC's partner VICTVS. Exact venues are confirmed close to each sitting. Recent overseas locations include:
- Pakistan: Islamabad, Karachi and Lahore have all hosted sittings
- India: New Delhi, Mumbai, Chennai, Kolkata, Bangalore and Hyderabad
- Nigeria: Lagos and Abuja
- Elsewhere: cities including Dubai, Dhaka, Cairo and Colombo
The cancellation rules reward early decisions. Cancel at least 42 days before the exam and you are refunded minus a 10% cancellation fee (£28.30 at the 2026 fee); cancel later and you normally lose the full £283 — unless you cancel and then email evidence of documented exceptional circumstances such as visa refusal, travel restrictions, ill health or bereavement. There is no transfer process: to change dates, cancel and rebook. Overseas booking closes roughly six weeks before the exam — and because candidates cancel before the 42-day cut-off to protect their money, returned seats often appear around then. Check daily if you missed the release.
What PLAB 1 actually tests
The GMC does not publish exact question weightings, so treat the shares below as a planning guide, not a guarantee. The consistent theme: common UK presentations, managed the UK way, at the standard of a doctor entering the second year of the Foundation Programme (F2).
| Area | Rough share | Highest-yield topics |
|---|---|---|
| Acute and emergency care | 10–15% | Sepsis, anaphylaxis, acute coronary syndromes, DKA, head injury rules |
| Cardiovascular and respiratory | 10–15% | Heart failure, atrial fibrillation, asthma and COPD step-up treatment, PE |
| Gastroenterology and surgery | 8–12% | GI bleeding, the acute abdomen, post-operative complications |
| Obstetrics and gynaecology | 8–10% | Pre-eclampsia, antepartum haemorrhage, contraception eligibility |
| Child health | 8–10% | The febrile child, developmental milestones, non-accidental injury |
| Mental health | 6–10% | Risk assessment, Mental Health Act basics, first-line drug choices |
| Endocrine, renal and urology | 6–10% | Diabetes management, AKI vs CKD, electrolyte emergencies |
| Neurology, ENT, eyes, skin, MSK | 10–15% | Stroke pathways, red eye triage, skin cancers, hot swollen joint |
| Ethics, law and professionalism | 5–10% | Consent, capacity, confidentiality, DVLA duties, safeguarding escalation |
| Prescribing and pharmacology | 5–10% | NICE first-line choices, interactions, prescribing in pregnancy |
Notice what is missing: rare syndromes, detailed pathology, exam trivia. PLAB 1 rewards doctors who drill safe, guideline-based first steps, not those who revise it like a specialty exam.
A realistic 12-week study plan
Twelve weeks at 2–4 hours a day suits most working doctors; full-time candidates can compress this to 8–10 weeks. Build everything around a UK-focused question bank, the GMC's own sample questions and spaced repetition. Aim for 3,500–4,500 questions in total.
| Weeks | Focus | Question volume | Revision method |
|---|---|---|---|
| 1–2 | GMC sample questions as a diagnostic, then core medicine (cardio, respiratory, GI) | 30–40/day, untimed | Read every explanation; start a flashcard deck from misses |
| 3–4 | Endocrine, renal, neurology, infection | 40–50/day | One-page NICE first-line summary per condition; tag weak topics |
| 5–6 | Obstetrics and gynaecology, paediatrics, mental health | 40–50/day | 20–30 minutes of flashcard review daily before new questions |
| 7–8 | Surgery, MSK, ENT, eyes, skin, plus ethics and law | 50/day, mixed subjects | One timed 90-question block each week to build pacing |
| 9–10 | Full mocks: 180 questions in 3 hours, one per week | 2 mocks + 30/day review | Analyse mocks by theme, not by question; redo everything flagged |
| 11 | Weak-area blitz from mock data; prescribing and safeguarding second pass | 50–60/day, targeted | Full flashcard sweep; repeat the GMC sample paper |
| 12 | Taper — light mixed questions, exam logistics, sleep schedule | 20–30/day | No new material after mid-week; match sleep to exam timing |
The single biggest predictor of a first-time pass is not hours studied but questions reviewed properly. A question answered, checked and converted into a flashcard is worth five questions rushed.
The traps that catch overseas graduates
Candidates from Pakistan, India and Nigeria consistently lose marks in three areas, because the UK answer differs from home practice.
- UK prescribing and NICE guidance. The correct answer is the NICE first-line option, not what is prescribed at home: nitrofurantoin for uncomplicated UTI, a stepwise asthma ladder, age-based first-line antihypertensives, no antibiotics for most sore throats. If your instinct says "give the stronger drug", pause — PLAB 1 usually wants the conservative, guideline-first step.
- Ethics, consent and capacity. Expect Gillick competence, the presumption of capacity in adults, and confidentiality exceptions such as informing the DVLA — with the paternalistic option deliberately tempting. Respect the competent patient's decision, involve seniors, never lie, never breach confidentiality without a defined legal ground.
- Safeguarding. In child protection scenarios the exam almost never wants you to confront parents or discharge the child; it wants escalation — senior review, the named safeguarding lead, admission if safety is uncertain. Doctors trained without formal safeguarding pathways lose easy marks here.
Give all three a dedicated pass in week 11 — they are dense with marks and light on reading.
Results, and what happens if you fail
Results appear in GMC Online about six weeks after the exam — the GMC emails you when they are ready. You see your score, the pass mark for your sitting, and feedback by clinical area against the candidate average.
If you pass, book PLAB 2 quickly: places queue just like PLAB 1, the fee is £1,036 from April 2026, and your two-year window is already running. PLAB 2 is sat only in Manchester, so overseas candidates also need a Standard Visitor visa — the application process is covered in our UK visit visa guide. If you fail, compare your score with the pass mark, change your method, and book the next sitting. Treat every attempt seriously: after a fourth fail the GMC allows one final attempt, applied for at least 12 months later and evidenced by 12 months of full-time clinical practice with structured supervisor reports, or a postgraduate qualification in a clinical subject — observerships, attachments and shadowing do not count. Budget the whole route before you start: our PLAB cost breakdown totals the exams, English test, travel and registration fees, and our PLAB support service covers planning, booking and structured preparation for both parts.
Frequently Asked Questions
How many attempts do you get at PLAB 1?
Four attempts as standard. After a fourth fail, the GMC allows one final attempt only after at least 12 months, evidenced by either 12 months of clinical practice with structured supervisor reports or a postgraduate qualification in a clinical subject. Each attempt is paid in full — £283 per booking from April 2026 — so a structured first attempt is far cheaper than a casual second one.
How long is a PLAB 1 pass valid?
Two years, counted from the date you sat the exam rather than the date results were issued. You must pass PLAB 2 within two years of passing PLAB 1, or the result lapses and you retake PLAB 1. After passing PLAB 2, your registration application should be approved within a further two years — with an older pass, the GMC asks for additional evidence.
Can I sit PLAB 1 in Pakistan, India or Nigeria?
Yes. As of 2026 the GMC runs overseas sittings at British Council venues, with recent locations including Islamabad, Karachi and Lahore in Pakistan; New Delhi, Mumbai, Chennai, Kolkata, Bangalore and Hyderabad in India; and Lagos and Abuja in Nigeria. Seats at these centres are the fastest to sell out — be logged into GMC Online the day places are released.
What is the PLAB 1 pass mark?
There is no fixed pass mark. The GMC sets it separately for each sitting using a standard-setting process, so published percentages from past exams do not carry over. Aim to score above 70% consistently in full timed mocks, and remember there is no negative marking — answer every question.
How long does PLAB 1 preparation take?
Most successful candidates prepare for 10–14 weeks, working through 3,500–4,500 question-bank items with proper review, weekly timed blocks and two full mocks. Doctors working full time should allow the longer end. Less than eight weeks is rarely enough for graduates new to UK guidelines and ethics.
Passing PLAB 1 first time comes down to booking early and preparing against the right blueprint. Global Pathways supports doctors through the whole GMC route — English evidence, GMC Online setup, exam booking and a structured study plan through OET Medicine preparation and PLAB coaching. Book a free consultation.