Exam pressure in healthcare training

High-stakes exams run through every healthcare career. Trainee pharmacists sit the Common Registration Assessment at the end of the foundation year. UK medical students pass the Medical Licensing Assessment before joining the register. Doctors in training face royal college membership exams, often while working full rotas. Most of the stress comes from three sources: the exam rules, the study load and life outside work. Each needs a different kind of help.

Know the rules before you revise

Exam rules decide what happens if things go wrong, so check them early. For the Common Registration Assessment, the regulations for 2026 sittings set out these points:

• The assessment has two parts on the same day: 40 calculation questions in Part 1 and 120 multiple-choice questions in Part 2. You must pass both at the same sitting.
• You get a maximum of three attempts, and only within the time limit for applying to register.
• Reasonable adjustment requests go to the GPhC, for candidates in Great Britain and Northern Ireland, by the published deadline. Late requests are not considered.
• If you sit while ill or affected by a known problem, the GPhC treats you as fit to sit. A known illness cannot later be grounds for appeal.
• You can withdraw before starting Part 1, and the sitting does not count as an attempt. Fees are not refunded.

Northern Ireland candidates apply through the Pharmaceutical Society of Northern Ireland and need at least 39 weeks of training. Medical students should read their medical school's guidance on the Applied Knowledge Test and the Clinical and Professional Skills Assessment, the two parts of the MLA. College exams have their own regulations on attempts and adjustments.

Agree study time with your supervisor

Revision alongside full-time clinical work needs a plan your employer has agreed to. Ask your designated supervisor, educational supervisor or line manager for:

• Protected study sessions on the rota, with dates written down.
• Annual leave or study leave around the exam date.
• No extra shifts in the final two weeks.
• A mock exam or feedback session with a senior colleague.

Foundation trainee pharmacists in community pharmacy often find study time squeezed by dispensing pressure. Record the agreed time and raise any repeated loss of sessions with your training programme lead. The workload guide covers how to raise staffing problems.

Reasonable adjustments for exams

Dyslexia, ADHD, anxiety disorders, diabetes and many other conditions can qualify for adjustments such as extra time, rest breaks or a separate room. Apply early with medical or specialist evidence. Under the Equality Act 2010 in England, Scotland and Wales, exam bodies and employers must make reasonable adjustments for disabled candidates. Northern Ireland has its own disability discrimination law with similar duties. If a request is refused, ask for written reasons and check the appeal process.

Look after sleep and health during revision

Night shifts and late revision wreck sleep, and poor sleep lowers exam performance. Keep at least one full rest day a week. The guide on sleep and night shifts has practical tips. If worry stops you sleeping or eating for more than a fortnight, see your GP or occupational health.

Support organisations during exam season

After a fail

A failed attempt is common and recoverable. Ask for your result breakdown, book a meeting with your supervisor and agree a new study plan before rebooking. Check how many attempts remain and the time limit for registration. Students should also read the student and trainee stress guide. If a fail leaves you feeling hopeless, use the urgent support page, call NHS 111 or Samaritans on 116 123.

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