MSRA – a guide for overseas doctors
- February 14, 2023
Many junior doctors applying for Specialty Training in the UK will need to take the MSRA or Multi-Specialty Recruitment Assessment.
The MSRA plays an important role in the shortlisting and assessment process for entry into postgraduate training in several specialties for ST1 and CT1 level jobs, by assessing essential competencies.
In this blog, we will be taking a closer look at the assessment, focusing on some key questions summarised below:
- Who needs to sit the MSRA?
- How is the assessment formatted?
- What is the structure of the MSRA?
- Where can I take the MSRA and how much does the assessment cost?
- How can I prepare for the assessment?
- #IMG Tips
Skip ahead to the relevant section if you know what you’re looking for.
MSRA Specialties
At present, the MSRA is being used within the following specialties:
- ACCS-Emergency Medicine
- Anaesthetics
- Child and Adolescent Psychiatry
- Clinical Radiology
- Community Sexual & Reproductive Healthcare
- Core Psychiatry Training
- Core Surgical Training
- General Practice
- Neurosurgery
- Nuclear Medicine
- Obstetrics and Gynaecology
- Ophthalmology
Not every specialty uses the MSRA in the same way, however on the whole, candidates’ scores from the MSRA are used as part of CT and ST recruitment to shortlist for interviews and selection centres, as well as making up part of your overall ranking (with the rest coming from interviews selection centres).
For example in 2023, GP, CAMHS, and Core Psychiatry Training will not have any interviews or selection centres and 100% of your rank will be determined by your MSRA scores. Core Surgical Training will also be using the MSRA in shortlisting for the first time this year.
MSRA Format
The MSRA is a single computer-based exam comprising two papers: Professional Dilemmas (PD) and Clinical Problem Solving (CPS). As an exam used across many specialties for entry into Specialty Training, the MSRA assesses a foundation level of competence.
There is an optional five-minute break between the two papers. If candidates choose to take a longer break, the extra time will be subtracted from the time available to complete the CPS paper.
A combination of question types is used within the assessment, primarily extended matching questions (EMQ) and single best answer (SBA) questions, however the assessment may also include multiple best answer (MBA) questions: up to 3 correct answers, picture questions: may include skin lesions, blood reports, ECGs etc., and algorithm questions – drag boxes to the right part of the algorithm or select the correct answer from a list.
Structure of the MSRA
The MSRA last 170 minutes and is divided into two sections: Professional Dilemmas (PD) and Clinical Problem Solving (CPS).
Professional Dilemmas (PD)
The Professional Dilemmas (PD) paper is a Situational Judgement Test (SJT) which measures how a candidate’s judgement regarding challenging professional dilemmas they may face.
The PD paper is not a test of knowledge of problem-solving ability or knowledge specific to specialty training within any specialty, but aims to assess professional attributes which are considered important for successful progression through training and performance in one’s clinical role.
Time: 95 minutes
Number of questions: 50
Context: the PD component is set within the context of Foundation Training with the candidate assuming the role of an F2 doctor. There is also a mixture of settings such as a hospital (across a variety of wards or placements), general practice and out-of-hours clinics.
Core competencies: professional integrity, coping with pressure, empathy and sensitivity (you can find more information on the behavioural indicators linked to these competencies here).
Clinical Problem Solving (CPS)
The Clinical Problem Solving (CPS) paper assesses a candidate’s ability to apply clinical knowledge and make clinical decisions in everyday practice.
Again, the CPS scenarios are based on Foundation level clinical practice. They test a candidate’s ability to synthesise and apply medical knowledge (not just knowledge recall).
Questions may relate to the investigation, diagnosis or management of common and important diseases as well as rare presentations.
Time: 75 minutes
Number of questions: 86
Context: the CPS covers 12 clinical topic areas relevant to general medicine. Each test paper includes a balance of scenarios which cover all 12 topics, including:
- Cardiovascular
- Dermatology / ENT / Eyes
- Endocrinology / Metabolic
- Gastroenterology / Nutrition
- Infectious disease / Haematology / Immunology / Allergies / Genetics
- Musculoskeletal
- Paediatrics
- Pharmacology and therapeutics
- Psychiatry / Neurology
- Renal / Urology
- Reproductive
- Respiratory
Core competencies: investigation, diagnosis, emergency, prescribing, management (you can find more information on these domains here).
Exam Centres for the MSRA
The MSRA is held remotely and is delivered in partnership with Work Psychology Group and Pearson VUE. Candidates will need to register for an account with Pearson VUE and once invited, they can book an assessment at a centre, date and time of your choosing (subject to availability).
The MSRA is delivered globally on several consecutive days in many Pearson VUE Computer Testing Centres. You can find your nearest Pearson VUE assessment centre by visiting the Pearson VUE website.
The exam itself is free to sit, but depending on the centre you choose, there may be additional travel and accommodation costs. It’s therefore advisable to book your seat as soon as possible for the best chance of securing a nearby centre.
Preparation for the MSRA
On the whole, your previous (and current) experience working as a junior doctor will have prepared you for most of the questions and scenarios within the MSRA, although to different extents, depending on where you have gained your experience.
However, as your MSRA scores are often added to the interview score to determine overall rank, or even to exempt you from interview, it may be advantageous to attempt to score as highly as possible.
Blueprint: First and foremost, you should use the MSRA blueprint to better understand the target domains.
Sample questions: Sample questions for both papers are available on the Health Education England Medical Education Hub. You can access these here.
Commercial resources: Exam revision courses, books and online question banks are available, although these are not officially endorsed, and you can find some of the most popular providers below:
|
4,000 Question bank and mock tests |
1,950 Question bank and mock tests |
2,200 Question bank and mock tests |
2,500 Question bank and mock tests |
|
£30 - £50 |
£35 - £55 |
£49 - £119 |
£25 - £30 |
#IMG Tips
- Start early – Once you have decided to sit the test, plan well in advance to give yourself enough time to prepare and score as highly as possible.
- Take a test tutorial – You can take a practice test to familiarise yourself with the controls and screen layouts in advance – see Pearson VUE or Oriel for details.
- Negative marking - One mark is given for each correct answer and negative marking is not used within the assessment, so try to answer all questions, even when unsure.
- Read carefully - Read the instructions and questions carefully – you may often be looking for the most suitable answer, rather than the only correct one.
Sources
https://www.bmj.com/careers/article/a-guide-to-the-multi-specialty-recruitment-assessment-msra-
https://heeoe.hee.nhs.uk/sites/default/files/msra_test_blueprint_information_nov_2019.pdf
The MSRA is a key examination for many IMGs developing their careers by entering Specialty Training. UK training programmes are very competitive and particularly for overseas doctors unfamiliar with the NHS system, taking the time for extensive preparation for the MSRA can greatly impact your chances of being successful in joining a training programme.
Read more useful articles on exams, NHS jobs and salaries in our IMG Resources library.
For regular news and updates, follow IMG Connect on social media using the links below:
Relevant Jobs
A UK-based mental health service is seeking a Consultant Child & Adolescent Psychiatrist to join their Neurodevelopmental Team. This is a part-time (0.8 FTE), permanent post, offering an exciting opportunity to take on a senior clinical leadership role within a well-established specialist service for children and adolescents with complex neurodevelopmental conditions.
The team operates within a multidisciplinary framework, delivering comprehensive assessments, pharmacological treatment, and evidence-based care for young people. The role is ideal for experienced consultants looking to shape service delivery while maintaining strong clinical involvement.
This opportunity is also open to international applicants, particularly those eligible for inclusion on the GMC Specialist Register and who will be applying via CESR.
JOB REQUIREMENTS AND DETAILS
-
Job Title: Consultant Child & Adolescent Psychiatrist – Neurodevelopmental Team
-
Contract: 8 Programmed Activities (PAs) per week – Part-Time
- Contract Type: Permanent
- Salary: £105,000 – £139,000 (pro rata, dependent on experience)
Applicants must have:
- Full GMC registration with a licence to practise
- GMC Specialist Register in Child & Adolescent Psychiatry
- Section 12(2) MHA approval, or a willingness to complete this upon appointment
- Experience working in child, adolescent, or neurodevelopmental psychiatric services
- Strong leadership, multidisciplinary collaboration, and communication skills
- The ability to travel independently across service sites, including schools and service users\' homes
CORE DUTIES OF THIS ROLE
-
Lead on psychiatric assessments, diagnosis, and pharmacological treatment planning for young people with complex and/or high-risk neurodevelopmental presentations.
- Provide consultation and guidance to the multidisciplinary team, as well as external agencies including paediatrics, schools, Tier 4 providers, and primary care.
- Maintain clinical oversight for young people under the care of the team, participating in emergency assessments and the consultant out-of-hours rota.
- Attend and contribute to weekly multidisciplinary team meetings and clinical formulations.
- Collaborate with carers, families, and professionals to co-create effective, evidence-based care plans.
- Support transitions from child to adult mental health services in line with protocol.
- Fulfil duties under the Mental Health Act, including conducting assessments and contributing to reports and tribunals as required.
- Maintain clear and timely medical documentation and support audit and quality improvement initiatives.
MANAGEMENT & STRATEGIC RESPONSIBILITIES
-
Provide senior clinical leadership in partnership with the non-medical Clinical Team Lead.
- Contribute to the development of service-wide clinical guidelines and care pathways.
- Support service planning and transformation initiatives based on emerging need.
- Actively participate in governance activities, clinical audit, and performance monitoring.
- Engage with stakeholders and external partners at strategic and operational levels.
LIFE IN THE REGION
This role is based in a well-connected and scenic part of the UK, ideal for those who enjoy a balance between urban accessibility and countryside living. With excellent road and rail links, London is just 1 hour by train and car, offering easy commuting and travel.
The area is highly attractive for families, with access to top-rated schools, green open spaces, and a vibrant local community. Whether you\'re seeking historic towns, cultural attractions, or tranquil rural retreats, this region offers something for everyone.
HOW WILL IMG CONNECT SUPPORT YOU?
When applying with IMG Connect, you’ll have the full support of an expert recruitment team who will be your recruitment and relocation partners throughout the process. We\'ll support you with:
- CV preparation with a bespoke session with one of our specialists.
- Application support with expert knowledge of NHS specialisms & recruitment practice.
- At least two video interview preparation sessions.
- Contract and offer negotiations for salary, relocation packages, tenure, and more.
Once you have accepted your new role, you’ll be supported by one of our dedicated relocation executives, who will guide you through the process, including:
- Document gathering and checking.
- COS and Visa Application support, if applicable.
- Support sourcing short- and long-term accommodation.
- Travel arrangements and family support for finding schools and other aspects of pastoral care.
A leading NHS mental health hospital in the East of England is looking for a Consultant Psychiatrist in Old Age Psychiatry with a focus on functional illness within inpatient care. The service sits within a well-integrated healthcare system combining mental and physical health services. The post is based on a 22-bed ward, supported by a multidisciplinary team including psychologists, occupational therapists, physiotherapists, and speech and language therapists. This Old Age Psychiatry job is open to both international and UK-based doctors, with MRCPsych or EEA specialist certification most encouraged to apply.
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case-by-case basis.
JOB REQUIREMENTS AND DETAILS-
Consultant level experience in old age psychiatry
-
Be eligible for GMC registration, either with MRCPsych (Full), or EEA specialist certification
-
Consultants with an interest and prior experience in old age psychiatry and inpatient functional illness should apply
-
The salary will be between £105,504 to £139,882 dependent on experience or grade
-
Provide medical oversight and psychiatric input for 22 beds (14 for functional illness, 8 for organic illness) on an inpatient ward
-
Conduct psychiatric assessments, care planning, and contribute to regular MDT reviews
-
Supervise junior doctors and support their training and development
-
Collaborate with community teams including the Crisis Resolution and Home Treatment Team for Older People (CRHTT-OP)
-
Liaise with other services such as social care, physical health teams, and voluntary sector partners to ensure coordinated care
-
Engage in clinical documentation, audits, research, and educational activities
LIFE IN THE REGION
This region offers a balance of vibrant urban living and tranquil countryside settings. From lively city centres with extensive amenities to quiet villages rich in charm, there’s something for everyone. The area benefits from excellent rail and road connections (50 minutes to London) high-performing schools, and a diverse mix of leisure and cultural attractions.
Steeped in history, the region is known for its architectural heritage and community spirit, making it a highly desirable location for professionals and families alike.
HOW WILL IMG CONNECT SUPPORT YOU?When applying with IMG Connect you’ll have the full support of an expert recruitment team who will be your recruitment and relocation partners throughout the process. We\'ll support you with:
-
CV Preparation with a bespoke session with one of our specialists
-
Application support with expert knowledge of NHS specialisms & recruitment practice
-
At least two video calling interview preparation sessions
-
Contract and offer negotiations for salary, relocation packages, tenure, and more
Once you have accepted your new role, you’ll then be supported and led throughout by one of our dedicated relocation executives who will guide you all the way to starting your new post, including:
-
Document gathering and checking
-
COS and Visa Application support if applicable
-
Support sourcing short- and long-term accommodation
-
Travel arrangements
-
Family support for finding schools and any other aspects of pastoral care
An NHS Board in Eastern Scotland is looking for a Consultant Psychiatrist with experience in Old Age Psychiatry to lead an outpatient community team.. The Psychiatry department comprises a team of psychiatrists and multidisciplinary professionals including Nurse Team Lead, Community Mental Health Nurses, Community Mental Health Nurses, Healthcare Support Workers, Care Home Liaison Nurses, Young Onset Dementia Nurse, Occupational Therapists, Psychologist, Dementia Post Diagnostic Support, Care managers, DPDS Link Worker, Alzheimer Scotland Link Worker.
This Psychiatry job is open to both international applications and UK-based doctors, though those with European Specialist or MRCPsych or equivalent are most encouraged to apply.
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case-by-case basis.
JOB REQUIREMENTS AND DETAILS
-
Consultant level experience in psychiatry
-
Be eligible for GMC registration, either with MRCPsych (Full), or EEA specialist certification
-
Prior experience in Old Age mental health care.
Anyone with consultant experience in old age psychiatry should apply. The salary will be between £107,144 - £142,369 per annum, dependent on experience or grade.
CORE DUTIES OF THIS ROLE
-
Provide clinical leadership and management in Old Age Psychiatry services.
-
Supervise junior doctors and contribute to their training and professional development.
-
Work closely with multidisciplinary teams to deliver high-quality patient care.
-
Participate in service development and improvement initiatives within the department.
LIFE IN SCOTLAND
This location offers a blend of urban convenience and rural tranquillity, with easy access to major cities such as Edinburgh, Dundee, and Glasgow. Whether you prefer city living with vibrant culture and nightlife or coastal and countryside retreats with stunning landscapes, there are plenty of options.
The region has excellent transport links, making commuting easy, and offers high-quality schools and a wealth of recreational activities, including outdoor pursuits, cultural festivals, and family-friendly attractions.
Scotland is steeped in history, known for its ancient castles, famous universities, and contributions to global innovation. The country provides a unique cultural experience, rich in traditions and scenic beauty.
HOW WILL IMG CONNECT SUPPORT YOU?
When applying with IMG Connect you’ll have the full support of an expert recruitment team who will be your recruitment and relocation partners throughout the process. We\'ll support you with:
-
CV Preparation with a bespoke session with one of our specialists
-
Application support with expert knowledge of NHS specialisms & recruitment practice
-
At least two video calling interview preparation sessions
-
Contract and offer negotiations for salary, relocation packages, tenure and more
Once you have accepted your new role, you’ll then be supported and led throughout by one of our dedicated relocation executives who will guide you through all the way to starting your new role including:
-
Document gathering and checking
-
COS and Visa Application support if applicable
-
Support sourcing short- and long-term accommodation
-
Travel arrangements
-
Family support for finding schools and any other aspects of pastoral care
An NHS teaching hospital in the South West of England is looking for a Consultant Obstetrician with an interest in High-Risk Obstetrics. The Obstetrics department comprises a team of 22 consultants and is supported by a large team of middle grade doctors. This Obstetrics job is open to both international applications and UK-based doctors, though those with European Specialist or MRCOG / FRCOG are most encouraged to apply.
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case by case basis.
JOB REQUIREMENTS AND DETAILS
Previous consultant experience is essential and relevant experience in high-risk obstetrics are required for this role, and anyone with an interest in maternal medicine, diabetes in pregnancy, or perinatal mental health should apply. The salary will be upwards of £105,504 dependent on experience.
CORE DUTIES OF THIS ROLE
-
Deliver high-quality care in general and high-risk obstetrics including antenatal, intrapartum, and postnatal management
-
Participate in a 1:9 on-call rota providing obstetric emergency cover
-
Lead and contribute to specialist outpatient clinics, particularly in maternal medicine or high-risk pregnancy care
-
Support teaching and training of junior medical staff and medical students
LIFE IN THE SOUTH WEST
This hospital is located in a lively town in the South West, surrounded by stunning coastal and countryside areas. Candidates may choose to live in a charming rural village or in a bustling town centre with access to shops, schools, and culture.
The area boasts excellent schools, efficient public transport, and ample leisure options like beaches, hiking trails, family attractions, and dining venues. It’s a fantastic destination for a balanced work-life experience.
Rich in culture and history, this region has strong maritime roots and is known for its contributions to the UK’s industrial and artistic heritage.
HOW WILL IMG CONNECT SUPPORT YOU?
When applying with IMG Connect you’ll have the full support of an expert recruitment team who will be your recruitment and relocation partners throughout the process. We\'ll support you with:
- CV Preparation with a bespoke session with one of our specialists
- Application support with expert knowledge of NHS specialisms & recruitment practice
- At least two video calling interview preparation sessions
- Contract and offer negotiations for salary, relocation packages, tenure and more
Once you have accepted your new role, you’ll then be supported and led throughout by one of our dedicated relocation executives who will guide you through all the way to starting to your new role including:
- Document gathering and checking COS and Visa Application support if applicable
- Support sourcing short- and long-term accommodation
- Travel Arrangements Family support for finding schools and any other aspects of pastoral care
Anyone requiring portfolio support (formally known as CESR) can have their required support discussed on a case-by-case basis.
JOB REQUIREMENTS AND DETAILS
- Consultant level experience in psychiatry
- Be eligible for GMC registration, either with MRCPsych (Full), or EEA specialist certification
- Prior experience in adult community mental health care is desirable.
Anyone with an interest in community or inpatient psychiatry should apply. The salary will be between £107,144 - £142,369 per annum, dependent on experience or grade.
CORE DUTIES OF THIS ROLE
- Provide clinical leadership and management in General Adult Psychiatry services.
- Supervise junior doctors and contribute to their training and professional development.
- Work closely with multidisciplinary teams to deliver high-quality patient care.
- Participate in service development and improvement initiatives within the department.
LIFE IN SCOTLAND
This location offers a blend of urban convenience and rural tranquillity, with easy access to major cities such as Edinburgh, Dundee, and Glasgow. Whether you prefer city living with vibrant culture and nightlife or coastal and countryside retreats with stunning landscapes, there are plenty of options.The region has excellent transport links, making commuting easy, and offers high-quality schools and a wealth of recreational activities, including outdoor pursuits, cultural festivals, and family-friendly attractions.
Scotland is steeped in history, known for its ancient castles, famous universities, and contributions to global innovation. The country provides a unique cultural experience, rich in traditions and scenic beauty.
HOW WILL IMG CONNECT SUPPORT YOU?
When applying with IMG Connect you’ll have the full support of an expert recruitment team who will be your recruitment and relocation partners throughout the process. We\'ll support you with:
- CV Preparation with a bespoke session with one of our specialists
- Application support with expert knowledge of NHS specialisms & recruitment practice
- At least two video calling interview preparation sessions
- Contract and offer negotiations for salary, relocation packages, tenure and more
Once you have accepted your new role, you’ll then be supported and led throughout by one of our dedicated relocation executives who will guide you through all the way to starting your new role including:
- Document gathering and checking
- COS and Visa Application support if applicable
- Support sourcing short- and long-term accommodation
- Travel arrangements
- Family support for finding schools and any other aspects of pastoral care