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 health and community services hospital on an island in the Channel region seeks a Staff Grade Obstetrics & Gynaecology doctor with skills in operative deliveries and general gynaecology. The department includes a team of consultants and is supported by a substantial team of middle-grade doctors. Applications are open to doctors from the UK and internationally, with preference given to those with a European Specialist qualification or MRCOG.
Portfolio support (CESR) discussions can be arranged on an individual basis.
JOB REQUIREMENTS AND DETAILS
The role requires 4 years of post-graduate medical training and 3 years in an Obstetrics & Gynaecology setting, with particular experience in labour ward management and operative deliveries. The salary range is £52,299 to £86,405, based on experience or grade.
CORE DUTIES OF THIS ROLE
- Participate in the middle-grade on-call rota to provide continuous Obstetrics & Gynaecology services.
- Assist Consultant Obstetricians and Gynaecologists in patient care and management.
- Attend outpatient clinics and theatre sessions, maintaining high standards of care.
- Engage in training, governance, and clinical audits.
LIFE IN THE REGION
The hospital is located in the island\'s capital, offering both urban and coastal living choices. Residents enjoy strong transport links to the UK, quality schools, and ample leisure activities, from beaches and nature trails to historical sites. The area offers a unique mix of British and French influences, seen in its cultural and historical landmarks.
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
- 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 acute hospital trust in the West Midlands is looking for a Specialty Doctor in Emergency Medicine with an interest in Paediatric Emergency Medicine, Major Trauma or Ultrasound. The Emergency Medicine department comprises a team of 16.7 consultants and is supported by a large team of middle grade doctors. This Emergency Medicine job is open to both international applications and UK-based doctors, though those with European Specialist or MRCEM qualifications 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
Full GMC registration, MBBS or equivalent and at least four years of postgraduate training (including at least two years in Emergency Medicine) are required for this role, and anyone with an interest in Paediatric Emergency Medicine, Major Trauma or Ultrasound should apply. The salary will be between £59175 and £95400 dependent on experience or grade.
CORE DUTIES OF THIS ROLE
-
Provide timely clinical care across all areas of the Emergency Department, including resuscitation, majors, minors, and paediatrics.
-
Support junior doctors and participate in departmental teaching, training, and induction programmes.
-
Collaborate with multi-disciplinary teams to ensure safe and effective patient flow and management.
-
Participate in the middle grade rota covering 24/7 Emergency Department services, including cross-site working.
LIFE IN WEST MIDLANDS
This post is based in Worcestershire, offering access to both Worcester and Redditch, with the choice of vibrant city living in Worcester or rural tranquility in the surrounding countryside such as Malvern Hills. The region boasts excellent transport links via rail and road, a strong selection of schools, and a wide range of leisure options including countryside walks, sports clubs, and cultural attractions. Historically, Worcestershire is steeped in British heritage, known for the Battle of Worcester and as the home of composer Edward Elgar, offering rich cultural and historical experiences.
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
Consultant Psychiatrist (General Adult Psychiatry) – Republic of Ireland
Location: Republic of Ireland - South
Salary: €222,215 to €266,925 per annum
Organisation: Health Service Executive (HSE), Ireland
Specialism: General Adult Psychiatry
Job Type: Inpatient and Community Services
A trust in the South of the Republic of Ireland is seeking a Consultant Psychiatrist with expertise in General Adult Psychiatry to lead a multidisciplinary team delivering both inpatient and community mental health services. The psychiatry department consists of a diverse and well-established team, including Consultant Psychiatrists, Nurse Team Leads, Community Mental Health Nurses, Occupational Therapists, Psychologists, Support Workers, and other allied health professionals.
This role offers an excellent opportunity to work across varied settings, contributing to high-quality care for adults with complex mental health needs. Applicants with European Specialist qualifications or UK CCT are strongly encouraged to apply, and both internationally based and Ireland-based doctors are welcome.
Job Requirements and Details
- Consultant-level experience in General Adult Psychiatry.
- Eligible for Medical Council of Ireland (MCI) registration with an equivalent European or UK specialist certification.
- Prior experience in adult mental health services is essential.
- Salary ranges from €222,215 to €266,925, depending on experience and qualifications.
Core Duties of the Role
- Provide clinical leadership in General Adult Psychiatry across both inpatient and community settings.
- Supervise and support the development of junior doctors and multidisciplinary colleagues.
- Deliver patient-centred care in collaboration with a skilled multidisciplinary team.
- Contribute to ongoing service development and quality improvement within the department.
Life in the Republic of Ireland – South Region
The South of Ireland is known for its high quality of life, combining vibrant urban life with the tranquillity of coastal and rural living. The region offers beautiful landscapes, excellent schools, rich cultural traditions, and a welcoming community. Well-connected transport links and a variety of recreational and family-oriented opportunities make it a fantastic place to live and work.
How IMG Connect Will Support You
By applying through IMG Connect, you will benefit from dedicated support throughout your relocation and recruitment journey, including:
- CV and application preparation tailored to Irish medical systems.
- Interview preparation, including two in-depth coaching sessions.
- Contract and salary negotiations to ensure you receive the best relocation package.
Once placed, our relocation team will assist with:
- Document collection and verification
- Visa and work permit guidance
- Short- and long-term accommodation solutions
- Travel planning and pastoral support for you and your family, including school search and local integration
This is an exciting opportunity to join a progressive and supportive mental health service, delivering high-impact care in General Adult Psychiatry within one of Ireland’s most scenic and vibrant regions.
Consultant Psychiatrist (Old Age Psychiatry) – Republic of Ireland
Location: Republic of Ireland - South
Salary: €222,215 to €266,925 per annum
Organisation: Health Service Executive (HSE), Ireland
Specialism: Old Age Psychiatry
Job Type: Inpatient and Community Services
A trust in the South of the Republic of Ireland is seeking a Consultant Psychiatrist with expertise in Old Age Psychiatry to lead a multidisciplinary team providing both inpatient and community services. The psychiatry department consists of a diverse team of professionals including Consultant Psychiatrists, Nurse Team Leads, Community Mental Health Nurses, Healthcare Support Workers, Care Home Liaison Nurses, Young Onset Dementia Nurses, Occupational Therapists, Psychologists, Dementia Post-Diagnostic Support, Care Managers, and other support staff.
This role offers a unique opportunity to work across both inpatient and community services, allowing for a broad and varied clinical experience in the field of old age mental health care. The position is open to both international applicants and those already based in Ireland, and those with equivalent qualifications such as a European Specialist qualification or CCT in the UK are strongly encouraged to apply.
Job Requirements and Details
-
Consultant level experience in psychiatry.
-
Eligible for Medical Council of Ireland (MCI) registration with equivalent European certification.
-
Prior experience in Old Age Mental Health is essential.
-
Salary will range from €222,215 to €266,925 depending on experience and qualifications.
Core Duties of the Role
-
Provide clinical leadership in Old Age Psychiatry services across both inpatient and community settings.
-
Supervise and support the training and professional development of junior doctors.
-
Work collaboratively with the multidisciplinary team to provide high-quality care to patients.
-
Participate in the development and improvement of services within the department.
Life in the Republic of Ireland - South Region
The South of Ireland offers a wonderful blend of vibrant urban areas and peaceful rural settings. With stunning coastlines, charming villages, and bustling cities, it’s an ideal location for both professional and personal life. Major cities offer excellent cultural, recreational, and family-oriented opportunities.
Transport links are efficient, and the region is home to highly regarded schools, a wealth of outdoor activities, and a rich cultural scene. Ireland\'s unique history and traditions provide a welcoming and enriching experience.
How IMG Connect Will Support You
When applying through IMG Connect, you’ll receive the full support of an expert recruitment team who will be your recruitment and relocation partners throughout the process. We will support you with:
-
CV preparation with a bespoke session with one of our specialists.
-
Application support with expert knowledge of Irish medical specialties and recruitment processes.
-
Interview preparation including at least two video calling interview sessions.
-
Contract and salary negotiations for the best possible relocation package, including accommodation and other benefits.
Once you have accepted your new role, IMG Connect’s relocation team will guide you through the entire transition, including:
-
Document gathering and verification.
-
Visa and work permit assistance if required.
-
Accommodation support for both short- and long-term housing.
-
Travel and relocation assistance, including support for your family in finding local schools or any other necessary pastoral care.
This is an exciting opportunity to join a dynamic team and contribute to the ongoing development of services in the field of Old Age Psychiatry in the Republic of Ireland\'s South Region.
An NHS general hospital in the East of England is looking for a Consultant General Radiologist with an interest in Gynaecology Imaging. The Radiology department comprises a team of 27 consultants and is supported by a large team of middle grade doctors. This Radiology job is open to both international applications and UK-based doctors, though those with NHS experience 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
FRCR (or equivalent), and completion of general radiology training and anyone with Gynaecology Imaging experience should apply. The salary will be between £105,504 and £139,882 dependent on experience or grade.
CORE DUTIES OF THIS ROLE
-
Provide a consultant-led service in General Radiology and subspecialty Gynaecology imaging.
-
Participate in the general radiology on-call rota (currently 1:15–1:16) and support acute inpatient and A&E CT, MRI, and ultrasound reporting.
-
Contribute to the supervision, teaching, and professional development of Radiology SpRs and other junior colleagues.
-
Engage in departmental governance, audit activities, and multi-disciplinary team meetings.
LIFE IN EAST OF ENGLAND
This role is based in a historic market town with easy access to urban centres and picturesque countryside. Families benefit from excellent schooling options and direct rail links to London, alongside coastal attractions and green spaces. The area is renowned for its Roman history and longstanding significance in shaping British heritage.