MSRA – a guide for overseas doctors 

  • April 06, 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: 

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

  1. 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. 
  2. 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. 
  3. 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. 
  4. Read carefully - Read the instructions and questions carefully – you may often be looking for the most suitable answer, rather than the only correct one. 


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: 



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