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: 

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: 



Relevant Jobs

99,532 - 131,964

An NHS Trust in the Midlands is in search of a Consultant Psychiatrist in Eating Disorders. The role is open to overseas consultants with experience or interest in Eating Disorders alongside UK middle grade doctors with S12 who have experience or interest in Easting Disorders. 

This role will primarily focus on the severe pathway. The appointed candidate will offer direct clinical care and clinical leadership to a diverse team, comprising specialist nurses, therapists, psychologists, dietitians, therapists, social workers, and peer support workers. Additionally, there will be occasional cross-cover duties for the inpatient consultants stationed at a 15-bed inpatient unit.

What is the NHS Foundation Trust like?
The NHS Trust serves a population of approximately 850,000 across several towns, provides comprehensive Mental Health Services. Alongside Learning Disability services for a significant region of the West Midlands, it offers tertiary services in Forensic and Child Psychiatry. Furthermore, it extends its reach to Community Health Services within its region. As a teaching Trust, it has strong ties with a university medical school, offering placements for medical students and engaging professionals in teaching and training. The Trust provides higher education facilities for continuous professional development and collaborates closely with the Academic Department of Psychiatry for research opportunities. 

What is the department & team like?

The Eating Disorders Service is a specialist, tertiary service staffed by 4.2 WTE Consultant Psychiatrists, 2.4 WTE specialty doctors, 1.0 WTE ST 4-6, 1.0 WTE CT3, and 1.0 WTE F2 doctor. This multidisciplinary team manages a range of complex cases, including patients with a BMI below 15, those with complex medical or psychiatric comorbidities, pregnant patients, and diabetic patients. Treatments provided encompass individual therapy based on psychodynamic, cognitive-behavioural, and systemic approaches. The service also offers specific pathways for patients transitioning from CAMHS, pregnant patients, and SEED patients, alongside a dedicated Clinic for Eating Disorders and Diabetes, with plans for an ARFID clinic.

Facilities include both an outpatient service and a 15-bed regional inpatient unit, all housed in a self-contained unit on a general hospital site. Annually, the service is expected to handle a caseload of approximately 230 patients, with around 360 new referrals. The team works closely with the Community Mental Health and Wellbeing Teams, the Crisis and Home Treatment Team, and the Gastroenterology Departments at the NHS Trust. This comprehensive service, supported by significant investment through the Community Mental Health Transformation Plan, aims to deliver high-quality, specialized care to patients with eating disorders across the town they service.

Career Development & Opportunities Available

The NHS Trust offers extensive career development opportunities, including CESR support for international doctors seeking specialist registration and access to specialty training. The Trust encourages the development of sub-specialties in areas like eating disorders and psychodynamic therapy.

The Trust is committed to service improvement and innovation through its transformation plan, which includes significant investment in services such as the new Community Eating Disorders Service. This dedication to growth and quality improvement creates an exciting environment for professionals aiming to contribute to meaningful changes in healthcare delivery.

Life like in the area

The town is an urban area with nearby rural settings, offering a diverse living environment for doctors. The city provides a mix of cultural activities, historic sites like a Cathedral, and scenic spots in the countryside. The area boasts a range of quality schools and universities. Excellent transportation links connect the city to major cities like Birmingham and London, with easy access to airports such as Birmingham Airport. The area offers a variety of housing options, from modern city apartments to charming rural homes, catering to different lifestyle preferences.


EEA Candidates:

  • Experience of working in Eating Disorders Psychiatry (Desirable)
  • Board Certified Specialist in Adult Psychiatry 

Non-EEA Candidates:

  • Specialist / Consultant experience in General Adult Psychiatry
  • Experience of working in Eating Disorders Psychiatry (Desirable)
  • MRCPsych (Desirable)

UK based applicants

  • Experience of working in Eating Disorders Psychiatry (Desirable)
  • S12 (Desirable)
£83945 - £95275
An excellent opportunity has arisen for a Specialist Grade in General Adult Psychiatry to join a trust on the south coast of England. This is a high-performing and supportive department for overseas doctors new to NHS jobs or UK-based doctors looking to advance their careers in the UK. CESR support is available.

MRCPsych - preferred 
S12 - preferred 
12 years post graduate experience with 6 years in psychiatry

What is the NHS Trust like?
The NHS Trust provides a range of high-quality specialist mental health, learning disability, and neurodiversity services, in the South West region. The Trust is passionate about promoting good mental health and wellbeing, striving to use the expertise and resources within the organization, and through partnerships, to deliver safe, high-quality services focused on people\'s recovery.

With an annual income exceeding £206 million, the Trust employs around 3,600 staff. Each year, it receives approximately 74,000 referrals and supports around 26,000 people every month. This passion and commitment shape the Trust\'s vision, mission, and strategy. The staff are pivotal in all activities, and the Trust is committed to fully involving them in the development of the organization and its services.

General Adult Psychiatry Department & Team

The Community Mental Health Services provide secondary care interventions for individuals referred by Mental Health Assessment workers and other teams, such as acute and inpatient services. The community teams manage caseloads that include individuals with a wide range of mental health difficulties and complexities, from those requiring intensive long-term care to those receiving short-term psycho-social interventions. The team collaborates constructively with various agencies within Torbay to ensure a coordinated approach to managing risk issues.

The team comprises a full-time Clinical Team Leader, Mental Health Nurses, Occupational Therapists, Social Workers, and Support Time and Recovery Workers. All three Community Mental Health Teams share an Accommodation Officer, a Personality Disorder Lead, and a Carers Support Team. The team employs a strong multidisciplinary approach, working cohesively to provide an effective and safe recovery-focused service to those referred. 

Life in South West

The South West of England offers both rural and urban settings, providing diverse living options. The region features stunning landscapes, including the Jurassic Coast, Dartmoor, and Exmoor, perfect for hiking and outdoor activities. There are high-quality schools and renowned universities, such as the University of Exeter and University of Bristol. Excellent transportation links include major motorways, rail services to London and other cities, and airports in Bristol and Exeter. Housing options range from urban apartments and suburban homes to countryside cottages, catering to a variety of lifestyles and preferences.

Am I eligible for this role?

MRCPsych - preferred
S12 - preferred 
12 years post graduate experience with 6 years in psychiatry - necesary 
52,530 - 82,400

An excellent opportunity has arisen for Specialty Doctors in Emergency Medicine to join an NHS Foundation Trust that is dynamic and dedicated to providing great service to their patients. The site that is ideally located near stunning blue flag beaches. The Emergency Medicine team boasts extensive experience and expertise in supporting doctors through the CESR programme. The current CESR programme includes a customized professional development plan tailored to meet the individual needs of each doctor, with available placements in Critical Care, Anaesthetics, Acute Medicine, and Paediatrics. 

This is a unique opportunity for Specialty Doctors seeking to advance their careers within the NHS in the UK. Successful candidates will have the option to participate in this CESR support programme, further enhancing their professional growth. Don\'t miss this chance to explore NHS jobs that offer both career progression and an excellent quality of life. Overseas applications from experienced Specialty Doctors and Consultants are welcomed. 

What is the NHS Foundation Trust like?

The NHS Foundation Trust is a district general hospital trust managing three hospitals. The Trust serves the different towns, delivering a broad range of medical services. They are performing at a good level across their services and continuously provides huge opportunities and benefits to the way they deliver patient care. The Trust focuses on delivering excellent general hospital services, serving a population of approximately 750,000 with the help of more than 9,000 staff members. The hospitals have around 1,100 beds in total, offering services including General Medicine, General Surgery, Neurology, Rheumatology, Gastroenterology, Dermatology, Gynaecology, and Paediatrics.

The Trust achieved foundation status in 2005 and, in October 2020, merged two of its hospitals to create a new organization, establishing one of their hospitals as the emergency care site and another as the planned care site. The Trust remains dedicated to continuous improvement, striving to provide high-quality, patient-centered care across all its facilities.

What is the department & team like?

The Emergency Medicine Department is a highly advanced and well-equipped unit, dedicated to providing emergency care. The department is staffed with a robust team of consultants and junior doctors, ensuring round-the-clock expertise and comprehensive patient care. The team is proficient in managing a diverse range of emergency cases, including trauma, cardiac emergencies, respiratory issues, and other urgent medical conditions. With access to advanced diagnostic tools and treatment facilities, they provide immediate and effective care for all patients.

The facilities within the department include modern resuscitation bays, dedicated observation units, and specialized treatment areas for both adults and children. These state-of-the-art resources enable them to handle high patient volumes efficiently and effectively. On average, the Emergency Medicine Department manages a significant number of emergency cases each year, reflecting its critical role in the region\'s healthcare system. Their commitment to delivering high-quality, patient-centered care is unwavering, supported by their experienced team and cutting-edge facilities.

Career Development & Opportunities Available

With an extremely active education/teaching programme supported by the consultant team, there is opportunity to work towards and complete CESR, get involved in active research and many aspects of CPD. Participation in research and educational activities will be encouraged.

  • Attractive salary and relocation package
  • Training and development opportunities
  • CESR support for those eligible
  • Tier 2 Health and Care Visa (sponsorship for the whole family)
  • Guidance regarding the CV and full interview preparation
  • Assistance regarding the GMC registration, visa, accommodation and transportation by an experienced onboarding specialist
  • Complete IMG Relocation service from start to finish of process
Life in the area

Nestled along England\'s picturesque south coast, the area offers a unique blend of urban amenities and coastal charm. Doctors enjoy proximity to both bustling city life and tranquil seaside retreats. Residents indulge in sailing adventures around harbour or stroll along its sandy beaches. The area boasts reputable schools and universities, nurturing young minds for future success. Transportation links are robust, with easy access to neighboring cities like Bournemouth and Southampton, as well as major airports. Housing options range from waterfront apartments to quaint cottages, catering to varied tastes and lifestyles. Poole epitomizes the quintessential coastal living experience.

Am I eligible for this role?

UK based candidates:

  • Experience in Emergency Medicine
EEA candidates: 
  • Experience in Emergency Medicine
  • MRCP
Non-EEA candidates:
  • MRCP
  • Experience in Emergency Medicine
51,000 - 83,000

This international psychiatry sponsorship scheme offers opportunity for experienced psychiatrists qualified abroad, who have already achieved higher postgraduate qualifications in psychiatry to be employed in a unique NHS job, and advance their career while employed within the NHS. Subject to GMC criteria this NHS Trust will sponsor eligible candidates for GMC registration and successful candidate will be employed on a health and care visa.

The programme is an innovative and structured sponsored scheme that supports suitably qualified international medical graduates (who do not have GMC registration) to be sponsored by the NHS Trust for GMC registration with a license to practice, and then be supported to advance their existing clinical and professional skills and receive valuable clinical experience with excellent supervised support.

Depending on your experience, interest and commitment, you will agree a personalised plan to support you to meet your training and development needs. This may be through supporting you to gain further qualifications like MRCPsych, entering UK higher training programme or pursuing CESR (Portfolio Pathway) route to gain specialist registration etc
You will be working at Specialty Doctor level and there are various opportunities across the Trust in specialties such as General Adult, Child & Adolescent (CAMHS), Learning Disabilities, and Older Adult Psychiatry. You will have the opportunity to work in either inpatient or community psychiatry clinics, and rotations can be arranged in various locations across the NHS Trust.

This programme is focused on doctors who do not have current registration with the GMC of the UK; however, it is not meant for doctors who have tried but have been unsuccessful in passing PLAB examination.

Person Specification



  • hold a primary medical qualification (PMQ) recognised by the UK General Medical Council (GMC).
  • acknowledge that, if I am successful in my application to join the EPUT Advanced Fellowship in Psychiatry scheme, you will need to seek verification of this primary medical qualification by the Education Commission for Foreign Medical Graduates (ECFMG) before the Trust can sponsor your registration to join the GMC medical register.
  • following undergraduate training, you completed an acceptable programme of practical training/internship (or equivalent) in Medicine of no less than 12 months.
  • you will have achieved a minimum overall score of 7.5 in the International English Language Testing System (IELTS) academic test, and at least 7.0 in each category OR have achieved a B in every category of the medical version of the Occupational English Test (OET).
  • have obtained a postgraduate qualification (PGQ) in psychiatry
  • Pass in papers A and / or B of MRCPsych examination



  • Hold significant post-graduate experience in psychiatry, this will have been through specialist psychiatry training, and working at a speciality doctor or consultant level. 
51,000  - 131,964

An outstanding NHS Trust are seeking experienced Child & Adolescent Psychiatrists to join the an NHS Trust that has been rated \"Outstanding\" overall by the CQC. This is a perfect time to join as the CAMHS is an award winning service. You will be working side by side with a team of driven and hardworking doctors. This is a great opportunity for overseas Psychiatrists who want to establish themselves in the NHS, and grow their consultant or specialist grade career.

The post is suitable for candidates holding specialisation in the EEA, or for experienced IMGs looking to complete CESR.


The NHS Foundation Trust provide health and social care for over 400,000 people with mental ill health, physical ill health and learning disabilities across four cities. They employ over 3,500 staff who deliver these services within the community as well inpatient settings. They also deliver a range of nationally commissioned specialist services including Tier 4 services for children and young people, perinatal services and medium and low secure learning disabilities services.

They have operated as an NHS Foundation Trust since our authorisation in August 2007, which gave them opportunities to further build upon and improve the services for their community. Benefits include a stronger involvement with local communities through their members and Council of Governors and the ability to borrow finance to support their capital investment programme. Over the years the quality of the mental health services and the achievements of the staff have been recognised nationally including the “Mental Health Trust of The Year Award” for 2020 at the Health Service Journal Awards.

In a recent NHS Staff Survey the trust achieved the best score for safety culture amongst mental health and learning disabilities trusts throughout the country. The staff have also said that they would recommend the trust as a place to work and as a place for their friends and family to receive care. They are driven by our values. If you believe in Respect, Kindness and a Positive outlook then you\'ll be right at home.


The Trusts Child and Adolescent Mental Health Service (CAMHS) is an award winning service and has received specific CQC recognition as being outstanding in 3 categories (Caring, responsive and well-led) they credit this to the outstanding people we have delivering care to our service users. It is a busy team covering 2 sites, and the team works on an outpatient model. The caseload for this post is estimated to be 120. The CAMHS department is part of the East and North Strategic Business Unit in the NHS Foundation Trust. CAMHS is divided into 5 service divisions. 

The CAMHS Community Eating Disorders Service is a newly expanded, multi-disciplinary team which provides specialist CAMHS input to children and young people with eating disorders. It provides home-based treatment, out-patient treatment and gate-keeps referrals to in-patient services. The team has a very positive reputation and the ED practitioners have won numerous Trust wide and national awards. The team has been successful in attracting Government funding to allow service expansion.

The post holder is Providing consultation, advice and appropriate support to professionals in the wider network of the young person and/or family. The post holder is expected to contribute to the supervision of the trainees and the specialty doctor allocated to the service. The post holder is expected to provide opportunities for case based discussion and teaching to the MDT.


Whether you want to live in London and commute, live in the country or small towns, working in this trust has something to offer. The Trust covers a mixed rural and urban area, including large and smaller towns. The area has excellent connections to London and the rest of the country. A large number of psychiatrists working in the trust choose to commute from London, some locations can be reached from London in 17 – 30 minutes depending on the locality. By car from several parts of North London the commute is under 30 mins.

The trust is a situated in beautiful county with picturesque, rural villages and a number of lovely, vibrant towns and garden cities. Ranked in 2016, by uSwitch Better Family Life Index, as the best place to raise a family, The region scored highly on top exam results, good pay prospects, high employment rates, fast broadband and better weather than other towns in the Index! It is also well known for its excellent schools, stunning countryside and fantastic local facilities which provide plenty of opportunities to relax and enjoy yourself away from work.

There are three major roads going North-South (the M1, the A1 and the A10). In addition the M25 passes through. Train services are also excellent with the journey time to London from some towns is less than 20 - 30 minutes. Education is of a high standard. Currently more than 160,000 children are educated in the county’s network of 566 schools made up of 17 nursery schools, 426 primary schools, 9 middle schools, 78 secondary schools, 27 Special Schools and 8 Education Support Centres. Exam results and SATs continue to be above the national average and the ration of pupils to teachers is among the best in the shire counties. There is also a wide range of public/private schools to choose from.


The combination of clinical practice and first-class academic connections means that medical professionals have a wide range of opportunities to develop their careers and achieve their aspirations. You will have access to leadership, teaching, educational and research opportunities for Continued Professional Develop (CPD).

If you are a new consultant you will receive mentoring and support from medical leads as well as access to a large peer group of enthusiastic and high-caliber Consultants.

In addition to the generous pension and annual leave that comes with NHS employment, the trust offers additional benefits to our staff including a salary sacrifice scheme enabling staff to drive a brand new car or purchase a new bike as well as an HMRC scheme enabling savings on registered childcare costs.


EEA Candidates:

  • Experience of working in Child & Adolescent Psychiatry
  • Board Certified Specialist in Child & Adolescent Psychiatry

Non-EEA Candidates:

  • MRCPsych
  • Experience of working in Child & Adolescent Psychiatry

UK based applicants

  • Experience of working in Child & Adolescent Psychiatry
  • Within 6 - 12 months of completing CCT

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