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 large NHS Trust in the Midlands is looking for a Consultant Interventional Radiologist with an interest in complex vascular and non-vascular procedures. The Radiology department comprises a team of experienced consultants and is supported by a large team of middle grade doctors. This Interventional Radiology job is open to both international applications and UK-based doctors, though those with European Specialist or FRCR 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
FRCR or equivalent and extensive experience in interventional radiology are required for this role, and anyone with an interest in complex vascular and non-vascular procedures should apply. The salary will be between £105,504 to £139,882 dependent on experience.
CORE DUTIES OF THIS ROLE
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Lead a comprehensive range of interventional radiology procedures under consultant supervision.
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Assist in the general radiology workload including the Interventional on-call rota.
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Lead teaching and supporting junior radiological staff and radiographers.
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Lead departmental audit and research activities, with the opportunity to pursue formal research.
LIFE IN THE WEST MIDLANDS
This role is based in the West Midlands, offering access to urban living in cities like Birmingham and more peaceful rural areas such as Solihull and Warwickshire. The region is known for its excellent schools, strong transport links, and a wide variety of leisure activities for individuals and families alike. With a rich industrial heritage, the West Midlands remains one of the UK’s most historically significant and economically vibrant regions.
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 – Child and Adolescent Mental Health Service (CAMHS)
South Wales
A dynamic and transformational CAMHS service in South Wales is seeking a Consultant Psychiatrist with a strong interest in child and adolescent mental health. The successful candidate will join a well-established multidisciplinary team delivering specialist care across the region, contributing to service development and clinical leadership within a collaborative and forward-thinking environment. Doctors with MRCPsych, CESR interest, or a European Specialist qualification are encouraged to apply.
This is a fantastic opportunity to work within a progressive mental health service with access to regional tier 4 services and a population of approximately 380,000. The post supports the organisation’s strategic vision to integrate CAMHS more closely into community settings while developing clinical pathways in areas including eating disorders, complex care, youth justice, and neurodevelopmental disorders.
We welcome applications for full-time, part-time, or flexible working arrangements and will support CESR (Certificate of Eligibility for Specialist Registration) development on an individual basis.
JOB REQUIREMENTS AND DETAILS
-
Salary: £109,725 – £145,478 dependent on Consultant experience.
-
Full GMC registration with a licence to practise is essential.
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Eligibility for inclusion on the GMC Specialist Register or within six months of CCT.
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Section 12 approval (or eligibility within 6–12 months).
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Experience delivering psychiatric care in CAMHS or related services is required.
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A collaborative, developmental, and family-focused approach, with excellent communication and leadership skills, is highly valued.
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Opportunities for career development through CPD, peer supervision, quality improvement, and service leadership.
CORE DUTIES OF THIS ROLE
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Provide consultant-level psychiatric care to children and adolescents as part of a multidisciplinary CAMHS team.
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Lead clinical care planning, review, and treatment delivery in partnership with colleagues across mental health, health, education, and social care.
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Work closely with specialist regional services including adolescent inpatient units, eating disorder outreach services, and forensic CAMHS consultation teams.
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Participate in the CAMHS consultant on-call rota (with prospective cover).
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Contribute to service improvement, pathway development, and integrated working in line with strategic planning goals.
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Provide supervision and clinical leadership to junior medical staff and allied professionals.
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Participate in annual appraisal, job planning, and revalidation, with access to local peer groups and CPD.
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Uphold principles of clinical governance, information governance, and risk management across the CAMHS Directorate.
LIFE IN SOUTH WALES
South Wales offers a rare combination of coastal beauty, green open spaces, and urban convenience. With beautiful landscapes, affordable living, and excellent local amenities, it is an ideal location for professionals and families alike. The region is well-connected by public transport and road networks and offers easy access to nearby cities and airports.
Healthcare professionals in the area benefit from a supportive and inclusive working environment and access to a wide network of services across health, education, and social care.
If you are passionate about delivering outstanding CAMHS care and want to help shape future services in a supportive, innovative setting, we welcome your application. Please note that we may close this post early if sufficient applications are received.
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.
Consultant Psychiatrist – Acute Inpatient Service
South of England | Close to London
- Salary: £109,725 – £145,478 dependent on Consultant experience.
- Recruitment premia £15,000 over 3 years *subject to policy requirements
- Relocation allowance: up to £8000 *subject to policy requirements
An inclusive and progressive NHS mental health trust in the South of England is seeking a Consultant Psychiatrist with a strong interest in acute inpatient care. The successful candidate will join a compassionate and collaborative multidisciplinary team, providing high-quality psychiatric care to adults and clinical leadership across inpatient services. Doctors with MRCPsych, CESR interest, or a European Specialist qualification are encouraged to apply.
This is a fantastic opportunity to join a leading NHS Foundation Trust known for integrated working, a strong culture of kindness and respect, and its commitment to clinical excellence and innovation.
Applications are welcome for full-time, part-time, or flexible working patterns. CESR (Certificate of Eligibility for Specialist Registration) support is available and tailored to individual needs.
JOB REQUIREMENTS AND DETAILS
-
Full GMC registration with a licence to practise is essential.
-
Eligibility for inclusion on the GMC Specialist Register or within six months of CCT.
-
Section 12 approval (or eligibility within 6–12 months).
-
Clinical experience in managing acute adult mental illness in inpatient settings is required.
-
Strong teamworking, communication, and leadership skills are essential.
-
Ongoing opportunities for professional development through training, leadership pathways, teaching, and academic engagement.
CORE DUTIES OF THIS ROLE
-
Provide Consultant-level psychiatric care to adult inpatients, in line with the Trust’s Acute Operational Policy.
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Deliver clinical leadership and active involvement in quality improvement initiatives.
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Work collaboratively with multidisciplinary teams and contribute to a recovery-focused, trauma-informed approach to care.
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Coordinate with specialist and community teams to ensure effective patient transitions and continuity of care.
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Supervise and support junior doctors, specialty trainees, and students.
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Participate in Consultant on-call rota (details available on request).
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Engage in audit, teaching, research, and service development activities.
LIFE IN THE SOUTH OF ENGLAND
Located in the South of England, this opportunity offers the perfect balance of professional fulfilment and quality of life. The area combines vibrant urban centres, picturesque countryside, and excellent transport links — with London just 30 minutes away by train, and both Heathrow and Gatwick airports nearby for easy international travel.
This region is known for its historic market towns, outstanding schools, and a wide range of cultural and recreational activities. Whether you\'re relocating alone or with family, it offers something for everyone — from city convenience to coastal calm.
The Trust is committed to inclusivity, wellbeing, and the development of its workforce, offering access to flexible working and a wide range of staff benefits.
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 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.
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Support junior doctors and participate in departmental teaching, training, and induction programmes.
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Collaborate with multi-disciplinary teams to ensure safe and effective patient flow and management.
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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