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
We are looking to recruit a Consultant Psychiatrist to a Crisis & Assessment Team role in the Channel Islands, a UK territory sitting off the coast of France and just a 1 hour flight from London. This job presents a great opportunity to advance your medical career in the UK.
The health service, separate from the NHS, is an integrated, taxation-funded system, free at the point of delivery, managed by the Health and Community Services Department on the island. Key benefits of working there are higher salaries than the NHS, lower taxes and sunnier weather.
Consultant Pay range - £110,257 to £164,372
Single rate of tax - 20%.
The Department & Team
The Crisis and Assessment Team (CAT) serves as the primary gateway to adult and older people\'s mental health services, conducting assessments in the community and emergency settings, alongside medical reviews. They collaborate closely with law enforcement, responding to Adult Protection Notices and coordinating mental health law assessments. This role within the CAT focuses on streamlining referrals, providing short-term crisis interventions, and ensuring individuals receive appropriate ongoing care. You\'ll engage with both working-age adults and older adults, with responsibilities extending to police referrals and mental health law assessments during standard working hours, with on-call commitments.
Continued Professional Development
Professional development is integral to their ethos, offering CESR Portfolio Pathway support, access to specialty training, and opportunities for sub-specialist development. They prioritize ongoing learning through conferences, local CME events, and a generous study leave allowance.
Life in the area
Living in this location offers significant financial benefits. The flat income tax rate of 20% is notably advantageous compared to the UK, and a generous public sector pension scheme is provided, not constrained by UK lifetime or annual contribution limits. The consultant contract closely mirrors the UK model but offers higher incremental levels starting at £110,257 and with a top basic salary of £164,372.
Am I eligible for this role?
UK based candidates:
- Experience in General Adult Psychiatry
- Specialist Registration or locum consultant experience
EEA candidates:
- Experience in General Adult Psychiatry
- European Specialist Qualification
Non-EEA candidates:
- MRCPsych
- Experience in General Adult Psychiatry
We are looking to recruit a Consultant Psychiatrist to an Old Age role in the Channel Islands, a UK territory sitting off the coast of France and just a 1 hour flight from London. This job presents a great opportunity to advance your medical career in the UK.
The health service, separate from the NHS, is an integrated, taxation-funded system, free at the point of delivery, managed by the Health and Community Services Department on the island. Key benefits of working there are higher salaries than the NHS, lower taxes and sunnier weather.
Consultant Pay range - £110,257 to £164,372
Single rate of tax - 20%.
What is the health & community service like?
Working in this location is professionally rewarding, offering high-quality, patient-centered care. Clinicians lead in developing and managing services, supported by strong links with UK specialists. With a generous study leave budget, doctors are encouraged to pursue further education. Exciting developments include a new general hospital and a new mental health inpatient unit. The service fosters strong relationships between mental health, primary, and secondary care, promoting joint learning and teaching in a modern education center.
What is the department & team like?
The inpatient services are currently undergoing extensive refurbishment, including two wards for older adults. One ward offers 14 assessment beds for individuals over 65 experiencing functional mental health issues, with some flexibility for those under 65. The other ward provides 10 assessment beds for patients with dementia. Following the refurbishment, the latter ward will feature 8 acute assessment beds and 8 transitional/step-down beds for those with dementia or enduring mental health problems who cannot be supported in local nursing or residential homes.
The Older Adults Community Mental Health Team (OACMHT) manages a caseload of about 300 patients, including new referrals triaged by the Crisis and Assessment team, providing both short-term treatment and long-term care coordination. The role involves providing medical support to the OACMHT alongside two other consultants and a staff grade doctor.
The post holder will join an established team, comprising 2 WTE older adult consultants, 1.0 WTE Associate Specialist (Memory Assessment Service), 2.0 WTE staff grades (inpatient and community), and 1.0 WTE F1 doctor (inpatients and community). Dedicated administrative support includes a 0.5 WTE medical secretary and ward and team secretarial support.
Continued Professional Development
This position offers further training and accreditation within psychiatry, including CESR Portfolio Pathway support, access to specialty training, and the opportunity to develop sub-specialist interests. The post holder will have ample opportunities to develop knowledge, skills, and experience through attendance at relevant courses, conferences, and locally organized CME events. The organization supports Continuing Medical Education with time and financial support, offering study leave of 30 days in 3 years and an annual study leave allowance. Regular case discussions, teaching sessions, and MDT supervision ensure ongoing professional development, meeting the Royal College of Psychiatrists\' CPD requirements.
Living in the Area
Living in this location offers significant financial benefits. The flat income tax rate of 20% is notably advantageous compared to the UK, and a generous public sector pension scheme is provided, not constrained by UK lifetime or annual contribution limits. The consultant contract closely mirrors the UK model but offers higher incremental levels starting at £110,257 and with a top basic salary of £164,372.
Am I eligible for this role?Am I eligible for this role?
UK based candidates:
- Experience in Old Age Psychiatry
- Specialist Registration or locum Consultant Experience
- Experience in Old Age Psychiatry
- European Specialist Qualification
- MRCPsych
- Consultant experience in Old Age Psychiatry
We are looking to recruit a Consultant Psychiatrist to a General Adult role in the Channel Islands, a UK territory sitting off the coast of France and just a 1 hour flight from London. This job presents a great opportunity to advance your medical career in the UK.
The health service, separate from the NHS, is an integrated, taxation-funded system, free at the point of delivery, managed by the Health and Community Services Department on the island. Key benefits of working there are higher salaries than the NHS, lower taxes and sunnier weather.
Consultant Pay range - £110,257 to £164,372
Single rate of tax - 20%
General Adult Psychiatry Department & Team
The inpatient service features 17 adult acute beds, including an extra-care area, for individuals aged 18 to 65 with severe mental illness requiring admission. The goal is to promote recovery and well-being, helping service users achieve their potential. The service caters to a diverse population with complex needs. The multidisciplinary inpatient team includes doctors (two part-time consultants, staff grade/clinical fellow, and F2), a clinical psychologist, nurses, a social worker, occupational therapists, an art therapist, healthcare assistants, and administrative staff.
The Home Treatment Team functions as a step-up, step-down service to prevent unnecessary hospital admissions and facilitate early discharge. They attend ward reviews, support patients on leave, and assist with discharge planning, also gatekeeping inpatient beds. The team includes two part-time consultants, a 0.5 FTE team manager, two FTE senior practitioners, 5.5 FTE nurse practitioners, one FTE social worker, three FTE senior HCAs, and one FTE occupational therapist. Covering all adult ages, there is an arrangement with an Older Adult Consultant for additional support if needed.
Continued Professional Development
This position offers further training and accreditation within psychiatry, including CESR Portfolio Pathway support, access to specialty training, and the opportunity to develop sub-specialist interests. The post holder will have ample opportunities to develop knowledge, skills, and experience through attendance at relevant courses, conferences, and locally organized CME events. The organization supports Continuing Medical Education with time and financial support, offering study leave of 30 days in three years and an annual study leave allowance. Regular case discussions, teaching sessions, and MDT supervision ensure ongoing professional development, meeting the Royal College of Psychiatrists\' CPD requirements.
Living in the Area
Living in this location offers significant financial benefits. The flat income tax rate of 20% is notably advantageous compared to the UK, and a generous public sector pension scheme is provided, not constrained by UK lifetime or annual contribution limits. The consultant contract closely mirrors the UK model but offers higher incremental levels starting at £110,257 and with a top basic salary of £164,372.
Am I eligible for this role?
UK based candidates:
- Experience in Adult Psychiatry
- Specialist Registration or locum Consultant Experience
EEA candidates:
- Experience in Adult Psychiatry
- European Specialist Qualification
Non-EEA candidates:
- MRCPsych
- Consultant experience in Adult Psychiatry
The health service, separate from the NHS, is an integrated, taxation-funded system, free at the point of delivery, managed by the Health and Community Services Department on the island. Key benefits of working there are higher salaries than the NHS, lower taxes and sunnier weather.
Consultant Pay range - £110,257 to £164,372
Single rate of tax - 20%.
The post holder will be expected to take on the full range of duties including the routine and emergency diagnosis and management of children and young people with significant mental health problems (up to the age of 18), the support of other team members, and providing consultation and advice to other agencies. Successful applicants will be encouraged to develop a special interest and take a clinical lead in one of the following areas: Eating Disorders, Crisis Intervention, Neurodevelopmental Disorders, or Transition.
The Health Service
Working for this service is professionally rewarding, offering high-quality, patient-centered care. Their clinicians lead in developing and managing services, supported by strong links with UK specialists. With a generous study leave budget, doctors are encouraged to pursue further education. Exciting developments include a new general hospital and a new mental health inpatient unit. They foster strong relationships between mental health, primary, and secondary care, promoting joint learning and teaching in their modern education centre.
Department & Team
The Mental Health Service is staffed by a dedicated multi-disciplinary team, supported by secretarial and administrative staff. The service provides comprehensive assessment, treatment, and therapeutic interventions for a wide range of developmental, behavioral, emotional, and psychiatric issues in children and young people up to their 18th birthday.
Currently, CAMHS manages 1,627 open cases. In 2022, 926 new referrals were received, with 752 new referrals to date in 2023. The current locum postholder\'s caseload is approximately 90, with most cases having an allocated care coordinator. While most new assessments are conducted by other members of the multi-disciplinary team, some will require an initial medical assessment. On average, there are 1-2 new assessments and 15-20 follow-up appointments per week, depending on case complexity and other commitments.
Continued Professional Development
The health service offers further training & accreditation within psychiatry, including CESR Portfolio Pathway Support, access to specialty training, and the opportunity to develop sub-specialist interest. The post holder will have ample opportunities to develop knowledge, skills, and experience through attendance at relevant courses, conferences, and locally organized CME events. Health & Community Services supports Continuing Medical Education with time and financial support, offering study leave of 30 days in 3 years, and an annual study leave allowance. Regular case discussions, teaching sessions, and MDT supervision ensure ongoing professional development, meeting the Royal College of Psychiatrists\' CPD requirements.
Living in the Area
Living in this location offers significant financial benefits. The flat income tax rate of 20% is notably advantageous compared to the UK, and a generous public sector pension scheme is provided, not constrained by UK lifetime or annual contribution limits. The consultant contract closely mirrors the UK model but offers higher incremental levels starting at £110,257 and with a top basic salary of £164,372.
Am I eligible for this role?
UK based candidates:
- Experience in Child & Adolescent Psychiatry
- Specialist Registration or locum Consultant Experience
- Experience in Child & Adolescent Psychiatry
- European Specialist Qualification
- MRCPsych
- Consultant experience in Child & Adolescent Psychiatry
A prime opportunity awaits a dedicated Specialty Doctor in Psychiatry to join the Crisis Resolution Home Treatment Team (CRHTT) for a NHS job in the UK, with CESR support. Located at Eaglestone Health Centre on Milton Keynes Hospital Campus, you\'ll provide top-tier assessment, consultation, and treatment for individuals in mental health crises, with office space and administrative support.
As part of a medical team with a Consultant Psychiatrist and Trainee Doctor, you\'ll demonstrate motivation, energy, and a fervent commitment to exceptional patient care. Strong teamwork, organizational skills, initiative, effective communication, and empathy are key. Operated by an NHS Foundation Trust that is known for excellence locally, nationally, and internationally, this role offers professional growth opportunities for EU-trained specialists and experienced IMGs seeking CESR completion.
What is the NHS Foundation Trust like?
Established in 2002 through the merger of several trusts, this NHS Foundation Trust is among the UK\'s largest. With about 7,000 staff, they serve a third of London\'s population and extend services to areas like Milton Keynes, Kent, Surrey, and Hampshire.
Their focus is on delivering patient-centered, safe, and effective care across various settings, from hospitals to community clinics and even patients\' homes. They emphasize community-based services, aligning with the NHS\'s modernization goals. They prioritize recruiting exceptional individuals who support patients and colleagues alike, offering opportunities for career development. The role entails participating in clinical supervision sessions with the team\'s consultant psychiatrist.
What is the Department & Team like?
The Crisis Resolution and Home Treatment Team (CRHTT) comprises a multi-disciplinary group of mental health professionals delivering a 7-day service for individuals in acute psychiatric crises. They offer intensive community-based interventions as an alternative to hospitalization and support early discharge, facilitating the transition back to the community. The team triages referrals, deciding on home treatment or admission, aiming to provide less restrictive alternatives to hospitalization when feasible.
The Team is composed of:
- 1.0 wte Consultant Psychiatrist
- 1.0 wte Specialty Doctor
- 1.0 wte Core Trainee / equivalent
- 1.0 wte Team Manager
- 3.0 wte Senior Practitioner Band 7
- 14.5 wte Mental Health Practitioner Band 6
- 2.6 wte Occupational Therapist Band 6
- 2 wte Therapy Support Staff Band 4
- 6.6 wte Support Worker Band 3
- 3 wte Medical Secretary and Team Administrator Band 4
The post holder is expected to make an assessment, diagnosis, formulation of risks and development of a management plan for new referrals, re-referrals and patients under the care of the team. The post holder is expected to identify need for referrals to other services such as referrals for psychological interventions and review treatment plans and risk assessments of patients in the service.
Career Development & Opportunities Available
There is real opportunity to progress through CESR at pace at this trust, with a strong desire for newly-qualified consultants to develop their specialty areas of interest and undertake in various cancer trials and research projects where possible. Research is encouraged here, particularly when this is appropriate to professional development and to the service development of the department.
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.
Life in South East
South East, a vibrant urban area in Buckinghamshire, offers a blend of city amenities and rural charm. Residents enjoy scenic parks & perfect for outdoor activities. The area boasts excellent schools and universities. Transportation links are convenient, with easy access to major cities like London and Birmingham via train and nearby airports like Luton and Birmingham. Housing options range from modern apartments in the city center to spacious suburban homes, catering to diverse preferences and lifestyles.
Am I eligible for this role?
UK based candidates:
- Experience in General Adult Psychiatry - Crisis Resolution Home Treatment Team
- Experience in General Adult Psychiatry - Crisis Resolution Home Treatment Team
- MRCPsych
- Experience in General Adult Psychiatry - Crisis Resolution Home Treatment Team