Understanding the MSRA

The Multiple Specialty Recruitment Assessment (MSRA) is a computer-based exam increasingly being used by many different specialties as part of core training applications. For all specialties, the MSRA score will contribute to or be the sole consideration for shortlisting candidates for limited interview slots for each specialty. Subsequently, the MSRA score will also (often) contribute to a candidate’s final score which determines the allocation of offers. 

Contribution of the MSRA to Different Specialty Applications

Specialty Training ProgramContribution of MSRA score for an invitation to interview Contribution of MSRA score to the allocation of offers 
ACCS Emergency Medicine 100%MSRA (40%) + Interview score (60%) 
Anaesthetics 100%MSRA (15%) + Interview score (85%) 
Clinical Radiology100% (All applicants that score higher than the cut-off score but are not initially invited to interview will be put on a reserve list.) MSRA + Verified self-assessment score + Interview score 
Community Sexual and Reproductive Medicine 100%Ranked on interview score 
Core Surgical Training 100%MSRA (10%) + Verified evidence score (30%) + Overall interview score (60%) 
Core Psychiatry TrainingN/A100%
General PracticeN/A100%
NeurosurgeryRaw shortlisting score and MSRA are scaled to produce a combined shortlisting score. Combined shortlisting/MSRA score will be used to rank applicants and fill interview capacity.Applicants will be ranked and appointed based upon their combined shortlisting/MSRA and weighted interview score 
Nuclear Medicine (ST3)100% (All applicants that score higher than the cut-off score but are not initially invited to interview will be put on a reserve list.) MSRA + Verified self-assessment score + Interview score 
Obstetrics and Gynaecology If you meet the bypass score (TBC) then you will not need to attend for interview. Those remaining will be ranked and invited to interview based on capacity.  If your MSRA score is too low, you will not be shortlisted. Scaled MSRA score (33.3%) + Overall interview score (66.7%) 
Ophthalmology MSRA results will be used to reduce the number of applicants for interview.MSRA score + Portfolio of evidence + Online Assessment 
Table 1 – How the MSRA is used in each core specialty application process

Exam Format


The exam is conducted on the computer and is 170 minutes in length. The two papers which make up the exam are independently timed. Remember to attempt all questions as there is no negative marking! 

SectionTime AllocatedNumber of Questions
Professional Dilemmas Paper95 minutes (+25-50% extra time)50 questions
~50% ranking questions 
~50% multiple choice, 3 actions you should take together
Optional Break5 minutes*
Clinical Problem Solving Paper75 minutes (+25-50% extra time)97 questions
~50% extended matching questions 
~50% single best-answer questions
Table 2 – Structure of the MSRA Exam

*Optional 5 minute break – excess time will be automatically be taken off from the Clinical Problem Solving Paper. If you chose to take the optional scheduled break, your computer will be locked by the invigilator for security purposes. Once you have completed your break, you will need to ask the invigilator to unlock your computer before you can continue with the MSRA. 

Professional Dilemmas Paper

Similar to the Situational Judgement Test, previously required for applying to the Foundation Program, the Professional Dilemmas Paper is designed to assess non-technical skills. Questions are set within the context of the Foundation Program, with the candidate usually assuming the role of a Foundation Year 2 doctor (within a range of contexts and rotations that a Foundation Doctor would realistically find themselves in). 

The questions are designed to cover three core competencies:

  • Professional Integrity
  • Coping with Pressure
  • Empathy and Sensitivity

There are 50 questions in total with two question formats. ~50% are ranking questions and ~50% are multiple-choice questions. Ensure to fully read the question stem. For the multiple choice question, check the 3 from 8 options are things that would all be done at the same time and are complimentary. Remember to rank or select options that would be the ‘ideal’ response (although this may differ from what is possible in reality).  

Clinical Problem Solving Paper

This paper covers clinical knowledge in the following 12 specialities (Table 3):  

CardiovascularRespiratoryGastroenterology/ Nutrition
Endocrinology/ MetabolicPaediatricsReproductive
Psychiatry/ NeurologyPharmacology and TherapeuticsMusculoskeletal
Renal/UrologyDermatology/ENT/EyesInfectious disease / Haematology / Immunology / Allergies / Genetics
Table 3 – Specialties covered in the Clinical Problem Solving Paper

The questions cover 5 core domains/competencies: 

  • Investigation: Specific investigations that are carried out in order to obtain a more conclusive diagnosis, or rule out possible causes of illness/injury. 
  • Diagnosis: Identification of a condition, disease or injury made by evaluating the symptoms and signs presented by a patient. 
  • Emergency: Potential serious illness requiring an immediate response (recognising patient risk based on suggested factors). 
  • Prescribing: Advising, authorising or reviewing the use of medicine/drugs as part of a patient’s clinical management plan. 
  • Management (non-prescribing): Advising, authorising or reviewing the use of other forms/methods of treatment (not medicinal/drug-related) as part of a patient’s clinical management plan 

~50% will be extended matching questions (list of 7-10 plausible response options and multiple, separate questions linked to this response set) and ~50% will be single best answers (select single most appropriate or likely answer out of 5-8 plausible responses for 1 clinical presentation). 

Logistics of Taking the Exam

Booking the Exam

Once you have submitted your Oriel Application for Specialty Training, for the specialty (or specialties) you have applied for, you will be notified to register for a Pearson VUE account. Subsequently, you will then be invited to book the MSRA (typically in mid-December). 

Try to book your exam date and centre as soon as possible to prevent having to travel far distances and missing desired dates. Please check your work schedule beforehand to know which dates and times you are available. Try to have a few days free before the exam to get yourself ready and in the exam mindset (try to avoid taking the exam after a night shift). 

A list of centres around you can be found at PearsonVue.

Important dates for Winter 2024 MSRA sitting:

  • The invitation date to book will be released no later than 19/12/2023
  • The MSRA exam dates will be between 4/1/2024 to 16/1/2024
Exam day

Aim to arrive 15 minutes before your scheduled exam time for necessary checks. Please remember to bring one government-issued identification which includes your name and a recent recognisable photo of you.

How to Revise for the Exam

Previous exam takers have recommended 2-3 months time for revision, beginning with a gradual approach and progressively intensifying your study efforts closer to the exam. This is feasible to do a busy rota, provided you plan ahead and remain motivated to consistently advance your revision.

Balancing a full-time clinical job with preparation for the MSRA can be challenging. It may not be feasible or worthwhile to revisit all your Medical School Finals notes thoroughly. For the clinical component, a popular and effective strategy, recommended by many who have taken the exam is to utilise various question bank(s), choosing those that align best with your learning style.

For the Professional Dilemma section, objective MSRA specific resources are somewhat limited. A beneficial approach is to utilise resources from previous Situational Judgement Tests, previously part of the Foundation Program application. We can provide these as Anki flashcards. Additionally, the GMC Good Medical Practice and other ethical guidance documents available on the GMC website are invaluable resources.

Customising your revision strategy to what suits you best is crucial. This might include methods such as using flashcards; spaced repetition technique for mastering difficult concepts and engaging in study groups for collaborative learning (join our Whatsapp group to find or create one). We highly recommend including timed papers, in your study routine, to enhance time management skills. As well, it a key strategy to incorporate flagging questions you are not sure about during timed mocks. It is important to ensure an initial answer is still recorded, as the exam has no negative marking, this ensures that you will leave no unanswered questions on the day of the exam.

It is essential to understand how important the MSRA contributes to your relevant specialty application (Table 1). For GP training, where the MSRA score is the only determinant for job offers and locations, you would want to allocate more time for preparation. For specialties where the MSRA score is just one of several criteria, equal emphasis might also be given to enhancing your portfolio or interview preparations.

Applying for any specialty training program is free, and while it might be tempting to apply solely to acquaint yourself with the MSRA format, it is important to weigh this decision carefully. Engaging in this process requires a significant investment of time, even just for taking the exam will require leave from work, which can be particularly challenging when you are scheduled to be on-call.

Only MSRA scores for GP applications can be carried forward to the next application cycle. For other specialties, a reapplication necessitates retaking the MSRA. Plan and prepare accordingly to optimise your chances of success in the specialty application of your choice.

Understanding your MSRA Score

There is no maximum achievable score on the MSRA. Your score is based on how you perform relative to the average of your cohort in that particular sitting. This normalisation process means your score reflects where you stand in comparison to other applicants. The score you receive for the Clinical Problem Solving and Professional Dilemmas paper are indicative of your relative performance in these areas compared to others in your exam cohort (Table 4).

Standardised Score RangeClinical Problem SolvingProfessional Dilemma
Approx % scoring in the rangeScore bandScore meaningApprox % scoring in the rangeScore bandScore meaning
Below 1707%1Very poor level of performance12%1Very poor level of performance
171-1857%1Very poor level of performance11%1Very poor level of performance
186-2107%2Below average performance28%2Below average performance
211-23020%2Below average performance23%2Below average performance
231-25018%3Good level of performance14%3Good level of performance
251-27016%3Good level of performance7%3Good level of performance
271-2908%3Good level of performance4%3Good level of performance
291-3103%3Very good level of performance1%3Very good level of performance
Above 3100.30%4Very good level of performance0.1%4Very good level of performance
Table 4: Interpreting your MSRA score

Next Steps

Mind the Bleep should not be the sole resource to depend upon for revision. Our goal is to establish a comprehensive framework that guides you on how to revise effectively while balancing a full-time job. We understand that for many, this might be the first significant exam since medical school. Therefore, our focus is on making your revision process as smooth and stress-free as possible, helping you to integrate studying into your busy schedule without overwhelming you.


Become familiar with the format of the MSRA exam:

Start revising:

  • Watch our webinar providing an explanation an Intro to the MSRA
  • Join our WhatsApp group to keep up to date with the latest available resources coming from Mind the Bleep, obtain updates regarding your application from peers, find people to create study groups with or just ask questions!
  • Use Mind the Bleep MSRA E-learning Course create a study plan and kick start your revision (under construction and soon to be released)

Professional Dilemmas Paper:

  • Watch our webinar on how to prepare for the Professional Dilemmas Paper
  • Anki flashcards of previous situational judgement test questions asked in previous applications for Foundation jobs
  • Familiarise yourself with GMC Good Medical Practice and other ethical guidance documents on the GMC website to understand approach to how to answer situation judgement related questions

Clinical Problem Solving:

  • Revision flashcards on Mind the Bleep Instagram page and ReviseMSRA
  • Mock question paper and answers provided by Passmed
  • Subscribe to a commercial question bank for more revision content
    • Note: Mind the Bleep remains impartial and does not endorse any specific question bank. Our aim is to support and enhance your revision journey towards achieving a high score.
  • Question banks which we have promo codes for:
    • ReviseMSRA – 15% discount with mindthebleep15
    • Passmed – 15% discount with mtb23msra
    • Medibuddy – 10% discount with MINDTHEBLEEP10.
    • Other question banks available: Passmedicine, MCQBank, Emedica, Pastest


Written by Dr Yue Wu (CT1 Anaesthetics North West London Deanery)

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