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 an offer.

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Contribution of the MSRA to various Specialty Programmes

Timeline for Preparing for the Exam

2-3 Months Before the Exam – Beginning to Revise

For some, this may be the first exam you will be taking since finishing medical school. Though it is common sense, it may be worthwhile to refresh your memory on basic exam techniques and previous revision methods which have worked well for you in the past.

It is worthwhile to consider how much contribution the MSRA has in the overall application process for the specialty you have chosen to apply for. For instance, MSRA contributes 100% to GP and psychiatry applications thus you may want to spend more time revising for this exam. Whereas, for other specialties, you may also want to allocate time early on to preparing for interviews if that is the main consideration for subsequent allocation of offers.

It is feasible to do well in the MSRA exam with a busy working rota but some organisation will be required to allocate sufficient time to revise for it. Aim to give yourself a revision period of around 2-3 months. A potential strategy could be starting with a few questions from a question bank every day and gradually increasing the number of questions in the last month and weeks. As you go through the questions, take notes or mark questions that you found difficult or responded to incorrectly. This will make it easier to identify the areas you are weaker at and require more time revising. Take time to read through the explanations to the correct answer in the question bank as it is unlikely you will have time to read through all the comprehensive and thorough notes you may have made in medical school on each topic.

A recommended balance would be to focus 70% of your revision time on the Clinical Problem Solving section and 30% on the Professional Dilemma section.

Aim to also do a timed paper as part of your revision preparation in order to familiarise yourself with the time pressure of the actual exam.

1 Month Before the Exam – Booking the exam

Once you have submitted your Oriel Application for Specialty Training, for the specialty 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 (aim to have this booked as study leave) 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.

Night Before the Exam

Try to get plenty of rest the night before. Cramming late the night before will realistically not help you in the exam. 

Exam day

Aim to arrive 15 minutes before your scheduled exam time for necessary checks. Please remember to bring one government-issued ID which includes your name and a recent recognisable photo of you. You will be given a locker to put away your personal belongings.

During the exam

Time management is important in this exam. If you are stuck on a question for longer than 1 minute (especially in the Clinical Problem Solving questions), move on to the next question and come back to it later if you have time. There is a function that allows you to flag questions. Use it to identify questions you would like to review later. Remember there is no negative marking, so remember to answer every question first time in case you do not have a chance to go back and review the question.

Exam Structure

The exam is conducted on the computer and is 170 minutes in length. The two papers which make up the exam are independently timed.

*Optional 5-minute break – excess time will be automatically 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. 

Remember to attempt all questions as there is no negative marking! 

Professional Dilemmas Paper

Similar to the Situational Judgement Test (SJT), designed for applying to the Foundation Program, in terms of both structure and themes, 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 an F2 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).  

There are not a lot of official MSRA resources available to prepare for the Professional Dilemma section of the assessment. It may be useful to cross-revise from SJT past papers which are available on the Foundation School website. Other useful resources include the GMC Good Medical Practice and other ethical guidance documents found on the GMC website.

Tips to when answering Profession Dilemma questions include:

• Pay close attention to the language in the question:
  • Answers which involve you ‘exploring’ a problem usually rank highly
  • Be careful about answers which include the words ‘always’ or ‘never’, or ‘argue’ or ‘confront’

• Base your answer on the information given
  • Often this is difficult as you may find yourself thinking that your answer would depend on x or y, but you can only answer with the information on the page.

• Patient safety is paramount
  • This usually comes above personal well-being e.g. being late for a family event if there is an immediate threat to patient safety.

• Always address problems promptly and directly
  • This is better than addressing problems slowly or indirectly, which is still better than addressing something unrelated to the problem.

• Try to solve the problem yourself first
  • It is often good to ‘explore’ the issue yourself first e.g. if there is a dispute with your colleague
  • Escalate within your relevant team if possible

• Direct communication is usually the best
  • E.g. a direct handover, directly speaking with a patient or encouraging colleagues to directly speak with someone they have a dispute with

• Answers which promote learning from events are generally good

Clinical Problem Solving Paper

This paper covers clinical knowledge in the following 12 specialities:  

• 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 

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). 

As most of you will be working a full-time clinical job whilst revising for the MSRA, there may not be enough time to go through all your Medical School Finals notes. Most people, who have done the exam, recommend revising using various question banks (of which is based on personal choice). As the MSRA exam is primarily geared towards applicants applying for GP training, aim to focus on breadth rather than depth when revising.

Resources to Prepare for the MSRA

• MindtheBleep Preparing for the MSRA webinar
• Professional Dilemmas Paper
  • SJT Past Papers on Foundation School website
  • GMC Good Medical Practice and other ethical guidance documents on the GMC website

• Clinical Problem Solving Paper
  • Question Banks
    • Passmedicine
    • MCQ Bank
    • Emedica
    • Pastest

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Further Reading and References

• MSRA assessment blueprint and information
• GPNRO resource bank for sample and practice questions

Written by Dr Yue Wu (F2), Dr Hamish Clark (GPST1), Dr Chloe Hall (CT1 Anaesthetics), Dr Jordan Li (GPST1)