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Your Essential Guide to the MSRA: What to Know and How to Prepare

By Dr Grace Ogwel (Obstetrics and Gynaecology ST1)


The Multi-Specialty Recruitment Assessment (MSRA) is a major stepping stone in the specialty training journey. As resident doctors, we all know that entry into specialty training is more competitive than ever and for many of us, just seeing those four letters can trigger a collective sigh (or panic).

This guide focuses on:

  • what the MSRA actually involves

  • how scoring works

  • the revision strategies that helped me

  • the mistakes to avoid

  • the most useful resources I used

My goal is to help you revise smartly, not endlessly!


What is the MSRA? Why does it matter?


The MSRA is a 170 minute, computer-based exam consisting of two parts.


​​1. Professional Dilemmas (PD) – 95 minutes, 50 questionsThis section tests your judgement, prioritisation, communication skills, and ethical reasoning. You’ll encounter situations from a variety of clinical settings, from hospitals to GP clinics, and occasionally even non-medical settings e.g. you overhear a conversation about a patient on a bus.

2. Clinical Problem Solving (CPS) – 75 minutes, 97 questionsThis is where your medical knowledge gets put to the test. It’s about applying knowledge safely and effectively, just like you do every day on the wards. 

The MSRA carries different weights depending on the specialty. When I applied for O&G, my score was used to shortlist candidates and determine whether I was called to interview. Following the interview, it made up 33% of my final ranking. 

Most specialties have an interview as part of the application process and the MSRA is important in shortlisting candidates for interview. For General practice (GP) and Psychiatry, the MSRA score is the only tool used in the allocation of offers. 

Please take the time to look into exactly what the application process consists of for the specialty(s) you are applying for


Key MSRA dates


Applications open: 23rd October 2025

Applications close: 20th November 2025

MSRA exam dates

  • Testing window 1 (all specialties): 6-19th January 2026

  • Testing window 2 (GP and Psychiatry): 12-25th February 2026

Recruitment outcomes: 17th March 2026


How MSRA Scoring Works (Simple Breakdown)


The exam draws from a bank of MSRA questions, with individual test papers curated from this pool.


Each section is scored separately at first, giving you your raw scores. These are then scaled to account for how tough that particular exam was and to show how you performed relative to other candidates. The scaled scores from CPS and PD are then combined into your overall MSRA score.

A score of 575+ is generally considered competitive across most specialties. But it’s not just about the combined score — some specialties also require you to hit a minimum score in each section before you can even be considered for shortlisting.


Professional Dilemmas (PD) MSRA Tips: How to Approach Questions Effectively


When I first started revising, the PD paper seemed like the “easier” half of the MSRA. I had done similar situational judgement exams back in medical school and remembered doing fairly well.

That said, I know that cohorts of resident doctors who graduated after 2022 may not have had exposure to SJT-style assessments. For you, Professional Dilemmas can feel really daunting or, on the flip side, there’s a risk of assuming it’s simple, something you can tackle with just “common sense,” and that it doesn’t require as much prep as the Clinical Problem Solving section. A key point to remember: each section is weighted evenly. 


Important: Don’t underestimate PD section, it can make or break your score!


If you’ve never done an SJT, struggled with it in the past, or think there’s no way to approach it strategically, think again! There is a logic and a structure to this section, and everything ties back to the GMC. Your goal is to be the doctor the GMC wants you to be. To do this, at the very least make sure you read:


  1. Good medical practice

  2. General Professional Capabilities Framework


The PD section primarily assess three key domains:

  • Professional integrity 

  • Coping with pressure 

  • Empathy and sensitivity 


MSRA PD Section: Question Types and How to Tackle Them


  1. Ranking questions: These ask you to order actions from most to least appropriate. 

  2. Multiple-choice (combination) questions: These ask you to select three actions that, together, safely resolve the situation.


MSRA PD Section Strategy: How to approach Professional Dilemmas


  1. Read the question carefully

  2. Identify the domain being tested e.g. is a colleague lying and my professional integrity being tested?

  3. Anchor yourself in GMC guidance

  4. Choose the safest, most professional action based on GMC ideals


Important: Use one question bank for PD, different banks will use slightly different reasoning and this can add confusion (and stress!)


MSRA Clinical Problem Solving (CPS): How to approach and ace this section


CPS is knowledge based but is aimed at the level of foundation level doctors. The challenge you will find is timing (you have 75 minutes to answer 97 questions), and possibly revising topics you haven't encountered since medical school(!) 


In this section you need to work quickly and decisively. 


The CPS section tests: investigations, diagnosis, emergencies, prescribing  and management decisions 


Clinical topics covered in the CPS section:


  1. Cardiovascular

  2. Dermatology / ENT / Eyes

  3. Endocrinology / Metabolic

  4. Gastroenterology / Nutrition

  5. Infectious disease / Haematology / Immunology / Allergies / Genetics

  6. Musculoskeletal

  7. Paediatrics

  8. Pharmacology and Therapeutics

  9. Psychiatry / Neurology

  10. Renal / Urology

  11. Reproductive

  12. Respiratory


Tip: Some subjects weigh far more heavily than others. For example, paediatrics alone carries the same weight as infectious disease, haematology, immunology, allergies and genetics combined. Prioritise these larger, high-yield topics first before moving on to smaller areas.



Effective Approach to MSRA Clinical Problem Solving (CPS) Section


If you’re sitting the MSRA, chances are you’ve already passed many tough exams to get this far, so you probably already know what works for you. That said, here are a few things I would recommend:


  • Start timed practice early. Getting used to the clock from the beginning makes a huge difference.

  • Read around the topics. Don’t just answer questions, make sure you understand the underlying principles. Tools like the Knowledge Bank in Passmedicine can help you do this efficiently.

  • Do full timed mocks once you’re underway in your revision. Simulating the real exam conditions will help build both stamina and confidence.

  • Keep CPS questions simple. The stems are short and sometimes feel like there isn’t enough information. Don’t overcomplicate things, focus on what’s being asked and apply your knowledge safely. I found that MCQbank had the most realistic question style.

  • Answer every question. There is no negative marking, so even if you’re unsure, pick an answer, flag it, and move on. Leaving questions blank is a missed opportunity.


Top Resources for MSRA Preparation: Study Tips from My Experience


MSRA Exam Day Tips: How to Stay Calm and Maximise Your Score


  • Arrive early. Give yourself time to settle, breathe, and get into the right headspace.

  • Eat properly beforehand. A long exam + an empty stomach = unnecessary stress. Fuel yourself well!

  • Use your 5-minute break between PD and CPS. Step away from the screen, breathe, stretch and reset.

  • Report any issues immediately. If something goes wrong during the test, speak to the local invigilator straight away.

  • Raise concerns within 24 hours. If anything affected your performance, submit this through Oriel/HEE within 24 hours.

  • Answer every question. If you’re unsure: pick something → flag it → move on. There is no negative marking, so leaving a question blank is never worth it!


I really hope this brief guide has been helpful, and I’m wishing you all the success in your MSRA. Please remember: specialty training entry is increasingly (and unnecessarily) competitive, and your exam result is not a reflection of your worth as a person or as a doctor. You are valuable regardless of the outcome. Best of luck with your preparation, you’ve got this!

​​If you have questions after reading this, please reach out, Melanin Medics is here to support you every step of the way.

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