Introduction
For many resident doctors applying for speciality training, the Multi-Speciality Recruitment Assessment (MSRA) can feel like a daunting hurdle.
It is one of the most competitive and high-stakes assessments in postgraduate medicine, and, in some specialities, your entire ranking depends solely on your MSRA score. The exam is designed to test both your professional judgement and your clinical reasoning under timed pressure, making it as much a test of technique as it is of knowledge.
The challenge is that the MSRA is sat by thousands of candidates every year, all at a similar stage of training. This means that small differences in preparation can have a huge impact on ranking, placement, and even whether you receive an offer. The good news is that with a structured plan, active study methods, and the right resources, the MSRA is entirely achievable.
This guide will walk you through everything you need to know: what the exam involves, which specialities use it, how it is structured, and why it matters. We will also cover proven revision strategies, resources worth investing in, and practical tips for exam day.
Along the way, we will highlight how Medset supports candidates with innovative preparation tools, including the AI-enhanced MSRA Question Bank.
This platform adapts to your performance, focuses revision on weaker areas, and uses spaced repetition and benchmarking to improve retention and confidence. With so much riding on your MSRA score, utilising resources that optimise your time is one of the smartest investments you can make.
What is the MSRA?
The Multi-Speciality Recruitment Assessment (MSRA) is a national computer-based exam used in the selection process for postgraduate medical training in the UK. It was introduced to provide a fair and standardised method of shortlisting across multiple specialities, and it has now become one of the most influential assessments in the recruitment system.
The exam is based on the Foundation Programme curriculum, which means it tests the knowledge and professional behaviours expected of a doctor at the end of Foundation Year 2 (FY2). It is delivered through Pearson VUE test centres in the UK and internationally, with limited provision for remote sittings under exceptional circumstances.
The MSRA consists of two back-to-back papers, both of which are mandatory:
Professional Dilemmas (PD) Paper
This is a Situational Judgement Test (SJT) designed to assess how you respond to realistic workplace scenarios. It focuses on professional attributes such as integrity, empathy, sensitivity, and the ability to cope with pressure.
Example: A colleague prescribes a drug at double the normal dose. Do you challenge them directly, escalate to a senior, or document the error? These questions test your judgement and prioritisation rather than pure clinical knowledge.
Common pitfalls: Choosing what seems efficient or personally convenient instead of what is safest for the patient, misjudging when escalation is necessary, or failing to demonstrate empathy and sensitivity when appropriate.
Clinical Problem Solving (CPS) Paper
This paper tests your ability to apply clinical knowledge in practical scenarios, using Extended Matching Questions (EMQs) and Single Best Answers (SBAs).
Example: You may be asked to select the most appropriate next investigation for a patient with chest pain, or to choose the best management for a febrile child.
Common pitfalls: Anchoring too quickly on one diagnosis, missing keywords such as “most appropriate next step”, or misreading the clinical stem under time pressure.
Both sections must be completed to progress. Scoring is reported in bands from 1 to 4, and a band 1 in either paper means you cannot continue in that recruitment round, regardless of your performance in the other.
Scores are standardised each year. For example, in General Practice, the average tends to normalise near 250 per paper, although the exact figure varies with each cohort.
Why the exam matters
The MSRA is more than just another test. It plays a pivotal role in shaping your postgraduate training opportunities, and in specialities, it carries more weight than your portfolio or interview performance.
In General Practice (ST1) and Core Psychiatry (CT1), the MSRA is the sole determinant of your ranking. Where you train, and even whether you receive an offer at all, depends entirely on your exam performance.
In Obstetrics and Gynaecology (ST1), a very high score can allow you to bypass the interview stage completely and progress directly to an offer.
In surgical and diagnostic specialities such as Neurosurgery, Core Surgery, and Radiology, the MSRA acts as a gateway to interview. A strong score can dramatically improve your chances of being shortlisted and securing a place.
Since the assessment is sat by thousands of candidates each year, the competition is intense. A high score is not just about passing. It can determine your speciality placement, your location, and your training trajectory for years to come.
This is why preparation matters. Structured practice improves your familiarity with question formats, sharpens your decision-making under time pressure, and builds stamina for exam day. Medset’s AI-enhanced MSRA Question Bank gives you an additional edge by adapting to your performance, highlighting weaker areas, and using spaced repetition to strengthen retention.
With your future career on the line, these features can make the difference between an average score and a competitive ranking.
Eligibility and Application
To sit the MSRA, you must hold a recognised medical degree and also meet the eligibility requirements of speciality you are applying to. The exam is open to both UK and international graduates.
Applications are made through the national recruitment system, Oriel, during the relevant speciality application window. Once the application period closes and candidates are longlisted, eligible applicants are automatically invited to register for the MSRA through Pearson VUE.
As demand for test centres is high, booking early is essential to secure a convenient location. If no local slots are available, you may be required to travel to another city or region. In exceptional cases, candidates may be permitted to sit the exam remotely, but this is not the standard arrangement and must be approved in advance.
Popular Pearson VUE centres fill very quickly, therefore, you will need to confirm your slot as soon as the invite arrives. If your nearest centre is booked up, you may have to travel further afield. Remote sittings are only permitted by exception and require prior approval.
Exam sittings: The MSRA is usually held twice a year, in January and February, with occasional additional sittings in September depending on demand.
Recent dates: 2–13 January 2025 and 17–28 February 2025. A September sitting also took place in 2024.
There is often a September sitting, but it is not guaranteed every year, so always check the current national recruitment website for up-to-date confirmation.
Cost: There is no direct fee to sit the MSRA. However, candidates are responsible for any associated travel or accommodation costs, which are not reimbursed.
It is important to remember that if you do not sit the MSRA during your application cycle, your speciality application will not progress further, regardless of your eligibility.
Understanding the Exam Format
The MSRA is a single sitting divided into two separate papers, both of which you must complete:
MSRA Exam Format
| Paper | Format | Number of Questions | Duration | Focus |
|---|---|---|---|---|
| Professional Dilemmas (PD) | Situational Judgement Test (SJT) | 50 scenarios | 95 minutes | Integrity, empathy, coping with pressure, and professional sensitivity |
| Clinical Problem Solving (CPS) | Extended Matching Questions (EMQs) and Single Best Answers (SBAs) | 86 questions | 75 minutes | Core clinical scenarios across multiple specialities |
Professional Dilemmas (PD)
This paper does not test clinical knowledge directly.
Instead, it assesses how you respond to challenging professional situations with patients and colleagues. Scenarios test your ability to prioritise tasks, communicate effectively, maintain professional standards, and show empathy.
Some questions will ask you to rank responses in order of appropriateness, while others will require you to select the most appropriate set of actions. Roughly half of the 50 scenarios are ranking tasks and half are select-three tasks; therefore, practising both formats is important.
Common pitfalls: choosing what appears efficient rather than what is safest for the patient, underestimating the importance of escalation, or overlooking the need to maintain professionalism in difficult scenarios.
Clinical Problem Solving (CPS)
This paper is designed to test how you apply clinical knowledge to realistic situations at Foundation Year 2 (FY2) level. It covers twelve domains: cardiovascular, respiratory, gastrointestinal, endocrine, renal and urology, musculoskeletal, dermatology, ear nose and throat (ENT), ophthalmology, neurology, psychiatry, reproductive health, infectious diseases and immunology, pharmacology, and paediatrics.
Two main question types are used:
Extended Matching Questions (EMQs): selecting the most appropriate answer from a large list of options, often applied to multiple scenarios.
Single Best Answer (SBA): choosing the best possible response from a shorter list for one scenario.
Common pitfalls: rushing through clinical stems, missing key words such as “next step” or “most appropriate,” and overcomplicating straightforward cases.
Pilot questions are sometimes included for quality assurance purposes. These do not contribute to your final score, but candidates will not be told which items are pilots, so all questions must be answered with equal care.
Why Preparation Matters
The MSRA is not an exam you can pass by relying on luck or last-minute revision. Its competitive nature and high stakes mean that structured preparation is essential. Thousands of candidates sit the assessment each year, and small differences in performance can determine your rank, whether you receive an offer, and where you are ultimately placed.
Key reasons why preparation is critical:
Weight in selection: In General Practice and Psychiatry, your MSRA score is the only factor that determines your ranking. In Obstetrics and Gynaecology, a very high score can allow you to bypass the interview stage altogether. In other specialities, the MSRA acts as the shortlisting tool for the interview.
Time pressure: You will be required to answer over 130 questions across two timed sittings. Effective pacing and stamina are as important as knowledge.
Competition: Places are limited and demand is high. Even a pass mark may not be enough to secure your preferred speciality or location. To be competitive, you need a score that stands out.
This is why investing in structured revision tools is invaluable. Medset’s AI-enhanced MSRA Question Bank is designed to help you practise efficiently, adapt to your strengths and weaknesses, and build exam stamina. Features include adaptive learning, personalised progress tracking, benchmarking against peers, and spaced repetition. Together, these methods help make your preparation not only more efficient but also more effective.
Crafting your revision strategy
High-yield CPS topics to prioritise include cardiovascular, respiratory, gastrointestinal, psychiatry, acute neurology, fluids and electrolytes, safe prescribing, sepsis recognition, and paediatric fever or dehydration.
Passing the MSRA is not about memorising facts, it is about combining knowledge with strong exam technique under pressure. Success comes from smart preparation and steady progress rather than last-minute cramming.
Plan Your Timeline
Most candidates prepare for 8 to 16 weeks, depending on their rota and commitments. Short, frequent sessions are more effective than occasional long marathons. A good pattern is 60 to 90 minutes on most weekdays, with a longer block at weekends. If you have a particularly heavy rota, lean toward the longer end of the preparation window.
Use the Syllabus as your Roadmap
The Clinical Problem Solving paper covers twelve clinical domains. Print the official syllabus, highlight high-yield areas such as cardiovascular, respiratory, gastrointestinal, and psychiatry, and treat it as your checklist. Tick off topics you have mastered and circle those that need revisiting. This ensures you do not focus too much on areas you already know well and reminds you to prioritise the ones you do not.
Study Actively
Active recall and spaced repetition are proven to strengthen memory. Flashcards, short written summaries, and question-based learning are far more effective than passively re-reading notes. After revising a topic such as acute asthma management, test yourself by writing out the emergency steps without looking at your notes. Then use Single Best Answer (SBA) practice to reinforce your recall.
Balance Practice and Review
Do not save practice questions until the final weeks. Begin early with untimed blocks to strengthen your reasoning, then build up to timed sets. Keep an error log, noting not just the topic but also why you answered the question incorrectly. Revisit this log weekly. Turning mistakes into learning opportunities is one of the fastest ways to improve.
Simulate Exam Conditions
The MSRA is mentally demanding. Sit both papers back to back in mock conditions at least two or three times before the real exam. Use strict timing, remove distractions, and reflect afterwards on what slowed you down or caused fatigue. This builds both confidence and stamina.
Group and Solo Study
Study groups can be motivating and help clarify situational judgment scenarios. However, deep consolidation usually happens during solo study. A balanced approach that combines accountability with focused personal study is most effective.
Resources for success
The quality of your resources is just as important as the number of hours you put in. Using a balanced mix ensures you cover the syllabus in depth while also practising exam technique.
Textbooks and Notes
Oxford Handbook of Clinical Specialties and Oxford Handbook of Clinical Medicine: concise refreshers for broad topics.
Clinical Problem Solving in Medicine: worked examples that closely mirror the exam format.
Oxford Handbook of Clinical Surgery: useful for quick reference in surgical domains.
Online resources and Videos
Quick online summaries and video explainers can be helpful for refreshing knowledge, but they must be paired with active question practice to be effective. Passive watching alone rarely improves retention.
Question Banks
Question banks are the backbone of MSRA preparation. They replicate the exam format, allow you to practise under timed conditions, and provide feedback that highlights weak areas. A high-quality bank ensures that you become fluent in the SBA and EMQ style of questioning.
Courses and Study Days
Intensive revision courses can give structure, highlight common pitfalls, and boost motivation. However, they should be used to supplement your personal revision plan rather than replace it.
Medset’s AI-enhanced MSRA Question Bank
Medset has developed a smart MSRA Question Bank specifically designed to improve efficiency and confidence:
- AI-driven adaptive learning that targets your weaker areas.
- Spaced repetition to improve long-term retention.
- Progress tracking that breaks down performance across all domains.
- Benchmarking that shows how your results compare to peers.
Explore the MSRA Question Bank here.
Exam Day Strategy
Strong preparation gives you the knowledge, but exam-day technique can make the difference between a good score and a great one. The MSRA is long and demanding, so pacing, mindset, and stamina are critical components for success.
General preparation
- Confirm your exam booking, travel, and identification documents in advance.
- Arrive early to reduce stress and settle into the environment.
- Use the Pearson VUE on-screen tutorial before starting to familiarise yourself with navigation and controls.
The exam software also provides a built-in glossary and abbreviations list, which can be invaluable if you momentarily blank on terminology.
During the exam
- Professional Dilemmas (PD): Focus on patient safety, integrity, and proportionality. Always choose the response that is safest and most professional, even if it seems less convenient.
- Clinical Problem Solving (CPS): Read the question stems carefully and identify the exact clinical question. Avoid rushing. Patient safety is usually the guiding principle when deciding between close options.
- Pacing: Work at a steady rhythm. Do not spend too much time on a single scenario. Flag difficult questions and return later.
Energy management
- Bring water and a small snack for the break between papers.
- Use the break to reset mentally rather than to cram. A refreshed mindset will help more than last-minute revision.
Mindset
- If one section feels tough, do not panic. Remember that scores are standardised, and what feels hard to you may, in fact, feel hard for everyone.
- Avoid dwelling on past mistakes. Keep moving forward to maximise your marks across the full paper.
Frequently Asked Questions
How often is the MSRA held?
The MSRA is usually offered twice per year, in January and February, with occasional additional sittings in September depending on recruitment demand. For example, sittings in 2025 were held from 2–13 January and 17–28 February. A September sitting also ran in 2024. Always check the official national recruitment website for the latest dates.
Where do I apply?
Applications are made through the national recruitment system, Oriel, during the relevant specialty application window. Once longlisting is complete, eligible candidates are invited to register and book their exam slot via Pearson VUE.
How much does it cost?
There is no direct fee to sit the MSRA. However, you are responsible for any travel or accommodation expenses. Since costs are not reimbursed, it is strongly advised to book a local test centre as early as possible to avoid unnecessary travel.
How many attempts do I get?
You are permitted one attempt per recruitment cycle. If unsuccessful, you may reapply in a subsequent cycle. If multiple sittings are scheduled within the same year, such as in January and February, you may be able to resit in the later window.
Do I need to pass both papers?
Yes. Both the Professional Dilemmas (PD) and Clinical Problem Solving (CPS) papers must be completed, and you must achieve the required threshold in each. A band one score in either section means you cannot progress, regardless of your other results.
What is the pass rate?
There is no fixed pass mark. Scores are standardised each year and reported in four bands. Band one indicates the minimum threshold has not been met, while bands two to four represent passable levels of performance. A significant proportion of candidates typically score in bands two to four, but the outcome depends on your chosen specialty’s requirements.
When should I sit the exam?
Most candidates attempt the MSRA when applying for CT1 or ST1 posts, often soon after completing Foundation Year 2. The best time depends on your specialty and your confidence with the Foundation Programme curriculum. Allow yourself sufficient lead time for preparation, especially if you are working a busy rota.
What if I need to re-sit?
If you do not meet the minimum threshold, you may be able to re-sit during a later sitting in the same year. If you pass but do not secure a training place, you will need to reapply in the following cycle. Using feedback and question bank data to target weak areas is essential before re-sitting.
Is the exam suitable for international candidates?
Yes. The MSRA can be taken at Pearson VUE centres internationally. International applicants should plan for travel, visas, and additional logistics. The competition ratio may vary depending on specialty.
What should I focus on if time is short?
Prioritise high-yield domains such as cardiovascular, respiratory, gastrointestinal, and psychiatry for the CPS paper, and practise situational judgement scenarios for the PD paper. A minimum of one or two timed mocks plus daily Single Best Answer (SBA) practice is recommended.
How do I manage revision with a heavy rota?
Consistency is more effective than intensity. Use flashcards or SBA blocks in short bursts during weekdays, then dedicate longer weekend sessions for mocks. Protecting your wellbeing is vital, as fatigue undermines both revision quality and exam-day performance.
Final thoughts
The MSRA is a demanding assessment, but it is also a gateway to some of the most rewarding training opportunities in the UK. Because multiple specialities use it, the impact of your score can be significant, influencing both your speciality allocation and your training location.
Every year, thousands of candidates succeed while balancing busy clinical schedules, night shifts, and personal commitments. The key is not working harder, but working smarter. Prioritise high-yield areas, use active recall and spaced repetition, and practise under exam conditions to build stamina and confidence.
Medset is here to support you with structured tools and resources. Our AI-enhanced MSRA Question Bank has been designed to help candidates prepare more efficiently, with adaptive learning that targets your weaker areas, benchmarking to track your performance against peers, and spaced repetition to strengthen memory.
Start preparing smarter today with the Medset MSRA Question Bank.
With the right plan, consistent practice, and a calm mindset, you can approach exam day with confidence and take a significant step forward in your medical career.
