A complete guide to the MSRA in 2024
Multi-Speciality Recruitment Assessment (MSRA)
The MSRA is an exam used as part of the selection process for the majority of U.K. post-Foundation training programmes.
When is the next MSRA sitting?
The most recent MSRA sitting was for the Round 3 recruitment cycle. The paper was sat between 5 to 12th September 2024. Results are expected by 3rd October 2024.
The 2025 MSRA sitting dates have not yet been released.
2024 MSRA Scores
Explore the scores from the 2024 sitting of the MSRA exam.
Tap chart to view scores and percentiles
Data obtained from NHS England
Format
The MSRA consists of two papers:
Professional Dilemmas (PD)
Optional 5 minute break
Clinical Problem Solving (CPS)
The total exam time is 170 minutes (2 hours and 50 minutes) with an option for a 5 minute break between the PD and CPS papers. This 5 minutes is not included within the 170 minutes.
The exam is held in Pearson Vue centres. It is administered on a computer with an invigilator present.
You will need to bring one form of government issued ID that includes your name and photograph to present to the invigilator on the day. For more information on ID requirements and what will happen on the day of the exam please see this page from Health Education England.
A brief history
The MSRA has evolved from a Situational Judgement Test that was first developed in 2007 by the General Practice National Recruitment Office (GPNRO). Prior to this the GPNRO were using white space questions. They found that the results of a SJT correlated better with performance at subsequent interview. It was also cheaper to mark.
By 2014 the test had only been taken up by one other speciality - Public Health. The potential for a broader test was seen however and a new exam was made, the Speciality Selection Test (SST), later renamed to the Multi-Speciality Recruitment Assessment (MSRA).
During the COVID-19 pandemic recruitment had to move online. Many recruitment offices started evaluating the MSRA as a ready made candidate to replace their in-person recruitment procedures. The amount of specialities using it exploded and it is now used by the majority of post-Foundation U.K. training programmes.
Specialities that use the MSRA
The MSRA is currently used as part of recruitment for 13 different speciality programmes.
Programmes use the MSRA in different ways. Broadly there are three distinct groups:
MSRA for selection for intervew
These speciality programmes use the MSRA to select which candidates progress to interview. Most of these programmes also use the MSRA score, combined with the interview score and sometimes a portfolio (verified evidence) score to make a total selection score. The candidates with the highest total selection score then get matched to the programme.
You can see the relative weighting of the MSRA / interview / verified evidence as their percentage of the total selection score in the table below.
MSRA for direct selection
Some programmes use the MSRA as the only means of selections. As such applicants with the highest MSRA scores match directly to the programme.
Hybrid
Gynaecology offer a hybrid model. The applicants with the highest MSRA scores match directly to the programme and bypass the interview. Applicants who do not meet this cut off still need to interview and their MSRA score still makes up 1/3 of their total selections score.
MSRA usage by speciality
| Specialty | Details |
|---|---|
| Anaesthetics CT1 | MSRA Purpose: Shortlisting for interview and 15% total selection score weight Interview Required: Yes Total Selection Score MSRA Weight: 15% Interview Weight: 85% |
| Acute Care Common Stem (ACCS) CT1/ST1 | MSRA Purpose: Shortlisting for interview and 15% total selection score weight Interview Required: Yes Total Selection Score MSRA Weight: 15% Interview Weight: 85% |
| Clinical Radiology ST1 | MSRA Purpose: Shortlisting for interview and 20% total selection score weight Interview Required: Yes Total Selection Score MSRA Weight: 20% Interview Weight: 50% Verified Evidence Weight: 30% |
| Child and Adolescent Psychiatry ST1 | MSRA Purpose: Selection Interview Required: No Total Selection Score MSRA Weight: 100% Additional Notes: Match to programme based on MSRA score |
| Psychiatry of Learning Disability ST1 | MSRA Purpose: Selection Interview Required: No Total Selection Score MSRA Weight: 100% Additional Notes: Match to programme based on MSRA score |
| Core Psychiatry CT1 | MSRA Purpose: Selection Interview Required: No Total Selection Score MSRA Weight: 100% Additional Notes: Match to programme based on MSRA score |
| Core Surgical Training CT1 | MSRA Purpose: Shortlisting Interview Required: Yes Total Selection Score MSRA Weight: 10% Interview Weight: 60% Verified Evidence Weight: 30% |
| Community Sexual and Reproductive Health ST1 | MSRA Purpose: Selection Interview Required: No Total Selection Score MSRA Weight: 100% |
| General Practice ST1 | MSRA Purpose: Selection Interview Required: No Total Selection Score MSRA Weight: 100% |
| Neurosurgery ST1/2 | MSRA Purpose: Shortlisting. MSRA makes up 40% of the shortlisting for interview score. Paper shortlisting makes up the other 60%. Interview Required: Yes Total Selection Score MSRA Weight: 30% Interview Weight: 70% |
| Nuclear Medicine ST1/2/3 | MSRA Purpose: Shortlisting Interview Required: Yes |
| Obstetrics and Gynaecology ST1 | MSRA Purpose: Shortlisting & Selection Interview Required: Yes (for some) Total Selection Score MSRA Weight: 33.3% Interview Weight: 66.6% Additional Notes: Highest MSRA scoring candidates receive offers directly, bypassing interview |
| Ophthalmology ST1 | MSRA Purpose: Shortlisting Interview Required: Yes Total Selection Score MSRA Weight: 20% Interview Weight: 30% Verified Evidence Weight: 50% |
Professional Dilemmas
The Professional Dilemmas (PD) paper consists of Situational Judgement (SJT) questions.
These questions present scenarios with challenges that a Foundation Year 2 doctor might face. You'll be given response options and asked to select the most appropriate action for a doctor at this level of training.
This Professional Dilemmas paper is 95 minutes long so you will have just under 2 minutes (114 seconds) per question.
The paper consists of 50 questions: 42 operational and 8 pilot. Only operational questions count towards your score. You won't know which questions are which during the exam.
How many types of Professional Dilemma questions are there?
There are 2 types of Professional Dilemma questions
Ranking Questions
Ranking questions present 4-5 options for you to order from most to least appropriate.
Each action is meant to resolve the dilemma within the scenario on it's own. When ranking the options you should consider the options indepedent of one another and not as steps that you may take sequentially.
You are given points for 'near misses' so it is important to try and rank each option, even if you are not sure.
Example Ranking Questions
You are a Foundation (F2) doctor working on an elderly care ward. Mrs Rennie, an 82-year-old patient, asks to speak with you privately. She explains that during a previous discussion with the consultant and her family, she agreed to be for CPR. However, she now tells you that she does not want CPR and only agreed earlier to keep her family happy.
Rank in order the following actions in response to this situation (1= Most appropriate; 5= Least appropriate).
Multiple Choice Questions
You will be given 8 options and asked to pick the 3 most appropriate responses to the scenario.
Unlike the Ranking questions the options in the Multiple Choice Questions are designed to be considered together. You must select the group of actions which together form the best collective response.
The marking scheme for Multiple Choice Questions is binary. You are given marks for each of the three correct responses only.
What are Professional Dilemma questions assessing?
Questions are constructed to test one or more of the following three domains. Within these domains are several behavioural indicators. These are the standards of behaviours for which the MSRA marking scheme is developed.
Professional Integrity
- Open and honest with others; willing to admit own mistakes.
- Treats others with respect and dignity and knows where personal/professional boundaries lie.
- Able to balance ethical tensions in relation to demand, resources and expectations.
- Strives for quality and manages risk.
- Works proactively and is inquisitive in approach.
- Takes responsibility for self, others and the health of the wider population.
- Demonstrates a commitment to equality of care for all and strives to act in the patients' best interests.
Empathy and Sensitivity
- Understands and manages own emotions; understands the impact of these on decision making.
- Willing to admit when experiencing difficulties and seek assistance where needed.
- Readily employs tactics for managing own stress and pursues a healthy work/life balance.
- Maintains a professional demeanour; remains calm under pressure.
- Demonstrates self-awareness, understanding own limitations and how behaviour may affect others.
- Accepts and manages uncertainty and change; responding flexibly when required.
- Is resilient, managing criticism well.
- Able to take on multiple complex roles and effectively balance differing responsibilities and commitments.
- Capable of modifying behaviour to adapt to differing roles or skills required in the future.
Coping with Pressure
- Employs a caring approach towards patients and colleagues.
- Capacity and motivation to view situations from the patient/colleague perspective.
- Demonstrates an understanding of others' situations and circumstances.
- Takes a holistic approach to patient care and considers social, psychological and emotional factors as well as the wider healthcare system.
- Empowers patients through involvement in their own care.
- Acknowledges and explores the patient's wants and needs.
- Takes a patient-centred approach, treating patients as individuals.
- Acts in an open and non-judgemental manner.
Clinical Problem Solving
The Clinical Problem Solving (CPS) paper is an applied knowledge test and consists of clinical scenarios that a Foundation Year 2 doctor may encounter.
This CPS paper is 75 minutes long, so you will have under 1 minute (46 seconds) per question.
The paper consists of 97 questions: 86 operational and 11 pilot. As with the PD paper, only operational questions count towards your score. You won't know which questions are which during the exam.
How many types of Clinical Problem Solving questions are there?
There are 2 types of Clinical Problem Solving questions
Extended Matching Questions (EMQ)
EMQ questions provide multiple clinical scenarios with the same list of 6-12 plausible responses for each. You should select the most appropriate response to each clinical scenario.
Single Best Answer (SBA)
You will be asked to select the single most appropriate answer out of 5-8 plausible responses. The main difference from EMQs is that there are fewer options, and the options will change for each question.
Clinical Topic Areas Covered in CPS
CPS questions are split across 12 different clinical topic areas. You will be asked questions from all of these clinical topic areas, even if it is not relevant to the speciality you are applying to.
Clinical Topic Areas
- Cardiovascular
- Dermatology / ENT / Eyes
- Endocrinology / Metabolic
- Gastroenterology / Nutrition
- Infectious Disease / Haematology / Immunology / Allergies / Genetics
- Musculoskeletal
- Paediatrics
- Pharmacology & Therapeutics
- Psychiatry/Neurology
- Renal/Urology
- Reproductive
- Respiratory
There are 5 domains that the questions aim to test for amongst these clinical topical areas.
Target Domains
- Investigation
- Diagnosis
- Emergency
- Prescribing
- Management (non-Prescribing)
MSRA Revision Resources
There are many resources available for MSRA revision. These can be split by paper.
Professional Dilemmas Paper Revision Resources
For the professional dilemma papers it is highly recommended to work through the official example paper. There are also example papers from the, now defunct, selection into the U.K. Foundation Programme SJT (UKFP). These can be harder to find and are scattered across the internet. To make life easier for you we've collated them all together and included them below.
Official MSRA Practice Papers
MSRA Official Practice Paper 2022
MSRA Official Practice Paper 2023
Same as the 2022 but excludes the infamous question 8 (the airport question)
MSRA Sample Questions 2020
Contains 12 professional dilemma questions not available elsewhere
MSRA Applicant Guide 2019
Contains 2 professional dilemma questions not available elsewhere
Official UKFP Practice Papers
UKFP questions are aimed at the level of Foundation Year 1 (FY1) doctors, compared to FY2 for the MSRA. This can lead to subtle differences in how answers are ranked. Please be mindful of this when working through these papers.
UKFP Sample Paper 2023
UKFP Practice Paper 2021 Part 1
UKFP Practice Paper 2021 Part 2
UKFP Practice Paper 2012 (Large Print)
Contains some overlap with the 2021 papers.
Examify
Here at examify we have developed the first and only validated professional dilemma question bank. We have trained an A.I. system that scores in the top 6.5th centile on the MSRA exam, high enough to get into any training programme. We have then used this A.I. to validated MSRA questions written by Subject Matter Experts. To learn more visit our homepage or read our white paper - Our plan to beat the MSRA.
Other
It is also recommended to read through the GMC's Good Medical Practice.
This is a document containing the standard to which U.K. doctors are expected to practice medicine.
Clinical Problem Solving Paper Revision Resources
The official MSRA practice papers contain numerous CPS questions to help familiarise yourself with the level the questions are targeted at and the format of the questions.
They do not contain enough questions for revision though. For further revision we recommend working through a question bank, the most popular of which is PassMedicine.