The MSRA is a computer based multiple choice exam that features both clinical questions and a situational judgement test. It's a pretty big deal as almost all doctors in the UK are required to sit it as part of the specialty training selection process and it has a pretty huge impact on your life and career as your score helps to decide what job you'll get and where you'll be training.
What Is The MSRA?
MSRA stands for Multi-Specialty Recruitment Assessment (MSRA) and it's a 3-hour computer-based exam that is used as part of selection into post-graduate specialty training. It's used predominantly for selection at CT1 and ST1 level as you can see from the diagram with the exam itself sat by most people in the F2 year after you apply for specialty training and before the interviews.
There are two sittings of the MSRA each year. One in January for Round 1 applications and one in September for Round 2 with booking opening the month before.
The MSRA was originally introduced as part of specialty selection for GP training and has gradually been rolled out to most other specialties. It's basically used as a way to shortlist candidates before selection interviews and it features a mix of clinical multiple choice questions like finals and situational judgement questions like the SJT split across two papers.
By way of a little medical education history. Health Education England who are responsible for all medical training in the UK paid a company called the work psychology group to review the specialty training selection process and they helped to design the MSRA. The MSRA was created to assess those with a foundation level of medical competence with the clinical questions based on the Foundation Programme curriculum and the situational judgement questions based on the Generic Professional Capabilities framework outlined by the GMC. As the content focuses on the foundation years the MSRA was deemed relevant and fair for doctors applying to any medical specialty. I'll let you folks debate that in the comments below. I'm not a huge fan of making doctors do even more exams at stressful times and that's why I wanted to do this video so you can hack the system by knowing how to do well and this hopefully goes someway to taking off some of the stress around your day jobs.
Which Medical Specialties Use The MSRA?
The MSRA is currently used for entry into postgraduate medical training for the following specialities:
- GP (100%): No selection center
- Psychiatry 100%: No interviews
- Radiology 33% (MSRA score can bypass interviews)
- O&G 25% (MSRA score can bypass interviews)
- Neurosurgery 40%
- Anesthetics 15%
- Ophthalmology 13%
- Nuclear Medicine (used at ST3)
- ACCS TBC
- Core Surgery 10%
The way that these specialties use the MSRA is very variable. For example during the pandemic GP and psychiatry switched from in-person interviews to only using the MSRA to select candidates. So for GP and psych 100% of your rank depended on how you score in the MSRA. It's the only thing that determined if you get a job and where that job is. There's no selection center, no interview, no portfolio at all for GP and psychiatry.
Most other specialties use the MSRA as part of your overall score and combine the MSRA with interviews. If you're applying for CT1 anaesthetics for example your MSRA contributes 15% of your overall rank.
It's sensible to check the website of the specialty you're applying to for year to year specifics on weighting as these percentages can vary. And it may be that the interviews go back to being in-person but regardless of the weighting and scoring the MSRA is still a significant contributor to where you get a job so let's look at the exam format and how to score highly regardless of what specialty you're applying to.
How Do You Apply To Sit The MSRA?
To book an MSRA exam you need to first apply for specialty training in one of the specialties that uses the MSRA. This is done through the Oriel application system. If you meet the eligibility criteria for that specialty you'll then be invited to book the MSRA exam. You can't apply directly to sit the MSRA. You have to first submit an application and have that application accepted.
Where Can I Sit The MSRA?
The MSRA is delivered in Pearson VUE test centres across several consecutive days within the MSRA exam windows in January and September each year. The MSRA can be sat in the UK and internationally and you can find the nearest test centre to you by heading over to the Pearson VUE website. It’s worth noting that there will be lots of people booking MSRA exam slots around specialty application time in November and August and there may not be availability at your closest Pearson VUE test centre, meaning travel further to sit your exam, so try and book early if you can.
What's The Cost Of The MSRA?
The good news is that the MSRA exam itself is free so you don't need to pay for it like professional exams. However, you may need to pay for travel or accommodation depending on where you chosen test center is for the exam. And expect to set aside around £200 for exam preparation with question banks and books. This is a pretty sensible investment in my opinion because, as we'll see later, doing as many realistic questions as possible is the best way to prepare for the exam.
What is the Format of The MSRA?
The MSRA is 2-hrs 55 minutes in total and is split into two parts - a Professional Dilemmas (PD) paper and a Clinical Problem Solving (CPS) paper.
There is a five minute break in between the two papers included in the overall time. The whole thing's done on computer in a test center under exam conditions. And the first paper is always the professional dilemma paper which is 95-minutes. Then there's a five-minute break and then there's the clinical problem solving paper, which is 75 minutes. You can't just start the CPS paper after finishing the PD paper. They are two separate papers under the same exam conditions so if you finish early you'll have to wait.
On the day each candidate is given different questions from a central question bank so the person sat next to you will have a different set of questions, which is done to limit any cheating or sharing of answers with candidates sitting the exam on different days.
How Many Questions Are In The MSRA?
The Professionals Dilemma Paper
The Professionals Dilemma Paper has 50 situational judgement style questions in 95-minutes of which 42 questions are scored and 8 are being piloted and carry zero marks but you don't know which these are.
The PD paper is split into two sections with about half the questions in section one, and half are in section two but section one carries the bulk of the marks as we'll see in a moment when we look at the scoring.
Section one of PD paper uses ranking questions. You get a scenario, there's four or five options and you rank them best to worse. In section two of the PD paper there's a scenario, there's eight options and you're asked to select the three most appropriate options from the list.
The main problem with the PD paper is time. With 50 scenarios and 95 minutes you get around 1 minute 48 seconds per question. However as the scenarios require some thought it can be easy to spend too long on some questions and run out of time. The key here is practice and to understand the scoring as we'll see in a second.
The Clinical Problem Solving Paper
The CPS paper is up next and has 97 clinical questions in 75-minutes of which 86 are scored and 11 are being piloted.
The 86 CPS clinical questions are split up equally into extended matching style questions where you are given a scenario and asked to choose the most appropriate option from a list of 7-10 possible answer options. And single-best answer style questions where you are asked to choose the most appropriate option from a list of 5 answer options.
You have around 45 seconds to answer each question on the clinical paper and the standard is similar to finals.
How Is The MSRA Scored?
Your overall mark for the MSRA comes from your combined score across the Professional Dilemmas Paper and the Clinical Problem Solving Paper.
Your overall score for each paper is then placed into a range and a band. The individual specialties using the MSRA will then use a cut-off score of their own selection.
As you can see only the top 1 or 2% of doctors score at the highest level.
There is no negative marking so you should answer every question but each paper is marked slightly differently so let's take a look at each in turn.
Professional Dilemmas Paper
The PD paper is a situational judgement test and as such it's scoring can be quite confusing. So let's spend some time understanding how the PD questions are marked as once you figure that out it really helps you when you come to select your answers.
The PD paper is a Situational Judgement Test (SJT) and it focuses on your approach to working as a doctor. Specifically, the paper measures your understanding of situations that arise for doctors in the NHS during Foundation Placement) and your judgement to select appropriate actions. It focuses on appropriate behaviours when interacting with patients and colleagues and in managing your work.
The PD paper assesses you against three core competencies from the person specification for specialty training:
- Professional integrity
- Coping with pressure
- Empathy and sensitivity
You don't need any clinical knowledge to answer the PD questions. But what really helps, is being familiar with the NHS and how it works and having a good working knowledge of the GMC ethical guidance and good medical practice.
Each question will give you a work based scenario where you have to make a difficult decision or use your judgment and some of them will involve ethical or professional dilemmas.
In section 1 which are the ranking questions each question is worth up to 20 marks.
So as we can see here in this example question there are 5 options which we then need to rank in order. For these ranking scenarios the answer options are discrete actions and they should not be thought of as chronological. You can only perform ONE best action so it's A OR B OR C not A THEN B. There is always a best order which the examiners set and then your answer is compared to this.
So for this question here's the answer order. There is a maximum of 20 marks if you get the exact order that the examiners set and then a range from 18-8 depending on how close your order is to theirs. In the exam you should compare each answer to the answers above and below and then on the computer screen you drag each answer and order your answers.
In section 2 of the PD paper, which is the multiple select section, each question is worth up to 12 marks.
Again here's a quick example. You get 4 marks for each correct answer. If you get all 3 correct you get 12, 2 you get 8, 1 you get 4. Now unlike ranking order for these scenarios the three most appropriate actions taken together should fully resolve the situation. So it's the combination of the 3 best actions that resolve the situation. It's A AND B AND C combined.
This subtle difference in how the section of the PD paper are marked causes a tonne of confusion so hopefully these examples help clear things up and you'll pick it up as you practise.
The Clinical Problem Solving Paper
The CPS paper is a little more straight forward. For each question, 1 mark is awarded for choosing the correct response without any negative marking.
In the CPS part of the assessment, candidates are presented with clinical scenarios that require them to exercise judgement and problem solving skills to determine appropriate diagnosis and management of patients. Questions focus on your ability to apply knowledge appropriately. The items are based on Foundation-level clinical practice, and test higher level knowledge of medical knowledge.
Questions are based on 12 clinical topic areas relevant to F2-level and each section of the CPS includes a balance of scenarios which cover all 12 topics.
The topics are:
- Dermatology / ENT / Eyes
- Endocrinology / Metabolic
- Gastroenterology / Nutrition
- Infectious Disease / Haematology / Immunology / Allergies / Genetics
- Psychiatry / Neurology
- Renal / Urology
The test also assesses the core competencies of investigations, diagnosis, emergencies, prescribing and management of patients.
- Investigation – Focusing on specific investigations to support a more conclusive diagnosis or to rule out possible causes of illness / injury.
- Diagnosis – Evaluating the symptoms presented by a patient to identify a possible condition, disease or injury.
- Emergency – Recognising patient risk and a potential serious illness requiring immediate action.
- Prescribing – Advising, authorising or reviewing a patient’s clinical management plan – specifically the use of medicine / drugs.
- Management (non-Prescribing) – Advising, authorising or reviewing a patient’s clinical management plan – specifically the use of non drug-related treatment.
How To Prepare For The MSRA
Let's dive into how to prepare for the MSRA in this section and cover the best resources to use, when to start preparing and how much time to spend revising around your day job when preparing for the exam to give you an idea of what you need to do to ace it.
Step one is to familiarise yourself with the MSRA exam format, timings and scoring and step 2 is then to practice, practice, practice.
Resources: Books and Websites
For the Professional Development Paper it is worth reminding yourself of the GMC ethical guidance and some quick summaries the GMC's Good Medical Practice. We would also suggest spending a little time going back over this guide and the official guidance to make sure you fully understand how the PD questions are scored. Other than that save yourself time and get straight into actually doing questions.
Resources: MSRA Question Banks
So without question the best way to prepare for the MSRA is to do as many active recall questions as possible. Preferably doing these under timed conditions with mock exams.
The best question banks have questions that are very close to the actual questions you will get in the actual MSRA and will come with full explanations. This is particularly helpful for the PD paper where some question banks nicely explain the reasoning behind the correct order or selection and this then helps you to switch your brain into thinking along those same lines.
Now there are a bunch of MSRA question banks out there so here are the best MSRA question banks to help you decide which is best for you, and remember you might want to sign-up to multiple banks to do as many questions as possible.
eMedica is one of the oldest MSRA question banks out there, originally designed for GP specialty selection when it was just the SRA. eMedica also run courses and have a host of other resources predominantly aimed at GPs that are worth checking out.
The eMedica MSRA question bank costs £49 for 1-month, £99 for 4-months, £109 for 6-months and various tiers in between.
The question bank comes with 1440 clinical questions and 120 SJT style questions together with a selection of mini and full mock exams. The web interface is quite basic but the content is generally felt to be pretty similar to the real exam.
PassMedicine has 2,500 clinical questions and 250 dilemma questions on offer. PassMedicine offers a 4-month subscription for £25 and a 6-month subscription for £30.
One of PassMedicine's most-liked features is it's textbook which offers explanations and information around clinical topics in detail. Questions were felt to be less similar to those asked at the final MSRA exam than other question banks but at such a low cost it's a fairly inexpensive risk to take.
MCQBank comes with 978 clinical questions and 206 PD questions.
The question bank costs £53 for 1-month access, £59 for 4-months and £75 for 6-months. The question content is very close to the real MSRA exam however the website design and layout may not be to everyone's tastes.
PasTest offers an offline app and 1,900 MSRA questions to practise. It has a modern interface, good explanations but perhaps not the most realistic questions.
It's pricing is a little different too offering £35 up to the next MSRA sitting and £55 for the sitting after that. So depending on how early you register you could pick up a good deal.
Shiken is a newer learning platform that features mobile app, a gamified interface and the ability to adjust your time per question which is helpful for MSRA revision. Shiken is a little different from the others on the list as it allows multiplayer and acts like a store hosting packages for different tests and exams.
The MSRA pack on the Shiken store comes with over 5000 questions which is the most on the list has and offers both 3, 6 and 12 months options together with fixed pricing to the date of the next exam.
When Should You Start Preparing For The MSRA?
The majority of successful applicants spend 1-2 months preparing. Start their preparation around application time. So if you're sitting the MSRA in January start revising in November and if you're sitting it in September get going in July.
How To Prepare For The MSRA Around Your Day Job?
For many people revising around a busy day job with oncalls and night shifts is the biggest challenge. If you start early and plan your revision around shifts it's definitely manageable. This is where the question banks come in really useful too. I'd spend the first few days making sure you understand the MSRA exam and then plan to do a few hours a day of questions getting through as many questions as possible. I'd recommend starting with the PD questions a there are fewer in the question banks and then attack the clinical questions. You can then factor in mocks and going back over questions nearer the exam.
Why Do People Fail The MSRA?
The commonest reasons for failing the MSRA are:
- Running out of time - the PD section in particular goes very quickly and it can be easy to spend too much time overthinking answers which then causes you to run out of time. To counter this I'd suggest practising lots of questions and timing yourself when you do so.
- Underestimating the difficulty of the exam - as it's a free exam and is part of specialty selection it might be easy to think "yep I know how to do an SJT exam" and then not prepare.
- Focusing on just one paper -
- Poor exam technique - the PD SJT questions require a certain technique that doesn't come naturally to some people. You need to treat it like a driving test and select the best responses against the guidance outlined in the GMC documentation.