If you’re applying for specialty training in the UK, you’ve probably heard whispers about the MSRA - the Multi-Specialty Recruitment Assessment. It’s one of those acronyms that floats around medical forums and WhatsApp groups, often accompanied by nervous jokes and study tips. But what exactly is the MSRA, who has to take it, and why is it so important for your medical career?
Let’s break it down clearly.
What is the MSRA?
The MSRA is a national, computer-based exam used in the recruitment process for several postgraduate medical training programmes across the UK. It’s designed to provide a fair, standardised way to assess both your professional judgement and your clinical problem-solving skills - two cornerstones of safe, effective medical practice.
The assessment is split into two parts:
Professional Dilemmas (PD)
This section is similar to a situational judgement test (SJT) and evaluates how you respond to challenging, real-world scenarios you might face as a doctor. You’ll be asked to rank or select the most appropriate actions in situations that test your empathy, professionalism, communication, and ethical reasoning.
Clinical Problem Solving (CPS)
This paper assesses your ability to apply clinical knowledge in context. Expect a broad range of foundation-level topics, from diagnosing common conditions to deciding on the most appropriate investigations or management plans.
Together, the two components take around three hours to complete - with 95 minutes for Professional Dilemmas and 75 minutes for Clinical Problem Solving. There’s usually an optional short break between them. The test is sat at a Pearson VUE centre or online, depending on current arrangements.
Who needs to take the MSRA exam?
You may need the MSRA for specialty training applications, as it plays a key role in recruitment for several popular programmes. These include:
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General Practice (GP)
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Core Psychiatry Training
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Clinical Radiology
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Obstetrics and Gynaecology
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Core Surgical Training
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Anaesthetics
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Neurosurgery
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Ophthalmology
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Nuclear Medicine
However, the weight the MSRA carries differs between specialties. For example, in GP and Core Psychiatry recruitment, your MSRA score alone determines your ranking and whether you receive an offer - there’s no interview stage at all. In other specialties, the MSRA might be used purely for shortlisting, or as one component alongside interviews or portfolio assessments.
That’s why it’s so important to check the specific recruitment guidance for your chosen specialty each year. Knowing exactly how your score will be used helps you plan your preparation strategically.
Why MSRA matters
In a competitive training landscape, the MSRA can make a huge difference to your future career. Here’s why it deserves your full attention:
1. It’s a gateway to a specialty
For many applicants, a strong MSRA score is the key to progressing to the next stage of recruitment - or even securing an offer outright. A few points can be the difference between your preferred deanery and a location miles from where you hoped to train.
2. It tests both your knowledge and judgement
Unlike a purely academic exam, the MSRA goes beyond textbook knowledge. It tests how you think, prioritise, and respond in the complex, people-centred world of clinical practice. That balance makes it a powerful indicator of your readiness for specialty training.
3. It levels the playing field
Because it’s a standardised national test, the MSRA helps ensure fairness across applicants from different medical schools, foundation programmes, and international backgrounds. Everyone is assessed on the same objective scale.
4. It rewards smart, structured preparation
The MSRA is one of those exams where technique matters. Understanding the question formats, managing your time, and practising realistic scenarios can dramatically improve your score. That’s why having access to targeted resources and high-quality question banks can make all the difference.
What to expect from the MSRA exam
The Professional Dilemmas paper typically includes around 50 scenarios, each presenting a situation you might face in clinical practice. You’ll either rank actions in order of appropriateness or choose the best combination of responses. There’s no single “perfect” answer - instead, success lies in showing balanced, professional judgement that aligns with GMC guidance and NHS values.
The Clinical Problem Solving paper usually contains around 86 scored questions, with some additional unscored pilot items. You’ll need to interpret data, weigh options, and apply core medical knowledge efficiently under time pressure. There’s no negative marking, so it’s always worth attempting every question.
Your final scores are standardised, which means they’re compared to other candidates’ performance to generate a scaled result. The higher your score relative to your peers, the better your ranking.
How to properly prepare
The MSRA is as much about strategy as it is about knowledge. Successful candidates consistently highlight the importance of early, structured preparation. Here are some key steps to guide your approach:
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Familiarise yourself with the format early - The question style can feel unusual at first, especially in the Professional Dilemmas paper. Practice helps you internalise what’s being tested.
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Practice under timed conditions - In the Clinical Problem Solving section, time pressure can be intense. Simulate exam conditions regularly to build speed and accuracy.
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Use trusted question banks - Quality practice questions - with clear explanations - are vital. They help you identify weak areas and learn the reasoning behind correct answers. Pastest’s MSRA revision resource is one of the best out there - with the largest question bank on the market, expertly crafted questions, and comprehensive coverage of 300+ topics based on detailed exam analysis.
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Revisit professional judgement principles - Refresh your understanding of core professional domains like integrity, empathy, and teamwork. The GMC’s “Good Medical Practice” is a valuable reference.
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Plan ahead - Booking your test slot early gives you more flexibility and avoids last-minute stress. Likewise, start revising well before your exam window opens.
The MSRA might seem like just another hurdle on the long road through postgraduate training, but it’s much more than that. It’s your chance to demonstrate the clinical insight and professional judgement that define a great doctor - and it can open the door to the specialty career you’ve been working towards.
With clear understanding, structured preparation, and access to high-quality practice resources, you can approach the MSRA with confidence - and turn it into an opportunity rather than an obstacle.