MSRA Exam – All you need to know

Esther is a Clinical Teaching Fellow from the Southwest of England. She sat the MSRA exam during her F2 year and secured a score within the top 10%, getting her first choice job. Together with MedProjectHub, she shares her top tips for acing the MSRA and securing your top job.

What will we cover?

What is the MSRA exam?

Download the recruitment guide!

The Multi-Specialty-Recruitment-Assessment is a computer-based assessment used by a variety of training schemes, including General Practice, Psychiatry, Radiology, Ophthalmology, Anaesthetics, O&G and Neurosurgery to name a few. With training scheme places becoming increasingly competitive, more and more specialities have included the MSRA to help narrow down prospective candidates, and indeed the COVID pandemic has fast-forwarded this.

It’s important to note that each speciality uses MSRA results differently – check specific national recruitment websites for further guidance.

Structure of MSRA exam

There are two component parts to the MSRA: a Professional Dilemmas paper and a Clinical Problem Solving paper.

  1. Professional Dilemmas (95 minutes)
    • Similar format to the SJT.
    • Designed to assess your responses to challenging situations that may arise while working as a junior doctor.


2. Clinical Problem Solving (75 minutes)

    • Based on the foundation programme curriculum
    • I found it very similar to medical school finals, with the questions more clinically based
    • This paper covers the following topics:
      • CVS
      • Dermatology, ENT, ophthalmology
      • Endocrinology
      • Gastroenterology
      • Infectious diseases
      • Haematology, Allergy Medicine, Genetics
      • MSK
      • Paediatrics
      • Pharmacology (don’t underestimate this topic, lots of questions on this!)
      • Psychiatry
      • Neurology
      • Urology and renal medicine
      • Reproductive health
      • Respiratory

How is it scored?

  • The scoring for the MSRA is a bit confusing.
  • It’s not negatively marked, thank goodness, so pop something down even if you’re not sure.
  • For GP applicants specifically, MSRA scores are normalised around a mean score of 250. In addition, the scores for each paper are banded from 1-4, where 1 indicates the minimum acceptable standard has not been achieved. If you’re looking to get into the top 10%, you will be looking to achieve a score of approximately 550 (although this is a very rough estimate as scores are normalised for every cohort).
  • In the Novemeber 2020 application cycle, GP selection was entirely based on your MSRA rank. Whether this continues or it returns to the normal process, we’ll just have to wait and see!

How long does it take to prepare for the MSRA exam?

  • In my opinion, this is an exam where hard work does pay off. Start early, approximately 3-4 months before the exam as a minimum. If you can put in a few hours of work most days, this will give you enough time to go through an entire question bank.
  • Don’t underestimate the difficulty of the MSRA – the content is very broad, and you’re expected to be knowledgeable over a wide range of specialities.
  • The more practice questions you do, the better your score will be.

Should I take the MSRA exam even if I’m not planning on entering a training scheme for this year?

  • TAKE THE EXAM! Consider it a free mock! Whether you want to start a training scheme immediately or not.
  • Crucially, you can hold your score for 12 months. A successful MSRA outcome will be valid for the entirety of the recruitment year in which it was undertaken (this is for GP specifically). If you get a good score and choose to re-apply in a subsequent round within the same recruitment year, your score will carry over. Many of my colleagues weren’t aware of this fact and wished they had attempted the exam for a) practice and b) if they managed to perform well, they could keep their score for the next application cycle.
  • All in all, by attempting the exam, you are keeping as many options open as

How should I prepare for the Clinical Problem Solving paper?

  • Especially considering the MSRA is free to take, it’s 100% worth investing in a question bank subscription.
  • Don’t bother making copious notes (and trust me, this is coming from someone who LOVED making pages of notes at medical school) – the best way to maximise your score is to get familiar with the exam question format from the start.
  • I solely used passmedicine and worked through the entire question bank topic by topic. Common themes recur in the questions, which helps to identify the weaknesses in your knowledge and consolidate your learning. The question bank comes with its own notes, which are really concise and saves you from making your own.
  • I used the website Quizlet to make flashcards on some topics and went through these the night before the exam to refresh my memory.
  • I didn’t find this section of the exam particularly time-pressured. You can flag questions that you want to go back to during the exam, and I had more than enough time to revisit these.

How should I prepare for the Professional Dilemmas paper?

  • I found this paper very similar to the SJT… except that this time you’ve been a fully-fledged doctor for more than a year, and you actually know how a hospital works!
  • The greatest challenge posed by this paper is time. Each scenario is quite wordy, and it can be easy to fall behind. Don’t agonise over each scenario, and stick to time.
  • I took a look at the GMC Good Medical Practice Guide before the exam and treated it like a textbook.
  • Quite honestly, the scenarios in the exam feel highly subjective, and it often feels like you don’t have enough information. Of course, medics always suffer from the tendency to overthink, which doesn’t help either.
  • But remember the age-old cliché – answer these questions like they’re your driving test. Ask yourself, ‘What would the GMC want a model junior doctor to do?’.
  • I didn’t find any question banks particularly helpful for the Professional Dilemmas paper. They were often much shorter than the actual exam questions.

The best preparation for the exam was my GP placement.

  • In my opinion, this hugely contributed to my score. It enabled me to get into the mindset of a GP. It felt like a significant advantage going into the exam.
  • Many of the questions reflect the clinical problems encountered in General Practice.
  • If you don’t have a GP placement, book a couple of taster days in GP before the exam.

Get familiar with the 2-week wait criteria.

  • Get to know the most common ones:
    • Breast, UGI, colorectal, head and neck, and skin cancer.
  • These common question themes come up repeatedly – get familiar with them and learn those red flags.

Looking for a textbook or revision resource?

  • Oxford handbook for General Practise: whilst this textbook isn’t necessary to pass the exam, it is a fantastic resource, especially if you will be doing a GP rotation. It’s a clear and concise textbook and contains all the 2-week wait criteria.
  • Passmedicine revision notes are a helpful
  • Clinical Knowledge Summaries (CKS). In particular, the back pain CKS is helpful for red flag back pain.
  • Official practise questions
  • Subscribe to the MedProjectHub blog to get all the latest articles to help your career development 
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