How to Ace the MSRA

What is the MSRA?

The Multi-Specialty Recruitment Assessment (MSRA) is a computer-based exam used to assess candidates applying for specialty training in the UK for certain specialties, including:

  • Anaesthetics

  • ACCS Emergency Medicine

  • Clinical Radiology

  • General Practice

  • Ophthalmology

  • Neurosurgery

  • Obstetrics & Gynaecology

  • Nuclear Medicine

  • Core Psychiatry Training

  • Community Sexual & Reproductive Health

If you’re applying to any of these specialties then you NEED to nail the MSRA as some of them ONLY use the MSRA score to judge your application.

Exam Structure

The exam is 170 minutes and comprises 2 parts:

  • A Professional Dilemmas paper (95 minutes)

  • A Clinical Problem Solving paper (75 minutes)

The exam is explained in detail in the MSRA blueprint.

Professional Dilemmas Paper

The professional dilemmas paper is essentially a ‘situational judgement test’, that is, a test to look at how you cope with difficult situations at the level of a foundation year 2 doctor (2 years after graduating medical school).

These include professional integrity, coping with pressure and empathy and sensitivity (as outlined in the exam guidance), so the focus is on professional attributes.

There are 50 questions to complete in 95 minutes (about 1.9 minutes per question).

The format of about half of the questions will be to ‘rank options in order’, which means ranking actions from most appropriate to least appropriate in a given scenario.

The other half of the questions will be ‘choose the 3 most appropriate actions’, where you get a list of 8 potential actions in a situation and you choose the 3 most appropriate.

Clinical Problem Solving Paper

The clinical problem solving paper tests how you manage the diagnosis and treatment of patients (essentially, how you apply your medical knowledge to a clinical scenario). It’s quite similar to medical school finals as it covers a lot of specialties (listed in their recruitment document, link below) and tests 5 core competencies: Investigation, diagnosis, emergency, prescribing and management.

This paper has 97 questions to complete in 75 minutes, (about 46 seconds per question).

The format of about half of them are extended matching questions (EMQs) where you get a list of 7-10 responses and then separate questions where the answers are within the list of responses.

The other half are single best answer (SBA) questions, where you just pick the most likely answer from 5-8 possible responses for one clinical presentation.

There is no negative marking, so attempt every question as you can’t be penalised!

For some free example questions, the GP recruitment website has a document with these on.

Revision Strategy

The main focus of your time will be on doing as many practice questions as you can.

The idea is to test your knowledge by doing questions from a question bank and in doing so, identify your areas of weakness, which you can read up on. Then, make flashcards on areas you need to learn and review these regularly. This is the most efficient way to revise for this exam because there is so much content to cover.

You can use paper or electronic flashcards - We recommend Anki as they use a spaced repetition system to show you the flashcards you got wrong more frequently than those you get correct.

The key is to create the flashcards yourself and then ensure you review them regularly (e.g. on your commute to work or lunch break). Consistency is the key here.

In summary, do questions, read up on mistakes, make flashcards and review flashcards regularly.

Question Banks

The 2 question banks that we recommend using are online and they are Passmedicine and MCQbank. A few other colleagues of mine recommend these as well. By the way, we're not sponsored by these websites.

Passmedicine is good to get tested on a broad range of topics and I like their explanations after each question, which often include current NICE guidelines. Also, they have a nice website which tracks your scores as well, if you like that sort of thing.

MCQbank also has representative questions that are quite similar to the exam.

We recommend doing one of them completely at first before trying the other. If you finish both, then you can move on to other question banks for more practice.

Other Resources

NICE guidelines

When learning about the questions you get wrong, NICE guidelines are good to read. The exam isn’t meant to test your knowledge of guidelines, however they are a good resource to learn about treatments for conditions. You can use the original NICE guidelines or NICE clinical knowledge summaries for something concise. Bear in mind that sometimes the question banks aren’t completely up to date so their answers may differ from NICE guidelines.

GMC good medical practice

For the professional dilemmas section, you’re being tested on your professionalism, so it’s good to familiarise yourself with 'Good Medical Practice', the professional guidelines for Doctors, which can be used to guide how you rank your answers.

GMP in action

One resource that some people used was Good Medical Practice in action, which are online scenarios on different professionalism scenarios that you can work through, with questions and answers based on GMP principles. They’re free and we did them to practise getting in the mindset of dealing with professional dilemmas, but we don’t feel strongly that they helped a huge amount. Do them if you want the practice.

UKFPO SJT practice papers

Although these are for the situational judgement test (SJT) for those applying for the UK foundation programme, it’s still free practice for you and they give rationales in the answer explanations. The guiding principles will be similar to those used in the MSRA (i.e. GMP).