What Is the MSRA Exam?
The Multi-Specialty Recruitment Assessment (MSRA) is a computer-based exam used across a wide range of UK specialty training (ST1/CT1) recruitment processes. It was developed by the Foundation Programme and is sat by junior doctors applying for General Practice, Core Psychiatry, Clinical Radiology, Core Surgical Training, and a growing number of other specialties.
The MSRA assesses two distinct competencies through two separate papers — clinical knowledge and professional judgement — in a single sitting lasting 2 hours 55 minutes. It is administered twice per year: Round 1 in January (for posts starting August) and Round 3 in September (for posts starting February).
⚠ 2026 Critical Update: MSRA as Sole Selection Tool
For 2026 entry, GP, Core Psychiatry, and CAMHS use the MSRA as the sole selection criterion — there is no interview. Your MSRA score alone determines which training programme and deanery you are offered. For GP and Psychiatry candidates, every single mark in the MSRA directly determines your career outcome. This makes thorough, structured preparation more important than ever.
The MSRA is a ranking exam, not a pass/fail exam. Candidates are not simply assessed as pass or fail — your normalised score determines where you rank nationally against all other applicants for your specialty and deanery. This is why even a 10–20 point improvement in your score can move you from a non-competitive programme to your first-choice deanery.
MSRA Exam Structure: Two Papers, One Sitting
The MSRA consists of two papers taken consecutively in a single computer-based sitting at an approved test centre. Understanding the structure of each paper is the first step in building an effective preparation strategy.
Paper 1 · Clinical Knowledge
Clinical Problem Solving (CPS)
Tests: Investigation, diagnosis, prescribing, emergency management, and non-drug treatment across all major clinical specialties
Paper 2 · Professional Judgement
Professional Dilemmas (PD)
Tests: Professional integrity, patient safety, working under pressure, ethical decision-making, colleague interactions — scored against pre-determined model answers
✓ The most important insight most candidates miss
The Professional Dilemmas paper accounts for approximately 50% of your total MSRA score. Many doctors spend the majority of their preparation on the CPS paper — the clinical content they feel more familiar with — and neglect the PD paper. This is a strategic error. The PD paper is highly learnable through structured practice, and it is the paper where dedicated preparation produces the largest score improvement relative to time invested.
Which Specialties Use the MSRA for 2026 Recruitment?
The MSRA is used across an expanding range of specialties. The role it plays varies — for some specialties it is the sole selection criterion, while for others it contributes to overall ranking alongside interview and portfolio scores.
| Specialty |
MSRA Role in 2026 |
Interview Required? |
Competitiveness |
| General Practice (GP) |
MSRA Only |
No interview |
High — Band 3–4 typically required for competitive deaneries |
| Core Psychiatry (CPT) |
MSRA Only |
No interview |
High — MSRA score alone determines allocation |
| CAMHS |
MSRA Only |
No interview |
Moderate — fewer applicants but score-dependent |
| Clinical Radiology |
Shortlisting + ranking |
Yes |
Very High — Band 4 typically essential |
| Core Surgical Training (CST) |
Shortlisting contribution |
Yes (ARCP + interview) |
High |
| Core Medical Training (CMT) |
Shortlisting + ranking |
Yes |
Moderate to high |
| ACCS (Acute Care Common Stem) |
Shortlisting contribution |
Yes |
High in EM and Anaesthetics pathways |
| Obstetrics and Gynaecology |
Shortlisting contribution |
Yes |
Moderate |
| Nuclear Medicine |
Shortlisting contribution |
Yes |
Lower competition |
| Ophthalmology |
Shortlisting contribution |
Yes |
Moderate to high |
Always verify your specific specialty's MSRA weighting on the official NHS England recruitment portal or your specialty's national recruitment website, as thresholds and interview requirements can change between recruitment cycles.
MSRA Scoring and Bands: What You Need to Aim For
MSRA scores are normalised with a mean of approximately 250 for each paper. The CPS and PD scaled scores are combined into a total score. Scores are then categorised into one of four bands based on cohort performance. Because scoring is relative, there is no fixed absolute score — your band depends on how you perform compared to other candidates sitting the same exam.
1
Very Poor
Below ~370
Below average performance. Non-competitive for most specialties.
2
Below Average
~371–461
May be shortlisted for less competitive programmes.
3
Good
~462–529
Competitive for most specialties. Good deanery choice.
4
Very Good
530+ combined
Competitive for all specialties including Radiology and London deaneries.
A combined score of 575+ is generally considered competitive across most specialties. For Clinical Radiology — historically the most competitive MSRA specialty — Band 4 is typically necessary. For GP in competitive London deaneries, candidates typically need to be in the upper portion of Band 3 or Band 4.
MSRA High-Yield Topics: Where to Focus Your Preparation
The CPS paper covers the full breadth of clinical medicine, but question distribution is not equal across specialties. Based on the Foundation Programme curriculum and analysis of recurring MSRA question themes, the highest-yield CPS topics are:
Clinical Problem Solving — High-Yield Subjects
- Cardiovascular Medicine: ECG interpretation, ACS management, heart failure pathways, arrhythmias, hypertension — consistently the most heavily tested CPS area
- Respiratory Medicine: ABG interpretation, COPD, asthma management, pneumonia, pleural disease
- Psychiatry and Neurology: Mental Capacity Act, Mental Health Act sections, dementia differentiation, stroke management, headache red flags
- Endocrinology and Metabolic: Diabetes complications, thyroid disease, adrenal pathology, calcium and sodium disorders
- Gastroenterology: GI bleeding pathways, IBD, liver disease, coeliac, acute abdomen
- Pharmacology: Drug interactions, prescribing errors, paediatric dosing, antibiotic choice — tested throughout every CPS topic area
- Reproductive Health and O&G: Ectopic pregnancy, pre-eclampsia, antepartum haemorrhage, contraception, menstrual disorders
- Paediatrics: Development milestones, safeguarding, febrile illness, NICE TRAFFIC light system
Professional Dilemmas — What the SJT Tests
The PD paper tests professional behaviours rather than clinical knowledge. It assesses how you respond to workplace scenarios involving:
- Patient safety and risk: Reporting concerns, escalating appropriately, duty of candour
- Confidentiality: Balancing patient rights with duty to disclose
- Colleague relationships: Raising concerns about a colleague's performance or wellbeing
- Working under pressure: Managing multiple priorities, asking for help appropriately
- Consent and capacity: Applying MCA 2005 principles in practical scenarios
- Professional integrity: Honesty with patients, accurate record-keeping, GMC Good Medical Practice
💡 The PD paper is not about being "nice"
A common misconception is that the Professional Dilemmas paper rewards the most empathetic or compassionate response. It does not. It rewards the response most aligned with GMC Good Medical Practice, Foundation Programme competencies, and NHS professional frameworks. Understanding the underlying principles — not just good intentions — is what moves your PD score into Band 4 territory.
How to Prepare for the MSRA: A 6-Week Study Plan
Most doctors preparing for the MSRA while working full-time need 4 to 8 weeks of structured preparation. The approach below is designed for a working Foundation Year 2 or Core Trainee doctor with approximately 10–14 study hours per week. See also our full preparation guides on the MedLumen blog.
Week 1–2 · Professional Dilemmas Foundation
Master the SJT principles before any clinical revision
Start with the Professional Dilemmas paper — not the CPS. Read GMC Good Medical Practice in full (takes 2 hours). Study the Foundation Programme competency framework. Do 10–15 PD practice questions per day with full explanation review, focusing on understanding the reasoning behind each model answer rather than memorising responses. The PD paper is 50% of your score — spending the first two weeks here is the highest-return preparation decision you can make.
Week 3–4 · High-Yield CPS Specialties
Cardiovascular, Respiratory, Psychiatry, Endocrinology
Cover the four highest-weighted CPS specialty areas systematically. For each: do 20–30 MedLumen MSRA practice questions by specialty in timed mode, then review all explanations with a focus on NICE guideline management steps. Do not skip pharmacology — it runs through every specialty and is consistently tested throughout the CPS paper. Increase to 30–40 questions per day total.
Week 5 · Remaining CPS Specialties + Mock Test 1
Complete coverage + first full mock under exam conditions
Cover remaining CPS specialties: Gastroenterology, O&G, Paediatrics, Musculoskeletal, Renal, Dermatology/ENT/Eyes. Then take your first full-length MSRA mock test (both papers, timed, no interruptions). Score yourself honestly — the result tells you which areas still need targeted attention in Week 6. Do not panic at a lower-than-expected mock score; this is the learning mechanism, not a prediction of exam performance.
Week 6 · Targeted Consolidation + Final Mock
Weak-area revision only, then final mock, then rest
Use your MedLumen analytics dashboard to identify your three lowest-accuracy topic areas from all previous sessions. Spend the first four days of Week 6 exclusively on those areas. No new content. Take your final mock exam 3–4 days before your exam date. In the last 48 hours: review only your bookmarked questions and the GMC Good Medical Practice summary. Sleep. The exam is a two-paper marathon — rest is preparation.
🤖
AI Adaptive Question Selection
MedLumen's AI tracks your accuracy across every MSRA topic and specialty. Questions that reveal your gaps appear more frequently — so every session automatically targets where your score can improve most.
📊
Live Pass Predictor & Analytics
Track your accuracy per specialty, per paper, and your projected score band in real time. Know exactly where you stand relative to Band 3–4 targets throughout your preparation.
📱
iOS & Android App
Practise MSRA questions on the
iOS app or
Android app during commutes, breaks, and shifts. All progress syncs in real time across devices.
📋
Full-Length MSRA Mock Tests
Timed, full-length mock exams for both the CPS and PD papers. Replicate the real exam timing and format to build stamina and identify time management issues before exam day.
📖
NICE-Aligned Explanations
Every question explanation references the relevant NICE guideline, Foundation Programme competency, or GMC framework behind the correct answer — so you understand why, not just what.
🔄
Unlimited Progress Resets
Reset your question bank and start fresh as many times as you need. Ideal for candidates sitting multiple MSRA rounds or returning to preparation after a gap.
MSRA Curriculum Coverage
MedLumen's MSRA question bank covers all topic areas across both papers. Click any topic to see the questions and your performance in that area:
MSRA Question Bank Pricing
All plans include full access to 650+ MSRA practice questions, both CPS and Professional Dilemmas content, mock tests, and the AI analytics dashboard. Start with a free trial — no credit card required.
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- iOS & Android app
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1 Year Access
$89.00
full 12-month access
- All 650+ MSRA questions
- CPS & PD papers
- Unlimited mock tests
- AI analytics + pass predictor
- iOS & Android app
- Covers 2 recruitment rounds
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Ideal for multiple MSRA attempts
Frequently Asked Questions About the MSRA
What is the MSRA exam?
The MSRA (Multi-Specialty Recruitment Assessment) is a computer-based exam used for specialty training (ST1/CT1) recruitment across a wide range of UK specialties. It consists of two papers: the Clinical Problem Solving (CPS) paper and the Professional Dilemmas (PD) paper, sat consecutively in a single 2-hour 55-minute session. For 2026 entry, specialties including GP, Core Psychiatry, and CAMHS use the MSRA as the sole selection criterion — your score alone determines your training programme allocation, with no interview required.
Which specialties use the MSRA for 2026 recruitment?
For 2026 entry, the MSRA is used by: General Practice (GP), Core Psychiatry, CAMHS, Clinical Radiology, Core Surgical Training (CST), Core Medical Training (CMT), ACCS (Core Anaesthetics, Emergency Medicine), Nuclear Medicine, Obstetrics and Gynaecology, and Ophthalmology. For GP, Core Psychiatry, and CAMHS, the MSRA is the only selection criterion — no interview is required, and your score alone determines your deanery allocation. Always verify your specialty's specific MSRA weighting on the official NHS recruitment website for your specialty.
What are the MSRA scoring bands for 2026?
MSRA scores are normalised with a mean of approximately 250 for each paper. The combined CPS and PD score is categorised into four bands: Band 4 (Very Good) — approximately 530+ combined, competitive for all specialties including Radiology and competitive London deaneries; Band 3 (Good) — approximately 462–529, competitive for most specialties; Band 2 (Below Average) — approximately 371–461; Band 1 (Very Poor) — below 370. A combined score of 575+ is generally considered competitive across most specialties. Bands vary between sittings as they are based on cohort performance.
When is the MSRA in 2026?
The MSRA runs in two rounds per year. Round 1 (January 2026): for posts starting August 2026 — the exam window is typically 2–13 January 2026. Round 3 (September 2026): for posts starting February 2027 — the exam window is typically early September 2026. Exact dates are confirmed on the official Health Education England and NHS recruitment portals. Book your test centre slot early — popular centres fill up weeks in advance.
How is the MSRA Professional Dilemmas paper scored?
The Professional Dilemmas (PD) paper is a Situational Judgement Test scored against pre-determined model answer combinations. Your score reflects how closely your responses match the model answers. Critically, there is no negative marking — every question should be attempted, even if you are uncertain, as partial marks can be awarded for near-correct responses. The PD paper accounts for approximately 50% of your total MSRA score, making it the most strategically important paper to prepare for. Structured SJT practice — not just clinical knowledge revision — is the most effective preparation approach.
How many questions are in the MSRA and how long is it?
The full MSRA exam lasts 2 hours 55 minutes and includes two papers. The Clinical Problem Solving (CPS) paper contains approximately 97 questions (86 scored, ~11 unscored pilot questions) answered in 75 minutes. The Professional Dilemmas (PD) paper contains 50 SJT scenarios answered in 95 minutes. There is a short optional break between papers. The exam is taken on a computer at an approved Pearson VUE test centre.
What topics does the MSRA CPS paper cover?
The MSRA Clinical Problem Solving paper covers: Cardiovascular medicine, Respiratory medicine, Gastroenterology and Hepatology, Neurology and Psychiatry, Endocrinology and Metabolic medicine, Infectious Diseases and Haematology, Musculoskeletal medicine, Renal and Urology, Reproductive Health and Obstetrics/Gynaecology, Paediatrics, Dermatology, ENT and Ophthalmology, and Pharmacology. Questions test clinical decision-making including investigation choice, diagnosis, prescribing, and management — all aligned with current NICE guidelines and the Foundation Programme curriculum. Cardiovascular and Pharmacology are consistently the highest-yield areas.
How many MSRA practice questions does MedLumen provide?
MedLumen's MSRA question bank contains 650+ validated MSRA practice questions covering both the Clinical Problem Solving (CPS) and Professional Dilemmas (SJT) papers. All questions are NICE-aligned and authored by UK doctors. The bank includes full-length timed mock tests, AI-adaptive question selection that automatically targets your weakest areas, detailed explanations referenced to specific guidelines, and performance analytics tracking your accuracy across every CPS specialty and the PD paper.
Is there a free MSRA practice questions resource or free trial?
Yes — MedLumen offers a 7-day free trial with full access to all 650+ MSRA practice questions, both CPS and Professional Dilemmas content, mock tests, and AI analytics. No credit card is required to start. This gives you a complete week of genuine MSRA preparation before deciding on a paid plan. After the trial, plans start from $14.99 for 1-month access.
How long should I prepare for the MSRA?
Most doctors preparing while working full-time need 4 to 8 weeks of structured preparation. The optimal approach for 6 weeks is: Weeks 1–2 focused on the Professional Dilemmas paper (SJT principles, GMC Good Medical Practice); Weeks 3–4 on high-yield CPS specialties starting with your weakest areas identified through question practice; Week 5 completing CPS coverage and taking your first full mock test; Week 6 on targeted weak-area consolidation and a final mock. Starting question practice from day one — not after reading — produces significantly better score improvement per hour of study.
Can I prepare for the MSRA on my phone?
Yes. MedLumen's MSRA question bank is fully available on the
iOS App Store and
Google Play for Android. Your performance data, bookmarks, and progress sync in real time across all devices. Practising MSRA questions in short sessions during commutes, breaks, and downtime between clinical shifts is one of the most effective preparation strategies for working Foundation Year doctors — building the consistent spaced repetition that maximises long-term retention.
Is MedLumen's MSRA content updated for 2026?
Yes. MedLumen's medical editorial team reviews and updates all MSRA content monthly to ensure alignment with current NICE guidelines, updated GMC Good Medical Practice guidance, and the latest Foundation Programme curriculum. The 2026 MSRA question bank reflects the two-sitting format (January Round 1 and September Round 3) and includes specific content addressing the updated scoring methodology and specialty-specific requirements for 2026 entry.
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