MSRA examination

The second step of the application process involves sitting the Multi-Specialty Recruitment Assessment (MSRA) exam. This is a computerised exam which was first utilised in General Practice recruitment but is now used across a variety of specialties in different ways to contribute to national selection including radiology, neurosurgery, and psychiatry. 

This exam must be sat exclusively in a Pearson Vue centre. Yes, you read that correctly. You will be sitting this exam in the same place you may have sat your driving theory test as a teenager or UKCAT test on entry to medical school.

Around mid-December, you should receive an email on the account linked with your ORIEL application, inviting you to register for the Multispecialty Recruitment Assessment exam via the Pearson Vue testing centre website.

In radiology training, the importance of this exam should not be underestimated. The MSRA is used in the national selection for radiology training in two ways.

  1. Shortlisting. 
  • The MSRA score will be used to shortlist eligible candidates for interview. 
  • This means that the MSRA score is used to determine the top cohort of candidates who are invited to interview. 
  • In 2020, the top 622 scoring candidates were invited to interview. The usual figure is the top 600 candidates but this will vary somewhat year by year.
  • In 2020, the minimum cut-off score for interview was 485. Candidates who scored above the cut-off point but did not form part of the top 622 were put on a reserve list. Please note, that many candidates score much higher than this. 
  1. Interview ranking.
  • In 2020, the MSRA score was weighted to contribute to 33% of the final score used to rank for ST1 training posts. The remainder is made up of scores at interview, which we will discuss later on.

It is therefore really important to set aside time to prepare and study for the MSRA exam. There are many resources available for the MSRA, including commercial courses and online question banks. 

The exam is made up of 2 main components:

  1. Professional Dilemmas (PD) – 95 minutes
  2. Clinical Problem Solving (CPS) – 75 minutes

The MSRA is sat in January of the year of application.

The first component (PD) consists of situational judgement questions covering various common and less common ethical dilemmas faced in clinical environments. The second component  (CPS) consists of questions covering clinical knowledge across all major medical and surgical specialties, roughly equivalent to the knowledge acquired by a foundation year 2 doctor in the UK.

Your final score will be available to view on ORIEL when released (refer to recruitment timetable for dates), and you will receive a total score as well as a breakdown of the above components.

We do not endorse any particular resources but from speaking to successful candidates and from my own personal experience, I found the following resources valuable:

  1. Passmedicine.com MSRA question bank. If using this resource, you should aim to complete the question bank at least once. Make sure to go back and complete the questions you answered incorrectly, as this will make up the bulk of your learning. I found the clinical question bank to be useful and comparable to the real exam. I would not recommend using this as the sole resource for the PD component, as from personal experience, I found the questions in the real exam pitched at a higher, more challenging level than those offered by this resource.
  2. MCQbank.co.uk. This resource was particularly useful for the PD component, as I found the questions to be more comparable to those in the real exam.
  3. Emedica MSRA course. This is a one-day face-to-face course held by Emedica in many cities across the country. I would say this type of course is not essential by any means but is particularly useful if you struggle with ethical or situational judgement dilemmas as it is an opportunity to discuss answers to questions in a supportive environment with a well-informed group of teachers. 
  4. MSRA Blueprint & Information Document. This document is freely available via the HEE GP recruitment website. Read this document carefully, as it covers the main components of the MSRA including the domains tested in good detail.

I repeat, do not underestimate the importance of this exam, particularly if you are not an FY2 applicant. 

Yes, the knowledge required for the exam is pitched at no more than 1-2 years post-graduation level, however it may have been a while since you have covered any paediatrics, cardiology or obstetrics knowledge, so keep this in mind when you start preparing. Try and identify your weaknesses early and target questions in those categories in your revision.

Anecdotally, I know of several, otherwise strong candidates who did not meet the cut-off for interview, and the comment they all made was that they did not adequately prepare for the exam and thought it was more ‘challenging’ than they had expected.

The following is not to scare you or put you off applying but will hopefully encourage you to maximise your MSRA preparation in the weeks and months prior. 

As mentioned above, the cut-off score for the interview was 485. My total score was 550. In general, this is regarded as a very good score which represented the top 25% percentile in 2020. A score of this level and above would allow straight offers without interview in specialties such as GP and Psychiatry in 2020. In the 2020 radiology application, a score of 550 gained me ‘only’ 29/40 points for the MSRA component of the overall ranking for ST1 posts. Therefore, it is clear that radiology applicants are doing very well on this exam in general.

From personal experience, I would recommend the ‘little and often’ approach, i.e. start a couple of months in advance and set yourself a minimum target of work for each day. This is particularly important if you have other commitments in your personal life.  A good aim to start with is 25 questions each day, building up to 100-150 a day before the exam. I would recommend taking some annual or study leave, if you are able to, at least a few days prior to the exam to really focus on completing as many practice questions as possible.

Some candidates like to use MCQ books and SJT books targeted at final year medical students, I did not do this, but it is another alternative resource to consider. Other websites which offer question banks include Emedica and Passtest.

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