A Guide to the Multi-Specialty Recruitment Assessment (MSRA)

Published on: 11 Aug 2022

Multi Specialty Recruitment Assessment MRSA

The Multi-Specialty Recruitment Assessment (MSRA) is a single computer-based exam comprising a Professional Dilemmas (PD) paper and a Clinical Problem Solving (CPS) paper. It is intended to assess candidates with a foundation level of competence.

Many specialties – namely community sexual and reproductive health, general practice, neurosurgery, obstetrics and gynaecology, ophthalmology, psychiatry (core and child and adolescent), and radiology – use the MSRA in selection processes for specialty training.1 Negative marking is not utilised. Consequently, candidates are encouraged to answer all questions.1

There is an optional five-minute break between the two papers. If candidates take a longer break, this extra time will be subtracted from the time available in which to complete the CPS paper.2


Professional Dilemmas (PD) paper

The PD paper is a situational judgement test (SJT) comprising fifty questions.1 Typically, 95 minutes are allocated for this part of the MSRA. Candidates may be allowed 25% or 50% additional time as reasonable adjustments under the Equality Act 2010.1 The PD paper poses workplace-based scenarios featuring professional dilemmas to assess candidates’ judgement of appropriate behaviour.

It does not test knowledge or problem-solving. Instead, the content relates to the GMC’s Generic Professional Capabilities framework and tests attributes that are important for doctors’ training progression and job performance. The three main competencies tested are professional integrity, coping with pressure and empathy and sensitivity.1 Knowledge of specialty training is not needed but a general understanding of primary and secondary care work is expected. Questions are set in the context of the UK Foundation Programme; candidates assume the role of F2 doctors. However, to make certain the fairness of the MSRA for all candidates including International Medical Graduates, questions do not entail any knowledge of policies or procedures that are specific to the UK.1

The scenarios are based across an array of settings that F2 doctors might be in, for example, hospital wards, general practices and out-of-hours clinics. Some questions may be based outside medical settings. The settings are there to provide context. However, the judgement required to answer the questions is not specific to one setting. 

Half of the questions in the PD paper are ranking questions and half are multiple-choice questions. Typically, the answer options are actions that can be taken in response to the circumstances in the scenario. Good, acceptable, and poor actions are included as options, as is the best action. Unrealistic actions are not included.

For the ranking questions, candidates must rank four or five actions in order of appropriateness, with the first and last ranked options being the most appropriate and the least appropriate, respectively. It is important to note that the actions are distinct and are not intended to be taken successively.1

Candidates’ answers are marked against pre-determined keys. More marks are awarded for greater similarity to the pre-determined key. Consequently, it is not necessary to rank the options in the same order as the pre-determined key to score highly on questions.1

For the multiple-choice questions, candidates must choose three out of eight answer options provided. These should be the three most appropriate actions that, when taken in conjunction, will be a complete resolution of the circumstances. Multiple-choice questions are also marked by comparing candidates’ answers to pre-determined keys.

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Clinical Problem Solving (CPS) paper

The CPS paper comprises 97 questions and assesses higher level synthesis of medical knowledge.1 Typically, this part of the MSRA is allocated 75 minutes. Candidates may be allowed 25% or 50% additional time. The CPS paper poses scenarios that test candidates’ ability to apply their knowledge and use problem-solving skills to make clinical decisions. The settings of the scenarios provide context, but the judgement required to answer the questions is not specific to one setting. The questions are based on the Foundation Programme curriculum and cover twelve topics relevant to general medicine (Box 1).1

The CPS paper tests five main competencies: investigation, diagnosis, emergency, prescribing and management (non-prescribing).1 The questions are posed in straightforward language and do not test knowledge that is specific to certain areas to ensure fairness for all candidates.


Box 1 – CPS clinical topics

Half of the questions in the CPS paper are extended matching questions (EMQs) and half are single best answers (SBA). EMQs feature sets of 7-10 answer options, each with multiple associated questions. For each question, candidates must choose the most appropriate answer option from the set. For example, candidates may be asked to select the most appropriate drugs, from a list, to prescribe to several different patients.

Each answer option may be selected once, or more, or not at all. For SBAs, candidates must choose the single most appropriate answer out of 5-8 answer options for a clinical presentation. For example, candidates may be presented with a short clinical case and asked to choose the single most appropriate diagnosis. One mark is awarded for each correct answer in the CPS paper.


Revising for the MSRA

Sample and practice questions for both papers of the MSRA are available here. Additionally, a demo test to enable candidates to familiarise themselves with the controls and screen layout is available here

Exam revision courses, books and online question banks are available. These are not endorsed by any of the question writers. Candidates may want to revise some topics before sitting the MSRA.


The MSRA for recruitment to GP specialty training 

After candidates have filled in their application for GP specialty training, and the deadline for application submission has passed, they are provided details to register with Pearson VUE. Applications are assessed using the criteria listed in the General Practice – ST1 Person Specification. Subsequently, longlisted candidates are invited to sit the MSRA. Candidates must book a test for their preferred centre, date, and time by logging onto their Pearson VUE account.

Any candidates who have requested special accommodation, not including extra time, will be contacted directly by Pearson VUE with test details.2

The MSRA is delivered on several consecutive days at many Pearson VUE Computer Testing Centres across the world. UK applicants must sit the MSRA at a UK testing centre; non-UK applicants may attend a testing centre nearest to their residence.

On the day, candidates must arrive a minimum of fifteen minutes before the test time. They must bring one form of original, valid government issued ID that includes their name, recent recognisable photograph, and signature. This may be a passport, driver’s license, military ID, ID card, alien registration card or local language ID.2

ID is only accepted if issued in the country the candidate is sitting the MSRA in. Candidates are not permitted to take personal belongings, for example, bags, books, notes, phones, and wallets into the testing room. Additionally, food and drink are not allowed.

Candidates are informed of their results some time after the testing period has ended. This date, for each recruitment round, is available on the GP National Recruitment Office (GPNRO) website.  The scores for each paper are normalised around a mean score of 250 with a standard deviation of 40.2 Consequently, there is no maximum achievable score.

Additionally, the scores for each paper are banded 1 to 4. Band 1 means that the minimum score has not been achieved. Candidates who score band 1 in either, or both, papers are unable to proceed with their applications.

All applicants to GP specialty training are required to sit the MSRA. Candidates who do not achieve the minimum score required for GP specialty training must resit.2 A successful outcome from the previous recruitment year cannot be transferred.

Candidates who have achieved the minimum score in an earlier round in the same recruitment year may transfer their score or resit to improve their score. However, regardless of whether this score is better or worse, it will replace the former score.2



1 - Multi-Specialty Recruitment Assessment (MSRA) – Test Blueprint & Information [Internet]. The General Practice (GP) National Recruitment Office. 2019 [cited 26 August 2021]. Available from: https://gprecruitment.hee.nhs.uk/Resource-Bank/Recruitment-Documents-Forms

2 - Applicant Guidance General Practice: Multi-Specialty Recruitment Assessment (MSRA) 2021-22 [Internet]. The General Practice (GP) National Recruitment Office. 2019 [cited 26 August 2021]. Available from: https://gprecruitment.hee.nhs.uk/Resource-Bank/Recruitment-Documents-Forms