The MSRA: Gateway to Training: IMG guide for UK practice (2026)

Key points

MSRA is a computer-based assessment used across multiple specialties; for some, it can be the primary ranking metric.
Two papers: Professional Dilemmas (SJT-style) + Clinical Problem Solving (broad medicine).
PD rewards “safe, escalatory, policy-aligned” judgement; CPS rewards speed + pattern-recognition under constraints.
If you’re applying to a specialty that uses MSRA for shortlisting, the MSRA is effectively your “entry ticket” to interview.

What specialties use it?

The MSRA is used by multiple national recruitment processes (and the list evolves). In recent recruitment guidance and specialty documents, it is referenced across areas including General Practice, Psychiatry, Radiology, Anaesthetics, ACCS-EM, Obstetrics & Gynaecology, Ophthalmology and more. Always confirm your target specialty’s current rules on the official recruitment pages.

The MSRA is delivered at Pearson VUE test centres. It is designed to assess competencies in person specifications using clinical scenarios, and it is intentionally broad: it tests how you think, not whether you can memorise one niche guideline.

MSRA structure (know this cold)

Paper 1 — Professional Dilemmas (PD / SJT)

95 minutes, 50 questions. This is judgement under pressure: prioritisation, escalation, professionalism, and safe systems-thinking.

Paper 2 — Clinical Problem Solving (CPS)

75 minutes, 97 questions. A wide breadth of medicine; high time pressure. (Historically, a subset of items may be unscored “pilot” items.)

Scoring behaviour

There is no negative marking: you are generally better off answering everything than leaving blanks.

The PD paper trap

Most candidates underperform because they treat PD like “common sense.” High scorers treat it like a rules-based system: immediate patient safety first, escalate appropriately, document, follow policy, be honest, seek senior support early, and avoid lone-wolf heroics.

Preparation plan (high leverage)

Build a “PD decision ladder”

Pre-commit to a sequence: immediate risk → seek senior support → follow local policy → document → reflect/learn. This prevents “storytelling” answers.

CPS = speed + coverage

Practise under timed conditions. Your aim is not perfection; it is “safe, correct, and fast” across a broad syllabus.

Target your weakest domains

Track misses by theme (e.g., acute medicine, prescribing, paeds, psych). Patch systematically rather than doing random question sets.

If you remember only one thing

MSRA is not an exam you “wing.” It is an exam you systematise: timed practice, post-session error logs, and a PD framework that is consistent and defensible.

Your learning path

Save your place and choose what comes next

Work through this guide (6 steps)

Use the actions from this article to track what you have worked through.

Paper 1 — Professional Dilemmas (PD / SJT)
95 minutes, 50 questions. This is judgement under pressure: prioritisation, escalation, professionalism, and safe systems-thinking.
Return to this section
Paper 2 — Clinical Problem Solving (CPS)
75 minutes, 97 questions. A wide breadth of medicine; high time pressure. (Historically, a subset of items may be unscored “pilot” items.)
Return to this section
Scoring behaviour
There is no negative marking: you are generally better off answering everything than leaving blanks.
Return to this section
Build a “PD decision ladder”
Pre-commit to a sequence: immediate risk → seek senior support → follow local policy → document → reflect/learn. This prevents “storytelling” answers.
Return to this section
CPS = speed + coverage
Practise under timed conditions. Your aim is not perfection; it is “safe, correct, and fast” across a broad syllabus.
Return to this section
Target your weakest domains
Track misses by theme (e.g., acute medicine, prescribing, paeds, psych). Patch systematically rather than doing random question sets.
Return to this section

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