This is the implementation companion to our PassMedicine MSRA analytics audit — read that for what the metrics mean; read this for what to actually do each week. The workflow exists to solve one problem: a self-directed clinical bank naturally over-feeds your comfortable domains and is blind to Professional Dilemmas entirely, so left to itself it will leave you confidently under-prepared on roughly half the exam.
What you are working with
As of 19 July 2026, PassMedicine offers low-cost fixed-term MSRA access with high question volume, timed and revision modes, and peer-comparison analytics; it advertises no AI tutor, and question selection is whatever you configure. Verify current counts and price on the product page. The exam is 170 minutes across two papers per NHS England's published structure — Professional Dilemmas (95 minutes, situational judgement, around 50 scenarios) and Clinical Problem Solving (75 minutes, single-best-answer and extended-matching, roughly a hundred clinical items at sub-minute pace). PassMedicine can drill CPS; it cannot touch PD.
The one-page plan
| Phase | Timing | Focus | Exit trigger |
|---|---|---|---|
| Baseline | Week 1 | Unseen CPS sample + first PD paper | ~100 CPS items logged; PD baseline taken |
| First pass | Weeks 2–5 | Domain-floored CPS + twice-weekly PD | Every CPS domain above floor |
| Pace + PD | Weeks 6–7 | Timed CPS blocks + consensus-scored PD | Sub-minute pace stable; PD logic improving |
| Simulation | Weeks 8–9 | Full timed both-paper mocks | Go/no-go on both papers |
Baseline both papers before personalising
Before you let filtered revision shape your feed, take a small blueprint-stratified unseen CPS sample and one full timed PD paper. Two baselines, because you have two exams. The CPS baseline gives you an honest strength/weakness map; the PD baseline tells you whether your instinct for professional-judgement ranking is anywhere near the consensus standard — and for many candidates it is not, which is exactly the thing a clinical bank will never reveal.
Domain floors — and a PD floor
Set a minimum question count per CPS domain proportional to the primary-care-weighted blueprint, and do not let a rising overall percentage substitute for meeting them. Then add the override the audit insists on: a weekly Professional Dilemmas floor measured in sessions, not questions. The commonest MSRA failure pattern is a candidate with excellent CPS analytics who treated PD as a week-before afterthought. A PD floor of two timed sessions a week from the start prevents it, and PassMedicine's dashboard will never prompt you to set one because PD is invisible to it.
Error taxonomy for two different papers
For CPS misses, use the six-type taxonomy: knowledge gap, misread stem, premature closure, guideline error, calculation error, time-pressure error — each with its own fix (source read, process fix, differential drill, dated guideline check, arithmetic under time, pacing work). For PD misses, the taxonomy is different and simpler: was it a principle error (you misjudged what professionalism required) or a ranking error (right principles, wrong order)? Principle errors need you to study the consensus rationale; ranking errors need pattern practice on how the exam weights patient safety, honesty, escalation and team-working against each other. Do not analyse PD misses with clinical logic — that is the category error the audit warns against.
The pace override CPS demands
CPS punishes slowness more than almost any UK exam, so build a specific override: at least three timed CPS blocks a week from the first-pass phase onward, run at forced sub-minute pace even when it costs accuracy. Untimed revision teaches the medicine; only timed blocks teach the clock, and on this paper the clock fails more candidates than the content. Track average time-per-item as a first-class metric, not an afterthought.
The switch to simulation
Move to full both-paper simulation when three conditions hold: every CPS domain floor met, CPS timed-block accuracy stable with pace under the paper's budget, and PD ranking logic measurably improving against consensus material. From that point, most sessions are full timed papers — CPS and PD — with targeted practice only to patch specific leaks. Simulating both papers together also rehearses the switch between an SJT mindset and a clinical mindset within one sitting, which is its own small skill.
A seven-day pattern for applicants
Monday: 50 PassMedicine CPS questions in floor-deficient domains, explanations read, misses taxonomised. Tuesday: a timed PD session on official-style material, reviewed against the rationale (not clinical logic). Wednesday: a timed, unseen 50-question CPS block in iatroX's free MSRA practice — adaptive selection across domains and a clean readiness signal. Thursday: 30 forced-pace CPS questions plus error review. Friday: second PD session. Saturday: a full timed both-paper simulation, reviewed same day. Sunday: rest. PassMedicine drills CPS; official material owns PD; iatroX measures on unseen items. Nothing overlaps, and nothing important is invisible.
A worked planning example
Suppose six weeks out your position is: CPS overall 70% but heavily weighted to women's health and dermatology; musculoskeletal and ophthalmology thin and under 62%; average pace 68 seconds per item against a paper that demands well under 60; and PD practice consisting of two untimed skims with no consensus-scored feedback. A dashboard-driven candidate reads "70%, on track" and keeps drilling their strong domains. This workflow reads it very differently and produces four concrete jobs.
Job one, coverage: musculoskeletal and ophthalmology take next week's largest CPS quota — roughly 150 questions between them, floors set and enforced — because they are both under-attempted and under-performing. Job two, pace: three timed CPS blocks this week run at a forced sub-55-second rhythm even at a temporary accuracy cost, because 68 seconds finishes the paper on adrenaline and adrenaline is not a strategy. Job three, PD: the two untimed skims become two timed, consensus-scored sessions with the rationale reviewed line by line, because half the exam currently has no honest measurement behind it. Job four, signal: one unseen timed CPS block from outside PassMedicine, so next fortnight's "progress" is measured on questions your history did not select.
The output is a week of quotas and appointments, not a pass prediction — because none of the numbers above can honestly produce one, and pretending otherwise is how candidates walk into the PD paper unprepared with a reassuring CPS percentage in their pocket.
Continue, supplement, switch or stop
Continue while floors fill and unseen CPS performance climbs. Supplement immediately if PD practice is lagging — that is the highest-yield fix available to most candidates. Switch only for a measurable CPS gap (our MSRA resource comparison is the place to decide). Stop accumulating CPS volume in the final fortnight; simulate both papers instead.
Three mistakes this workflow is designed to stop
First, treating PD as a week-before task. It is roughly half the assessment, it is a distinct skill scored against consensus, and the candidates who leave it until the end are the ones whose strong CPS scores do not save them — the PD floor from week one exists precisely to prevent this. Second, drilling CPS untimed. Accuracy without pace is a false comfort on a paper that gives you under a minute an item; every CPS block from the first-pass phase should carry a clock, because the clock is the examiner most people underestimate. Third, letting the strong domains eat the calendar. Women's health and dermatology feel productive because you are good at them, but maintenance is cheap and growth there is marginal — the marks live in the domains you are avoiding and the paper you are postponing. If you catch yourself reaching for a comfortable topic, that is the signal to open a floor-deficient one instead.
Frequently asked questions
Is PassMedicine enough for MSRA on its own? No — it can carry CPS volume, but Professional Dilemmas needs consensus-scored official practice regardless of your bank, and readiness needs unseen timed CPS blocks from outside your history.
Which MSRA component does PassMedicine not reproduce well? The entire Professional Dilemmas paper, plus the sub-minute pacing pressure of CPS that untimed practice never builds.
How many PassMedicine questions should I complete per day for MSRA? 40–60 CPS questions on study days, distributed by floor deficits, with PD sessions and timed blocks protected separately — composition matters more than raw count.
When should I stop using PassMedicine and move to mixed mocks? When CPS floors are met, pace is under budget and PD logic is improving — usually the final two to three weeks, given to both-paper simulation.
How should I combine PassMedicine with iatroX without duplicating practice? PassMedicine for CPS domain drilling; iatroX (free for MSRA) for unseen adaptive CPS measurement; official material for PD — three jobs, no repeated questions.
Editorial notes and references
Written by Dr Kolawole Tytler, NHS GP and founder of iatroX. Last checked 19 July 2026; MSRA timings are NHS England's, PassMedicine details vendor-published — verify counts, prices and the applicant guidance for your round. Disclosure: iatroX offers a free competing MSRA bank. Corrections via the feedback route on iatrox.com. References: NHS England MSRA structure (medical.hee.nhs.uk); PassMedicine product pages; related reading: the PassMedicine MSRA analytics audit and what a good MSRA score is.