The Multi-Specialty Recruitment Assessment is the standardised written exam used for recruitment into UK specialty training programmes. If you are applying for GP training, psychiatry, radiology, ophthalmology, public health, community sexual and reproductive health, or other specialties that use the MSRA, your score on this exam significantly influences where — and whether — you train.
Understanding the format, the scoring, and the preparation requirements is not optional. The MSRA is highly competitive and small score differences determine deanery allocation.
Format
The MSRA consists of two papers sat on the same day.
Paper 1: Professional Dilemmas (SJT). 50 items testing situational judgement, professional behaviour, and ethical reasoning. Each item presents a workplace scenario and asks you to rank responses or select the most and least appropriate actions. This paper contributes 50% of your total MSRA score.
Paper 2: Clinical Problem Solving (CPS). 97 items testing clinical knowledge through SBA questions. Covers medicine, surgery, paediatrics, O&G, psychiatry, pharmacology, and clinical sciences. This paper contributes 50% of your total MSRA score.
Total exam time: approximately 3.5 hours (2 hours 34 minutes total testing time).
2026 Dates and Administration
The MSRA is typically held in January-February. For the 2026 recruitment cycle (applying in autumn 2025 for ST1/ST3 posts starting August 2026), the exam was held in January 2026. Results are released within weeks and feed directly into the specialty recruitment process.
The exam is delivered at Pearson VUE test centres across the UK and internationally. IMGs can sit the exam at international test centres.
Which Specialties Use the MSRA
The MSRA is used for recruitment to GP training (ST1), core psychiatry training (CT1), radiology (ST1), ophthalmology (ST1), public health (ST1), community sexual and reproductive health (ST1), and other specialties as determined by HEE/NHSE recruitment. GP training is by far the largest user.
Each specialty weights the MSRA differently in its overall recruitment score — some use it as the sole shortlisting tool, others combine it with portfolio scores and interviews.
Scoring
MSRA scores are standardised. The Professional Dilemmas paper and Clinical Problem Solving paper are scored separately, then combined equally (50/50) to produce a total MSRA score.
Competitive scores vary by specialty and deanery. GP training typically requires higher scores for London and popular southern deaneries, with lower thresholds for less competitive regions. Specialty-specific competitive scores are discussed in the dedicated article below.
How to Prepare
For Professional Dilemmas: This paper tests workplace judgement, not clinical knowledge. The principles are GMC Good Medical Practice, NHS values, teamwork, escalation, patient safety, and professional integrity. Practise ranking exercises and "most/least appropriate" formats specifically — the question style is different from SBAs and requires a different skill set.
For Clinical Problem Solving: This paper tests clinical knowledge across the full breadth of medicine. Use a Q-bank mapped to MSRA content: iatroX Q-Bank provides free, adaptive spaced repetition across clinical domains. PassMedicine, Emedica, or Pastest provide MSRA-specific question pools for exam-volume practice.
Verify clinical knowledge against UK guidelines. Ask iatroX provides instant NICE/CKS/BNF-grounded answers with citations. The CPS paper tests UK management pathways — not international textbook recommendations.
Do mock exams under timed conditions. At least 3-4 full timed mocks covering both papers. The time pressure is significant and must be practised.
The MSRA rewards candidates who prepare for both papers equally. Candidates who focus only on clinical knowledge and neglect Professional Dilemmas lose 50% of their potential marks.