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The Multi-Specialty Recruitment Assessment — the gateway to GP, psychiatry, ophthalmology, anaesthetics ACCS, O&G, neurosurgery, paediatrics and other UK specialty training programmes. Two computer-based papers (CPS and PD) covering clinical problem-solving and professional dilemmas. On iatroX.
Full MSRA bank, AI Tutor and timed mocks — $29/month or $99/year. All paid exam banks included.
97 single-best-answer items · 75 minutes · ~47 seconds per question · tests clinical knowledge applied at FY2 standard across the medical specialties
50 scenarios · 95 minutes · situational judgement test format with most-appropriate / least-appropriate / ranking items · tests professional values, integrity and decision-making
GP, psychiatry, ophthalmology, anaesthetics (via ACCS), obstetrics & gynaecology, neurosurgery, paediatrics, public health, radiology (CT1), occupational medicine, community sexual & reproductive health
CPS and PD are scored separately. Total score combined with other selection-process scoring weights to rank candidates for interview/offer. Different specialties weight CPS and PD differently — GP uses 1:1, psychiatry weights CPS more heavily, others vary.
Three rounds per year — Round 1 January (for August start), Round 2 April (re-entry), Round 3 September (February start for some specialties). 2026 specific dates and booking windows published on the NHSE Specialty Training portal and Oriel. Application via Oriel; testing via Pearson VUE.
Approximate distribution of the Clinical Problem Solving (CPS) paper. The Professional Dilemmas paper does not have a clinical-content blueprint — it covers professional values and integrity scenarios across the FY2 working environment.
Drawn from candidate reports of recent MSRA rounds and the FY2-level UK clinical content emphasis.
Mental health — depression and anxiety stepped care, suicide risk assessment, recognising bipolar disorder, sectioning under the Mental Health Act. Mental health is the largest single content block.
Paediatrics — fever in under-5s (NICE NG143 traffic-light system), bronchiolitis, recognising sepsis, paediatric resuscitation algorithm, immunisation schedule basics
Acute emergencies — sepsis SSC bundles, MI ACS algorithm, asthma severity ladder, anaphylaxis, DKA fluid replacement. Speed under time pressure matters.
Women's health — contraceptive choice (UKMEC categories), menstrual disorders, ectopic pregnancy red flags, gestational diabetes screening, postnatal mental health
Prescribing safety — pregnancy categories, common drug interactions, polypharmacy in elderly (STOPP/START principles), MHRA Drug Safety Updates
Pacing for CPS — 97 items in 75 minutes = ~47 seconds per question. This is unusually fast. Most candidates report time pressure as the principal challenge. Speed training is essential.
Professional Dilemmas — common scenario types: patient safety vs autonomy, escalation to seniors, raising concerns about colleagues, capacity assessment, time management dilemmas
Resource integrity — most-appropriate vs least-appropriate options often differ subtly. The MSRA expects the formal "correct" professional response per GMC Good Medical Practice, not what doctors might do in practice.
Observations from UK foundation doctors and recent MSRA candidates. Verify against current NHSE specialty training guidance.
Candidate-reported observations — not official guidance.
A pragmatic phased approach used by recent UK foundation doctors who passed the MSRA at competitive levels for GP, psychiatry or ophthalmology.
A live item from the iatroX bank. Try it before launching a full session.
A 61-year-old woman presents to the emergency department with 2 days of dysuria, left loin pain, fever and rigors. She has type 2 diabetes mellitus and normally has a creatinine concentration of 72 micromol/L. She is alert. Her temperature is 39.1°C, heart rate is 112 beats/min, blood pressure is 108/68 mmHg, respiratory rate is 22 breaths/min and oxygen saturation is 96% on room air. Her NEWS2 score is 5. Urinalysis is positive for nitrites and leucocytes. Venous blood gas analysis shows a lactate concentration of 2.6 mmol/L. Her creatinine concentration is 126 micromol/L. Blood cultures and a urine sample have been obtained, intravenous access is in place, and there are no clinical features of fluid overload. What is the most appropriate immediate management?
Why iatroX is built differently for MSRA.
Every iatroX item is tagged to a blueprint topic, so your performance dashboard mirrors the structure of the exam itself.
The engine surfaces your weakest topics first, in real time, instead of marching you through a static syllabus.
Incorrect items return at increasing intervals to interrupt the forgetting curve and lock knowledge into long-term memory.
Timed full-length simulations that mirror the official exam structure under realistic conditions.
One iatroX subscription includes the MSRA bank, the Socratic Tutor inside supported sessions, and every other premium iatroX exam bank.
Cancel anytime · 7-day money-back guarantee on annual
Free MSRA sample questions are available without a subscription. Full adaptive access to the 1,500+ MSRA bank, including CPS and Professional Dilemmas practice, dashboard, mocks and supported Tutor workflow, is included with an iatroX subscription.
Three rounds per year. Round 1 typically in January (for August training start), Round 2 in April (re-entry), Round 3 in September (February training start for some specialties). 2026 specific dates and booking windows are published on the NHSE Specialty Training portal and Oriel.
Two papers sat at a Pearson VUE test centre. Paper 1 — Clinical Problem Solving (CPS): 97 single-best-answer items in 75 minutes. Paper 2 — Professional Dilemmas (PD): 50 situational-judgement scenarios in 95 minutes. Both papers are sat on the same day.
GP, psychiatry, ophthalmology, anaesthetics (via ACCS), obstetrics & gynaecology, neurosurgery, paediatrics, public health, radiology (CT1), occupational medicine, community sexual & reproductive health. Different specialties weight CPS and PD differently in their selection processes.
There is no fixed pass mark. Your raw score is converted to a scaled score (typically out of 250-300 per paper) and combined with other selection-process scoring weights. Your rank against other applicants determines whether you secure an interview/offer for your chosen specialty programmes.
The MSRA is a recruitment assessment, not a registration or postgraduate fellowship exam. You take the MSRA when applying for specialty training. UKMLA / PLAB 1 are the GMC registration assessments. MRCP-1 is the first postgraduate membership exam. The standards are similar (FY2 / IMT1 clinical level) but the purpose differs — MSRA ranks you for training; MRCP-1 awards membership.
iatroX questions are written by UK foundation and specialty doctors and mapped to the published MSRA CPS blueprint and FY2 standard. PD scenarios are mapped to the published professional-dilemmas framework. The bank is updated when NHSE issues blueprint or content-map changes.
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Reviewed by Dr Kola Tytler MBBS CertHE MBA MSt MRCGP · Last reviewed 12 May 2026
See our methodology and editorial policy.