About the exam
MSRA Exam structure
An independent guide to the current NHS England Multi-Specialty Recruitment Assessment: Professional Dilemmas, Clinical Problem Solving, normalised results and specialty-specific recruitment use.
Issuer and path
Multi-Specialty Recruitment Assessment Study Guide is administered through NHS England. Check official resources before booking, retesting, or relying on a stale requirement.
Professional Dilemmas
50 scored + 0 pretest
A 95-minute Situational Judgement Test with 50 F2-context scenarios split approximately evenly between ranking and select-three formats.
Clinical Problem Solving
86 scored + 0 pretest
A 75-minute Foundation-level clinical reasoning paper with 86 items split approximately evenly between Extended Matching and Single Best Answer formats.
Follow the invitation and the exact specialty guidance
Use Oriel and the Pearson VUE instructions supplied for your allocated window. Resolve reasonable adjustments early, verify identification and appointment details, and treat every specialty's current threshold, weighting, interview and score-transfer rules as separate.
Official Outline Coverage Map
Coverage is mapped to official outline item counts so content depth can be checked without hard-coding a single exam.
| Topic | Official outline items | Your questions | Your flashcards | Confidence |
|---|---|---|---|---|
| Professional Integrity Judgement | 0 | 50 | 6 | Priority |
| Professional Dilemmas Ranking Format | 0 | 50 | 6 | Strong |
| Coping with Pressure Judgement | 0 | 100 | 6 | Priority |
| Empathy and Sensitivity Judgement | 0 | 50 | 6 | Priority |
| Professional Dilemmas Select-Three Format | 0 | 50 | 6 | Strong |
| Investigation Reasoning | 0 | 15 | 6 | Priority |
| Extended Matching Questions | 0 | 15 | 6 | Strong |
| Cardiovascular | 0 | 15 | 6 | Good |
| Endocrinology and Metabolic | 0 | 15 | 6 | Good |
| Diagnosis Reasoning | 0 | 15 | 6 | Priority |
| Single Best Answer Questions | 0 | 15 | 6 | Strong |
| Dermatology, ENT and Eyes | 0 | 15 | 6 | Good |
| Gastroenterology and Nutrition | 0 | 15 | 6 | Good |
| Emergency Recognition and Response | 0 | 20 | 6 | Priority |
| Infection, Haematology and Immunology | 0 | 20 | 6 | Good |
| Respiratory | 0 | 20 | 6 | Good |
| Prescribing Reasoning | 0 | 20 | 6 | Priority |
| Pharmacology and Therapeutics | 0 | 20 | 6 | Good |
| Paediatrics | 0 | 20 | 6 | Good |
| Non-Prescribing Management Reasoning | 0 | 13 | 6 | Priority |
| Musculoskeletal | 0 | 12 | 6 | Good |
| Psychiatry and Neurology | 0 | 12 | 6 | Good |
| Renal and Urology | 0 | 12 | 6 | Good |
| Reproductive | 0 | 12 | 6 | Good |
How to use this guide
Prepare for two papers and one changing recruitment context
Learn the official assessment blueprint first. Treat score thresholds, interview bypass, shortlisting and final weighting as specialty-specific rules that must be rechecked each round.
1. Blueprint
Learn both paper purposes, formats, timing and official domains.
2. Professional judgement
Apply patient safety, F2 limits, integrity, pressure management and empathy.
3. Clinical decision
Use Foundation-level synthesis across the five CPS decisions and twelve clinical areas.
4. Official rehearsal
Practise the four response formats without sharing or reconstructing live items.
5. Recruitment rule
Apply the resulting scores exactly as the current specialty and round specify.
One assessment, two constructs
Do not answer PD like a knowledge test or CPS like an opinion survey
Professional Dilemmas rewards expert-aligned professional judgement; Clinical Problem Solving rewards the correct Foundation-level clinical decision.
Professional Integrity
Honesty, responsibility, respect, boundaries, equality, quality, risk and patient interest, including ranking-item control.
Choose a topic to open below
Coping with Pressure
Self-awareness, help-seeking, resilience, calm professional conduct, uncertainty and competing responsibilities.
Choose a topic to open below
Empathy and Sensitivity
Patient-centred and colleague-aware judgement, including the select-three response format.
Choose a topic to open below
Investigation
Choose discriminating and proportionate investigations across Foundation-level presentations.
Choose a topic to open below
Diagnosis
Identify the most likely condition from symptoms, signs, risk and test results.
Choose a topic to open below
Emergency
Recognise serious illness, prioritise immediate response and avoid delay caused by premature diagnostic closure.
Choose a topic to open below
Prescribing
Select, authorise or review medicines safely within a clinical management plan.
Choose a topic to open below
Management (Non-Prescribing)
Choose non-drug treatment, referral, monitoring, follow-up and multidisciplinary actions.
Choose a topic to open below
Professional Integrity Judgement
Prioritise patient safety, candour, respect, responsibility and proportionate escalation while recognising F2 limits.
Key rules
Rule 1
Protect patients first while remaining open, honest and accountable.
Exam cue: Identify the immediate safety risk before the interpersonal discomfort.
Rule 2
Address concerns directly when safe, document appropriately and escalate through a proportionate route.
Exam cue: Prefer actions that gather facts and use an appropriate senior route.
Rule 3
Respect confidentiality, dignity, equality and professional boundaries.
Exam cue: Keep the F2 role and limits explicit.
Common traps
Ignoring a concern to preserve relationships.
Prevention: Name the controlling rule before selecting the answer.
Escalating publicly or punitively before clarifying facts where no immediate danger exists.
Prevention: Name the controlling rule before selecting the answer.
Taking responsibility for a decision beyond competence.
Prevention: Name the controlling rule before selecting the answer.
Memory anchors
Safety First
Protect the patient before protecting convenience or reputation.
Candour
Be open about mistakes and act to reduce harm.
Proportionate Escalation
Use the least excessive route that still controls the risk.
F2 Limits
Seek senior help when authority or competence is exceeded.
Respect and Dignity
Professional action must not humiliate patients or colleagues.
Own the Next Step
Do not pass a live concern away without ensuring follow-through.
Next best moves
Quick check-up
Use a short quiz to confirm the rule pattern is actually sticking.
Check-up Questions
A nurse tells you that a colleague has twice prescribed for the wrong patient but corrected both orders before administration. What is the most appropriate response?
You notice that you documented an examination finding in the wrong patient’s record. No treatment decision has yet been made. What should you do first?
Answer all questions to submit.
Next step personalized recommendations
Open another topic next
Official resources
Verify the details with the official sources
Use these links for eligibility, scheduling, handbook rules, and issuer updates. Our guide helps you study; official sources tell you what the testing partner currently requires.
NHS England MSRA hub
Current central navigation for taking, preparing for and understanding the two MSRA papers.
MSRA overview and specialty list
Current delivery partners, 2026 sitting information and specialties or programmes using MSRA.
MSRA structure
Current 170-minute sequence, paper timings, scheduled break and equated-form guidance.
Professional Dilemmas paper
Official F2 context, three competencies, 50 scenarios, formats and scoring.
Clinical Problem Solving paper
Official five domains, twelve topic areas, 86 items, EMQ and SBA formats and scoring.
MSRA outcomes
Oriel result reporting, normalisation, no fixed maximum and final-outcome guidance.
Official MSRA practice paper
Published sample items, answer keys and rationales for the four response formats.
2026 specialty recruitment webinar
Current one-sitting-across-specialties rule and examples of sole-selection, shortlisting and combined use.
2026 Obstetrics and Gynaecology scoring
Current example of interview bypass and combined MSRA plus interview scoring.
FAQ
Common MSRA questions
What is the current MSRA structure?
It is a 170-minute computer-based assessment delivered through Pearson VUE. Professional Dilemmas comes first for 95 minutes, followed by an optional five-minute scheduled break and then Clinical Problem Solving for 75 minutes. Each paper has its own countdown timer.
What does Professional Dilemmas assess?
It is a Situational Judgement Test about how an F2 doctor should behave in challenging professional situations. It measures professional integrity, coping with pressure, and empathy and sensitivity rather than clinical knowledge recall.
What are the Professional Dilemmas formats?
The paper contains 50 scenarios. Around half ask candidates to rank four or five independent actions from most to least appropriate. Around half ask candidates to select the three most appropriate actions from at least eight plausible options.
How is Professional Dilemmas scored?
Responses are compared with predetermined expert keys. Ranking questions award more credit the closer the order is to the key; select-three responses are also compared with the key. There is no negative marking, so every scenario should be attempted.
What does Clinical Problem Solving assess?
It assesses synthesis and application of Foundation-level clinical knowledge in everyday practice. Its five decision domains are investigation, diagnosis, emergency, prescribing and management that does not involve prescribing.
What clinical topics appear in Clinical Problem Solving?
The official blueprint lists twelve: Cardiovascular; Dermatology, ENT and Eyes; Endocrinology and Metabolic; Gastroenterology and Nutrition; Infectious Disease, Haematology, Immunology, Allergies and Genetics; Musculoskeletal; Paediatrics; Pharmacology and Therapeutics; Psychiatry and Neurology; Renal and Urology; Reproductive; and Respiratory.
What are the Clinical Problem Solving formats?
There are 86 items. Around half are Extended Matching Questions, where several cases share seven to ten options that can be reused. Around half are Single Best Answer questions with one case and five to eight plausible responses.
How is Clinical Problem Solving scored?
Each correct item earns one mark and there is no negative marking. The later recruitment result is normalised, so raw item count should not be treated as the final specialty ranking scale.
Is there one universal MSRA pass score?
No. Specialties and recruitment rounds set their own appointability, shortlisting, bypass, weighting, transfer and resit rules. NHS England also states that normalisation means there is no meaningful fixed maximum score.
How do specialties use the MSRA?
Use varies. Current General Practice and Core Psychiatry recruitment can rank and offer solely from MSRA. Some specialties use it only for shortlisting; others combine it with interview scores. Current Obstetrics and Gynaecology also uses a high-score interview-bypass route.
Do I sit the MSRA separately for every specialty?
Normally no. NHS England's 2026 recruitment webinar states that one sitting and score carry across the specialties using MSRA within that recruitment round. Each specialty still interprets and weights the result independently.
How are results reported?
Results are published in Oriel against the relevant application. Candidates receive component and recruitment feedback according to specialty guidance. GP's mean-250, standard-deviation-40 and band 1-to-4 interpretation is GP-specific and must not be universalised.
Can an MSRA result be appealed or re-marked?
The published assessment outcome is final and cannot be reviewed, re-marked or disputed. There is no assessment appeal process. A complaint about how recruitment was administered is a separate matter handled through the national complaints route.
Can everyone take the MSRA remotely?
No. Current OnVUE delivery is offered case by case as a reasonable adjustment for applicants with extenuating circumstances. Standard delivery is through Pearson VUE centres, and candidates must follow the instructions in their invitation.
Can candidates share remembered live questions?
No. NHS England states that sharing information about actual assessments is unacceptable and viewed as unprofessional behaviour. Multiple equated forms are used, and preparation should rely on the published blueprint and official practice paper.
Why is full mock practice disabled in this module?
The authored bank supports four-choice analysis of candidate rankings, candidate three-action sets, single-best-answer cases and linked EMQ-style cases. Full mock remains disabled because the generic player cannot reproduce ranking partial credit, selecting three of at least eight actions, seven-to-ten-option EMQ controls or the live paper timing faithfully. Use the official NHS England practice paper for exact response-format rehearsal.