MSRA Exam Format Explained: Professional Dilemmas and Clinical Problem Solving Papers

Quiz MSRA Practice Questions

MSRA exam format: how the Professional Dilemmas and Clinical Problem Solving papers work

The Multi-Specialty Recruitment Assessment sits between many UK doctors and their next step into GP or another specialty training programme, yet its two-paper structure often causes more confusion than the clinical content itself. Candidates frequently underestimate how differently the Professional Dilemmas and Clinical Problem Solving papers are marked and timed. Understanding the exact format before test day helps you allocate revision time sensibly, pace each paper correctly, and avoid the administrative slip-ups that catch out otherwise well-prepared applicants.

What the MSRA is and who needs to sit it

The MSRA is a computer-based assessment used by NHS England (Health Education England), delivered in partnership with Work Psychology Group and administered through Pearson VUE test centres. It forms part of the selection process for doctors applying to General Practice ST1 and a range of other specialty and core training programmes across England, with equivalent arrangements in Northern Ireland and Scotland. Applications and eligibility checks are handled through Oriel, the UK-wide portal for postgraduate medical, dental, public health and healthcare science recruitment, before candidates are directed to book their MSRA slot separately via a Pearson VUE account.

The two-paper structure and timing

The assessment totals 170 minutes and is split into two distinct papers with an optional five-minute break between them:

The Professional Dilemmas (PD) paper runs for 95 minutes in normal time, and the Clinical Problem Solving (CPS) paper runs for 75 minutes in normal time. Candidates who qualify for reasonable adjustments under the Equality Act 2010 can be granted 25% or 50% extra time on each paper. It is worth noting that both papers are scored with no negative marking, so there is no benefit to leaving a question unanswered.

Inside the Professional Dilemmas paper

The PD paper is a situational judgement test made up of 50 scenarios set at Foundation Programme (F2) level, covering both clinical and non-clinical situations. Roughly half the scenarios ask you to rank four or five possible actions from most to least appropriate, and the other half ask you to select the three most appropriate actions from a list of eight options. Rather than testing medical knowledge, PD assesses three professional attribute domains: professional integrity, coping with pressure, and empathy and sensitivity. Because scoring is based on closeness to an expert-agreed answer key rather than a single “correct” response, practising a wide range of realistic scenarios matters more than memorising a fixed set of rules.

Inside the Clinical Problem Solving paper

The CPS paper measures how well you apply clinical knowledge to everyday decisions rather than simple recall, and it is calibrated to Foundation Year 2 level practice. It contains 86 items split evenly between extended matching questions, where several scenarios share a bank of seven to ten possible answers, and single best answer questions, where one scenario is followed by five to eight plausible options. Content is drawn from twelve clinical domains, including cardiovascular, gastroenterology and nutrition, endocrinology and metabolic medicine, musculoskeletal, paediatrics, psychiatry and neurology, pharmacology and therapeutics, and renal and urology, among others. Within these domains, questions test five underlying competencies: investigation, diagnosis, emergency response, prescribing, and non-prescribing management.

Which specialty training programmes use the MSRA

For the current recruitment cycle, the MSRA is used for entry to programmes including Acute Care Common Stem Emergency Medicine, Anaesthetics CT1, Clinical Radiology ST1, Core Psychiatry CT1, Core Surgical Training CT1, General Practice ST1, Community Sexual and Reproductive Health ST1, Neurosurgery ST1 to ST3, Nuclear Medicine ST3, Obstetrics and Gynaecology ST1, and Ophthalmology ST1, with equivalent programmes recruiting in Northern Ireland and Scotland. Because the specialty list and testing windows can change between recruitment rounds, always confirm which programmes require the MSRA for your specific application year against the official guidance before you book.

Booking, testing windows and a common mistake to avoid

For the 2026 recruitment cycle, MSRA sittings are split across two windows, one in January and one in February, with the February window reserved for candidates applying to Core Psychiatry and/or General Practice only, while the January window is open to all other eligible specialties. A mistake worth flagging early: registering a Pearson VUE account and receiving registration confirmation is not the same as being invited to book your test slot. Treat these as two separate steps in the process, and check your Oriel and Pearson VUE accounts regularly rather than assuming one confirmation email covers everything.

Common preparation mistakes

Three mistakes come up repeatedly among MSRA candidates. First, spending disproportionate revision time on CPS clinical content while barely touching PD scenarios, even though PD carries equal weight in the overall 170 minutes. Second, treating PD as a test with obviously “right” answers rather than practising the ranking and multiple-response format under time pressure, where pacing across 50 scenarios in 95 minutes is the real challenge. Third, forgetting that the MSRA outcome is final once released and cannot be reviewed, re-marked or disputed, which makes thorough preparation and careful in-test time checks more important than for assessments with an appeals route.

A study strategy for the two papers

Because CPS has almost twice as many items as PD but only slightly more time allocated, build your revision timetable around item-level pacing from the start: CPS gives you under a minute per item on average, while PD gives you nearly two minutes per scenario. Work through clinical domains systematically for CPS, prioritising areas you have not covered since finals or early Foundation training, then layer in mixed-domain timed sets to rebuild speed. For PD, focus less on “correct” answers and more on consistently applying the same professional reasoning across professional integrity, coping with pressure, and empathy and sensitivity scenarios, since consistency is what the marking rewards.

Practising with Easy-Quizzz MSRA practice questions

Once you understand the official format, structured practice helps you convert that knowledge into exam pacing. The MSRA practice questions on Easy-Quizzz mirror the two-part Professional Dilemmas and Clinical Problem Solving format, letting you rehearse both ranking and multiple-response PD scenarios alongside EMQ and single best answer CPS items in a timed setting. Use topic-by-topic sets early on to identify weak clinical domains, then move to full-length timed simulations closer to your booked date so that pacing across 170 minutes feels familiar rather than new on test day.

Practical next steps

Confirm your eligibility and application status on Oriel, set up your Pearson VUE account promptly once invited, and check whether your specialty falls into the January or February window for the current cycle. Build a revision plan that treats PD and CPS as separate skills requiring separate practice, and leave time in the final fortnight for full-length timed run-throughs rather than only topic-based drilling. Finally, read the official guidance on remote onVUE testing and reasonable adjustments early if either might apply to you, since both involve separate eligibility steps.

How many questions are in the MSRA?

The Professional Dilemmas paper contains 50 scenarios, and the Clinical Problem Solving paper contains 86 items, for 136 questions across both papers.

Is there negative marking in the MSRA?

No. Both the Professional Dilemmas and Clinical Problem Solving papers are marked with no negative marking, so every question should be attempted.

Can I sit the MSRA remotely instead of at a test centre?

Remote testing via onVUE may be available for eligible candidates. Eligibility criteria and availability can change between recruitment cycles, so check the current guidance on the official NHS England Medical Training Recruitment site before assuming you qualify.

Can I get extra time in the MSRA?

Candidates with a qualifying need under the Equality Act 2010 can apply for reasonable adjustments, which may include 25% or 50% extra time on each paper. Apply for adjustments through the official process well ahead of your booking window.

Sources consulted: the official MSRA overview and the Oriel recruitment portal from NHS England.