Exam guide
The Multi-Specialty Recruitment Assessment (MSRA), explained
NHS England's specialty recruitment assessment rather than a college exam: one foundation-level clinical paper and one professional dilemmas paper, sat back to back. Set by NHS England.
Last checked 15 August 2026. Confirm current fees, dates and the live syllabus on NHS England's own site before booking.
How the exam is structured
| Papers | Clinical Problem Solving (CPS); Professional Dilemmas (PD) |
|---|---|
| Questions | 136 across 2 papers |
| Time | 170 minutes total (75 min for Clinical Problem Solving (CPS), 95 min for Professional Dilemmas (PD)) |
| Question types | ~43 SBA + ~43 EMQ; 50 SJT (rank 5, or select 3 of 8) |
| Options per SBA/MCQ | Varies by paper: 5—8 per CPS single best answer, 7—10 per EMQ option list, and 5 (ranking) or 8 (select three) on Professional Dilemmas. |
|---|---|
| Sittings per year | 1 |
| Set by | NHS England |
Where the marks are
Most candidates revise every domain evenly by accident, which spends most of their time on a fraction of the paper. A SpecialityMCQs session is built to the weights below, then tilted toward whichever domain is currently costing you marks.
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Empathy and sensitivity (PD)
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Professional integrity (PD)
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Coping with pressure (PD)
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Cardiovascular (CPS)
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Dermatology / ENT / Eyes (CPS)
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Endocrinology / Metabolic (CPS)
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Gastroenterology / Nutrition (CPS)
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Infectious disease / Haematology / Immunology / Allergies / Genetics (CPS)
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Musculoskeletal (CPS)
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Paediatrics (CPS)
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Pharmacology and therapeutics (CPS)
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Psychiatry / Neurology (CPS)
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Renal / Urology (CPS)
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Reproductive (CPS)
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Respiratory (CPS)
NHS England publishes each paper's item count (86 CPS, 50 PD) and names the topics and competencies each one covers, but no weighting across them — the official guidance goes only as far as saying each paper 'includes a balance of scenarios which cover all 12 topics'. The CPS-to-PD split shown here is derived from those official item counts; the even split within each paper is SpecialityMCQs's, not a published one.
A sample question
Written in-house to the MSRA style and answered against a named, current source — not claimed to be from a past paper. It plays exactly as it would in the app.
A 34-year-old woman attends to discuss contraception. She has migraine with aura about three times a year, each attack preceded by twenty minutes of visual zigzag lines. She has never smoked, her BMI is 24 kg/m² and her blood pressure is 118/74 mmHg. She has no other medical history and takes no regular medication. She asks to start the combined oral contraceptive pill, which a friend recommended. What is the most appropriate advice?
- Source
- UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) 2025 (College of Sexual and Reproductive Healthcare (CoSRH, formerly FSRH), 2025) — Category 4 conditions for combined hormonal contraception: migraine with aura
- Checked
- Read against this source on 18 Aug 2026. If the guidance changes, the question comes back for another read before it is shown again.
Where this answer comes from
TAKEAWAY
Migraine with aura is UKMEC category 4 for every combined hormonal method — pill, patch and ring — at any age and at any attack frequency, because it is the aura rather than the headache that marks the ischaemic stroke risk. It is one of the few absolute contraindications a foundation doctor is expected to apply without specialist input, and the reason it is asked so often is that the alternative is straightforward: progestogen-only and intrauterine methods are essentially unrestricted and can be started the same day.
Why D is right
Migraine with aura is UKMEC 4 for combined hormonal contraception — a condition representing an unacceptable health risk. The progestogen-only pill, implant and injectable and both intrauterine methods sit at UKMEC 1 or 2 and can be started at the same appointment.
Attack frequency does not change the category. The aura itself carries the arterial risk, and UKMEC applies the same restriction however rarely the attacks occur.
Continuous regimens reduce withdrawal headaches, but oestrogen exposure is unchanged or higher. The regimen is not what makes the method unsuitable.
No evidence supports antiplatelet therapy as a way to offset the arterial risk of combined hormonal contraception in migraine with aura, and it adds bleeding risk to an otherwise healthy woman.
The history describes a typical aura and needs no specialist confirmation before UKMEC can be applied. Deferring leaves her without contraception for months and risks an unintended pregnancy.
You just answered one. Five a day are free.
Start freeA real question, written in-house to this exam's style, shown exactly as it would play in the app.
Where SpecialityMCQs fits
SpecialityMCQs's MSRA bank grows toward the weights above, written as single best answer and extended matching items set in UK NHS practice. Sessions balance every domain, then tilt toward whichever is currently costing you marks. Anything you miss returns on a spacing curve until it sticks, and every answer names the source it rests on and the date that source was last read.
New questions a day are free, with no card required, and the review deck is free for good.
Questions about the MSRA exam
What is the Multi-Specialty Recruitment Assessment (MSRA)?
Multi-Specialty Recruitment Assessment (MSRA) is set by NHS England. NHS England's specialty recruitment assessment rather than a college exam: one foundation-level clinical paper and one professional dilemmas paper, sat back to back.
How many questions does the MSRA exam have, and how long do I get?
Multi-Specialty Recruitment Assessment (MSRA): 136 questions across 2 papers (170 minutes). Option counts vary: 5—8 per CPS single best answer, 7—10 per EMQ option list, and 5 (ranking) or 8 (select three) on Professional Dilemmas.
What does the MSRA blueprint cover?
The chart on this page shows the highest-weighted domains. NHS England publishes each paper's item count (86 CPS, 50 PD) and names the topics and competencies each one covers, but no weighting across them — the official guidance goes only as far as saying each paper 'includes a balance of scenarios which cover all 12 topics'. The CPS-to-PD split shown here is derived from those official item counts; the even split within each paper is SpecialityMCQs's, not a published one.
Does the MSRA exam include extended matching questions (EMQ)?
Yes. Alongside single best answer items, part of the MSRA exam uses extended matching questions: a themed option list shared by several stems. SpecialityMCQs practises these in the same layout, with the option list beside the stem rather than folded into a single-best-answer format.
How many times a year can I sit MSRA?
1 sitting a year, per NHS England's own published calendar. Confirm current dates and fees on their own site before booking.
Is SpecialityMCQs affiliated with NHS England?
No. SpecialityMCQs is an independent revision tool and is not affiliated with, endorsed by, or accredited by NHS England.
Sitting a different exam? SpecialityMCQs also covers MRCS Part A , MRCOG Part 1 and Part 2 , MRCPCH Foundation of Practice and Theory and Science , MRCPsych Paper A and Paper B , MRCEM Primary and MRCEM SBA and Final FRCR Part A (Clinical Radiology) , each with its own guide.
SpecialityMCQs is an independent revision tool. It is not affiliated with, endorsed by, or accredited by NHS England, or any other exam authority. This page summarises that body's own published exam information for candidates and is not a substitute for it. Always confirm current syllabus, fees and dates on their own site before applying.