The MSRA explained: Clinical Problem Solving and Professional Dilemmas

The Multi-Specialty Recruitment Assessment is a shared entry assessment used across a range of specialties, from GP training to several others. Your score is used to rank you against other applicants, so it is a competitive assessment rather than a simple pass or fail: the mark you need is whatever the competition ratio for your specialty demands in that round.

It is sat in the specialty recruitment window, at a test centre or online under supervision, and it is made up of two papers taken in one session: Clinical Problem Solving and Professional Dilemmas.

CPS tests foundation-level clinical knowledge under time pressure. It is 86 items in 75 minutes, which is well under a minute per item, so it rewards recall you do not have to reconstruct from first principles.

The paper mixes two item types. Roughly half are single best answer questions, where each stem has one clearly best option among several. The rest are extended matching questions, where a themed list of options serves several stems in turn. Single best answers run about five to eight options; extended matching lists run about seven to ten.

The clinical content covers twelve topic areas across general medicine and its neighbours, from cardiovascular and respiratory to paediatrics, psychiatry and therapeutics. NHS England states that each paper includes a balance of scenarios covering all twelve topics, but does not publish a weighting across them, so no revision plan can honestly claim to know the exact split.

Professional Dilemmas is a situational judgement test. It is 50 items in 95 minutes, and it does not test clinical knowledge at all — it tests judgement against the professional values expected of a foundation doctor: empathy and sensitivity, professional integrity, and coping with pressure.

Two response formats appear. In ranking items you place five responses in order from most to least appropriate. In select-the-three items you choose the three most appropriate actions from a list of eight. Marking rewards how close your answer is to the reference answer rather than an all-or-nothing match, and there is no negative marking, so an incomplete answer is always worth attempting.

The score you see reported is normalised across candidates. NHS England is explicit that there is no maximum achievable score, so treat any practice mark as a relative signal, not an exam grade.

The two papers reward different work, so split your time deliberately.

• For CPS, practise fast recall across all twelve topic areas rather than deep study of one. The clock is the real examiner, so questions answered under time pressure are worth more than leisurely reading.
• For PD, practise the reasoning, not answers to memorise. Work through why one action outranks another against patient safety, honesty and escalation, so a new scenario is a variation on a principle you already hold.
• Track which topics keep costing you marks and return to them, rather than re-drilling what you can already do. Anything you get wrong should come back to you a few days later, before you would have forgotten why.

This is how the SpecialityMCQs MSRA revision is built: sessions cover the full set of topics rather than your comfort zone, tilt toward the ones currently costing you marks, and bring misses back on a spacing schedule. Professional Dilemmas items are practised in the ranking and select-three formats the assessment actually uses.