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The MSRA Assessment: What it is and How to Pass

If you are preparing for MSRA – either for GP or Speciality Entry – this blog is for you!

For our MSRA Gold Pass Package, Audiobook Courses, Online Courses, Mock Exams and Clinical Flash Cards click here: MSRA Resources

What this blog covers

✓ What is the assessment?
✓ Format of the MSRA
✓ The Professional Dilemma (SJT) paper (+ example question)
✓ The Clinical paper (+ example question)
✓ How is it marked?

✓ How to Prepare and Pass
✓ How can we help?
✓ On a final note…

What is the MSRA?

The Multi-Specialty Recruitment Assessment (MSRA – also known as SRA) is a computer-based assessment and forms part of application for UK postgraduate training in the following specialities:

✓ General Practice
✓ Radiology
✓ Psychiatry
✓ Ophthalmology
✓ Obstetrics and Gynaecology
✓ Neurosurgery
✓ Child and Adolescent Mental Health Services (CAMHS)
✓ Community Sexual and Reproductive Healthcare (CSRH)
✓ Anaesthetics

Each speciality utilises your MSRA result in a different way – it is worth looking at the individual specialty websites (for example the GPNRO website for GP Training) for further information.

For the purposes GP Training application, the MSRA can be taken at various centres across the UK. For a full overview of getting into UK GP Training read our blog here.

Your MSRA result lasts for the duration of the recruitment year in which it is taken (the recruitment year is from November to October) – it can not be carried over into the following recruitment year and will have to be retaken if application occurs again in the next recruitment year. You can resit MSRA within the same recruitment year if you are unsuccessful in an attempt.

MSRA Exam 2021 – First Round

The MSRA dates for round 1 in 2021 have been announced.

The first round will be taking place from 28th January to 12th February 2021.

Format of the MSRA

✓ The assessment consists of two types of question papers:

a) Clinical questions (75 minute paper)
b) Professional dilemma questions (95 minute paper)

✓ The Professional Dilemma Paper usually happens first and is shortly followed by the Clinical Questions paper.

✓ A 5 minute break occurs between papers (countdown appears on screen).

✓ There is a countdown timer for each individual paper on the screen.

✓ Total duration of the assessment is just under 3 hours (175 minutes, including break).

✓ The Professional dilemma paper (SJT) consists of 50 Situational Judgement Test questions in 95 minutes – this paper occurs first. See below for more details and example questions.

✓ The Clinical problem solving paper (CPS) consists of 97 clinical questions in 75 minutes – this paper starts 2 minutes after completion of the SJT paper. See below for more details and example questions.

The Professional Dilemma (SJT) Paper

✓ Paper duration: 95 minutes

✓ Number of questions: 50 (see this video which covers how to approach the two main types of MSRA SJT Question)

✓ Assesses 3 core competencies (covered in our MSRA SJT Principles Audio course):
a) Professional Integrity
b) Coping with Pressure
c) Empathy and Sensitivity

✓ It assesses how someone behaves when posed with a potential professional dilemma at work as well as your ability to judge the situation and decide how to approach it.

✓ No clinical knowledge is assessed in this paper and there is NO negative marking.

✓ There are two types of question (see this video which covers how to approach the two main types of MSRA SJT Question):

1) Ranking questions – These are questions where you are presented with four or five actions relevant to the scenario and are asked to rank how you would approach the situation in order or appropriateness (with ‘1’ being most appropriate and ‘5’ being the least appropriate action)
2) Multiple choice questions – These will ask you to choose the three most appropriate actions related to the situation from a list of eight – the combination of these three actions should help resolve the situation in the question.

Sample SJT Question (see more in our MSRA SJT Mock Exams)

You are a FY2 Doctor on an orthopaedic ward. Your team have just seen an elderly Spanish man on the busy ward round who understands limited English. Your registrar has gained written consent from him for a hip operation scheduled for 2 days time. One of the nurses quietly says to you that she suspects the patient was just nodding politely and understood very little. She says she does not want to undermine the registrar. You know his daughter visits daily and always translates if she is present. Do you:

Rank the following actions in order from the most appropriate (1) to the least appropriate (5) in this situation.

A)  Call the patient’s daughter directly to alert her what has happened
B)  Address your registrar in front of the patient about these concerns, presuming the patient does not understand
C)  Speak to the registrar privately at the end of the ward round about the concerns
D)  Ignore the nurse’s comment as the patient’s daughter could always relay any concerns when she visits later
E)  Encourage the nurse to speak up and then carry on with your ward round tasks

Suggested Answer: CBAED

C is the best option as you are speaking directly with the registrar, and not undermining them in front of the patient or team. The question states that the ward round was busy so waiting until the end may be more appropriate, especially as the operation is still in 2 days time. GMC Good Medical Practice states that you should make sure ‘arrangements are made, wherever possible, to meet patient’s language and communication needs’ and be satisfied that consent is taken before providing treatment. As the nurse is reluctant to speak it is important to ensure the concerns do not go unnoticed, especially since you are aware his daughter usually translates.

B is not as good an option because although it does directly act on your concerns, it undermines the registrar in front of others and may impact your working relationship. Furthermore, it may distress the patient who has limited understanding of English. It ranks higher than A, E or D because at least the concerns are actively voiced directly to him.

A is a poor option as it potentially breaches patient confidentiality and may cause distress to the patient and relative. You are taking action to try and ensure patient understanding but going about it in a way that i) undermines the registrar, ii) may negatively impact your working relationship and iii) may negatively impact the patient and family’s trust in the medical care being provided. 

E is the next worst option here as although you are encouraging her to speak up, you are not taking any responsibility in following this up – and thus checking to ensure that the consent taken is valid. 

D is the worst option as it disregards a suspicion that the consent taken was invalid and fails to act on this at all. Relying on the patient’s daughter to relay any concerns that the patient may confide to her is inappropriate. This does nothing to actively voice concerns to the registrar, who is a position to discuss the operation again and ensure consent taken is valid (in the presence of an appropriate interpreter if necessary).

The Clinical Paper

✓ Paper duration: 75 minutes

✓ Number of questions: 97

✓ Assesses your ability to apply clinical knowledge to help make clinical decisions – it is not a test of pure knowledge.

✓ Questions can assess 5 core competencies:
a) investigation
b) diagnosis
c) emergency
d) prescribing
e) management

✓ 12 clinical topic areas are included – all covered in our MSRA Clinical Crammer Online Course:
– Cardiovascular
– Dermatology/ENT/Eyes
– Endocrinology/Metabolic
– Gastroenterology/Nutrition
– Infectious/Haematology/Allergy/Genetics
– Musculoskeletal
– Paediatrics
– Pharmacology and Therapeutics
– Psychiatry/Neurology
– Renal/Urology
– Reproductive
– Respiratory

✓ There are two different types of question:
1) Extended matching questions – EMQ (chose the single most appropriate answer from a choice – answers relate to several questions)
2) Single best answer – SBA (choose the single most appropriate answer from a choice – answers relate to a single question)

Sample Clinical Question (see more in our MSRA Clinical Mock Exams)

Ruby is 2 years old and is seen today with her father as she has had a one week history of runny nose and has complained her throat hurts. This morning she has noted a rash on both cheeks but nowhere else on the body. Ruby is well in herself and eating, drinking, passing urine and opening her bowels as normal. She has no other medical history and is up to date with immunisations. She is not lethargic and on examination today is playing happily in the consulting room, has normal observations and an unremarkable respiratory and throat examination. There is a diffuse erythematous rash on both cheeks. What is her most likely diagnosis?

A)  Scarlet Fever
B) Herpes virus type 6
C)  Measles
D)  Rubella
E)  Parvovirus B19

Suggested Answer and key Learning Points: E

– Slapped Cheek Syndrome (usually school age children) is caused by the organism Parvovirus B19.
– An erythematous facial rash (one or both cheeks) is a key defining feature but usually other prodromal features are common eg low-grade fever, myalgia, nausea, runny nose
– The condition is usually mild and self-limiting.
– Treatment is mainly supportive eg rest, fluids, analgesia.
– Complications are rare in health people, if patient is pregnant then further advice should be sought.

What is the pass mark for the MSRA?

There is no specific pass mark for the MSRA. There is no maximum score for the MSRA and your result is dependent on the results of other candidates within your cohort taking the MSRA exam.

You will be allocated a band number between 1 and 4. A band 1 score in either paper usually means the candidate has been unsuccessful. Band 4 represents a high score.

Each Speciality will utilise MSRA marks in a different way. Please visit the relevant Speciality recruitment website for full details.

For GP training the MSRA is marked using a method called normalisation. The MSRA scores for GP training candidates are normalised around a mean score of 250 with a standard deviation of 40.

How to Prepare for and Pass MSRA

Firstly I would suggest becoming familiar with the controls and exam set up by looking at the demo videos at the Pearson VUE and Oriel sites.

From my own experience with doctors preparing for MSRA there are two main chosen approaches – question-bank based and ‘formal revision’ based – and I am often asked which is best.

My simple answer is that relying on one method alone can leave you a little short. No question bank can cover every aspect of the MSRA, whilst purely reading books and guidelines will not give your brain adequate exposure to problem-solving. If planned well, both should be used hand-in-hand as both have advantages in terms of improving retention and performance.

Making optimum use of time is important – using travel time to answer a few questions here or there, or listen to a chapter of our MSRA Clinical Crammer Audiobook or MSRA SJT Principles Audiobook courses for example, can add to the formal preparation time that you sit down to do.

Some prefer visual learning – for example our MSRA Clinical Crammer Online Course allows you to follow syllabus-based teaching on screen.

Another very common question that I get asked is ‘which question bank should I use?’ I have not had experience of all banks on the market but all I would say is try and have some variety. Often doctors rely on only one question bank and get very used to a certain style of question-writing – doing the same style of question 2-3000 times is bound to trigger your brain to think in a certain way and it can be very confusing when another ‘style’ is suddenly encountered in the exam.

Whether you purchase two question banks, or whether you simply hire a few MSRA question books from the library, try to at least use two sources – our MSRA Online Mock Exams can offer a different style of question, as well as pressurised practice under timed-conditions – something that many candidates miss out in their preparation.

How can we help you score well?

Our popular and comprehensive MSRA Gold Pass Package contains an all round and complete preparation plan for boosting your MSRA score. It contains all of the below courses and products in one discounted bundle.

1) Our MSRA Clinical Crammer Online Course. 9+ of core clinical teaching teaching that you watch, pause and rewind as many times as you like. 1, 3, 6 or 12 month subscription options. For a free video sample click here.

2) Our MSRA Clinical Crammer Audiobook Course. 6+ hours of focused clinical teaching, mapping the SRA blueprint syllabus. Designed to listen to as many times as you like, offline or online. No expiry. For a free sample click here.

3) Our MSRA SJT Principles Audiobook Course. 1 hour audio course focused on breaking down the GMC’s Good Medical Practice guidance, covering how to approach professional dilemma SJT situations for your assessment. Designed to listen to as many times as you like, offline or online. For a free sample click here.

4) Our MSRA Mock Exams. Question papers and layouts similar to the real MSRA, our focused Mock Exams expose you to common areas that doctors struggle with. Explanations are to-the-point and based around key principles and guidance that you need to know. For our Mocks and bundles click here.

5) Our Flash Revision Cards. 150 highly focused teaching cards to use on the move. Covers all key UK guidelines as well as investigations and treatments for multiple common exam conditions. Posted to your home, worldwide. For samples click here.

6) Our free teaching and support through Social Media: plenty of daily teaching through our Flagship GP Training Facebook Support Group,  YouTube channel and Instagram page.

On a final note

If you are preparing for the MSRA I wish you good luck! It can he a challenging assessment but as long as you balance question banks with background preparation you should do very well.

Our videos on how to effectively plan, prepare and boost exam preparation may help.

I look forward to supporting you through your successful selection process, and if applying to GP training I hope to meet you on our GP training courses!

Good luck and #CanPassWillPass

Dr. Aman Arora

Dr. Aman Arora

GP and full time medical educator

Courses / products that other people used

Dr. Aman Arora

About Dr. Aman Arora

GP and full time medical educator

Former GPVTS Programme Director

Former NHS GP Appraiser

Former GMC PLAB 2 Examiner

Fellow of Royal College of GPs (FRCGP)

Former HEEWM Advanced AKT Trainer

Running Exam Prep courses for 10 years

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