Advice for Sitting the MSRA

Author: Milad Tavakoli

Introduction

The Multi-Specialty Recruitment Assessment (MSRA) has become a decisive factor in CST shortlisting. In this bulletin, I will attempt to explain how the exam has evolved over recent years and how to best revise for it. With the proposed changes to ST1 recruitment, MSRA may ultimately be of less relevance. However, it is still important to acquaint ourselves with the exam while it is being used for CST applications.

A Brief History of the MSRA

The Multi-Specialty Recruitment Assessment (MSRA) was first introduced by Health Education England in 2015. The aim was to create a standardised system of measuring clinical aptitude and reasoning nationally.

Originally, the MSRA was used predominantly in the recruitment of General Practice, Psychiatry, and Public Health trainees. These specialties received large numbers of applicants and the exam was to allow for a reliable assessment of their clinical knowledge and reasoning.

Over time, the MSRA was thought to be a predictor of later academic success and as a result, an increasing number of specialities including Radiology, Obstetrics and Gynaecology, and most recently, Core Surgical Training (CST) adopted it.

For CST, the MSRA was formally integrated into the 2023 recruitment cycle. The aim was twofold:

1. To reduce the administrative burden of analysing large numbers of applications

2. Allow for an objective measure prior to interviews

Why It Matters for OMFS Trainees

OMFS trainees occupy a unique position in surgical recruitment. Many enter medicine after completing a dental degree, often with extensive surgical experience but limited exposure to the Foundation Programme structure that underpins most CST applications.

The introduction of the MSRA could be viewed as a leveller. But it also has introduced “one more exam” which can be disheartening for trainees, especially as they would be taking this exam while considering MRCS and finalising their ST1 applications. However, shortcomings in portfolios are somewhat offset by the MSRA (the MSRA counts towards 10% of the final score).

Structure of the MSRA

The MSRA consists of two online components, taken on the same day at an approved Pearson VUE test centre. It is sat annually, typically between January and February, and the results are used to generate part of the CST shortlisting score.

a. Professional Dilemmas (PD) Paper

• Duration: 95 minutes

• Format: 50 scenarios, each assessing judgement, prioritisation, and professional conduct.

• Focus: Tests non-clinical attributes including teamwork, integrity, patient safety, and ethical reasoning.

The PD paper is similar to the SJT used for the Foundation Programme and other SJT examples in dental core training. For most OMFS trainees, their experience in clinical situations should allow a level of advantage.

b. Clinical Problem Solving (CPS) Paper

• Duration: 75 minutes

• Format: Multiple-choice and extended-matching questions

• Content: Covers medicine, surgery, emergency care, paediatrics, psychiatry, and prescribing.

The CPS paper assesses the ability of candidates to showcase their clinical knowledge. A disappointing feature is that most of the subjects assessed have very little to do with OMFS or even broadly surgery. However, the knowledge expected is that expected of a medical graduate with some postgraduate experience in foundation training.

Scoring and Its Impact on CST Selection

In the CST recruitment model, the MSRA score contributes up to 10% of the total shortlisting score, complementing the 50% portfolio and 40% interview weighting. The exact contribution may vary slightly between recruitment years.

Here’s how it works in practice:

• Every applicant is ranked based on their MSRA performance.

• Interviews are offered to the top 1200 scoring candidates (remember that training numbers have not changes over the past two decades)

It has to be noted that no matter how good your portfolio is, you will not receive an interview offer without a score in the top 1200.

How to Prepare

The main advice here is to prepare early. I would say about 3 months of preparation is required.

a. Preparing for the Professional Dilemmas Paper

This section rewards insight into professional behaviour rather than memorisation of rules.

Key preparation steps:

1. Read and internalise the GMC’s “Good Medical Practice” and the “Duties of a Doctor.”

2. Practise scenario-based questions using online resources such as:

• PassMedicine MSRA SJT

• MCQBank

• Pastest MSRA Professional Dilemmas section (I did not personally use this resource)

3. When answering, focus on underlying principles:

• Patient safety always comes first.

• Escalate appropriately (to seniors, consultants, or clinical governance as needed).

• Fairness and confidentiality are always key.

• Team dynamics matter—supporting colleagues while maintaining professionalism e.g. consider help for an alcoholic colleague after making sure risk of patient harm has been eliminated

b. Preparing for the Clinical Problem Solving Paper

The CPS section is more traditional in format. Think of it as somewhat similar to progress test questions.

Recommended strategy:

1. Start with a question bank—PassMedicine  ((I used this and it is good for a breadth of knowledge but less helpful in its explanations) )or MCQBank (the interface is very clunky but the explanations are superb)

2. Focus on the following high-yield areas:

• Acute medicine (chest pain, shortness of breath, sepsis).

• Surgical emergencies (acute abdomen, trauma, hernia, appendicitis).

• Prescribing and adverse drug reactions.

• Psychiatry (especially risk assessment and management).

• Paediatrics (common infections, safeguarding).

• Pregnancy

3. Use concise revision notes such as Zero to Finals or Geeky Medics for quick refreshers.

4. Time your practice (do questions under exam conditions)

I personally found the SJTs fine but the medical topics particularly those about non-surgical paediatrics and pregnancy conditions required more attention.

c. Timeline and Practical Tips

A realistic preparation timeline is 3 months, with 2–3 hours of focused study per day.
Suggested schedule:

• Month 1: Familiarise with format; read GMC guidance; start question banks.

• Month 2: Intensify question practice; review weak areas; complete mock exams.

• Month 3: Focus on timing, test strategy, and high-yield revision.

Practical advice:

• Read the explanations particularly those on MCQBank.

• Simulate exam conditions at least twice before the test.

• Avoid overthinking SJT questions

Common Pitfalls

Several avoidable mistakes can undermine performance:

• Do not neglect the Professional Dilemmas section (remember it carries similar weight)

• Memorising answers rather than understanding reasoning.

• Insufficient timing practice—both papers are time-pressured.

Final Thoughts

For better or worse, the MSRA is now a reality for CST applications and has to be respected as such. The biggest challenge in my opinion, is that it happens at the same time as everything else happening: ST1 interview preparations and evidence-gathering, and FY2 work.

However, it is not beyond a measure of control and early preparation will help you to achieve a high score.